September 8, 2022
Dear Patients of Sansum Clinic,
It has been a while since we have sent out an email update on the state of COVID-19. We have all become somewhat used to living with the virus, and the periodic peaks and valleys that each significant variant has brought. We thought it might be helpful to bring people up-to-date with what we are seeing, and to provide the latest information on the new bivalent booster shots arriving on the scene.
Let’s start with some big-picture trends we are seeing.
- Despite the very significant community spread of COVID-19 with the newest variants – Omicron BA.5 and to a lesser extent, BA.4, there was not the increase in hospitalizations and mortality that accompanied the earlier surges. If you can recall the days of early 2020 with completely overwhelmed hospitals, the most recent surge locally and nationally was not like that. We think that is the result of several events:
- Some changes in the biology of the virus itself, as the newer variants, though more infectious, do not seem as virulent when looking at large samples of patients. (Obviously, for a given individual, this variant can be very problematic, but across large numbers of infections, it appears less harmful than its ancestors.)
- There is more immunity in the population – immunity from prior COVID-19 infections and from vaccinations. We know in both of those cases, the immunity is far from what we wish it were. People are clearly getting infected even after being vaccinated and previously infected. But, there is good data that shows prior vaccination or infection, and particularly both, provide protection from severe illness and hospitalization.
- There are treatments that reduce the chance of severe illness. There are monoclonal antibody injections that are effective, though those are tricky because it is hard to keep up with the changes in the variants. There are also some oral anti-viral medications now that directly interfere with the “machinery” of the virus, and tend to work regardless of the variant. Paxlovid is the most commonly used of those medications, and it has been proven quite effective in preventing hospitalizations, particularly in older patients (those over 65) in a recent study. (You will recall that advanced age is still viewed as the variable most correlated with bad outcomes from COVID-19.)
With that background, new booster vaccines have now become available. Below I am sharing a version of an update that Marjorie Newman, MD, our Medical Director, sent out to our physicians and providers about these new bivalent boosters. We will soon be offering these bivalent vaccines to our patients during some office visits and on a limited basis in vaccine clinics. We currently have a supply of both the Pfizer and the Moderna bivalent booster vaccines, and will do our best to accommodate requests for a specific formulation based on availability. Local pharmacies are giving these new boosters out as well. We are not aware at this time of any booster vaccine clinics being planned by others in our community, but as with everything COVID, things will likely change.
I hope you find this detailed information from Dr. Newman (pasted below) helpful. And as always, we are appreciative you have chosen Sansum Clinic for your healthcare.
Kurt Ransohoff, MD, FACP
Sansum Clinic CEO & Chief Medical Officer
UPDATE FROM MARJORIE NEWMAN, MD, SANSUM CLINIC MEDICAL DIRECTOR
Last week, the Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) voted to endorse the updated bivalent COVID-19 boosters developed by Pfizer and Moderna, which target the BA.4 and BA.5 Omicron subvariants (currently the dominant subvariants circulating in the U.S.) as well as targeting the original SARS CoV 2 virus strain that emerged in Wuhan, China more than two years ago. Pfizer’s bivalent booster was approved for individuals age 12 and older, while Moderna’s bivalent booster was authorized for individuals age 18 and older.
The eligible age groups can receive the boosters if it has been:
- at least two months after completing the primary vaccine series
- at least two months after receiving the most recent booster with the prior monovalent vaccine
- at least two months after being ill with COVID-19
Some ACIP panel experts expressed concern that two months may be too short a time frame and suggested that perhaps waiting 3-4 months after a last vaccine or infection would strengthen people’s response to an updated vaccine. However, the ultimate decision was to recommend at least a two-month interval to decrease the complexity of the recommendations, and also suggested that individuals can speak with their healthcare providers to determine the most appropriate time frame based upon their specific situation, especially for those individuals who are immunocompromised. A shorter interval would be advisable for the immunocompromised or those who have had a recent COVID-19 infection. Many experts suggest waiting 3-4 months after an infection before receiving the booster.
Based upon recent history, public health officials are expecting another wave of COVID-19 infections this fall as immunity from the prior vaccines or prior illness wanes, more contagious omicron subvariants spread, and people spend more time indoors as the weather turns colder and families gather for the holidays. The CDC and the FDA anticipate that the new bivalent boosters will provide more durable protection against infection, mild illness and severe disease. As a result, anyone who is eligible should be encouraged to get a bivalent booster.
Of note, the original monovalent vaccines are no longer authorized to be used as a booster dose in people ages 12 and older (Pfizer) or 18 and older (Moderna) now that the reformulated (bivalent) booster vaccines have been approved. However, the ACIP indicated that the monovalent vaccines are still to be used as primary series doses since the amount of mRNA in the primary vaccine formulation is higher (more antigenic) than in the bivalent booster formulation.
Below are some answers to some common questions about these new bivalent boosters which may be helpful:
What are these new COVID-19 boosters, and how do they differ from the existing ones?
Until now, COVID-19 booster shots have been monovalent or univalent. That means they only contained one version of the mRNA sequence for the SARS-CoV-2 virus’ spike protein — the one that came from the original strain which emerged in late 2019 in Wuhan, China.
The boosters that just got approved are considered bivalent vaccines. That means they contain the mRNA sequence for the spike protein of two strains of SARS-CoV-2:
- The original strain from Wuhan, and
- The current predominant subvariant of Omicron, BA.5. The spike protein on the surface of both Omicron’s BA.4 and BA.5 subvariants is exactly the same. So, this booster should protect people against both.
Who is eligible for a bivalent COVID-19 booster shot? The two vaccines have different age restrictions.
- Moderna: 18 years and older
- Pfizer: 12 years and older
You only need a single booster shot of the bivalent vaccine to be considered fully boosted, but you’re not eligible to get it unless you’ve already been fully vaccinated with either Johnson & Johnson/Janssen’s original one-shot regimen, or Pfizer, Moderna’s or Novavax’s original two-shot regimen. You are eligible to get a bivalent booster shot two months after you’ve been fully vaccinated or two months after your last monovalent booster. The CDC and California Department of Public Health (CDPH) indicate that like an annual flu shot, everyone who is eligible to be boosted, should get boosted.
Of note, the bivalent booster recommendation replaces previous booster recommendations for people ages 12 years and older.
This means that everyone ages 5 years and older who are eligible for a booster dose will now only be eligible for ONE booster dose.
– People ages 5 through 11 years (who received Pfizer-BioNTech primary series): eligible for 1 monovalent booster dose
– People ages 12 years and older: eligible for 1 bivalent booster dose (and if the individual is 12-17 years old they should receive the Pfizer bivalent booster).
Can I get a bivalent booster now, if I just recently got my second univalent booster? No. You’ll need to wait until two months have passed since your last booster shot.
How long do I need to wait to get the bivalent booster if I’ve had COVID-19? If you were very ill, you’ll need to wait at least until the worst of your symptoms have resolved, and you have met the criteria to leave isolation. Immunologists indicate that patients with recent COVID-19 infections should consider waiting three or four months instead of two (counting from the time they first showed symptoms or tested positive) to get a booster shot.
Are there any special considerations around scheduling, given that it's also time for flu vaccines? No. The Centers for Disease Control and Prevention (CDC) say there’s still no need to stagger your vaccinations. If you’re due for both, you can get your flu shot and your COVID-19 booster at the same time on the same day. You can even get them in the same arm, if you want to cut down on the amount of soreness you experience.
Can I get the bivalent booster from a different manufacturer from my primary series or prior monovalent vaccine booster (for example, can I get the Pfizer bivalent booster even though I had the Moderna vaccines in the past)? Yes. It’s OK to
mix and match as long as you’re eligible for the vaccine you prefer.
Can I get the bivalent booster if I regularly receive EVUSHELD injections to protect myself from COVID-19? Yes. Those who take EVUSHELD antibody therapy to protect themselves from severe COVID-19 infection can receive the bivalent booster, if eligible. Those who receive a vaccine dose (primary or booster) should wait at least two weeks before getting the EVUSHELD injection, according to the
Centers for Disease Control and Prevention’s advisory group. However, if you received EVUSHELD there is no minimum interval time frame required from receiving EVUSHELD to receiving a COVID-19 vaccine or booster.
For individuals who are immunocompromised and who have recently completed a two dose primary series and are due for the next dose, should they get a third monovalent dose or should the third dose be the bivalent booster dose? The third dose should be the bivalent booster dose given two months after the last monovalent dose. People who are or who become moderately or severely immunocompromised should follow the COVID-19 vaccination schedule according to their age and immune status at the time of eligibility for that dose. For example, people who become moderately or severely immunocompromised after completing a 2-dose mRNA primary series do not need additional primary doses; however, they should follow the schedule for people who are moderately or severely immunocompromised for the booster dose. See attached link (or the slides below) from the CDC which outlines the updated COVID-19 vaccine schedule.
https://www.cdc.gov/vaccines/covid-19/downloads/COVID-19-vacc-schedule-at-a-glance-508.pdf
When might the bivalent boosters be offered to children under 12? At this time, there are no changes to the vaccine schedules for children age 6 months through 11 years. Some experts have indicated that the bivalent booster formulation will likely be authorized within the next three to six months for children under age 12, or potentially even sooner. Manufacturers are using the exact same processes to make the bivalent boosters as they did to make the originals. So, while the change in proteins included is an important one, it’s still relatively small from the point of view of the body’s developing a new adverse reaction to it.
How can I get a bivalent booster if it has been at least 2 months since my last vaccine or COVID-19 infection?
- For patients age 12-17- Appointments for children to receive the Pfizer bivalent booster can be made through MyChart or by calling our Hitchcock Pediatrics Department at (805) 563-6211.
- For patients age 18 and older-Our Pesetas Immunization Tent will be providing the bivalent Booster starting September 8th and patients can schedule via MyChart or by calling (805) 681-7805 for an appointment. In addition, we will soon have boosters available at some of our primary care office locations for administration at office visits once we receive sufficient supplies. In addition, many local pharmacies have supplies and you can schedule a booster appointment on line with the pharmacy of your choice.