AMA Update September 4, 2024 N/A Unger: Hello and welcome to the
AMA Update video and podcast. Three updated versions of the
COVID vaccine are now available. But who needs them? And when is the best
time to get them? Here with us today to
share all the details is AMA's in-house vaccine expert
and ACIP liaison, Dr. Sandra Fryhofer, in Atlanta. I'm Todd Unger, AMA's chief
experience officer in Chicago. Dr. Fryhofer, thanks
for joining us today. Dr. Fryhofer: Well, Todd,
thanks for having me back. Unger: Well, let's
get right to it, a lot of people out there
with COVID right now, a lot of interest
in the vaccines. So tell us more about them. When were they approved? And who needs them? FDA approved COVID vaccine 2024 (Novavax approval) Dr. Fryhofer: Well, a
lot's been happening, and here's the timeline. On Thursday, August 22, FDA
authorized and approved Pfizer and Moderna mRNA versions of the
2024-2025 updated COVID vaccine. Both of them target the KP.2
strain of the JN.1 lineage. Now, at that time, the updated
Novavax protein-based vaccine was still under FDA review. And then more than a
week later, on August 30, the Friday before Labor Day,
FDA authorized a third shot, the Novavax version. And it also targets JN.1. ACIP recommendations (Pfizer, Moderna, Novavax vaccine) ACIP, the CDC's
Advisory Committee on Immunization
Practices, had already voted to recommend them
at its June meeting. A dose of the updated 2024-2025
COVID vaccine is recommended for everyone six
months and older. This is a universal
recommendation, just like the one we have for flu. This updated vaccine
is not a new vaccine. It's just a strain change. Novavax vs Moderna: Updated COVID vaccine 2024 Just like we do for flu
vaccine each season, we update the strains each year. Now, vaccine was ready
to ship, so once FDA gave the green light,
vaccine was on its way to clinics and pharmacies
around the country. Both of the mRNA vaccines are
authorized or fully approved for those six months and older. The Novavax version
is only authorized for those 12 and older. And again, a dose of the
2024-2025 COVID vaccine is recommended for everyone
six months and older. This includes people
who have never been vaccinated, people who have
been vaccinated in the past, as well as those who've
previously had COVID. So that's who can get them,
but the big question is when. Unger: Absolutely. There are a lot of
questions about that. How soon can you get the updated
dose after you've had COVID and after you've received, let's
say, a previous vaccination? COVID vaccine type: Novavax vs Pfizer vs Moderna Dr. Fryhofer: Well, there
are some slight differences between the two
vaccine platforms. For the updated mRNA vaccines,
guidance from CDC and FDA says you can get a dose
at least two months after your last dose
of any COVID vaccine. But if you recently had COVID,
you can wait a little longer. How long after COVID to get vaccine CDC suggests waiting at least
three months after infection to get the shot to maximize
immune response to vaccination. Novavax COVID-19 vaccine dosing schedule The FDA authorized the interval
for the updated Novavax protein-based vaccine is
not as straightforward. It depends on the
type of vaccine you received in the past
and the number of doses. A dose of the updated
Novavax vaccine can be given at least two months
after your last mRNA COVID vaccine dose. A dose of the updated
Novavax vaccine can be given at least two
months after previous completion of a Novavax two-dose
primary series. So for those who go with
Novavax for all their doses, FDA's updated authorization
reiterates the importance of an initial two-dose
primary Novavax series with those doses given
at least three weeks apart. And this new vaccine
can be used for that. Unger: OK, so it
sounds like there's some leeway in terms of when
you can get the updated dose. But what should people
consider in determining the best time for them? COVID vaccine timing: How long does it take for the COVID vaccine to be effective? Dr. Fryhofer: You have
the most protection in the first few weeks to
months after vaccination, and after that,
antibodies tend to wane. So you might want
to time vaccination so antibodies will be at
their peak for big events like weddings and
major meetings. But understand, while
you wait, you still run the risk of getting
infected with COVID, and it's much safer to build
up antibodies with vaccination than with infection. That's why those at highest
risk should probably not wait. They should get the updated
dose as soon as possible, at least two months from
their last mRNA dose, or at least three months after
previous COVID infection. COVID precautions: How to prevent COVID Now, right now, there's
lots of COVID circulating, so if you do decide to
wait on vaccination, try to avoid crowded
indoor settings. But if you can't
avoid them, consider wearing a high-quality mask. Most people have at least
some antibodies against COVID from previous infection,
previous vaccination, or both. But if you haven't
recently been infected COVID immunity after infection 2024: How long do COVID antibodies last? and you didn't get a
dose of last year's shot, you don't have
updated protection, which means you're sort of a
sitting duck for getting sicker. This new shot can wake up
your body's immune system and update your
antibody protection against COVID threats. Our computers need
update for cybersecurity, so so does our immune system. And a dose of the
updated vaccine updates your immune
system's protection against coronavirus threats. And if you're in
a high-risk group, the best sure way
to stay well is to go ahead and get a dose of
the updated vaccine as soon as possible. Unger: Well, that's a great
way to think about it. Everything needs an update,
including your vaccine. Dr. Fryhofer, you
mentioned that there are those who are at higher
risk, who should really consider getting it now. Who are those people that
you're talking about? COVID hospitalization by age (COVID 65 and older) Dr. Fryhofer: Hospitalization
rates for COVID are highest for those aged
75 and older and in infants under six months old. These little babies are
too young to be vaccinated themselves, but
maternal vaccination during pregnancy
and breastfeeding can help protect
these little babies. Hospitalization rates are also
high in adults aged 65 to 75. And we're still seeing
racial and ethnic disparities in hospitalizations. COVID-associated
hospitalizations are highest in American
Indians, Alaska Natives and in Black populations. COVID in seniors and COVID vaccine for immunocompromised Two-thirds of COVID
hospitalizations are in those aged 65 and older. So people age 65 and
older, as well as people living in long-term care
facilities, are at high risk. People with
immunocompromising conditions and chronic medical conditions
are also at greater risk. People with
immunocompromising conditions don't always have a
robust immune response after vaccination, and
that's why FDA has also COVID medication: Pemgarda FDA approval (prophylactic, monoclonal antibody) authorized the
monoclonal antibody PEMGARDA for those with
immunocompromising conditions. It can be given prophylactically
to help protect these patients from getting COVID. Now, it's not a treatment. It's prophylactic. Another added benefit
of getting vaccinated is it decreases the chance
of getting long COVID. And in a recent news conference,
CDC director Dr. Mandy Cohen reminded that every age
group is at risk for COVID, including young children. In fact, the highest numbers
of emergency department visits for COVID over the summer were
in children under five years old. Unger: That's a really
important point. I also heard someone say you
can't get long COVID if you don't get COVID, so more impetus
to get that updated vaccine. Dr. Fryhofer, are they
recommending just one shot this year? Or should anyone receive
more than one dose? mRNA vaccines: CDC recommendations for COVID vaccine Dr. Fryhofer: A dose
of the updated vaccine is recommended for everyone
six months and older. And unlike last year,
additional doses are not recommended for
those 65 and older yet, but that could change. People with
immunocompromising conditions not only need at least
one updated dose. They may need more. And of course, those
under five years old may need more than one updated
dose if they're still completing their primary mRNA series. COVID vaccine for kids under 12 But to clarify, only the mRNA
Pfizer and Moderna versions are authorized for those
under 12 years old. These mRNA vaccines
have full approval for those age 12 and older. Novavax COVID vaccine 2024 The updated Novavax
vaccine is authorized only for those aged 12 and older. And again, for those who go with
Novavax for all their doses, FDA authorization
reiterates the importance of an initial two-dose
primary Novavax series with those doses given
at least three weeks apart. Unger: And Dr. Fryhofer,
you mentioned up front about the variant that this
particular update is targeting. Can you talk a little bit
more in detail about that and how this year's shot
compares to last year's updated vaccine? What is the latest COVID variant? Dr. Fryhofer: The virus
is constantly changing, and new variants
continue to emerge. Last year's vaccine specifically
targeted omicrons XBB.1.5, which is no longer circulating. Now JN.1 lineage
variants are dominant. Both of the new mRNA COVID
vaccines target the KP.2 strain of the JN.1 lineage. The updated Novavax
protein-based vaccine targets the JN.1 strain. And you can think of
JN.1 as the tree and KP.2 as one of its branches. COVID variant 2024 (FLiRT COVID meaning, KP311) As of August 20, FLip, SLip,
FLiRT, and de-FLiRT variants are currently circulating,
and they got these nicknames from the location
of their mutations. And they include any variants
starting with KP or JN that has this same set of mutations. KP.3.1.1 accounts for 37%
of new COVID illnesses. KP.2.3 is at 14.4%. New COVID variant: LB1 (JN.1 COVID variant) A new variant, LB.1, is
now gaining steam at 14.1%. All of these are
relatives of JN.1. Understand, these new COVID
vaccines have been updated to give you the best protection
from JN.1-based variants, and these are the ones
that are circulating now. Unger: All right. If you happen to be
unfortunate and get COVID, what about treatments? Dr. Fryhofer: Well,
fortunately, Paxlovid Paxlovid effectiveness continues to be effective
against JN.1 and FLiRT variants. Paxlovid is a
protease inhibitor, and its mechanism
of action involves a part of the virus that's not
related to the spike protein. Paxlovid cost: Is Paxlovid covered by medicare? Paxlovid is available
for free for people on Medicare and Medicaid. There's also some
government funding to cover it for people who are
uninsured through the so-called PACS access program. Unger: Now, Dr. Fryhofer, I
realized that COVID might not be top of mind for everyone. So give us a little
bit of perspective. How bad was COVID last year? COVID statistics: COVID-19 deaths Dr. Fryhofer: Todd, in 2023,
nearly a million people were hospitalized from COVID. More than 75,000 died. And to put this
into perspective, during the 2023-2024 flu season,
nearly 45,000 died from flu complications. COVID vaccines and flu
vaccines helped protect us from severe disease,
hospitalization and death. Unger: That's really good
perspective, big numbers. Are these vaccines
covered by insurance? You mentioned before
about Paxlovid, but what about the vaccine? And likewise, is
there a backup plan for people who are uninsured? Free COVID-19 vaccines Dr. Fryhofer: COVID vaccines are
covered by Medicare, Medicaid and many private insurances. CDC's Bridge Access
Program, which provided 1.5 million
free COVID shots for uninsured and
underinsured people, ran out at the end of
August, and unfortunately, it will not be renewed. CVS COVID vaccine cost no insurance A CVS spokesperson said
that the out-of-pocket costs at CVS for COVID vaccines for
uninsured people is over $200. What is the Vaccines for Children program? However, uninsured and
underinsured children can get COVID vaccines for
free under VFC, the Vaccines for Children program. VFC is celebrating 30 years of
providing life-saving vaccines to children at no cost. It's a fabulous program, but
there's not a similar program for uninsured adults,
though many experts say there should be. And I agree. However, at least
for the time being, CDC has managed to repurpose
62 million unspent dollars to state and local
health departments to help them cover the cost of
vaccine for uninsured people. But there are 25 to 30
million uninsured adults, and this won't
cover all of them. However, the
government will make up to four free COVID
tests per household available again this year. You can sign up to receive
them at covidtest.gov, Order free COVID tests 2024 and I think that website
is supposed to go active at the end of this month. Unger: Excellent. Dr. Fryhofer, there are
a lot of people out there that just simply
have booster fatigue. How do we convince them
to get this updated shot? How long do COVID vaccines last? Dr. Fryhofer: It's clear
COVID is not going away. It's now endemic. It's here to stay. And as we all know, uptake of
the 2023-2024 updated COVID vaccine was very disappointing. Only 22.5% of adults and only
14% of children received it, and we certainly hope uptake of
this new vaccine will be better. And even if you've missed
the last few doses, you really need to
consider getting this one, especially if you're
in a high-risk group or around someone who is. And here's why-- antibodies
from previous infection and previous vaccination
are starting to wane. The virus has changed a lot. Also, antibodies we've built
from previous infection and previous vaccination
don't work as well against these new variants. Our antibody protection
needs a refresh. So getting a dose of the
2024-2025 updated COVID vaccine is the best way to catch
up and level set and update your immunity to
help stay protected. Unger: Well, Dr.
Fryhofer, COVID vaccines aren't the only ones we need
to think about right now. What are some of the
other vaccines that should be on our radar at this time? COVID RSV and flu vaccine at the same time Dr. Fryhofer: We're about
to end our respiratory virus season, which means there are
three shots, COVID, flu and RSV, to think about, recommend
and receive, if indicated. And you can get all of these at
the same time at the same visit if you need them
and if you choose. A dose of the
updated COVID vaccine is recommended for everyone
six months and older. Everyone six months and
older needs flu vaccination every year. And for those 65 and older,
one of the higher dose flu shots is preferred. RSV vaccine for seniors Everyone 75 and older needs a
single dose of the RSV vaccine. So do those aged 60 to 75
with certain risk factors. But if you received
an RSV vaccine dose in a previous season, you
don't need another one. RSV vaccine for babies And remember, RSV is also
the most common cause of hospitalization for
infants in the U.S., and we now have two new ways
to protect little babies, a maternal RSV
vaccine given to mom and the new long-acting
monoclonal antibody, nirsevimab, given to babies. RSV vaccine for pregnant women: When is RSV season? (maternal vaccines) RSV season typically runs
from October through March, and pregnant people whose baby
will be born during RSV season are eligible for the vaccine
at 32 to 36 weeks of pregnancy. But if they receive the RSV
vaccine in a previous pregnancy, they do not need another
RSV vaccine dose. Also, make sure those
age 65 and older, Pneumococcal vaccine as well as people with
certain medical conditions are up to date on
pneumococcal vaccination. So lots of things to
think about at this time. Unger: Well, exactly. You have shared quite
a bit of information. Any final thoughts? Recommended 2024-2025 COVID vaccines (5th COVID vaccine booster) Dr. Fryhofer: Please
don't understand-- underestimate the power of
physician recommendation. Adults and children who
receive a health care provider recommendation are more
likely to get vaccinated. Physician recommendation
is so important. Unger: As always,
thank you so much, Dr. Fryhofer, for being here
and sharing your expertise and letting us know what we
need to do about updated COVID vaccines and other vaccines
heading into the fall. That wraps up today's episode. To support more important public
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