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Should you get a COVID vaccine booster? What if you had a reaction to the first shot?

Stacy Vasquez, CEO of the Birmingham VA receives the COVID-19 vaccine. The first COVID-19 vaccines given in central Alabama were administered at the Birmingham VA Medical Center just after 3 p.m. today. The three veterans were all POW’s from World War II and the Korean War. (Joe Songer | jsonger@al.com).

William Thornton

Worried about potential side effects of the COVID-19 vaccine? Are you unsure what activities are safe following vaccination? Whether you’re vaccinated or not, AL.com will be reaching out to public health experts to get your concerns addressed about the COVID-19 vaccine.

Just send an email to vaccines@al.com and we’ll get an expert to directly answer your question.

With cases of COVID-19 rising in Alabama, should vaccinated people get a booster? What about healthcare workers? And what about people who might be allergic to the ingredients in the various vaccines? What if you only got one shot and had a reaction – should you get another?

These were some of the questions readers of AL.com posed regarding the COVID-19 vaccines.

To get some answers, we consulted William Schaffner, a doctor and professor of infectious diseases at Vanderbilt University Medical Center and Paul Goepfert, director of the Alabama Vaccine Research Clinic and a professor of medicine and microbiology at UAB who helped work on the clinical trials that proved the J&J vaccine works.

It should be noted that any questions you have about your own health should be addressed with your primary care provider.

Question: “Having been vaccinated with the Moderna vaccine in February 2021. Is a booster recommended?”

Answer: Schaffner pointed out that the Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP) has provided recommendations on vaccine use since the 1960s. That’s a 15-member panel that reviews data and provides guidance on all vaccines, not just COVID-19.

At its last meeting, the ACIP did not recommend boosters for any of the current vaccines. The only reasons a booster might be needed, he said, would be sudden increases in vaccinated people needing to be hospitalized, or if the existing virus variants could evade the current vaccines. Neither of those is occurring, he said.

The committee is still looking at whether immunocompromised people need a booster, which would affect about 2% to 4% of the U.S. population.

“At the moment, boosters don’t seem to be needed,” he said. “On an individual basis, there are doctors out there caring for immunocompromised people who have advised them to get a booster. It’s not a formal recommendation, but we know it’s happening out there, to some degree.”

The ACIP is still gathering data and could make future recommendations based on that.

While some vaccinated people have become infected with COVID-19, Schaffner said, the incidents of serious hospitalization have been minimal for all of the vaccines – Moderna, Pfizer and the one-shot Johnson & Johnson. “They’re all pretty much in the same ballpark,” he said. “None of them are perfect.”

However, he pointed out that while there are some vaccines – tetanus, measles – that are perhaps 98-99% effective, the COVID-19 vaccines are actually more reliable than the annual flu vaccine at preventing serious infections, because of the frequent mutations of influenza varying from year to year.

“The COVID vaccines are more effective than we would have hoped,” he said.

Question: “Please ask when healthcare personnel can get a booster.”

Answer: Schaffner said health care systems nationwide are beginning to make COVID-19 vaccines mandatory for workers. Right now, the emphasis is on getting all health care workers their primary vaccination.

“The healthcare environment, if you’re attentive to all personal protective equipment (PPE) and infection control, is actually a pretty low-risk environment,” Schaffner said. “Working with patients, you’re actually at lower risk than you are when you go home and interact with people in the community. That’s because we’re so rigorous in training.”

Question: “What is the alternative to shot if you are allergic to components?”

Answer: Schaffner recommends that anyone with concerns about allergies to ingredients should consult with their own physician, or an allergist.

“You should talk about the ingredients, the nature of your allergy, and whether you ought to get vaccinated with any of the three available vaccines,” he said. “If you’ve got a history of serious allergies, that’s clearly the best way to go. There are ways patients can, if they choose, be vaccinated, but they should talk to their allergist.”

Question: “I had COVID August 2020. Received ONE Pfizer vaccine in March 2021. I felt so badly I choose to not receive the second dose. Can I safely take another dose of Pfizer?”

Answer: “This individual likely had a good immune response following infection and the first vaccine shot,” Goepfert said. “Many people have fewer symptoms after the second vaccine shot, especially if they did have COVID previously.”

Question: “I had a reaction to the Moderna shot #1. Stevens-Johnson syndrome (a rare, serious disorder usually with flu-like symptoms, followed by a painful rash that spreads and blisters). Doctor advised not to take shot # 2. What should I do now?”

Answer: Goepfert agreed that someone with Stevens-Johnson syndrome should not get a second shot of the Moderna vaccine, but they could consider getting the Johnson and Johnson vaccine, due to its different mechanism of action.

“They should discuss that option with their physician,” Goepfert said.


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