You were fully vaccinated and had a brief period of “back to normal,” well, long enough for the Delta variant to gain strength. Until we have enough individuals fully vaccinated the virus will continue to mutate. That is a topic for another discussion, today, I want to cover what has changed for fully vaccinated individuals should you become exposed to COVID-19 and the new recommendations for additional vaccinations.
Be proactive, know the transmission rate of COVID-19 in your community. The CDC has made this easy for anyone to follow by using the CDC COVID Data Tracker. To reduce the risk of being infected with the Delta variant and possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.
If you are immunocompromised, have underlying medical condition, or elderly, you may be at risk for severe disease and choosing to wear a mask for protection regardless of the transmission level is also advisable. In addition, you may be able to help protect a member of your household who has a weakened immune system or unvaccinated if you continue to wear a mask in indoor public spaces.
One of the biggest changes for vaccinated individuals is how to respond if you are exposed to COVID-19. If you have had close contact with someone who has COVID-19, you should get tested 3-5 days after your exposure, even if you don’t have symptoms. You should also wear a mask indoors in public for 14 days following exposure or until your test result is negative. You should isolate for 10 days if your test result is positive.
The definition of close contact is one who was within six feet (laboratory-confirmed or a clinically compatible illness) for a cumulative total of 15-minutes or more over a 24-hour period (for example, three individual five-minute exposures for a total of 15-minutes). An infected person can spread SARS-CoV-2 starting from two days before they have any symptoms (or, for asymptomatic patients, two days before the positive specimen collection date), until they meet criteria for discontinuing home isolation.
Recommendations for unvaccinated individuals has not changed. With a known exposure through close contact, the recommendation remains a 14-day quarantine.
With the Delta variant surging and cases of COVID-19 increasing significantly across the United States, an additional dose could help prevent serious and possibly life-threatening COVID-19 in immunocompromised people. On August 16, 2021, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommended that people whose immune systems are moderately to severely compromised receive an additional dose of mRNA COVID-19 vaccine at least four weeks after an initial two-dose mRnA series.
Currently, the CDC is recommending that moderately to severely immunocompromised people receive an additional dose. This includes people who have:
- Been receiving active cancer treatment for tumors or cancers of the blood
- Received an organ transplant and are taking medicine to suppress the immune system
- Received a stem cell transplant within the last two years or are taking medicine to suppress the immune system
- Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection
- Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response
For people who received either Pfizer-BioNTech or Moderna’s COVID-19 vaccine series, a third dose of the same mRNA vaccine should be used. A person should not receive more than three mRNA vaccine doses. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered.
The FDA’s recent EUA (emergency use authorization) amendment only applies to mRNA COVID-19 vaccines, as does the CDC’s recommendation.
Emerging data have demonstrated that immunocompromised people who have low or no protection following two doses of mRNA COVID-19 vaccines may have an improved response after an additional dose of the same vaccine. There is not enough data at this time to determine whether immunocompromised people who received the Johnson & Johnson’s Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.
There is limited information about the risks of receiving an additional dose of vaccine, and the safety, efficacy, and benefit of additional doses of COVID-19 vaccine in immunocompromised people continues to be evaluated. So far, reactions reported after the third mRNA dose were like that of the two-dose series: fatigue and pain at injection site were the most commonly reported side effects, and overall, most symptoms were mild to moderate.
At this time, the FDA/CDC guidance has not changed for any other groups than those addressed above, however, news agencies and social media have been reporting that this recommendation is pending. The expectation is that a decision will be made to include additional/booster doses for general population at eight months past second dose. Stay tuned.
Resources:
COVID-19 Vaccines for Moderately to Severely Immunocompromised People | CDC
8/16/2021 TDH Health Advisory – Additional COVID-19 mRNA vaccine dose for immunocompromised individuals