Should you get a booster dose of COVID vaccine? – Michigan Medicine

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The latest vaccine recommendations for all ages.
This story was last updated on November 24, 2021.
Hundreds of millions of people in the United States have rolled up their sleeves to be vaccinated against COVID-19. With a new pronouncement from the Food and Drug Administration and the Centers for Disease Control and Prevention, many millions more are going back for another dose.
Those who have been vaccinated should be assured that overall, the vaccines work to reduce the risk of severe disease, hospitalizations, and death. Recent data collected by the CDC show that unvaccinated people are 14 times more likely to be hospitalized with COVID-19 than those who are vaccinated.
Yet, while all the vaccines are still highly effective at preventing severe illness, hospitalization and death, the number of infections in vaccinated people, particularly those over age 65, began to concern researchers in both in the U.S. and abroad.
The vaccines appear to lose a bit of effectiveness over time, and the Delta variant, the predominant COVID-19 variant in the U.S., is two times more infectious and causes more serious illness than previous COVID-19 variants. Waning immunity combined with the emergence of the highly contagious delta variant of the coronavirus has led to more infections and the need for booster shots.
“Booster shots are not unique to COVID-19 vaccines. We are used to getting annual flu booster shots and boosters for Tdap (tetanus, diphtheria, and pertussis) every 10 years to help our bodies maintain a high level of immunity against vaccine-preventable diseases. We are now seeing more and more breakthrough COVID-19 infections in fully immunized people. People are not as well protected with the vaccines as they were before the emergence of the delta variant.” said Pamela Rockwell, D.O., FAAFP, a Michigan Medicine family physician and professor in the department of family medicine at the University of Michigan Medical School. She represents the American Academy of Family Physicians on the CDC’s Advisory Committee for Immunization Practices (ACIP) that just approved the new recommendation that people age 18 years and older who received Pfizer or Moderna COVID-19 vaccines may get a booster, expanding their previous recommendations on who can and who should get boosters. In October, ACIP had already recommended that all people over 18 who received the J&J single dose vaccine should receive a booster shot.
After reviewing the data and a somewhat contentious debate over whether booster doses were necessary for everyone regardless of age or underlying medical conditions, experts have come to agree that all adults over age 18 should consider getting a booster dose of the vaccine for COVID-19 based on individual risks and benefits. The previous booster recommendations focused on adults who have underlying health conditions or who work in high-risk professions.
The FDA and CDC had already approved and recommended a third dose of mRNA COVID-19 vaccines as part of a primary series for moderately and severely immunocompromised people in August. This 3rd dose is recommended for all moderately-severely immunocompromised people ages 12 and older, given 28 days after receipt of the second dose of their primary mRNA vaccine series and considered part of a 3-dose primary series for this select group of highly vulnerable people. New ACIP booster dose recommendations also apply to immunocompromised people after completion of their 3rd dose of an mRNA vaccine.
Here, Rockwell helps breakdown what the new booster dose recommendations mean for everyone in a quick, easy-to-understand guide.
Everyone 50 years and older who received an mRNA vaccine (Pfizer or Moderna) SHOULD get a booster at least 6 months after completing their primary 2-dose COVID-19 series with any of the COVID-19 vaccines authorized in the U.S. Waning immunity, the Delta variant predominance, and the high percentage of Americans with one or more underlying medical conditions like diabetes, obesity, heart disease, cancer, and asthma that put them at higher risk for severe disease from COVID-19 informed this recommendation. The highest risk for severe COVID-19 disease remains for those over 65 years.
Everyone 18 and older living in a long-term care setting such as residential care, assisted living, nursing homes, and continuing care retirement communities SHOULD get a booster at least 6 months after completing their primary 2-dose COVID-19 series with any of the COVID-19 vaccines authorized in the U.S. Adults living in long term care facilities like nursing homes are particularly vulnerable to infections, given their age, underlying health conditions and increased exposure from living in a group setting.
Everyone 12 and older moderately to severely immunocompromised SHOULD get a booster at least 6 months after completing their primary 3-shot COVID-19 series with any of the COVID-19 vaccines authorized in the U.S.
Everyone 18 and older moderately to severely immunocompromised SHOULD get a booster at least 6 months after completing their primary 3-shot COVID-19 series with any of the COVID-19 vaccines authorized in the U.S.
All adults 18 and older without immunocompromise MAY get a booster at least 6 months after completing their primary 2-dose COVID-19 vaccine series based on individual risks and benefits of vaccination. With rising breakthrough infections in vaccinated people, and the number of younger adults who have underlying medical conditions, booster shots will help prevent future infections, transmission of infections, and work-lost and disruption of education and activity due to COVID-19.
Everyone 18 years and older who received a single dose J&J vaccine primary series SHOULD get a booster shot at least 2 months after receiving their single dose. This booster dose may be any of the COVID-19 vaccines authorized in the U.S. and note that it is recommended 2 months after the single dose primary series vaccine. The J&J vaccine was found to be less effective than the mRNA vaccines and data show that a booster elevates the vaccine’s effectiveness to 94% against symptomatic disease from COVID-19 and increases antibody levels by four to six times, compared to one dose alone.
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Said Rockwell: “I recommend everyone over age 5 to get vaccinated with a primary COVID-19 vaccination series if they are not already vaccinated and continue mitigation practices like wearing a mask. And everyone over age 18 should consider a booster shot, especially those people over 50 to help protect themselves not only from breakthrough infections, including the potential of a severe breakthrough COVID-19 infection, but also from the risk of long-haul COVID symptoms that can occur even if you only have a mild case of COVID. Vaccination will help stop the spread of COVID-19 in our communities and help protect others around us who may be more vulnerable to COVID-19 disease and bring us closer to an end to this awful pandemic.”
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Vaccination is not all people in this group should do, she adds.
“It’s important for immunocompromised people to wear masks in public, maintain social distancing of at least 6 feet from people they do not live with, avoid crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider, and to encourage everyone over the age of 5 who interacts with them closely to get vaccinated if they aren’t already,” she said.
“They may not realize how much they are putting you at risk, or that your immunocompromised state puts you at high risk of severe COVID-19,” she added. “Ask them to help protect you.”
Rockwell also encourages people who get a third or booster dose of COVID-19 vaccine to sign up for the CDC’s V-safe system which will text them occasionally to ask them to report any reactions to the vaccine. This will help collect data that will guide the vaccination process and look for any rare effects.
SEE ALSO: If I’m Immunocompromised, Should I Keep Wearing My Mask Once I’m Vaccinated?
While the overwhelming majority of people hospitalized for COVID-19 right now are unvaccinated adults and children, many of the rest of those in hospitals for COVID-19 care have a condition or take a medication that affects their immune system.
If you have fall into one of the categories below as defined by the CDC as those individuals moderately-severely immunocompromised, contact your health provider or your child’s provider to see whether they recommend a third dose.
Been receiving active cancer treatment for tumors or cancers of the blood
Received an organ transplant and are taking medicine to suppress the immune system
Received a stem cell transplant within the last two years or are taking medicine to suppress the immune system
Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
Advanced or untreated HIV infection
Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response (>20 mg prednisone/day for at least two weeks)
The FDA and CDC continue to monitor how well vaccines are protecting people in the real world to try and make the best decisions possible to protect public health, and these new recommendations are subject to change as even more data is collected.
Ending the pandemic will take more than just vaccination, including booster doses. Until cases are brought under control, wearing masks, improving indoor ventilation and other public health measures will be needed to slow the spread of COVID-19 and prevent hospitalization. However, getting shots to the 45% of the U.S. population who are not fully vaccinated will go a long way to ending the current crisis and as such, remains a top priority for the CDC and other health professionals.
Read about Michigan Medicine’s latest research and medical breakthroughs on our science-driven sister blog.
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