‘Tripledemic’: Your Questions Answered

On September 19, Medscape hosted a dwell digital occasion round this yr’s “tripledemic” of COVID-19, influenza, and respiratory syncytial virus (RSV).  The CDC’s Manisha Patel, MD, MS, MBA, spoke with Dr Eric Topol, Medscape’s Editor-in-Chief, throughout the occasion, throughout which viewers members requested questions of our panelists.  

Under, Dr Patel addresses a number of of the questions from the viewers with necessary implications for affected person care. You may hearken to the complete recording of the occasion right here.

Q: Can a affected person who had Guillain-Barré syndrome (GBS) a few years in the past after receiving the influenza vaccine take the present vaccine for RSV?

Dr Patel: A historical past of GBS following prior vaccines is just not a contraindication nor a precaution to RSV vaccines. Severe neurologic occasions, together with GBS and different inflammatory neurologic occasions, had been reported after RSV vaccination in medical trials. Whether or not these occasions occurred as a result of probability or whether or not RSV vaccination will increase the danger for inflammatory neurologic occasions is presently unknown. Utilizing shared medical decision-making, RSV vaccination in older adults ought to be directed to those that are at elevated threat for extreme RSV illness and subsequently more than likely to profit from vaccination.

As for all FDA-approved vaccines, CDC will conduct post-marketing security surveillance to additional inform RSV vaccine suggestions. For extra data, see CDC’s vaccine security surveillance webpages.

Q: If somebody simply received COVID this month, can we assume that they’re protected against the present pressure, and do not want the vaccine for 4-6 months?

Dr Patel: Getting a COVID-19 vaccine after you get well from COVID-19 an infection supplies added safety in opposition to COVID-19. You could contemplate delaying your vaccine by 3 months. Nonetheless, sure elements may very well be causes to get a vaccine sooner relatively than later, similar to private threat of extreme illness, threat of illness in a beloved one or shut contact, native COVID-19 hospital admission stage, and the most typical COVID-19 variant presently inflicting sickness. Individuals who already had COVID-19 and don’t get vaccinated after their restoration are extra more likely to get COVID-19 once more than those that get vaccinated after their restoration.

Q: Is there worth in a second flu vaccination in any season, for instance, for the older or the immunocompromised populations?

Dr Patel: Youngsters aged 6 months by way of 8 years who haven’t beforehand acquired  not less than two complete doses of trivalent or quadrivalent influenza vaccine 4 or extra weeks aside earlier than July 1, 2023, or whose influenza vaccination historical past is unknown, want two doses of 2023-24 influenza vaccine, given not less than 4 weeks aside.

There are particular influenza vaccination suggestions for older adults and immunocompromised individuals. Presently, there’s not a suggestion for a second influenza vaccine in a season for these populations.

For older adults, the Advisory Committee on Immunization Practices recommends that individuals aged 65 years and older  preferentially obtain any one of many following larger dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). If none of those three vaccines is offered at a chance for vaccine administration, then some other age-appropriate influenza vaccine ought to be used.

Information assist better potential good thing about HD-IIV3, aIIV3, or RIV4 relative to standard-dose unadjuvanted IIVs on this age group, with essentially the most information accessible for HD-IIV3. However comparisons of those vaccines with each other are restricted.

Immunocompromised folks ought to obtain an age acceptable IIV4 or RIV4. LAIV4 shouldn’t be used. The immune response is perhaps decreased in folks on sure drugs, chemotherapy, or transplant regimens.

The timing of influenza vaccination relative to a specified interval earlier than or after interventions that compromise immunity could also be acceptable. The Infectious Ailments Society of America has printed steering in regards to the timing of vaccination in relation to such interventions.

Q: The place will we match within the pneumococcal vaccines amongst these three different vaccines, within the context of administration this fall?

Dr Patel: Pneumococcal illness could cause critical medical illness together with pneumonia, bacteremia, and meningitis. Pneumococcal vaccination is really useful for kids, adults age 65 years and older, and other people with sure underlying medical circumstances. It is vital for folks really useful to obtain these vaccines to be updated on their pneumococcal vaccinations. Suppliers can co-administer pneumococcal vaccinations with different vaccines.

Suppliers can use the PneumoRecs VaxAdvisor app to find out if a affected person wants pneumococcal vaccination.

Q: If a affected person is on an immunosuppressive and/or methotrexate (MTX), do you must skip just a few doses of MTX or immunosuppressive for a response? Is that identified?

Dr Patel: Sufferers ought to speak with their medical doctors about their diploma of immunosuppression to allow them to take the required precautions to maintain themselves protected and wholesome this fall and winter viral season. Administration of COVID-19 vaccines shouldn’t be delayed in sufferers taking immunosuppressive therapies. At any time when potential, COVID-19 vaccines ought to be administered not less than 2 weeks earlier than initiation or resumption of immunosuppressive therapies. For sufferers who obtain B-cell–depleting therapies on a unbroken foundation, COVID-19 vaccines ought to be administered roughly 4 weeks earlier than the following scheduled remedy.

Timing of COVID-19 vaccination ought to be considered to accommodate present or deliberate immunosuppressive therapies, optimization of each the affected person’s medical situation and anticipated response to vaccination, and the person advantages and dangers.

On a case-by-case foundation, suppliers caring for these sufferers could administer Moderna, Novavax, and Pfizer-BioNTech COVID-19 vaccines exterior of the FDA and CDC dosing intervals when, based mostly on their medical judgment, the advantages of vaccination are deemed to outweigh the potential and unknown dangers for the recipient who’s immunocompromised.

The utility of serologic testing , mobile immune testing, or B-cell quantification to evaluate immune response to vaccination and information medical care has not been established. Such testing exterior of the context of analysis research is not really useful at the moment.