Nebraska doctor explains who should get updated COVID vaccines

And with a recent uptick in COVID-19 activity in Nebraska and the nation as a whole, those new shots come at a good time, said Dr. Mark Rupp, chief of the infectious diseases division at the University of Nebraska Medical Center.

“I’m enthusiastic about folks getting the vaccine and hopefully tempering ongoing COVID transmission,” he said.

While COVID case counts and hospitalizations are nowhere near what either Nebraska or the nation saw in earlier waves, Rupp said, Nebraskans are hearing more anecdotal reports of friends, neighbors and family members testing positive for the virus. Patients hospitalized at Nebraska Medical Center with COVID-19 now figure in the double digits after being in the single digits — and on some days, zero — earlier this summer.

Concentrations of virus particles in wastewater in the state, as well as the U.S. as a whole, had increased to the highest levels since last spring, although the Nebraska Department of Health and Human Services’ latest report showed a downturn in preliminary data for Sept. 6.

But quashing transmission of the virus now can only help, particularly with another respiratory illness season on the horizon. Last year’s confluence of COVID-19, influenza and respiratory syncytial virus, or RSV, strained some hospitals and clinics.

Rupp said previous versions of the vaccine have been shown to be effective at preventing infection with and transmission of the virus in the first months after vaccination. Over time, however, protection against infection wanes. Americans who got last fall’s booster now are nearing a year since their last dose.

“I think we’re going to be able to take this in stride, particularly if we have more and more people affording themselves of the protection that is offered by the vaccine,” he said.

The vaccines continue to show good protection against severe illness and death. Fortunately, fewer people over time have developed severe disease requiring hospitalization.

“But it certainly is continuing to occur,” he said.

The new vaccines also are patterned on variants of the virus that are a closer match to those circulating now than past shots, Rupp said. Available data also suggests the new booster is effective against emerging strains, including BA.2.86, that had initially raised alarms.

“It’s not perfect, and it certainly doesn’t prevent people from developing mild disease,” he said, “but (the vaccine) does continue to protect against more severe illness.”

Should everyone get them?

Nationally, some have debated whether the new vaccine should be recommended for most Americans or just those at greater risk of serious illness, such as the elderly and immune compromised, as has occurred in some countries.

Rupp said that argument makes some sense. But from a public health standpoint, he said, it makes sense to vaccinate a broader swath of Americans. While younger people are at less risk of severe disease, they can still become seriously ill. They can also spread the virus to those at higher risk.

“This is much the philosophy that we’ve had with influenza virus now for years and years, that this is a good vaccine, it’s a safe vaccine, we should be using it broadly across society to protect everyone but in particular to protect those who are most vulnerable,” Rupp said. “Really, at all age groups, this is a good public health strategy.”

While some have raised concerns about rare cases of myocarditis among young men after vaccination, the risk of the complication has proved greater after infection, he said.

The condition, while still rare, was more common with initial doses of the vaccine than with the booster available last fall, Rupp said. Some researchers believe the initial cases were related to the fact that there was little time between the first two doses. Most believe the will be less risk with the new booster.

While the federal government has signed off on the mRNA vaccines made by Pfizer and Moderna, he said, consumers likely will have another option. Regulators also are expected to authorize an updated version of the protein-based Novavax shot in the coming weeks.

What uptake of the vaccines will look like, however, remains to be seen. Only 17% of Americans got the last booster. Nebraska did slightly better with 17.7% of its population getting the shot.

Can I get them together? And when?

The new vaccine also comes as people are beginning to think about getting shots to protect against other respiratory illnesses, including influenza and RSV. A new RSV vaccine was approved in May for people over 60. Another was OK’d for pregnant women to protect them and their infants.

Rupp said people can safely get their COVID and flu shots at the same time. The two shots were given together last year with no issues. The CDC also says it’s OK to get COVID, flu and RSV shots together.

However, he cautioned that it’s still a little early to get the flu shot. As with the COVID vaccines, its protection wanes over the months. For people who can time their shots, he recommended getting the COVID shot now, given that the coronavirus is circulating in the community, and the flu shot between mid-October and early November so they’re at maximum immunity in January and February, when flu typically peaks.

When it comes to the RSV shot for older people, he said, patients should speak to their health care provider about their individual risk and timing. Studies indicate that shot provides a fair amount of protection even into the following year.

However, a small amount of data has indicated that getting the RSV vaccine with other shots may somewhat decrease protective antibodies. Whether that translates into less protection in the real world, however, isn’t known, he said.

“So the official word is you can give all three of those vaccines together, they are safe,” he said. “But I think there are some reasons people would want to time their vaccines to give them maximum protection against things in conjunction with what we see in the community.”

As of Friday, the new COVID-19 booster did not yet appear to be available anywhere in Nebraska. The Lincoln-Lancaster County Health Department said it was still awaiting final guidance from the federal government and would provide more information “in the near future.”

“The updated vaccine is coming at crucial time,” said Health Director Pat Lopez. “We expect to see more cases of COVID-19 in the months ahead along with other respiratory viruses. We recommend residents get the updated vaccine as soon as it’s available locally so they have heightened protection as we move into fall and winter.”

Long COVID and other considerations

Rupp said people also need to remember that the COVID vaccines reduce the risk of long COVID, including in young people.

And while fewer people are testing for COVID-19 and other respiratory illnesses, he said, testing and getting a diagnosis allows people to access the effective treatments available for flu and COVID.

It’s also still reasonable to try to reduce risk in other ways, he said, by avoiding crowded, high-risk settings with poor ventilation, particularly for those at higher risk of serious illness. Those who can’t avoid such situations shouldn’t feel shy about wearing a KN95 respirator to further minimize the risk.

“We need to get ... more accepting of seeing those folks wearing their masks,” he said. “It may protect them, it may also be protecting you, so we should be welcoming that.”

Cost

Unlike past years, most people now will get COVID vaccines where they get flu shots, at pharmacies and doctors’ offices. But instead of the federal government picking up the tab, the cost this year will be covered by Medicare and private insurers.

Free vaccines, however, will be available to the uninsured and underinsured through health departments, federally qualified health centers and some pharmacies through what’s known as the Bridge Access Program. Locations are expected to be available later this week on the Vaccines.gov website.