Dr. Gelman gives the 411 on COVID-19 boosters

Can I really get any booster shot – is it safe to mix? Is it recommended that I get the same brand booster that I got for the original COVID-19 vaccination?

Although a heterologous (mix and match) series of FDA authorized/ approved COVID-19 vaccines is permitted, and was deemed safe, the optimal combination, interval and dose efficacy remains unknown. A homologous (same dose as primary vaccine series) should be the first choice as long as it does not delay vaccination.

When should I get my booster?

If you received Pfizer or Moderna, you should speak with your doctor about receiving a booster at least six months after completing your last COVID-19 vaccine series.

If you received Johnson & Johnson, please speak with your doctor about getting a booster dose at least two months after completing your last COVID-19 vaccination. CDC is recommending everyone ages 16 and older, medically able to tolerate it, receive a booster dose. Teens 16-17, can receive a Pfizer booster. For individuals 18 and older, they can receive Pfizer, Modera, or Johnson & Johnson.

Currently, the CDC is recommending that moderately to severely immunocompromised people receive an additional (third) dose as part of their primary vaccine series, which has been approved for emergency use for Pfizer ages 12 and older and Moderna ages 18 and older. Individuals who received a third dose as part of their primary vaccine series should speak with their doctor about receiving a booster dose 6 months after the last dose (third dose) for a total of four doses.

Where can I get the booster? Do I need to go to a pharmacy or state-run site, or can I just get it at my doctor’s office?

Your primary care provider is the ideal setting for COVID-19 vaccination including third dose and/or booster doses. Residents should not delay vaccination, and if their provider does not have availability, please visit vaccines.gov for nearest vaccination site, availability, vaccine type and schedule. If you are unable to access the website, please call the Orange County Office for the Aging 845-615-3700 or the Orange County Department of Health 845-291-2330

Should my doctor check my antibody levels to determine if I really need the booster yet? If yes, how many antibodies is considered “low” or “at-risk”?

No, please get vaccinated as soon as you are eligible under the current recommendations. Currently, there is no gold standard test for antibodies, the sheer presence of antibodies does not indicate protection from infection upon exposure. The level of antibodies needed to neutralize disease upon exposure, remains unknown, as well as concerning given the number of newly emerging mutated variants.

If I had COVID-19 and haven’t been vaccinated, how long should I wait until I get the first dose?

Individuals who were symptomatic must wait for the end of their isolation period (10 days), AND 24 hours fever free without use of fever reducers, AND improvement of symptoms. As long as the person has improvement of symptoms and afebrile in the last 24 hours of their isolation (10 days) without a fever reducer, they may be vaccinated.

For individuals who were asymptomatic, their isolation ends 10 days after the test was collected.

If I got COVID-19 after vaccination, how long should I wait until I get the booster?

Individuals must wait for the end of their isolation period (10 days) AND 24 hours fever free without use of fever reducers, AND improvement of symptoms.

Is a booster just a third dose – or does it have a different “formula”? Have the vaccines changed since Spring ‘21 to accommodate for variants?

The formulation remained the same as the primary vaccine series, except the Moderna booster dose is half of the amount in its primary vaccine series (also the concentration and dosage recommendations are different for the pediatric population).

With that said there is a distinct difference between the definition (not formulation) of “third dose” and the “booster dose.” CDC is recommending that moderately to severely immunocompromised people receive an additional (third) dose as part of their primary vaccine series, which has been approved for emergency use for Pfizer ages 12 and older and Moderna ages 18 and older. Individuals who received a third dose as part of their primary vaccine series should speak with their doctor about receiving a booster dose 6 months after the last dose (third dose) for a total of four doses.

The vaccines have not yet changed to accommodate for new variants, however clinical trials continuously test existing vaccine efficacy against newly emerging strains of virus.

What side effects can I expect from the booster?

Similar post-vaccine administration side effects as the primary vaccine series, to include but not limited to: at the site of injection -pain, redness, swelling; throughout the rest of the body - tiredness, headache, muscle pain, chills, fever and/or nausea.

What do scientists know so far about Omicron variant?

For Omicron, scientists have uncovered an estimated 30-40 mutations on the spike protein alone, as compared to 9-17 on the spike protein of the more prevalent Delta variant. Ongoing research for newly emerging strains of SARS- CoV-2 include examination of potential for increased transmissibility, increased disease severity and evidence of impact on diagnostics/treatment/vaccines (antigenic escape/vaccine resistance and/or resistance to pharmacological treatments/ interventions).