Vaccine roll-out has been a bumpy affair in some parts of the United States, but as the options for COVID-19 vaccines increase, your turn may be coming up soon. As you plan to get vaccinated against the SARS-CoV-2 virus that causes COVID-19, there’s a few things you should know in advance to help you best prepare.
Types of COVID-19 Vaccines
Currently, two vaccines are available in the United States, one made by Pfizer with its German partner BioNTech and the other by Moderna. Both of these vaccines are mRNA vaccines and require two doses for full efficacy.
Conventional vaccines typically introduce a weakened version of the infectious agent to the host to stimulate an immune response. But mRNA vaccines “include the (genetic) code — the mRNA — for a piece of the virus’ spike protein.” Spike proteins are the structures on the outside of the virus particle that give it the crown-like appearance that lends it the name coronavirus.
“Your body’s cells use that (mRNA) code to make part of the spike protein but not an entire functioning virus. Your immune system recognizes this protein as foreign and generates a memory response” in the immune system.
Once that immune response has been established, your body is now prepared if it gets exposed to the real virus and can mount “a much stronger, quicker attack on the virus’ spike protein before it can effectively spread in the body and make you sick,” Eddy explains. Some evidence points to the immune response from an mRNA vaccine potentially being even stronger than the response from having had the infection itself.
Viral Vectored Vaccines
Another vaccine that may receive emergency use authorization from the FDA in the coming weeks is a one-dose option made by Johnson & Johnson. That vaccine works a little differently from the Pfizer and Moderna options.
Called a viral vectored vaccine, it uses a harmless adenovirus — from a large family of viruses that are often responsible for common colds — that’s been engineered to carry genetic code for the coronavirus’ spike proteins. Once this “Trojan horse” adenovirus enters a cell, it causes the cell to make more spike proteins that prime the immune system to be ready in case the person is infected with the actual SARS-CoV-2 virus. This technology has been used by Johnson & Johnson in the past to make an Ebola vaccine that’s in use in Europe.
A big upside to the Johnson & Johnson vaccine is that you only need one dose to be fully vaccinated, rather than the two doses spaced a few weeks apart with the Moderna and Pfizer vaccine.
Oxford-AstraZeneca has also developing a viral vectored vaccine that has been used in some parts of the world already. However, South Africa announced in early February that it was halting use of this vaccine there after a small clinical trail suggested it was ineffective in preventing mild to moderate illness from a mutated variant of the virus that’s quickly becoming the predominant strain in that country.
[See: Myths About Coronavirus.]
Quick Yet Safe
In regards to all of these efforts to bring effective and safe vaccines to market as quickly as possible, it’s important to note how that’s been possible. Pharmaceutical companies and manufacturers have worked together in unprecedented ways over the past year to develop these vaccines in record time, but they weren’t starting from scratch.
Many companies that have been racing to develop viable options had other products already in the works because of previous outbreaks of similar viruses, such as the virus that caused the SARS outbreak in 2002 and the MERS outbreak in 2012. Researchers were able to adapt what they’d been working on for those similar viruses to the specifics of this new virus and begin clinical trials much faster than if they’d been starting from zero with a brand-new vaccine.
This speed of vaccine development has been a point of concern for some people, but it shouldn’t be, says Dr. Supriya Narasimhan, chief of infectious diseases at Santa Clara Valley Medical Center in San Jose, California.
“Even though everyone feels that these vaccines are new and developed very quickly, they underwent rigorous scientific trial — as good as any other vaccine we safely take. And the mRNA technology itself is not new, it has been in development for decades, it was just never funded enough to come to the mainstream.”
We’re able to have these vaccines so quickly because of decades of vaccine research and an overall advancement of science, says Dr. Richard Seidman, chief medical officer of L.A. Care Health Plan, the largest publicly operated health plan in the U.S. “Science is progressing at record-breaking speeds all around us, and new scientific methods and technology has enabled us to rapidly develop new, safe and effective vaccines that undergo rigorous clinical trials before approval.”
Overcoming Vaccine Hesitancy
It’s true that there’s lingering skepticism in some communities across the U.S. based on past experiences, Seidman notes. “Many people are appropriately skeptical of the U.S. government when it comes to their health care based on past tragic violations of ethical practice, including the Tuskegee study in which African American men were studied to observe untreated syphilis without their knowledge or consent.”
However, he encourages “everyone who is eligible for the vaccine to be vaccinated. But more importantly, I encourage everyone to make their own, informed decisions about what’s best for themselves, their family and loved ones and their community.”
Which Vaccine Should I Pick?
The simple answer: whichever is available soonest. You may not have a choice as to which vaccine you can get, as the manufacturers have focused on delivering their products to specific regions of the country in order to vaccinate as many people as possible as quickly as possible.
Supplies are still too scarce for anyone to be too choosy about which vaccine to get. The good news is that both the Pfizer and Moderna vaccines currently available are quite similar in how they work and in their efficacy rates.
The Pfizer vaccine has been authorized for use in people 16 years old and older. This vaccine was shown to be 95% effective at preventing symptomatic COVID-19 infection after the administration of two doses. This efficacy was virtually the same across all participants regardless of age or race. Doses must be kept in ultra-cold storage until they’re ready to be used, and the special freezers that can meet these requirements are in limited supply.
The Moderna vaccine is authorized for use in people 18 years old and older, and the company is currently testing its vaccine in 12- to 17-year-olds. Moderna’s vaccine was found to be 94.1% effective at preventing symptomatic COVID-19 after administration of a second dose. The efficacy was noted as being slightly lower in people aged 65 and older, but those findings may have been influenced by the small size of the cohort being tested in that age range. Race/ethnicity did not seem to impact efficacy. Doses of this vaccine also need to be kept very cold, but are a little easier to work with than the ultra-cold necessary to preserve the Pfizer vaccine.
Johnson & Johnson announced in late January that its one-dose vaccine had been shown to be 66% protective against moderate to severe COVID-19 infection. It also was found to be 85% effective in protecting against severe disease. There were no hospitalizations or deaths among people in clinical trials who got the vaccines, which is encouraging data the FDA is reviewing. Assuming that the emergency use authorization request is granted, you can expect to see this vaccine arriving in clinics in late March or early April.
While the vaccine is our best means of bringing this pandemic to heel, there are some potential side effects be aware of before you take the shot. People who’ve been vaccinated have reported side effects that “are similar to other vaccines routinely given,” Seidman says.
These responses are normal and may include:
— Redness, pain, tenderness and swelling at the injection site.
— Muscle aches and pains.
— Fever and chills.
— Joint pain.
— Nausea and vomiting.
Narasimhan says that side effects are fairly common but usually tend to be “mild to moderate” and usually “resolve in 24 to 72 hours post vaccination.”
They’re actually a sign that your immune system is responding appropriately to the vaccine, Eddy says. “You may have unpleasant symptoms that can last a few hours to days, but this is encouraging in the sense that your body is responding and you are likely generating immunity.”
These symptoms may be more noticeable after the second dose, Seidman notes.
You can take an over-the-counter nonsteroidal anti-inflammatory medication like ibuprofen or acetaminophen to tamp down unpleasant symptoms.
Dr. Charles C. Bailey, medical director for infection prevention at St. Joseph Hospital and Providence Mission Hospital in Orange County, California says that some “more serious side and rare effects are always possible” with any vaccine. You should confer with your doctor if you have any underlying medical conditions or have previously had a negative reaction to another vaccine. Though it’s rare, it’s possible that you might develop a reaction to this vaccine
“To date, we have not seen vaccine-associated Guillain-Barre syndrome,” a potentially serious neurological disorder that’s rarely associated with flu vaccinations.
In some rare instances, allergic reactions have occurred. These reactions are often mild and may include:
— Itching at the injection site.
— A rash.
— Facial flushing.
In a few extreme cases, people have experienced “a more serious allergic reaction called anaphylaxis,” Narasimhan says. Anaphylaxis can be life threatening. Symptoms may include:
— Swelling of face or lips.
— A sensation of choking or the throat closing off.
— Confusion, dizziness or lightheadedness due to decreased oxygen to the brain.
— Low blood pressure.
— Increased heart rate.
— Shortness of breath or wheezing due to swelling of the airways.
“Anaphylaxis is very rare and needs immediate medical attention and immediate administration of epinephrine among other medicines,” Narasimhan says. This is why vaccine administrators require that recipients wait for at least 15 minutes after an injection before leaving the clinic.
Taking that time to pause before leaving allows health care professionals to intervene immediately if a problem arises. “All vaccine providers are expected to have the equipment on hand to manage and treat this and any other serious reactions to the vaccine,” Seidman says.
Despite the side effects, Narasimhan underscores that the vaccine is safe. “The side effect profile of these vaccines is not any worse than any other vaccine that we know of. Thousands of healthcare workers have taken it safely,” with millions upon millions of doses being administered with very low incidence of side effects, allergic reactions or other complications. Narasimhan says that the side effect data that’s been collected is “not out of the expected range for any vaccine.”
Preparing for Your Shot
Before you head to the doctor’s office, pharmacy or drive-thru vaccination clinic, you can take some steps to get ready for what’s to come.
— Talk to your provider about concerns. If you’re concerned about vaccine side effects, be sure to talk it through with your doctor before you arrive for a shot.
— Know your allergens. If you have a history of allergies to any medication, you’ll probably need to be observed for a longer period of time, typically about 30 minutes, post vaccination to make sure you don’t develop a reaction, Narasimhan says. “Although 85% or so of allergic reactions develop immediately, 15% can develop several hours later, so people should know to seek care or call 911 depending on severity if they develop symptoms later.”
— Bring your EpiPen if you have one. If you have a history of anaphylaxis and have been given an EpiPen, bring that device to the vaccine appointment. “People who have a life-threatening allergy to other vaccines should discuss with their allergist-immunologist upfront before coming for their vaccine appointment and should preferably get it in a setting where appropriate medical care can be given if a reaction should occur, such as in a clinic or hospital, not a drive-thru,” Narasimhan says.
— Skip the second dose if an allergy occurs. Eddy notes that while medicines like epinephrine are on hand at vaccination locations to be given immediately to address any allergic reactions, if you’ve “a severe or immediate allergic reaction to a first dose or to one of the vaccine’s components, you shouldn’t receive the vaccine.”
— Know your medications. Narasimhan says people who take blood thinners, common for people with heart issues and other conditions, can still get safely vaccinated “but we hold pressure on the injection site for longer (about 2 to 3 minutes) to ensure that the injection does not cause bleeding into the muscle.”
— Know your COVID history. you had COVID-19 and were treated with monoclonal antibodies, you need to wait 90 days before you get the vaccine. “This is to make sure that the prior treatment doesn’t interfere with the vaccine’s effect,” Narasimhan says.
— Know when you’ve had other vaccines recently. You should schedule your COVID vaccine appointment at least 14 days apart from other vaccine appointments you have coming up or may have recently received, such as the flu or shingles vaccine. “Because these vaccines are new and have not been studied when co-administered with other vaccines, the CDC recommends a 14-day interval between COVID vaccine and other vaccines,” Narasimhan explains.
— Take someone with you. If you can, arrange to have a friend or loved one accompany you for the vaccine, especially if you have concerns about allergies or side effects or aren’t comfortable around needles or doctors.
— Eat a small meal before you go. “If you tend to feel queasy with needles, you shouldn’t take the vaccine on an empty stomach,” Narasimhan says.
— Call your doctor. If you develop side effects after your shot, contact your health care provider for advice. Bailey says side effects typically begin “within hours of the vaccination and last a day or two. More prolonged symptoms or severe or escalating symptoms should prompt caregiver follow-up, starting with a phone call.”
— Skip the pre-shot painkiller. Bailey also says you should avoid taking any steroids or non-steroidal anti-inflammatory agents such as ibuprofen prior to the shot, as in theory, these could “blunt the desired immune response to the vaccine.” However, if you do experience post-vaccine side effects such as a mild fever or muscle aches, it’s OK to use ibuprofen or anti-fever agents such as acetaminophen.
— Make arrangements with work. Some people have reported feeling “lousy” after receiving one or both doses of the vaccine, and Eddy notes that you should “be prepared to feel unwell in the 1 to 2 days after getting the vaccine. It wouldn’t be wise to schedule important events on these days” or to schedule a shot the day or two before a big event that can’t be moved. He also recommends having a “contingency plan for important duties like childcare and discuss with your boss that you may not be at work those days.”
— Be patient. It takes about 10 to 14 days for your body to produce the antibodies that afford protection. Continue being vigilant about social distancing and masking to prevent transmission of the virus in the interim. And it may take a while before you can even access the vaccine yourself, depending on where you live and where you fit in the triage for doses. To all this, Seidman encourages you to “be patient, persistent and supportive of the enormous effort to vaccinate hundreds of millions of people in the United States and billions of people across the globe as quickly as possible.”
— Get your second dose. The two vaccines that are currently being deployed in the U.S. require two doses. “Even though one dose provides some protection, you need both doses to gain the optimal protection,” Narasimhan says. These does should be administered a couple of weeks apart to work as has been demonstrated in clinical trials. Check with your health care provider about optimal scheduling for your second dose and be sure to keep the appointment.
— Know which vaccine you received. It’s also important that you “don’t mix and match” when you go back for your second dose, Narasimhan says. Studies have not been conducted on efficacy when mixing the two brands of vaccine that are currently available. While they both use mRNA to stimulate an immune response, they aren’t the same, so it’s best to stick with whichever brand of vaccine you had first for your second dose. Researchers are investigating the question about mixing and matching, but until such time as we have more scientific data that they can be used interchangeably and still trigger the same immunity levels, it’s best to stick with the same brand for both doses.
— Keep masking and social distancing. Narasimhan says that even after you’ve gotten your shots, it’s really important to keep up the mask wearing and social distancing. “We know the vaccine is highly effective in preventing symptomatic COVID-19 disease and severe illness from COVID-19, but we don’t know if it prevents asymptomatic infection — that was not studied. This means there’s a possibility that a vaccinated person may not become sick, but could still carry and transmit the virus.” We also don’t know how long immunity will remain after vaccination. You may need a booster each year to keep your defenses up.
— Quarantine if you’ve been exposed. Even after you’ve been immunized, if you’ve been exposed to someone who has COVID-19, you should still quarantine, Bailey says. This recommendation is “based on the fact that the clinical trials upon which the FDA okayed vaccine use did not fully investigate the ability of the vaccine to prevent COVID transmission.” The vaccines have shown efficacy in reducing severity of disease, but we still don’t have all the answers about whether a vaccinated person can spread the virus to others.
A Word About Variants
Lately, a lot of the news about the pandemic has been focused on the emergence of several variations, or mutations, to the virus that may help it evade your immune system’s response to a previous infection or a vaccine.
Genetic mutation of viruses is common and normal, but the problem with this virus is that the new variants appear to be more easily transmitted from one person to another. It’s also unclear whether emerging variants of the virus, the so-called South African and UK variants, for example, will be covered by the vaccine.
“Until we know these answers, it’s very important to keep masking, socially distancing and practicing good handwashing until we can see a drop in COVID rates. This is extremely important until we can get the vaccine out to every nook and cranny to get herd immunity,” Narasimhan adds.
Vaccinate to Reduce Severity
Lastly, if you’re still unsure about getting vaccinated against COVID-19, consider what’s at stake. “Each person should weigh the risk of refusing the vaccine due to fear of side effects to the risk of getting severely ill with COVID, passing it on to their family and the risk of death from the same,” Narasimhan says.
Even if you get vaccinated, it’s still possible to get sick with COVID-19. But, the vaccines currently available have been shown to reduce the severity of the illness.
“The vaccine might also decrease the likelihood of developing long-haul syndrome and lessen the chances that you can pass on virus to family or friends,” Eddy says. He adds that when you get vaccinated, you’re “doing the wider population a service by helping to stop the spread of the virus. It’s important that we vaccinate as many people as possible as quickly as possible because the more the virus is allowed to spread, the more likely it is to change into variants for which current vaccines may not be effective. We’re in a race with the virus — please help us win.”
It’s impossible to know how any individual will respond physically to an infection, and while some people experience very minimal symptoms, hundreds of thousands of others have died because of this virus. Narasimhan asks, “what would you choose? I would choose the vaccine every time even if the side effects were 10 times as bad, not only because I care about myself, but also because I care for my patients and family and I care about them. This is why health care workers like me have been vocal on social media about promoting our positive experience with the vaccines: We need to dispel hesitancy.”
She encourages you to “read experiences of people who have shared how they overcame their doubts” and talk to your doctor. “That’s what we are here for, and there’s no shame in asking. I would rather you ask me than bottle your fears about vaccination and refuse a life-saving vaccine.”
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