Times Observer file photo A patient receives a dose of COVID-19 vaccine at a clinic in Warren County. The latest guidance, according to sources in the county, calls for booster shots for all adults and ‘third shots’ for people with certain immune-compromising conditions.

To booster or not to booster… “who” is the question.

The coronavirus is two years in and still going strong.

At this point, in this country, there are three approved vaccine brands for adults. One of those (Pfizer) is approved for kids as young as 5.

There are guidelines for booster doses and additional “third doses” or “fourth shots.”

“Current recommendations by the CDC are for everyone aged 5 and older to receive an age-appropriate COVID-19 vaccine unless a contraindication exists — such as allergy to a component of the vaccine, severe allergic reaction to a previous dose, etc.,” Gaughn’s Drug Store Clinical Coordinator Justin Scholl said. “Boosters are recommended for everyone over the age of 18.”

“The FDA has approved boosters for all over the age of 18,” Warren General Hospital Chief Nursing Officer Joe Akif said. “There have not been any boosters approved for the under-18 group at this time.”

Thousands of Warren County residents have already received booster shots. According to Monday data from the Pennsylvania Department of Health, there had been 5,298 booster shots administered in the county.

“For those looking to get a booster, you may get a booster typically six months after the original series of shots,” Akif said. “If you have contracted COVID and you were vaccinated, recent guidelines are for you to receive your booster between two weeks and three months after your last symptom of COVID.”

Just because a person received a Moderna vaccine, doesn’t mean that person has to get a Moderna booster.

“When the FDA approved the boosters, they also approved the mixing and matching of the boosters,” Akif said. “From a dosing perspective, Pfizer and J&J are the same and Moderna is half the dose. Some recent studies have shown that the Moderna vaccine has developed more immunity when given as a booster with any of the three approved vaccines.”

“The main message is to get a booster,” he said. “They all provide additional coverage. Don’t’ worry over this one or that one, just get the booster.”

“In terms of choice of booster product, there isn’t really a hard recommendation for preference of one product over the other,” Scholl said. “There is some data from a very small clinical trial – only 150 patients per group so not significantly powered to make a strong recommendation – that suggested that switching products might improve the levels of antibodies produced.”

“The important caveat here is that this study didn’t look at clinical outcomes such as a reduced number of illnesses or hospitalizations,” he said. “Since the correlation between a level of antibodies and clinical outcomes has not yet been determined, simply saying that more antibodies will protect better isn’t entirely certain.”

“There did not appear to be any safety concerns from mixing either,” Scholl said. “For this reason, the recommendation is that any vaccine can mix with any other vaccine when we are talking about boosters. The CDC is casting a wide net here to ensure that limited access to a particular product doesn’t create a barrier to getting a booster.”

“The crossover does not apply to the initial primary series,” he said. “Patients should complete the primary two-dose – or three-dose in the case of immunocompromised individuals – with the same product.”

The ‘third dose’ or ‘fourth shot’ is a special situation for patients with particular health conditions.

“The FDA has also recommended that immune-compromised individuals speak with their physician about a fourth shot,” Akif said.

“The distinction between ‘booster’ and ‘third dose’ is that when we are giving an additional third dose of COVID-19 vaccine to those with immunocompromised conditions, that dose is still working to develop a baseline level of antibodies that may not have developed to the original two-dose series due to the patient’s immunocompromised condition,” Scholl said. “These folks will get their ‘booster’ six months from the third dose instead of the second dose.”

“This distinction is especially important for those who initially received the Moderna vaccine: the ‘third dose’ is the same 0.5mL dose as the initial two-dose primary series, whereas the ‘booster’ is half the original dose (0.25mL).”

The Johnson & Johnson vaccine does not have a ‘third dose’ recommendation, he said.

FLU SHOTS

Flu season took a year off, there were no reported cases in late 2020 and early 2021, but has returned to Warren County.

Those looking to protect themselves against the flu may do so at the same time as they get a COVID vaccine.

“The flu shot can be given with the COVID-19 vaccine either or the same day or any time before or after,” Scholl said.

“Regarding the flu shot, this can be received at the same time as the COVID vaccine booster,” Akif said. “Many people are waiting two weeks in between shots, but that is not necessary with the COVID and flu vaccines.”