Flu shots and the ALL-NEW COVID boosters!

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:

• Both Pfizer and Moderna have released a new bivalent booster vaccine, meaning that it protects against the original strain and the new Omicron strain of the COVID-19 virus.
• The boosters that people have been receiving in the last few months are with the original vaccine, and as we have seen with the spread of the Omicron variant, even though the old boosters may protect against severe disease and hospitalization, they did NOT do a very good job protecting against infection with the Omicron strain.
• At this point, it is recommended that everyone get a booster shot with this new bivalent vaccine, whether you’ve only had the original two shots, or you had two boosters already, or you’ve just had one dose of the Johnson & Johnson vaccine.
• Currently, our office only has the Moderna bivalent booster because first shipments with Pfizer required orders that were too large for us to be able to give before they expired, but we do expect to get the Pfizer shots in the future. The recommendations are that regardless of which vaccines you received initially, you can mix and match your booster shots. Therefore, everyone is eligible for the Moderna bivalent booster.

 
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!