UPDATED COVID-19 BOOSTERS

Dear Friends,

As many of you know, this week the FDA authorized and the CDC recommended the use of “updated” or “bivalent” mRNA COVID-19 booster vaccines for individuals 12 years and older:

The following individuals are eligible for the updated bivalent mRNA COVID-19 boosters:

  • Moderna bivalent booster: Individuals 18 years and older, if it has been at least 2 months since they have completed primary vaccination or have received the most recent booster dose with any monovalent COVID-19 vaccine.
  • Pfizer bivalent booster: Individuals 12 years and older, if it has been at least 2 months since they have completed primary vaccination or have received the most recent booster dose with any monovalent COVID-19 vaccine.

Our recommendations:

  • In general, we are recommending that all eligible individuals proceed with obtaining an updatedbivalent mRNA COVID-19 booster this fall.
  • The timing of when you should receive an updatedbivalent booster depends upon your individual risk for COVID-19.  While the new boosters are approved to be received as early as 2 months after your most recent booster, most experts are recommending waiting at least 4-6 months after your most recent booster or COVID-19 infection.

FAQs:

  • It is called a “bivalent” vaccine because it targets the original strain (what you have already received in your primary vaccinations/boosters) and the BA.4/BA.5 omicron subvariants (to provide better protection against currently circulating strains).
  • The previous monovalent mRNA COVID-19 vaccines will no longer be available as booster vaccines (they are still available for anyone who has not received their primary vaccination series).
  • The side effect profile of the updatedbivalent mRNA COVID-19 booster is expected to be similar to the side effect profile of the previous monovalent mRNA COVID-19 vaccines.
  • You can receive the flu shot and updatedbivalent booster at the same time.
  • Currently, there is no clear evidence that it’s beneficial to “mix and match” the Moderna/Pfizer vaccines (there also appears to be no harm in “mixing/matching”).  Thus, in general, I’ve recommended that patients receive the same type of (Moderna/Pfizer) vaccine as they received previously since we know that you tolerated it relatively well.
  • It is expected that these updatedbivalent boosters will be recommended for younger pediatric groups in the coming weeks.

Here are the relevant websites to schedule your booster vaccine appt (appts are expected to become available in the next 1-2 weeks).  It’s likely that the pharmacies will be more flexible/prepared to administer these updated bivalent booster vaccines so you may want to start there:

WEIGHING THE BOOSTER IF UNDECIDED

For some people getting the updated booster may be a more nuanced decision. The newest Omicron variants have less severe clinical manifestations, particularly in previously vaccinated patients, and Paxlovid is an effective therapy for older or immunocompromised patients. Nonetheless, the newer variants are more transmissible and most people will incur increased exposure to them in the next 6 months as people are generally less cautious. For people under 60 and without co-morbidities the vaccine benefits are smaller. With each decade after 60 and with underlying medical conditions that predispose someone to more severe manifestations of Covid, the risks are higher and the updated booster is theoretically more beneficial. While I believe the boosters are safe and provide individual as well as community benefits for adults, the individual benefits are not equivalent for all people.  Correspondingly, for those seeking a more cautious path with the vaccine you could also wait 2 months for the collection of the first sets of outcomes data with the new booster and better understand the clinical benefits across age groups before making a final decision.

Hiroyu Hatano MD and Bradford Rabin MD are concierge medicine doctors caring for patients in the San Francisco Bay Area including Palo Alto, Menlo Park, Los Altos, Portola Valley, and Woodside.

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