Should you get a second COVID-19 vaccination?

New federal guidelines for second COVID-19 booster doses have left many Minnesota vaccine recipients questioning when and if they should get another shot.

Monica Heltemes, 51, diligently sought COVID-19 shots last spring and a booster dose in November, but the occupational therapist isn’t sure she wants a fourth dose now. The Dayton, Minn. woman noted that a breakthrough coronavirus infection in December already gave her an immunity boost.

“Cases are low in Minnesota,” she said. “So if I think I’d get an extra boost from a second vaccine, I’d want to wait until there’s a bigger threat on the horizon before I take it.”

As newly eligible individuals snapped up vaccination appointments at the pharmacy this week, Heltemes was hardly alone in her indecisiveness. Federal guidelines on Tuesday allowed second COVID-19 booster shots for people who are 50 or older, have a compromised immune system, or who have only received two doses of the less effective Johnson & Johnson vaccine, but did not specifically recommend that people get them Looking for .

The expansion facilitates a stronger refresher recommendation in the event of another wave of the pandemic, but for the time being even infectiologists are unsure. dr Frank Rhame, a virologist with Allina Health, said the Food and Drug Administration and the Centers for Disease Control and Prevention bypassed their vaccine advisory committees, which could have provided clearer advice.

“Maybe the CDC will give us more,” said Rhame, who led a local arm of the J&J vaccine clinical trial. “It’s probably a good thing, but it’s too speculative to provide a good basis for recommendation yet.”

The federal guideline stratifies Minnesota beyond a simple 4.2 million vaccinated and 1 million unvaccinated people ages 5 and older. There are 330,000 Minnesotans who have only completed the first of a two-dose series, 1.6 million fully vaccinated people who have not received a booster, and 2.2 million people who have received initial boosters and are up to date.

Some Minnesotans are already in the new category: Double-Boosted. Second booster shots are allowed four months after first booster shots as there is evidence that immunity wanes over time.

Jean Butala, a 66-year-old retired teacher from Bloomington, received her second booster shot Thursday without an appointment at the state’s community immunization clinic in the Mall of America. It was also a no-brainer for Annandale’s Ann Dropps, who knew three people under 40 who had severe COVID-19 earlier this year, and two of them died.

“One is still on a ventilator and will need a miracle to survive… need I say more,” she said in a post to the Minneapolis Vaccine Hunters Facebook group.

The pandemic risk is currently low in Minnesota, which has recorded a total of 4.2 million coronavirus infections and 12,410 COVID-19 deaths. Nearly one in four COVID-19 tests was positive in mid-January, when the fast-spreading Omicron variant swept across Minnesota. That rate fell to 2.9% in the week ended March 24.

Minnesota’s COVID-19 hospitalizations also fell from 1,629 on Jan. 14 to 189 on Thursday.

Cari Trousdale, 63, said the low spread of the virus gave her a break but scheduled a refresher appointment for next week because she has diabetes and is at an increased risk of COVID-19. The Mendota Heights woman drove 800 miles together to receive her first COVID-19 vaccine doses in Wahpeton, ND last year

“I’m pretty willing to do anything to mitigate my risk of getting COVID,” she said.

Health officials urged people not to confuse questions about a second booster shot with the proven benefits of the COVID-19 vaccine. People who were boosted during the Omicron wave were 21 times less likely to die than unvaccinated people, the CDC reported this week.

“There appears to be some benefit in getting the booster shot, although the biggest benefit is seen when you go from unvaccinated to vaccinated,” said Dr. John O’Horo, an infectious disease specialist at the Mayo Clinic. “The boosters also offer a real additional benefit.”

Mayo doctors advised against waiting for booster shots due to recent infections because post-COVID-19 immunity levels can vary in strength and duration.

A recent US study found slightly stronger immune responses when people switched between Pfizer and Moderna vaccines for their first boosters, but O’Horo said there was limited evidence for second boosters. People will get protection whether they stick with or switch vaccine types, he said, so people shouldn’t delay the booster because of this issue either. The exception is the single-dose J&J vaccine; Individuals who have only received two doses of this type are encouraged to switch to their next booster dose.

Bloomington-based HealthPartners contributed to the national research that motivated the CDC’s decisions. This week’s results showed that the vaccine’s effectiveness in preventing hospitalizations was 31% in single-dose J&J recipients and 67% in those who received two doses. Protection increased to 78% in J&J recipients who switched to other vaccines for booster shots and to 90% in recipients of Moderna and Pfizer vaccines for their first shots and booster shots.

“We don’t know what’s coming next,” said Dr. Malini DeSilva, co-author of HealthPartners’ national study. “It’s still very important to get vaccinated if you haven’t already.”

Only 3.6% of the doses given in Minnesota were of the Johnson & Johnson vaccine, but it was given to Gov. Tim Walz and former Gov. Tim Pawlenty at a public event. Walz later received a different type for his booster. Pawlenty is among nearly 29,000 Minnesotans who have received just two doses of J&J, making them eligible for a second booster shot regardless of age or medical condition.

Pawlenty said he plans on getting a Pfizer or Moderna booster, “but might wait a bit to see if the CDC actually recommends it.”

COVID-19 vaccines lost effectiveness during the Omicron wave. Fully vaccinated individuals accounted for 37% of Minnesota’s COVID-19 deaths in the second half of 2021, but 55% in the first month and a half of 2022, according to state breakthrough infection data. Even the latter number reflects a lower risk, however, as fully vaccinated people make up 79% of Minnesota’s adult population — and they are disproportionately older and at greatest risk of severe COVID-19.

Declining effectiveness has kept Jason Michaelson, 45, of Apple Valley, from getting an extra booster shot when he’s eligible, because current vaccines are designed against viral variants that stop spreading. However, his wife could get a booster shot due to her underlying health issues.

“I have no interest in a fourth take of the same thing,” he said. “If the manufacturers produce one on omicron or whatever the next variant of spiking will be, I’ll be there.”

Manufacturers are aiming for updated and variant-specific vaccines, but studies in animals this year have not demonstrated any added benefit over booster doses of existing vaccines.

Elisabeth Schulte, 55, said she was glad to have the time. The Osseo woman has already received four doses as a person with an immunocompromising condition, but won’t be eligible for a fifth until May. Schulte credits the vaccine with protecting her while she cared for an ailing 10-year-old daughter who tested positive for COVID-19.

“Honestly, I’m a little more hesitant about this one than the last one, but I don’t think it’s enough that I don’t do it,” she said. “It doesn’t seem like there’s much information out there other than ‘You can get it!'”

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