By Mary Bavaro, MD, Infectious Disease Specialist and Connie Davis, MD, Chief Medical Officer

COVID-19:

What are the current COVID-19 vaccination recommendations?
The Centers for Disease Control and Prevention (CDC) recommends COVID-19 primary series vaccines for everyone ages 6 months and older and COVID-19 boosters for everyone eligible ages 5 years and older. The CDC does not recommend mixing products for your primary series doses. If you received Pfizer-BioNTech (monovalent), Moderna (monovalent), or Novavax COVID-19 for the first dose of your primary series, you should get the same vaccine for all following primary series doses.

• Pfizer-BioNTech COVID-19 vaccine (monovalent) 3 weeks (or 21 days) after the first dose.
• Moderna COVID-19 vaccine (monovalent) 4 weeks (or 28 days) after the first dose.
• Novavax COVID-19 vaccine 3 weeks (or 21 days) after the first dose.

I heard about a new vaccine. What is the Novavax vaccine?
Novavax is a COVID-19 vaccine produced through Novavax, Inc. This vaccine has two doses in the primary series, given three to eight weeks apart. People who are moderately or severely immunocompromised are recommended to receive two doses, given three weeks apart. A third primary dose is not currently authorized. Novavax COVID-19 vaccine is not authorized for use as a booster dose. This vaccine is a protein subunit vaccine similar to a protein-based influenza vaccine. It does not contain eggs, preservatives, latex or metals. It may be given to individuals ages 12 and older.

What is the most recent information about COVID-19 boosters?
New COVID-19 booster shots that are designed to fight multiple omicron variants (BA.2, BA.4 and BA.5) are available now. Check the websites below for times and locations. The FDA does not recommend the previous monovalent booster. Please ensure you are up to date on the primary series with traditional monovalent vaccine and get your first or second booster with the new bivalent vaccine booster. The newer variants are highly contagious. COVID-19 vaccines and boosters have been helpful in reducing the severity of illness and are preventing some hospitalizations. For more information, go to:

• Skagit County COVID Vaccine Locations (skagitcountywa.gov)
• How to Get Your Shot | Snohomish Health District, WA (snohd.org)
  

The Moderna COVID-19 vaccine, bivalent, is authorized for use as a single booster dose in individuals 18 years of age and older, if it has been at least two months since the patient has completed primary vaccination or since they received their last booster dose.

The Pfizer-BioNTech COVID-19 vaccine, bivalent, is authorized for use as a single booster dose in individuals 12 years of age and older if it has been at least two months since the patient has completed primary vaccination or since they have received their last booster dose.

If you are 12 years of age or older, it is recommended that you receive one of the bivalent booster doses. Children ages 5-11 who have completed their initial vaccine series are recommended to continue to get the monovalent booster. At this time there is not an authorized booster for children ages 6 months to 4 years of age. Everyone ages 5 years and older are recommended to get their first booster after completing their COVID-19 vaccine primary series, if eligible. Second booster doses are recommended for adults ages 50 years and older and some people ages 12 years and older who are moderately or severely immunocompromised. To determine if you need a booster, please go to:

• https://www.cdc.gov/coronavirus/2019-ncov/vaccines/ booster-shot.html

Why are we still seeing COVID-19 infections?
The newest omicron variants spread much more easily than previous versions and many people are not fully vaccinated. Antibodies from vaccines, booster shots or a COVID-19 infection decrease over time, making it easier for people to get infected for the first time or to get the illness again. With the omicron variant, after the first booster dose, protection begins to decrease around six months after vaccination. Researchers do not know yet how long the immunity after a second booster dose lasts. Lastly, schools and businesses are open, more people are traveling and fewer people are wearing masks.

FLU:

Do I need to be vaccinated against influenza this year?
Yes. There is concern that the U.S. may have a severe flu season this year based on trends in the Southern Hemisphere. Given that people are traveling, eating out more and schools and businesses are open, we expect to see more traditional respiratory illness this winter. Flu season in Australia began earlier than usual and was the most severe in five years. The flu season in the U.S. tends to follow the flu season in Australia. Up to 41 million people catch the flu every year, on average, resulting in about 52,000 deaths according to the CDC. The influenza vaccines that will be offered in the U.S. this year will protect against two strains of influenza A and two strains of influenza B.

Monkeypox:

I have heard that there are cases of monkeypox in Washington. What is monkeypox?
Monkeypox (MPV) is a viral illness that can cause rash and other symptoms. It does not commonly occur in the U.S., but there is currently an outbreak of monkeypox with cases spreading around the world including in the U.S. While many of the current cases are occurring in men who have sex with men, monkeypox can spread person-to-person with any kind of close, skin-to-skin contact with an infected individual. Check for the number of MPV cases in Washington by visiting:

• Monkeypox (MPV) Data | Washington State Department of Health (doh.wa.gov)

How contagious is monkeypox?
Monkeypox can spread from the time symptoms start until the rash has fully healed. People who do not have monkeypox symptoms cannot spread the virus to others. Unlike the virus that causes COVID-19, monkeypox is primarily spread through close contact and does not spread through the air over long distances. While current cases mainly involve men who have sex with men, anyone who is sexually active with multiple partners or who are partners with someone who has sex with multiple partners can be at risk for being exposed to monkeypox. Other risk factors may include travel to areas where monkeypox is currently present or close/non-sexual contact with a known case.

What happens if I am exposed to or get monkeypox?
Contact your healthcare provider if you are concerned you might have monkeypox or have been exposed, as vaccination and testing might be indicated. If you are exposed to monkeypox or have monkeypox, isolate yourself from other people and from animals. Do not kiss, hug, cuddle, sleep, or have sex with others. Wear a well-fitting medical mask around others. Do not share bedding, towels, dishes or utensils and wash your own laundry and dishes. Routinely clean and disinfect commonly touched surfaces and items. Do not use commercial travel, including an airplane, bus, taxi or shared car.

What are the signs and symptoms of monkeypox?
Patients may present with fever and rash. Symptoms may also include headache, muscle aches and backache, swollen lymph nodes, chills and exhaustion. The rash can look like pimples or blisters that appear on the face, inside the mouth, or on other parts of the body such as hands, feet, chest, genitals or anus.

How can I avoid getting monkeypox?
To protect yourself and others from monkeypox, the recommendation is to avoid close contact/sexual contact with anyone who has open wounds, sores or rashes that look like monkeypox. Do not touch the rash or scabs of a person with monkeypox. Do not kiss, hug, cuddle or have sex with someone with monkeypox.

Should I be vaccinated?
Vaccination is only currently recommended for post-exposure prophylaxis after exposure to a confirmed case. It should be given ideally within four days of close exposure to a confirmed case. Vaccination is also recommended for pre-exposure prophylaxis for high-risk individuals. The vaccine is very limited in supply, and is being utilized nationally for monkeypox pre- and post-exposure prophylaxis. Vaccination will be available through Public Health.

For more information about monkeypox, please visit: https://doh.wa.gov/you-and-your-family/illness-and-disease-z/monkeypox.

If you have symptoms of monkeypox or think you may have been exposed, contact your health care provider or Skagit County Public Health at 360-416-1500; Snohomish Health District at 425-339-3503 or Island County Public Health at 360-679-7350.

Connie Davis, MD has served as the Chief Medical Officer for Skagit Regional Health since 2012. Mary Bavaro, MD, is part of a team of Infectious Disease specialists with Skagit Regional Health.