Should I Get a COVID-19 Booster?
Such a common question these days… I’m gonna answer this from a dermatologist’s perspective. If you are opposed to the vaccine, this won’t apply to you because you are still trying to decide about the initial vaccine. Please no hate mail!
There are dermatologic therapies that might place a patient in the group recommended to get a third dose. So, I felt a need to write about it. I will be presenting the recently released recommendations published in the Journal of the American Academy of Dermatology (JAAD).
President Biden initially proposed a booster to those who received Moderna or Pfizer vaccine. The recommended timing for the third dose was 8 months after the second dose. At the time of writing this, there does still seem to be debate from the CDC and the FDA on rather this is needed for Moderna or just Pfizer. There is no recommendation at all for those who received Johnson and Johnson.
At the time of this post, the FDA has preliminarily approved a 3rd dose of the Pfizer vaccine only for those 65 and up AND those at high risk of “serious illness”. At this point in time, there is not a concise list of who falls in the “serious illness” category. This third dose is now recommended 6 months after the first dose.
At the time of the JAAD article, the third shot was recommended only for those who are immunocompromised in some way. The reasoning is that these patients may have produced an inadequate response to their initial vaccine.
According to the study in the JAAD, the initial response to the vaccine could have been reduced in those taking the following medications:
Steroids (prednisone >20 mg per day), Mycophenolate mofetil (name brand Cell Cept), Methotrexate, cyclosporine, JAK Inhibitors (still in Clinical trials) and Rituximab.
For other biologic medications the antibody response was likely sufficient.
A stronger consideration and urgency of a third dose is recommended for patients receiving the above medications, solid organ and stem cell transplant recipients, patients with HIV or other immunodeficiencies, and those undergoing active treatment for malignancy. Active treatment for malignancy does not include localized and treated Basal Cell Carcinoma and Squamous Cell Carcinoma.
Here’s the answers to a few additional questions…
What is the difference between receiving a third dose and a booster? The dose and everything are the same. However, it is only technically called a booster if you developed an adequate response to the first two doses.
Do I get the same vaccine, or does it matter? Right now, the recommendation is to try to get the SAME vaccine that you had the first time if possible.
Should I get my antibodies tested first? I’ve debated this one myself… Just a reminder that we have two major types of immunity: B cell and T cell. Antibodies only measure B-cell immunity, not T-Cell immunity. There is no simple, commercially available test for T-cell immunity. If you don’t have antibodies, you might still have T-cell immunity. At this point, we still do not know much about what role T cell immunity plays in fighting the virus. An antibody test looks for IgG antibodies. There are two types of antibody tests. One type just gives a positive or negative. The other type actually gives a number. However, there is no agreed-upon number that means you have adequate levels of immunity. So, no. The only reason I would recommend getting antibody levels checked would be if you had a horrible reaction to the initial series and you are trying to justify skipping the third dose.
Listed below are some of the articles I think are helpful for educating regarding the third dose/booster. The JAAD article is referenced as well.
I hope this helps. We will be contacting our patients on methotrexate and mycophenolate mofetil to make sure they are aware of the recommendations in the JAAD. In the end, there are still more questions than answers for average Americans. So, trust your gut.
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JAAD article https://www.jaad.org/action/showPdf?pii=S0190-9622%2821%2902370-7