Your COVID Questions

I understand that that immunocompromised individuals who received Pfizer or Moderna COVID-19 vaccine are eligible to receive a third dose. Has the FDA authorized an additional dose for immunocompromised people who received Johnson & Johnson (J&J) COVID-19 vaccine?
The Food and Drug Administration (FDA) continues to review data and has not yet commented on whether an additional dose of J&J is needed for those who are immunocompromised. Pfizer and Moderna preceded J&J by several months. Thus, there has been less time to observe waning immunity from J&J that would necessitate an additional dose. We do expect that within the coming weeks, the FDA will make a determination. 

Who qualifies as immunocompromised?
A list of conditions that qualifies an individual for a third dose can be found on the SVMC website here.

How can someone who is meets the definition of immunocompromised get the third shot? 
SVMC provides vaccine 6 days per week at it’s COVID Resource Center located on the former campus of Southern Vermont College. You can schedule a time online at svmcvaccine.timetap.com

Why do people who are vaccinated get COVID-19?
People who are vaccinated are still susceptible to breathing in the virus when indoors close to someone infected. The virus will then replicate in the nose, throat, and lungs. If the person happens to get a test as this is happening, the test will be positive. The person is most likely asymptomatic. Occasionally, the person will develop mild symptoms while their body is mounting the immune response it learned from the vaccine. Such symptoms include a day or two of fever, sore throat, cough, or muscle aches. Rarely, a vaccinated individual will develop worse symptoms and end up in the hospital. The majority of these patients are elderly or immunodeficient.

Do the vaccines work against the delta variant?
The vaccines remain highly efficacious at preventing serious infection leading to hospitalization or death from all variants of the virus, including delta. Approximately 95% of patients hospitalized with COVID-19 are unvaccinated. That number has held since delta became the dominant strain in the early summer. We have observed a greater number mild infections from delta in vaccinated individuals than we saw with earlier strains.

Do I need to get a booster?
We expect that within a few weeks, the FDA will authorize a third dose to everyone who previously received Pfizer or Moderna vaccine. The timing will be 6 months, or possibly 8 months, after the second dose. Definitive guidance will be released soon.

Why are boosters recommended so soon?
Since the rise of delta in the U.S., there has been a slight increase in vaccinated individuals who test positive for COVID and are asymptomatic or exhibit mild symptoms. Although these individuals have little risk of developing severe disease, they can spread the virus to others, including those who are unvaccinated or are considered vulnerable, typically the elderly or immunosuppressed. Some countries have been giving a third dose to certain populations. Early experience in those receiving a third dose has shown significant improvement in protection against developing COVID-19.

Will we need boosters every 6 months?
The third dose should stimulate a lasting response, priming immune memory at the level of B cells and T cells. We will use observational experience—monitoring people over time—to determine whether regular boosters will be needed and the optimal time increment between doses. The answer may be annual or every 5 years or a different duration.

Is it better to receive a third dose of the same vaccine or should the vaccines be mixed?
The idea of “mixing” of vaccines originated early in the vaccine effort, when supplies were severely constrained. Using different vaccines has not shown to have benefit over using the same vaccine. The purpose of the third dose in the general population is to stimulate immune cells to respond to the same antigen encountered during the first two doses, providing lasting immune memory. Thus, it is recommended that one receive the same vaccine if available. 

How do I get the third shot? 
SVMC provides vaccine 6 days per week at the COVID Resource Center located on the former campus of Southern Vermont College. We anticipate FDA authorization for the general public in late September. Those who received their second dose over 8 months ago will be eligible. Once federal and state guidance is provided, we will link online scheduling on svhealthcare.org.

Answered by Trey Dobson, MD, chief medical officer at Southwestern Vermont Medical Center in Bennington.