Make sure your vaccinations are up to date.
By Linda Rath | Updated Oct. 17, 2023
If you take drugs that suppress your immune system, you may worry about the effect of your medications on vaccine effectiveness as well as the effect of vaccines on your disease. Here’s the latest information, including updated information about the 2023-2024 COVID-19 vaccine.
2023-'24 COVID-19 VACCINE
Who needs it: The Food and Drug Administration (FDA) in September approved a new COVID-19 vaccine for fall/winter 2023-2024. It replaces earlier vaccines and boosters and is intended for everyone aged 6 months and older.
How it’s different from the last COVID booster: Boosters administered in the fall of 2022 were bivalent, meaning they were designed to protect against two strains — the original COVID-19 virus and Omicron subvariants. Those strains are no longer circulating, and the bivalent booster isn’t in use.
According to some experts, the bivalent booster was relatively ineffective against BA.4 and BA.5, the Omicron subvariants it was meant to target. That’s because the immune system tends to go after threats it recognizes rather than those it doesn’t. In the case of the bivalent booster, the immune system may have attacked the original virus, which, although included in the vaccine, had disappeared by 2021.
The new monovalent shot has been updated to better protect against a single more recent strain called XBB.1.5 (though it also is no longer circulating). Because current strains are closely related to XBB.1.5, both Moderna and Pfizer say their updated vaccines remain effective against the rapidly evolving virus.
A Novavax vaccine that has been updated to include the spike protein from the XBB.1.5 variant has been approved for anyone aged 12 years and older. Novavax is protein-based, which some people may prefer to an mRNA vaccine. If you recently had COVID-19, experts say your natural immunity should protect you for a few months, so it’s best to wait before getting the new shot.
What if I am immunocompromised? If you are seriously immunocompromised, the number of doses you need of the updated vaccine depends on your age and previous immunizations. Here’s what the CDC recommends if you’re unvaccinated or previously received a Pfizer or Moderna vaccine:
- If you’ve never been vaccinated, three doses of the updated vaccine
- If you had one dose of an earlier vaccine, two doses of the updated vaccine
- If you had two or more doses of an earlier vaccine, one dose of the updated vaccine
Peter Marks, director of the Center for Biologics Evaluation and Research at the Food and Drug Administration (FDA), acknowledges that vaccine effectiveness is short-lived and that it’s not possible, practical or cost-effective for at-risk people to keep getting shots every few months. For now, the FDA has decided to treat COVID with a yearly shot, just like the flu, with the hope the virus doesn’t undergo a major mutation in the meantime. Immunocompromised people should decide with their doctor whether they need or want additional doses.
How effective is the updated shot? The COVID-19 shot won’t necessarily prevent infection, but it can help protect against severe illness, hospitalization and death. If you’re infected with COVID-19, you’re not likely to be as sick for as long. Even a mild bout, though, can lead to long COVID, a debilitating condition that lingers months or years after the initial infection and is thought to affect tens of millions of people worldwide. If you’re at higher risk or live with someone who is, consider taking extra precautions, such as masking and social distancing when hospitalizations climb in your area.
Where can I get it? The 2023-2024 vaccine rolled out in September and is available in most major retail pharmacies and health systems, but many people are not getting it. Part of the problem may be cost. From the beginning of the pandemic, the federal government supplied free COVID-19 shots to everyone who wanted one. Now, the government is out of the vaccine business and insurers are in. The shots should still be free for people with private insurance, Medicare or Medicaid, with no deductibles or co-pays. But according to the National Pharmacists Association, at least 20% of people are experiencing insurance snafus. If you run into problems with your insurance company, stand firm. The updated shots should be free, whether you get them in or out of network.
If you are uninsured or under-insured, you can get the updated vaccine at no cost through the Bridge Access Program, which distributes free shots to local health departments, health centers and more than 20,000 participating pharmacies.
Who needs it: The CDC recommends seasonal flu shots for almost everyone over 6 months of age. This includes people who have a rheumatic disease or take drugs that suppress the immune system, though they may not respond as well to the vaccine as other people.
Flu vaccines are updated every year in the U.S. based on past seasons and forecasts of how the virus might change. Overall, flu vaccine effectiveness ranges from 40% to 60%, according to the CDC. Vaccines approved for 2023-'24 are all quadrivalent, meaning they are protective against four main groups of flu viruses most likely to spread this season.
Older adults, who are at greater risk of serious flu complications, should receive a high-dose flu vaccine; vaccines tend to be a little less efffective because the body’s immune response weakens with age. Pregnant women also should receive a vaccine.
eople who are moderately or severely ill with COVID should delay getting vaccinated until they have recovered. Those who are mildly ill might want to consider delaying a vaccination just to avoid symptom confusion, the CDC recommends.
If you are immunocompromised or take medications that compromise immunity, like some arthritis drugs, you should be vaccinated. But talk first to your health care provider about the best time to receive a flu vaccine so your medications won't interfere with its effectiveness. For example, if you take methotrexate or rituximab, ask your provider about stopping the drug for one or two weeks to make it more effective.
If you take immunosuppressants, are immunocompromised or over age 50, you should not get a vaccine made from a live virus, such as the nasal vaccine (FluMist Quadrivalent).
It’s convenient and generally safe to get the flu and COVID shot together, but aim to get the flu shot in the fall. Getting it too early means its effectiveness could wear off before the end of flu season in May.
To be sure the adjuvants in mRNA vaccines don’t interfere with the uptake of the flu vaccine, some experts recommend getting the shots in separate arms. And if you have a particularly strong reaction to vaccines, such as fever, chills, headache and fatigue, it’s better not to combine them.
HERPES ZOSTER/SHINGLES VACCINE
Who needs it: The CDC recommends the Shingrix vaccine for adults aged 50 and older, including those who are immunocompromised. It’s the first shingles vaccine approved for immunocompromised people. The Shingrix vaccine is also recommended if you ever received the Zostavax vaccine – a live vaccine no longer used in the U.S. – have already had shingles, take drugs that suppress your immune system or aren’t sure if you’ve had chickenpox. After a bout of chicken pox, the varicella zoster virus hibernates in your body and may re-emerge years later as shingles. COVID-19 vaccines can reactivate the varicella zoster virus in some people, especially those with inflammatory forms of arthritis.
The Shingrix vaccine is given in two doses, two to six months apart. It’s about 90% effective, even for people with autoimmune diseases.
Protects against: Bacteria that can cause pneumonia, sinus and ear infections, meningitis and bloodstream infections
Who needs it: The CDC recommends the pneumonia vaccine for children under age 2, unvaccinated adults over age 65 and kids and adults with certain chronic conditions, such as diabetes, heart disease, lung disease, HIV, sickle cell disease or who smoke, have a cochlear implant or are immunosuppressed.
The type of vaccine and vaccine schedule depend on your age, health and previous pneumonia vaccines. For example, if you’re aged 65 or older and have never had the pneumonia vaccine, you may receive a shot of PCV 15 followed by PPSCV about a year later – sooner if you have certain medical conditions. If you receive the PCV20 first, you won’t need a follow-up shot.
The ACR recommends the pneumonia vaccine for people under 65 who are on medications that suppress the immune system, though they’re not likely to have a robust response to it. If you have inflammatory arthritis, discuss the timing of the vaccine with your doctor. Ideally, you should get it before you start immunosuppressant drugs or when your disease isn’t active.
PERTUSSIS/WHOPPING COUGH VACCINE
Protects against: a severe respiratory infection that can be fatal in infants and debilitating in adults
Who needs it: Those 19 or older who haven’t had a Tdap (tetanus, diphtheria and pertussis) booster
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