[Hac-announce] Fwd: Top 6 questions answered about fall vaccines
Manny Sholem Ratafia
manny at ratafias.com
Tue Aug 27 12:01:43 EDT 2024
There is some useful new info here from epidemiologist Katelyn Jetelina
on COVID and flu vaccines and diagnostics.--Manny
"...it has been said that democracy is the worst form of Government
except for all those other forms that have been tried from time to time..."
Winston S Churchill, November 11, 1947
-------- Forwarded Message --------
Subject: Top 6 questions answered about fall vaccines
Date: Tue, 27 Aug 2024 13:47:01 +0000
From: Your Local Epidemiologist <yourlocalepidemiologist at substack.com>
Reply-To: Your Local Epidemiologist
<reply+2g7bko&a13t&&c2e79ca2bd82ec4774fe5b7f3b224a18dd3230b8ec2665c1d15f2f24cab5e01e at mg1.substack.com>
To: manny at ratafias.com
Top 6 questions answered about fall vaccines
Waiting, co-administration, kids, Novavax, and free at-home antigen tests
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------------------------------------------------------------------------
Top 6 questions answered about fall vaccines
<https://substack.com/app-link/post?publication_id=281219&post_id=148147800&utm_source=post-email-title&utm_campaign=email-post-title&isFreemail=true&r=a13t&token=eyJ1c2VyX2lkIjo0Njc5OTMsInBvc3RfaWQiOjE0ODE0NzgwMCwiaWF0IjoxNzI0NzY2NDUwLCJleHAiOjE3MjczNTg0NTAsImlzcyI6InB1Yi0yODEyMTkiLCJzdWIiOiJwb3N0LXJlYWN0aW9uIn0.-g7VNLfu83a9b5qIZpwpXyFjGZ67bTtfzl2vCnF0aY8>
Waiting, co-administration, kids, Novavax, and free at-home
antigen tests
Katelyn Jetelina <https://substack.com/@yourlocalepidemiologist>
Aug 27
<https://substack.com/@yourlocalepidemiologist>
<https://substack.com/app-link/post?publication_id=281219&post_id=148147800&utm_source=substack&isFreemail=true&submitLike=true&token=eyJ1c2VyX2lkIjo0Njc5OTMsInBvc3RfaWQiOjE0ODE0NzgwMCwicmVhY3Rpb24iOiLinaQiLCJpYXQiOjE3MjQ3NjY0NTAsImV4cCI6MTcyNzM1ODQ1MCwiaXNzIjoicHViLTI4MTIxOSIsInN1YiI6InJlYWN0aW9uIn0.HLe25lKfq2MqDcIvq_hqiYO1eKQ9_6IfOOANpcusaXE&utm_medium=email&utm_campaign=email-reaction&r=a13t>
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<https://substack.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.u1hCUmYPkp1ISmQa6z_I5eLptI2PGSW7D-eXQE5-1go?&utm_source=substack&utm_medium=email>
READ IN APP
<https://open.substack.com/pub/yourlocalepidemiologist/p/top-6-questions-answered-about-fall?utm_source=email&redirect=app-store>
We received many follow-up questions after the last YLE email
<https://substack.com/redirect/ae180301-2c6a-4c53-991b-afa35a873090?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>about
options for fall vaccines. Here are the answers to your top questions!
The bottom line is: Get your fall vaccines—it will cut your risk of
diseases by half.
Let’s dig in.
------------------------------------------------------------------------
*1. How long after a Covid-19 infection/vaccination should I wait?*
We have frustratingly scarce scientific guidance on timing. What we do
have tells us this:
*
/*Minimum wait: 2-3 months*/. A Covid-19 vaccine doesn’t add much
benefit within 2
<https://substack.com/redirect/ecb06c63-2864-4ffd-814f-6e6c49ac1145?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>-3
months
<https://substack.com/redirect/88705b92-fae7-4fb7-a3d9-07d19660cd3d?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo> of
infection. We don’t /have /to wait 2-3 months after infection—we
won’t “exhaust” or “overwhelm” our immune system. But waiting will
reinforce our B cells (our antibody factory that stores some
long-term memory).
*
/*Maximum wait: 8-12 months. */The longer we wait, the more we get
out of the vaccine. One study found
<https://substack.com/redirect/d05be848-75ba-4f4f-943c-a424cb8c7c08?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>that
waiting 8 months increased neutralizing antibodies 11 times more
than waiting 3 months after infection, which would increase the
likelihood of preventing infection. Another study
<https://substack.com/redirect/72c1a245-68f4-4950-b624-16b5b88caee3?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo> found
that a 12-month interval improved vaccine effectiveness against
hospitalization. But, of course, waiting is a gamble, especially for
high-risk people.
Try not to overthink it. 4-6 months is usually the sweet spot. Your
healthcare provider is an excellent resource for discussing timing!
------------------------------------------------------------------------
*2. What if I was */*not*/*recently infected? And why are
vaccines becoming available */*after */*the Covid-19 summer
peaked? *
The U.S. government is trying to force our seasonal flu model to fit
Covid-19, but it’s not working well. Covid-19 is clearly not a
once-a-year thing—it’s now settled in two waves per year. These vaccines
were initially planned in anticipation of the winter wave, but the FDA
pushed the release up because we’ve had such a big summer wave.
This makes it very hard to decide /when/to get the Covid-19 vaccine if
you have /*not recently had an infection or vaccination*/: Get it now or
wait until late fall. I’ve struggled with the decision but decided to
wait until Halloween. It will still take some time for vaccines to make
it to doctors’ offices, and then a vaccine will still take two weeks to
work. By then, we will (hopefully) be well on our way down the current
wave. Since I’m not high-risk, I might as well wait to catch the next
wave, which will coincide with fun holiday activities I don’t want to miss.
(Dr. Jen Dowd—one of my favorite scientific communicators— just
wrote a great post for those seeking more advice on timing. Check it
out here.
<https://substack.com/redirect/46abf278-1f2d-4616-bce5-787a7603b39a?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>)
Regardless, if the U.S. wants Covid-19 vaccines to have a dramatic
population-level effect—like how flu vaccines reduce the impact of flu
yearly on hospitals and individual disruptions—we need to have vaccines
/before/ a wave. Implementation would be challenging but not impossible.
------------------------------------------------------------------------
*3. Can I get the flu and Covid-19 vaccine at the same visit?*
Yes! This is called co-administration, and it’s recommended for
convenience—you don’t have to visit the pharmacy or doctor twice.
Studies have been conducted
<https://substack.com/redirect/8a035dbd-a105-4682-a02e-227988079aec?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>on
the safety and effectiveness of co-administration with Covid-19
vaccines. In one database, about 454,000 people got the flu and Covid-19
vaccines. Both worked great. The rate of side effects was the same or a
little higher among those who co-administered; however, no specific
safety concerns were identified.
<https://substack.com/redirect/952f0753-0f85-43e9-8a46-19bbf0aa0e6f?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>
(Source: CDC)
There is no combined shot. (Some companies are working on it. Maybe next
year?)
------------------------------------------------------------------------
*4. Is it worth it for kids? What do other countries do? *
In the U.S., everyone 6 months and older is eligible for Covid-19,
similar to other countries (like Canada or Japan). Kids in the U.K. or
Australia qualify for the Covid-19 vaccine if they have a pre-existing
condition. (Note: Not all kids get the flu vaccine in these countries
either mainly due to the cost—the government pays for the vaccine, so
they must consider this.)
*
/*Death*/: Covid-19 is about as deadly as the flu among kids but far
less risky than for older adults (or those under 6 months
old). Covid-19 is more risky for those under 6 months, which is why
it’s important to get the vaccine during pregnancy.
<https://substack.com/redirect/e92c3793-bb81-451e-927c-99f6b66cae68?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>
*
/*Effectiveness*/: They work for kids. Last season, the pediatric
vaccines provided ~60% additional protection against going to urgent
care for Covid-19, compared to not getting the vaccine.
<https://substack.com/redirect/b64322ee-f4b0-42ee-9d77-ab004873f1f8?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>
(Source: CDC
<https://substack.com/redirect/e3b94831-82e2-4ad5-b342-c56d84ca1f85?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>)
*
/*Safety*/: Unfortunately, the public hasn’t seen myocarditis (i.e.,
inflammation of the heart muscle) data for last season yet, but
there’s no reason to think it’s changed—while there is a safety
signal among young men, the risk dropped dramatically for boosters.
An analysis last year
<https://substack.com/redirect/0d95d599-a42b-4eb2-928d-071615a49649?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>showed
that the benefits still outweigh the risks. The most common causes
of myocarditis are viral /infections/, where it’s typically much
more severe
<https://substack.com/redirect/b89cf965-865e-4bf4-9920-fe795091e1ca?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>.
*
/*Missed school days*/: I’m frustrated that we don’t have robust
data for other outcomes, such as reduced sick days. Since
vaccination prevents ~20% of infections in the first few months, we
can assume vaccines reduce sick days “a bit.” But other than that,
we don’t know, which is unhelpful for parental decision-making.
------------------------------------------------------------------------
*5. Are you sure that Novavax isn’t better than mRNA vaccines? *
Both are good shots. I’m uncomfortable saying one is immunologically
better than the other. We’ve had some head-to-head studies (here
<https://substack.com/redirect/dcaafe96-f8ea-4188-a364-c4f1a337bbaf?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>,
here
<https://substack.com/redirect/3f6fb20f-7830-4ded-a42e-466ada6532e1?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>,
here
<https://substack.com/redirect/927fcb03-c4d9-4d69-b1a7-fe0d4805f3f8?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>,
and here
<https://substack.com/redirect/e0ad99d5-5149-4f74-aa09-e416a32f5b7e?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>)
showing lots of similarities and some subtle differences:
/*Similarities*/
*
Both provide a solid first line of defense (i.e., neutralizing
antibodies), which helps prevent infection in the first months (but
is not perfect.)
*
Both strengthen a solid second line of defense (i.e., T cells),
which helps prevent severe disease.
/*Differences*/
1.
/*Negative*/: Novavax produced lower levels of a specific antibody
called IgG. This /may/contribute to more infections
<https://substack.com/redirect/ae6c035c-109a-432a-9716-4b61ad0d0dd1?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>after
Novavax than mRNA vaccines.
2.
/*Positive*/: Novavax had a more durable response over time (waned
less quickly).
3.
/*Positive*/: Novavax has fewer side effects, like pain and muscle
aches. For this reason alone, I will be getting Novavax this fall.
<https://substack.com/redirect/9558fc9a-b25d-4cc4-9544-921864dc558f?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>
Side effects from varying combinations of COVID-19 vaccines. Figure from
the Lancet, with YLE annotations. Original source here
<https://substack.com/redirect/e0ad99d5-5149-4f74-aa09-e416a32f5b7e?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>.
------------------------------------------------------------------------
*6. Free antigen tests will be available again this season. *
The U.S. government plans
<https://substack.com/redirect/665b9e82-456b-4f42-96a4-0381cf9e3a4e?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>to
give each household four free at-home Covid-19 tests again this season.
This should open in late September. I will be sure to update you when
you can order your tests.
There are flu/Covid-19 combined at-home antigen tests now
<https://substack.com/redirect/85d6452b-a572-46dc-a08d-820b04531ade?j=eyJ1IjoiYTEzdCJ9.fXnNfjqEHuJb90uhUC5MuKSqDSSONTVxMYyEVAne1uo>.
There isn’t one for RSV yet.
------------------------------------------------------------------------
*Bottom line*
Fall is almost here! Make a plan to get your vaccines. The best vaccine
is the one you get. Our priority is preventing severe disease among
high-risk individuals, but staying up to date has secondary benefits for
everyone!
Love, YLE
------------------------------------------------------------------------
/“Your Local Epidemiologist (YLE)” is founded, operated, and written by
Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two
little girls. During the day, she is a senior scientific consultant to a
number of organizations, including CDC. At night, she writes this
newsletter. Her main goal is to “translate” the ever-evolving public
health science so that people will be well-equipped to make
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