COVID shots for 65+
As many of you have heard, last month the CDC announced that all patients 65 years and over should get another COVID vaccine if it has been over 4 months since their last one. This vaccine is the exact same one that was introduced last September, and this recommendation was made because in patients over 65, antibodies formed to the COVID vaccines are not as robust and do not last as long. At this point, COVID levels in the community are not as high as they were over the winter, and the numbers of people being hospitalized or dying are definitely much lower. However, people are still getting infected, and the vast majority of people who are hospitalized are those over 65. We are also worried about long COVID, with more than 15% of people reporting they have long COVID symptoms. The best way to prevent long COVID of course, is not to get it. One of the concerns I initially had with getting another COVID vaccine was that in the beginning, there were some studies that suggested that too many COVID vaccines may blunt the desired protective effect of subsequent vaccines. However, it seems that it is not the case, as people do still mount a good response. There is even a case of a 62-year-old man in Germany who got over 200 COVID vaccines in a little over two years! He agreed to be studied, and his immune system was still functioning normally. While we would never recommend this, at least it is reassuring that in this particular case, there was no sign of a blunted response to multiple vaccines. We also know that the current vaccine is about 40-50% effective at preventing infection (although much higher at preventing severe infection). This supports the phenomenon that we’ve all seen where people who have been properly vaccinated still end up getting COVID. While we would love this to be higher, a 50% reduced risk with the vaccine is better than a 0% reduced risk for not getting the vaccine. So who should get this vaccine now? We do anticipate a new COVID vaccine this fall, which will be newly formulated to best match what the current circulating strains are at that time. As long as you have not had a COVID vaccine or actually had COVID in the last four months and you are 65 years or older, you are eligible. These are the people I feel should get another vaccine now:
We currently only have the Pfizer vaccine, so if you specifically want the Moderna vaccine you can get it at a local pharmacy. However, there were some studies earlier on that showed that people that got the vaccines actually had a little better immune response. Finally, a reminder that if you have cold or allergy symptoms, be sure to test for COVID. Even though we don’t have to isolate as long as we did in the past, it is important to know if you have COVID, and some people should still be treated with Paxlovid. Measles Measles had previously been thought to be eliminated in the US, but there has been a resurgence recently. The number of cases since the beginning of 2024 are now as high as the entire number of cases in all of 2023. The vast majority of these cases are from people who come back to the US after traveling internationally, although there is also risk in children because a higher percentage of children are not getting their measles vaccines. There has been a lot of confusion over the years about measles because there have been both inactivated vaccines, at least two different live attenuated vaccines, and also different dosing regimens. Therefore, depending on when you were born, you may not have been fully vaccinated and therefore may be at risk for getting measles. This is my recommendation:
One last thing – you may have hear there was a cyberattack at Change Healthcare last month. It has not directly affected Scripps, but it did interfere with our ability to get results from Scripps Labs sent directly to our electronic medical record. If it makes no difference to you, having labs drawn at LabCorp or Quest will make it easier for the results to be sent directly to our EMR. Hopefully this will be fixed soon. Thanks for reading!
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We now have all the 2023 vaccines in the office — both Pfizer and Moderna 2023 updated COVID vaccines, the high dose influenza vaccine, as well as the new RSV vaccine. Because we have so many vaccines to give, PLEASE do not call the office for appointments. Instead, please adhere to the following:
Here is a reminder about these vaccines: COVID vaccines
Influenza vaccines
RSV vaccine
A new vaccine for a virus called RSV (Respiratory Syncytial Virus) is currently available, and we will be offering vaccinations for it by the beginning of next month. Here is some information about this virus and the vaccine.
What is RSV? RSV is a respiratory virus that usually causes mild cold-like symptoms, but in older individuals with certain medical problems, it can cause severe symptoms that require hospitalization and can even lead to death. We normally think about RSV affecting young children, but we have found more recently that adults can be affected as well. In the US, more than 177,000 patients over age 65 are hospitalized every year with RSV, and about 14,000 patients over age 65 die each year from RSV. If it’s so common, why are we only hearing about it now? We have not been testing adults for RSV in previous years, as there is no specific treatment for the infection, but last year, we had a significant increase in the number of adults hospitalized with RSV. Vaccines for RSV have been in development for decades, but now are finally available, both for adults as well as children. Currently there are two vaccines, both manufactured in a method similar to older hepatitis vaccines, and not the method of the recent COVID vaccines. These new RSV vaccines are over 80% effective in preventing severe symptoms and hospitalizations associated with the virus. Which adults should be getting this vaccine? Right now, the CDC has recommended that adults age 60 years and over talk to their healthcare providers about whether or not they should receive the vaccine. This is different than some other vaccines, where the CDC recommend that everybody over a certain age should get a particular vaccine. You can certainly schedule an appointment to discuss whether you should get the vaccine, but here are our basic recommendations: Who do you recommend should definitely get this vaccine? We definitely recommend that you get this vaccine if you are age 60 or over and have any of the following:
What if I don’t meet any of those criteria? If you are age 60 or over and don’t meet the above criteria, you’re certainly eligible to receive the vaccine. However, for most people that are otherwise fairly healthy, we are generally recommending holding off on the vaccine for right now. These are our reasons:
Certainly, if you still have questions about the RSV vaccines, feel free to call the office for an appointment to discuss. For those of you at a higher risk that do want to get the vaccine, we will be getting them in by the beginning of this month. We would not recommend getting the vaccine together with the COVID vaccine, but you can get it with the flu vaccine. There is a mild adjuvant in the RSV vaccine to boost your immune response, but the reaction to it (achiness, low grade fever) is usually less than the other adjuvant vaccines such as Shingles. Update on influenza vaccines We have been informed by the manufacturers of the Flublok vaccine that there is some issue the CDC has with their reporting this year, so the vaccine release will be delayed, and it may actually not be released this year. Therefore, we will be ordering the Fluzone quadrivalent vaccine, which will be for patients ages 65 and above, and they should be coming in by the end of the month. For patients under age 65, we do have the quadrivalent Flucelvax which we have carried in the past. The timing for these vaccines have not changed – we recommend waiting until the end of October or November, unless you will be traveling overseas in which case you should get the flu vaccine earlier. Update on the new COVID vaccines The release of the new 2023 COVID vaccines has been slow, but it may be currently available at some pharmacies if you need to get it right away. We have been told to expect the vaccine at our office by the beginning of October. We will send out an announcement when the vaccine does become available. Flu season is coming soon, and we will have some other new recommendations this year. We still feel the optimal time to get vaccinated for influenza in San Diego is late October or November because flu season here peaks around January or February, and by vaccinating around November, you will have the most antibodies to protect you around the peak of flu season. However, if you are traveling out of town before November, you can certainly get your vaccine sooner, and some years (like last year!), flu season can come early. The CDC usually recommends getting the flu vaccine right now, as soon as it's available, but that's because they are more concerned about developing "herd immunity" in a community -- if more people are vaccinated early on, there is less chance that influenza hits that community hard later on. That’s different than our recommendation, which is based on the best protection for an individual.
Once again this year, we will be carrying TWO different flu vaccines. We have the usual 4-strain (quadrivalent) flu vaccine that everyone is eligible to receive. We also have a HIGH DOSE 4-strain vaccine called Flublok. This vaccine has three times the amount of antigen for 4 different strains, and studies show that it gives 30% better protection than the usual 4-strain flu vaccine when tested in patients ages 50 and above. We do NOT carry the so-called "senior” flu shot (Fluzone High-Dose) which is usually the one that most pharmacies will try to administer to seniors. Given a choice between Flublok and Fluzone, I would choose Flublok because this vaccine is not grown in eggs (unlike the Fluzone), so it avoids the possible mutations that can occur in egg-grown vaccines that can alter the final product. However, the difference is not huge, so if you can’t get Flublok, the Fluzone High-Dose is certainly a good substitute. Therefore, we are recommending the Flublok vaccine in all patients ages 50 and above, although you certain can get if you under 50 if you choose to. If you get your flu shot elsewhere, please let us know so we can document it in our records. Most insurances, including Medicare, do cover all flu shots, but if it is not covered, Flublok costs around $80. If you happen to be in the Ximed building on a Tuesday, Wednesday or Friday starting in October, you can just stop by the office to see if you can get the vaccine. If you want to come in on a Mondays or Thursday, please call us first. If you have questions, please contact our office by phone at 858-452-7040 or through your web portal (accessed through www.sun-md.com). Update on the NEW COVID-19 Boosters New COVID-19 booster vaccines are in production and are expect to be released in late September, and everyone should read the information below:
Hopefully that answers your questions. In a couple of weeks, we will send out another letter about the new RSV (Respiratory Syncytial Virus). We do not recommend it in everyone over age 60, only for certain groups of people. There is no rush to get the vaccine right now, so stay tuned for the update in a couple of weeks! Wynnshang Sun, M.D. Flu season is coming soon, and with everything being open, we are probably going to have many more cases of the flu this season compared to the last two. We feel the optimal time to get vaccinated in San Diego is late October or November because flu season here peaks around January or February, and by vaccinating around November, you will have the most antibodies to protect you around the peak of flu season. However, if you are traveling out of town before November, you can certainly get your vaccine sooner. The CDC usually recommends getting the flu vaccine right now, as soon as it's available, but that's because they are more concerned about developing "herd immunity" in a community -- if more people are vaccinated early on, there is less chance that influenza hits that community hard later on.
Once again, we will be carrying TWO different flu vaccines. We have the usual 4-strain (quadrivalent) flu vaccine that everyone is eligible to receive, called Flucelvax. We also have a HIGH DOSE 4-strain vaccine called Flublok. This vaccine has three times the amount of antigen for 4 different strains, and studies show that it gives 30% better protection than the usual 4-strain flu vaccine when tested in patients ages 50 and above. There is also a "senior” flu shot called Fluzone High-Dose which also protects against 4 strains of influenza, and it is usually the one that most pharmacies will try to administer to seniors. Given a choice between the two of them though, I would choose Flublok because this vaccine is not grown in eggs (unlike the Fluzone), which prevents the possible mutations that can occur in egg-grown vaccines that can alter the final product. However, the difference is not huge, so if you can’t get Flublok, the Fluzone High-Dose is certainly a good substitute. Therefore, we are recommending the Flublok vaccine in all patients ages 50 and above, although you certainly can get if you are under 50 and you choose to. If you get your flu shot elsewhere, please let us know so we can document it in our records. Most insurances, including Medicare, do cover all flu shots, but if it is not covered, Flublok costs around $80. If you happen to be in the Ximed building on a Tuesday, Wednesday or Friday starting in October, you can just stop by the office to see if you can get the vaccine. If you want to come in on a Mondays or Thursday, please call us first. If you have questions, please contact our office by phone at 858-452-7040 or through your web portal (accessed through www.sun-md.com). Update on the ALL-NEW Bivalent COVID-19 Boosters New COVID-19 booster vaccines are now available and everyone should read the information below:
When should I get this new booster? The CDC recommends that you get your bivalent booster at least two months after your last COVID vaccine, whether it was the primary series or a booster shot. Even people who have received four shots already should still get this one because it gives more protection against Omicron. People who received one shot of the Johnson and Johnson vaccine should also get this new booster. Having said that, there are many experts that feel that getting another booster shot so soon after getting the previous one may not elicit a significant antibody response. Indeed, studies show that you build more antibodies if it has been at least 4-6 months since your previous vaccine. Therefore, I feel that the optimal time to receive this new bivalent booster is at least 4-6 months after your last COVID-19 shot. What if I recently had COVID? If you have had COVID in the last few months, it is a good chance that you were infected with Omicron, so this booster may not be as important to get right away. The CDC states that as soon as you have recovered from a COVID infection, you can receive a booster shot, but they do acknowledge that waiting about three months after an infection may be a better option because the infection will likely give you some protection already, and the additional time will allow the booster to give you a better antibody response down the road. Therefore, I also recommend waiting at least 4-6 months after recovering from COVID to get this new booster. I heard that this booster has not been tested in humans. Is it safe? Both the Pfizer and Moderna bivalent boosters are pretty much the same as the original vaccine. There were some human studies that incorporated the original strain plus the Omicron BA.1 strain earlier this year, and these initial studies showed a significant elevation in the neutralizing antibodies against Omicron compared to the original vaccine. However, BA.1 quickly became overtaken by Omicron BA.4 and BA.5 strains, so the manufacturers change their “formulas” to develop the current bivalent vaccines. While we don’t have hard numbers from human trials showing how much better these boosters are against protecting against Omicron, the studies are currently ongoing. This is a very similar situation to the annual flu vaccines we give. We try to predict which strains of influenza are going to be most dominant each winter and tailor the influenza vaccine to those strains. We don’t wait and test them each year, because the flu season would be over by the time we got the results back. Similarly for this new bivalent vaccine, we don’t want to wait to test it because we may have a different strain in six months. In summary, this vaccine is still very safe. I’m in! Now how do I get this booster? We did receive our first delivery of the Moderna bivalent booster and are administering it in anyone ages 50 and above or anyone who has a significant underlying condition that puts them at risk for complications. If you are in this category and happen to have an appointment in the office in the next few weeks, you may be able to receive the vaccine at your appointment, so let us know, preferably by sending a message through the patient portal. If you are in this category and would like to make an appointment for the vaccine, please send us a message through the portal specifying the days and times that you would be able to come in. Most likely, we will be administering these shots on Tuesdays, Wednesdays, and Fridays. And finally, if you are healthy and below 50 and would like to receive this vaccine as soon as possible, you can put your information in this survey and we will call you if we have extra shots that need to be used up before the end of the day, or after we open up the vaccine appointments to everyone. Other than at our office, you can also get an appointment at a local pharmacy to receive this booster, or book an appointment through myturn.ca.gov when the site opens up. Should I get my flu shot early so I can get it with my bivalent booster now, or should I wait until November to get them both? There is no one right answer to this. If you are over 65, received your last booster six months ago, have not had COVID yet, and plan on taking a trip or attending a large indoor gathering in the near future, you can certainly get them both now. Without having such an exposure coming up, you can get your COVID booster now and wait until November to get your flu shot. If you just had COVID-19 three months ago, I would wait until November until getting both the flu and COVID booster. Remember, it is not a problem to get the COVID booster with any other vaccine. Hopefully that answers your questions. Fingers crossed that this winter will be much better than the last two! |