This webinar was recorded on October 13, 2022

The new Omicron bivalent vaccine is raising questions as we move towards flu season when we usually get other important vaccines as well.  Join us as we look at these vaccines and national guidance.


  • Dr. Purvi Parikh
  • Tonya Winders


Transcript:This transcript is automatically generated. While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Speaker 1 (00:04)

This is Sally Schoessler, Director of Education for Allergy and Asthma Network, and we’re excited to present our 40th webinar in our COVID-19 series. We began these webinars in March of 2020 and we have been doing them either monthly or every other week or in the very beginning we did them every seven to ten days. But our webinars have had over 77,000 views. As we work to bring you the latest evidence based information on COVID-19 today we’re going to focus on vaccines for COVID-19, the flu and pneumonia, and what you need to know as we walk through this unusual time in public health. Allergy and Asthma Network lives out our mission every day. And that’s the end. The needless death and suffering due to asthma, allergies and related conditions through outreach, education, advocacy and research. If you’ve been at one of our 40 webinars, you’ve probably come to know Dr. Purvi Parikh. We’re so delighted. She continues to join us as our medical expert. Dr. Parikh is an adult and pediatric allergist and immunologist at Allergy and Asthma Associates of Murray Hill. She is currently on faculty as clinical Assistant Professor in both departments of Medicine and Pediatrics at New York University School of Medicine.

Speaker 1 (01:28)

She has been passionate about health policy and is on the board of Directors of the Advocacy Council of the American College of Allergy, Asthma and Immunology. She is a spokesperson for Allergy and Asthma Network and we’re so proud when she goes out there and speaks on all of ours behalf. She frequently makes appearances as a medical contributor on our behalf to NBC, Fox, CNN, Wall Street Journal and CBS. Well, we thank you Dr. Parikh, for being with us today and we’re going to look forward to hearing from you in just a few minutes. So today’s program is going to be organized into three sections. We always start with the current state of COVID-19. Then we’re going to look at vaccines, the Omicron, bivalent vaccine, flu and pneumonia. And then we’re going to go on with frequently asked questions about vaccines. So what we’re going to do first is start with the poll. We always like to know who’s here with us today. So I would like to have you mark what category best describes you. Now if we could provide more categories, we sure would, but the software only allows us to use this many.

Speaker 1 (02:36)

So are you a physician, a physician’s assistant, a nurse or school nurse, a respiratory therapist, asthma educator, a health educator, or a patient? So if you can go ahead and just let us know who’s here. It’s so important for us to know who the audience is that we’re speaking to. But also we just really enjoy finding out who is listening in. So we’ve got just about two thirds of the listeners having chosen a category. So we’ll just wait another minute here to see who’s here today. So if you can quickly get that in there. Here we go. Let’s look to see. We have 2% physicians, 5% physicians assistants and nurse practitioners, 72% of nurses and school nurses, respiratory therapists, asthma educators, and healthy educators are about 18%. And we have 4% of patients. Every once in a while I get somebody saying I don’t know what I am and I like, well, put down that you’re a patient then, because we’re all a patient with something. Our president, CEO, Tonya Winders is unable to be with us today and she often speaks about the current state of COVID-19. So I’m going to take that today.

Speaker 1 (03:53)

First thing we always check is the John Hopkins Global map. And we’ve been looking at this ever since COVID began. They used to update it about every 2 hours and it’s not quite that often anymore, but it is updated daily and sometimes more than once a day. Now, when we look at these numbers, please always remember they’re not going to go down. You can’t say, oh darn, the total cases are up again. This is a cumulative chart. So the total cases across the globe are now over 600,000, no, 600 million, I’m sorry. Total deaths are at about six and a half million. But the green number is the one that’s really the most exciting and that’s, that 9 billion vaccine doses have been administered and that’s billion with a B. So that, that’s very exciting to see. That kind of a response from people when it comes to trying to safeguard their health. This map shows the current cases of COVID-19 in the United States. The darker the state, the more COVID there is in that state. So take a look at where you are located and see if you’re one of those states that are lighter in color with less COVID or darker where the numbers are higher.

Speaker 1 (05:07)

A lot of times we’ll see the darker numbers on each coast, but it’s not quite that today. And that’s a chart that we uploaded today. Let’s look at the news. What’s in the news? Well, one thing that we’re hearing about is that evidence is building that the northern hemisphere is on course for a surge of COVID-19 cases this autumn and winter. And the reason there’s new strains and the Omicron variant, which has been very virulent and also behavior changes. People are not social distancing like they did, they aren’t wearing masks like they did. So last winter we certainly were still playing it pretty careful. You don’t see that quite as much anymore. But also there’s always a concern about waning immunity, you know, that you if you’ve had it and immunity begins to wane. Now the other big news this week, and this is news as of yesterday, is that the COVID-19 booster for children ages five to eleven has been authorized by the Food and Drug Administration for both Pfizer BioNTech and Moderna. And the director of the Disease Centers for Disease Control and Prevention gave a thumbs up on the shots a few hours after the FDA authorized them.

Speaker 1 (06:25)

So these vaccines should soon be available at area pharmacies and at pediatrician offices. So if you’re someone who’s interested in having your child get that Omicron booster, it is approved now and you can certainly talk to your healthcare provider as to where the best place to get that is. Also, since we have so many school nurses listening, it also means that you’re going to see more children coming in having had this on a crowd booster. So it’ll be interesting to see what happens to the number of cases in the schools now that that’s available. The other thing in the news is CDC and Travel, the Centers for Disease Control Intervention will no longer maintain a list of COVID-19 travel advisories for foreign countries. And this is another sign of that shift from pre pandemic normalcy. Well towards that again and really looking at COVID becoming endemic instead of pandemic. But we are still seeing about 1400 people around the world dying each day from the virus. So it may be something we’re not as impacted by on a daily basis, but certainly it’s not over. So we have our second poll question and as we look ahead for today’s webinar, the question is, are you concerned about this year’s flu season?

Speaker 1 (07:46)

So some of the answers we have here for you is yes, I’m very concerned, yes, I’m somewhat concerned, no, I’m not concerned. And one, I haven’t really thought about it. So I think one of the reasons we haven’t seen such bad flu seasons for the last couple of years is that we’ve all been in the house, we’ve all been masked, we’ve all been social distancing, so flu didn’t spread like it might have. So I think that that’s something that it’s interesting now that we’re coming out of all those COVID restrictions, will there be a difference in the flu season as well? So we’ve got about three quarters of people that have answered, so please put your answer in quickly and we will take a look. I didn’t mean to hit that. And here we go. Let’s look at the results. 33% are very concerned, 55% are somewhat concerned, not concerned or haven’t thought about it, are both at 6%. So that’s that’s just very interesting to look at when we look at the daily trends in COVID-19 cases across the US. We’ve been monitoring this chart since January of 20 when it started, and here we are in October of 22 and we’re definitely seeing our numbers coming down, but you can see that huge spike when we would get a new variance.

Speaker 1 (09:15)

And we’re certainly very cognizant of that as we’re looking at the cases. But this is the picture of where we’ve been and hopefully that line is going to keep going down as we move forward. So we’re going to turn now to Dr. Purvi Parikh and talk about vaccines, the Omicon Bivalent, as well as flu and pneumonia.

Speaker 2 (09:38)

Okay, thank you very much. So I didn’t answer the poll because I was a panelist, but I’m in the very concerned category as well, so I agree with the majority of you. And the reason being is Australia, since they’re always opposite to us, just had their winter and it was actually their worst flu season in the last five years. So I am worried that that may happen here. And as a result, I got my flu shot yesterday actually. So I just wanted to share that bit of information. But we hear this term a lot… vaccine, especially in the last two to three years. And what is it? It’s become, unfortunately a very politicized and polarized topic. But just simply the facts are that it’s a substance used to stimulate the production of antibodies as well as other parts of your immune system and provide immunity against one or several diseases prepared from the causative agent of a disease it’s products or a synthetic substitute treated to act as an antigen without actually inducing the disease. So the vaccines protect you by getting your own immune system ready to fight something without actually making you have to get sick and go through the illness.

Speaker 2 (11:01)

And a quick history of COVID vaccines. This has been actually, believe it or not, the largest vaccine campaign in all of history. And the biggest, this is even bigger than polio, measles, and anything else in the past. But in 2020, the FDA gave emergency use authorization to two vaccines. It was around November, December time, if you remember, right near the end of the year to Pfizer Moderna. It was very much welcome, especially in the healthcare community. In 2021, FDA gave the emergency authorization to Johnson and Johnson for their vaccine. And then in 2022, finally, we had vaccines that were approved for children six months and older. And 2021, we had some for older children, but the younger kids were waiting for quite some time. And also it’s not on this timeline, but over this time period between 21 and 22, both Pfizer and Moderna received their full FDA authorization. So they’re no longer emergency use, especially for the adult population. So I just want to make that note that they’re no longer considered in that experimental or emergency category. Now we have ample data and billions of doses, as Sally had mentioned, that have been administered globally.

Speaker 2 (12:30)

And now the newest one on the scene is the Omicron Bivalent vaccine approved for emergency use in adults. And yes, the breaking news was now it’s approved in the younger children as of yesterday. And I like to practice what I preach, so I got my macron booster as well, eleven days ago last week. So, current COVID-19 vaccine coverage in the US. So, as you can see, this map is great because it gives an idea of where vaccine uptake is best and the darker shades are where there’s a very good uptake, unfortunately, because it’s become so political. A lot of it may mirror some of the political map, but hopefully people realize that this is a nonpartisan issue. So the Amicron bivalent vaccine. So until now, the COVID-19 vaccines have all targeted the original coronavirus strain that first came on out in early 2020. But as we all know, since then many variants have emerged, alpha, Delta, Omicron most recently. And Omicron is especially concerning because we found that it really evaded vaccine immunity. The good news was there was still good coverage in terms of severe disease and death, but the milder and moderate infections we were seeing quite a few people get sick with.

Speaker 2 (14:06)

The new US boosters are a combination, that’s what Bivalent means. So that means it contains part of the original components of that original COVID-19 virus, and the other part is protection against these Omicron variants. So BA Four and BA Five specifically, which are one the most contagious currently the most dominant strain circulating around the US. And what we weren’t as well protected against previously. So the new Bivalent vaccines are designed to offer that extra protection against the Omicron variants, which are now the dominant strain. And this is why I ultimately decided to get it, because for me it had been over a year since my last booster and I wanted that Omicron specific protection. So CDC, the side effects of the vaccine are very similar to that of the two dose series, and serious side effects occur, but they’re very rare. Common side effects are pain, redness, swelling where the shot was administered, fatigue, headache, muscle pain, joint pain, chills, swelling of the lymph nodes in the arm where the shot was given, nausea or vomiting or fever. In my personal experience, actually, the side effects from the Omicron booster were far better actually than shot number two and three, for me at least.

Speaker 2 (15:34)

So hopefully other people have similar experience. I only had a sore arm, I was expecting the worst, but it luckily never came. And then people are urged to get this vaccine before the possible surge of cases. So fall and winter every year, even pre pandemic is notorious for being bad for all respiratory viruses and infections. Because we’re indoors more, these things spread more easily indoors. Updated booster is available to anyone ages twelve and older, and now, as we heard as of yesterday, even younger, and it should be at least two months from your last dose of COVID vaccine. I, as an immunologist, this is my personal opinion, not official guidelines. Think even four to six months is better because sometimes when you get vaccines too close to one another, your immune system can become too used to them, especially if it’s the same vaccine. If it’s different vaccines, that’s not the case, but the longer gaps are sometimes beneficial. So flu season 2022-23 so, as I had mentioned earlier on, US often follows countries like Australia as a preview of what might be to come. And the Southern hemisphere had a very bad flu season, as I mentioned.

Speaker 2 (16:58)

So this is why we’re all concerned about fall and winter surge of this year. And an impactful flu season usually means a lot of circulating flu, resulting in more cases, hospitalizations and death than in previous flu seasons. And especially because, as we mentioned earlier, a lot of those restrictions that were in place that actually helped us against the flu, like masking, less travel, working from home, are now all gone. So we’re kind of left unprotected. Let’s see what happens. But it may be bad. The last bad season was 2017 to 18, which makes sense given that the pandemic started 20 2021. And so this poses a risk, especially to very young children who may not have had much of any exposure to influenza. And remember, with influenza, it can be very serious in young children. We see pediatric deaths all the time, so that’s concerning, especially in very healthy young children. It’s not certain that the US. Flu season will be an exact replica of the Southern Hemisphere because the timing and ages of those that are hospitalized are critical. But it’s better, in my opinion, to be over cautious than under cautious. So, COVID and flu vaccine.

Speaker 2 (18:28)

So these are available again to all Americans, and you can get them simultaneously on the same day if you are busy and want to get it over with. I know many people who have and have done fine side effects, again, are mild and temporary. Many don’t even have any additional ones that have gotten the two together. They actually made no difference in terms of side effects and when to get your vaccine. So it will vary by person and should be discussed with your doctor. But for majority of people, the best time is right now, if you haven’t already. CDC flu vaccine recommendations is similar to last year, that most Americans should get their shot in September and October. And Dr. Rasha, who is a well respected physician on the White House task force, has said that he really believes this is why God gave us two arms, one for the flu shot and one for the COVID shot. So that’s my first time hearing that, but I really like that quote. And pneumonia. We always forget about pneumonia, but this, just like viruses, bacterial infections, especially respiratory ones, can spread more rapidly in the winter months for the same reasons.

Speaker 2 (19:52)

And pneumonia is a big problem. 1.5 million people were diagnosed with pneumonia in an emergency in the emergency department in 2018, and 44,000 people died from pneumonia. So it’s not a benign condition. And most of the people affected by pneumonia in the US. Are adults. Vaccines and appropriate treatments like antibiotics could prevent many of these deaths. So there are some people who are more likely to get pneumonia, and these are adults that are 65 and older. So that’s why we recommend pneumovax or pneumonia vaccine. And the stronger one, the prevnar for all individuals 65 and up, and also children younger than five years old, because, remember, as children before age five, your immune system is still developing. So these children are largely unprotected against a lot of infectious diseases, and pneumonia is one of them. So many children also get their prevnar vaccines under that age group. But also, many people don’t realize that there’s a whole slew of medical conditions that qualifies you for the pneumonia vaccine, even if you’re just 18 and above. So that’s a lot of counseling, I think, that people don’t realize that if you’re an asthmatic and you’re 18 or above, you should be getting your pneumonia vaccine every five years, because that puts you at higher risk.

Speaker 2 (21:19)

The same goes for COPD, diabetes, heart disease, anyone who smokes cigarettes, even if you haven’t, even if you don’t have a lot of other medical problems, that by itself is a reason that you should be getting your pneumonia vaccine. And that also includes all tobacco products, by the way. So a lot of people think this is just a disease of the elderly, but it’s not. And in fact, guidelines show that the vaccine should be given to 18 and up who have those conditions. And, of course, immunocompromised and many other things like autoimmune disease, et cetera. So pneumonia, and now COVID-19 pneumonia is a complication of the COVID-19 virus. So some people, when they get sick with the virus, their lungs become filled with fluid, become inflamed. This leads to breathing difficulties. Many times, it can lead to hospital admissions, ICU, even death. And it takes hold in both lungs, air sacks filled with fluid, there’s very little oxygen exchange. That’s why many of these individuals need their supplemental oxygen, may need some type of mechanical ventilation if it’s very bad. And people can’t recover from regular pneumonia, usually without lasting lung damage, although I do see it from time to time in some of my patients if it was a bad pneumonia.

Speaker 2 (22:41)

But the COVID-19 pneumonia can be very severe and can cause a lot of lung damage. And we’ve even seen people that have had to go for lung transplants and then people who were very young and healthy before double lung transplants, all because of COVID-19. They were non smokers, had no other issue. This is all pre vaccine, of course, but it really destroys your lungs. And if you’ve seen a covered lung post COVID-19 pneumonia, it looks far worse than a smoker’s lung who smoked for 40, 50 past years. It’s actually quite scary and impressive. So the three factors in coronavirus lung damage are disease severity, of course, the coronavirus itself. Whether you have a mild, moderate or severe case, your underlying health conditions, some things may set you up to be more likely for COVID pneumonia, like having chronic obstructive pulmonary disease, heart disease, obesity, other lung conditions or a weakened immune system. And then treatment. I’m a firm believer that early and aggressive treatment can help prevent this. So a patient’s recovery and long term lung health is going to depend on what kind of care they get and how quickly and timely support in the hospital for severely ill patients can minimize this lung damage.

Speaker 2 (24:07)

And of course, vaccines are huge because the vaccines help protect you from getting the most severe forms, which include this awful COVID pneumonia. So, types of pneumococcal vaccines. So there’s two types of pneumococcal vaccines available in the United States. The pneumococcal conjugate vaccines, which are the brand name is Prevnar, but that’s PCV 13, PCV 15 and PCV 20, and the pneumococcal polysaccharide vaccine, which is also known as pneumovax. And these are important because the pneumovax actually protects against more strains, 23 to 25 strains of this bacteria, strep pneumonia. But these conjugate vaccines are very important because they actually stimulate both your antibodies and your T cells. So the two work very well together and that’s why we recommend both the polysaccharide and conjugate vaccine. So you’re doubly protected against pneumonia, especially if you’re in those high risk groups. So, elderly, heart disease, diabetes, et cetera, COPD lung disease. So, pneumococcal vaccine, who and when to vaccinate. So, children younger than two years old should receive the prevnar 13 or 15 in a series of four doses. Usually the doses are given at two months, four months and six months. And then around age one. And then children two to four years of age without certain medical conditions will also get a dose.

Speaker 2 (25:50)

And then older children who have certain medical conditions. So that includes things that increase the risk for pneumonia. So they’ve had a cerebral spinal fluid leak, chronic lung disease, including asthma, cochlear implant, diabetes, and CDC has more details. If you are wondering if your child fits in this range, and again, same with the old six to 18, there’s certain medical conditions that qualify, as you can see. And then for 18 and up, there are certain conditions that qualify. So again, certain chronic medical conditions, smoking, asthma, that all fits for 18 and up. So something to think about, especially if you have kids that are heading off to college and turning 1819, that often people forget about the pneumonia vaccine and the CDC recommends it for everybody 65 and up. So a study looking at the COVID vaccine and pneumonia found that while the authorized COVID-19 vaccines remain the most important strategy for preventing COVID, obviously, the investigators found that older adults who had received both their pneumococcal conjugate vaccine, which prevents acquisition of certain pneumococcal strains, experienced actually a 35% lower risk of COVID-19 diagnosis than those who did not receive the vaccine. And in contrast, the alternative pneumococcal vaccine, which is the polysaccharide one, which prevents against severe disease but doesn’t block kind of the acquisition of the bacteria, didn’t show that protection.

Speaker 2 (27:29)

So that’s why it’s important to do both types of pneumonia vaccine. And you might wonder like why would a pneumonia vaccine protect against COVID? But we saw that actually, even with those people vaccinated to measles the same phenomenon. Because the thought is, when you get your immune system ready to fight one type of bug, it secondarily, which is so cool about the immune system equips itself to fight even other respiratory pathogens and predators. So that doesn’t mean to forego your COVID-19 vaccine, but just know that all of these vaccines are not only helping you for that one targeted infection, but could also have a side benefit of protecting you against other illnesses as well. So some frequently asked questions, I’ve been getting this a lot, so what if someone is fully unvaccinated? Can they get the Omicron vaccine? So, no, we still recommend that you get the original series of the COVID vaccine. And the reason being is that you need that initial protection against the original strain of the virus. And we have good data showing that those initial two shots still are protecting quite well in the majority of people against severe disease and hospitalization.

Speaker 2 (28:50)

And then once you’ve gotten those, then you can go forward and get the Omicron booster and you should. And like I said, I recommend four to six months after your second COVID shot if you’re still in that initial immunization series. Do you trust this booster? What are the potential side effects? So, yes, I trust the booster. The data shows that it is effective and safe and the amount of side effects that we see with this booster is very similar or the same as the same as the previous COVID vaccines. And the reason why I trust it is there’s nothing really new about the vaccine technology. They’re using the same exact mRNA technology that billions have received and it’s just basically the strain that’s being tweaked. So it’s the same way that our flu shots got updated every year. I have the same faith in the COVID booster. And how long after having COVID-19 can I get this booster? So, the recommendation is that as soon as you are symptom free and out of the five day isolation period, or ten, if the illness was moderate, according to CDC. However, usually the usual recommendation is about two to three months.

Speaker 2 (30:02)

And new data shows, as I was mentioning before, there’s some benefit to having those gaps. So 90 days is ideal. Now, if you were sick with COVID and you received a monoclonal antibody for treatment, then you have to wait 90 days no matter what because it’s not good to get it prior. Should people consider travel plans and gatherings as they decide when to get their booster? Yes, absolutely. But it’s not in the way you think. So you shouldn’t delay the booster until after you travel. In fact, if you’re planning to travel, get the booster at least ten to 14 days prior. So that way you’re protected. And whoever you’re visiting with, especially around the holidays, are protected, too. You don’t want to get a vulnerable family member sick, I’m sure. And is there any harm in getting both the updated booster and the flu shot at the same time? No, there’s no harm whatsoever. As I mentioned, many get it together and have already, and actually they haven’t reported it to me. Anecdotally any side effects of it being worse, getting it together. So COVID and flu, are we setting ourselves up for another twindemic?

Speaker 2 (31:21)

So that’s the biggest worry. So that’s why all health officials right now, all doctors, nurses are all pushing to get both, right? Because in the past two years it’s been hard to say because we’ve still had a lot of masking, had a lot of restrictions. So we don’t really know what will happen now that things are kind of lifted. So we’ll see. We’re hoping not, but that is a very real possibility. And it is possible to contract both at the same time. There are two different viruses. I’m sure you heard the term fluorona last year, luckily not many cases of two at the same time. But you don’t want to be that one unlucky one that gets two viruses at once. So can children get the COVID-19 vaccine at the same time as the flu vaccine? So, yes, they can. And often children get multiple vaccines, as you know, at the same time, and I think it may be worth it. So that way you don’t have to subject your child to multiple, multiple trips to the doctor’s office. So all children six months of age and older should get both as soon as it’s available.

Speaker 2 (32:35)

And again, five and older are eligible for the new bivalent booster, and then twelve and up may need more depending on their specific condition and age. And then will COVID-19 vaccines become an annual thing like flu shot? So we don’t know. I mean, it’s very likely, but let’s see, it all depends on how the season goes, how our own immunity holds up. So it may become annual or it might be similar to something like pneumonia. We have to do it every five years, we’ll see something in between. So pneumonia and COVID-19, does the pneumococcal shot protect against COVID-19? So, not directly, as we mentioned, because pneumonia is a bacterial lung infection, but as we mentioned, it could be an indirect benefit. And remember, sometimes when you get sick with the virus, it sets you up with a secondary bacterial infection. So there’s a lot of levels in which both can be protected. Can the pneumonia vaccine be given with the COVID-19 vaccine? So yes, you can. It is still safe and effective. And Pfizer just announced the result of a study where they gave the two together both the prevnar 20 pneumococcal vaccine with a booster dose of their COVID vaccine, and it was perfectly safe.

Speaker 1 (34:08)

Okay, Dr. Parikh, that was so much great information, so grateful. So we’re going to take a look. now and take a look and see what are the questions that people are asking, and we’ll get to as many of these as we can. Someone is saying, I’m extremely immunocompromised, and due to illnesses and hospitalizations, I haven’t received my final fourth dose booster. Should I get the final booster or just get the Omicron by Valent booster?

Speaker 2 (34:37)

That’s a great question. So you should just get the Omicron bivalent booster, and that’s what most places are recommending now. So the reason why we were recommending that fourth dose before the booster for severely immunocompromised is because the Omicron booster didn’t exist yet, but now that it’s in existence, it is a better choice for your fourth shot.

Speaker 1 (34:58)

Okay, great. So you can get the COVID booster and the flu shot on the same day, but if you don’t get the flu and the COVID booster together, what would be the recommended spacing and days between the vaccines that people should think about?

Speaker 2 (35:13)

You can do it however you want. You can even do it the next day if you want. Some people may want to wait if they react to one, wait until they’re feeling back to normal again and get the second one. There’s no right or wrong answer. I personally did them about a week apart, only because, one, I had to go to two different locations. One, I get my own office, and then one, I had to go to the pharmacy. But there’s no required waiting time or recommended waiting time.

Speaker 1 (35:45)

Okay, thank you. Our next question is I’m concerned with worldwide vaccine equity. Can you address that issue, please?

Speaker 2 (35:53)

Yeah, that’s actually a big concern for many people. And I agree with your concern, because the real issue is we’re not really safe until there is equity, right? Because an outbreak anywhere is an outbreak everywhere. So even if you don’t look at it from an altruistic standpoint, it’s actually in our best interest to make sure everyone on Earth has access to vaccines and boosters, because we’ve seen in the last two to three years how fast infectious diseases can circle the globe. Right? And now in New York, we’re seeing cases of polio again and things that we thought were long eradicated and monkey pox. I absolutely think that vaccine equity should be a top priority for all countries because it’s a security issue, if you think about it, health security, too.

Speaker 1 (36:50)

Thank you. Our next question is very interesting. Is it true that steroids will decrease the COVID vaccine protection?

Speaker 2 (36:58)

That’s a very good question. Yes, steroids do decrease your immunity, so it can have an impact on the vaccine protection. But it’s not all steroids. So it’s only oral or injectable or what we call systemic steroids. So if you’re using steroids in your asthma inhaler or nasal spray or even on your skin for eczema, that actually won’t decrease the efficacy of the vaccine that much. So you don’t have to stop it or worry about that. But if you’re someone who needs to take prednisone, for example, on a daily basis because of a condition, even then it’s still in your best interest to get the vaccine. And we found that even though you’re even at higher risk, we found those individuals still had good responses. But let’s say you just had a small course of steroids, then you should discuss with your doctor when the best timing is so that you can get the biggest bang for your buck out of that shy.

Speaker 1 (37:59)

Well, that’s interesting. Someone is asking, should someone with asthma take all of the following vaccines? Flu, pneumonia, and the COVID booster?

Speaker 2 (38:08)

Yes, all three, because asthma is a higher risk condition for all of them, for all respiratory illnesses. Actually.

Speaker 1 (38:19)

I wasn’t ompletely understanding that question. Someone asked if the bivalent vaccine for five to eleven year olds was out already or still waiting for FDA release. And we spoke about that earlier in the webinar, but if you would like to just hit that one one more time, Dr. Park, that would be great.

Speaker 2 (38:39)

Sure. Yes, it was just yesterday, and I believe the FDA approved it. But then, as you know, there’s multiple committees, and I think the CDC is the final sign off before it actually hits the pharmacies and doctor’s offices. So if it’s not readily available right now, it should be, I would imagine within the next week, the latest.

Speaker 1 (39:02)

Okay, thank you. If someone has never been vaccinated for COVID, but has had COVID two times, should they get the COVID booster?

Speaker 2 (39:11)

Yes, I would recommend it. And the reason being is getting COVID definitely gives you immunity and natural immunity. We know it has a lot of benefits, but it’s very variable in the sense that we don’t know how robust it is, how long lasting it is. And unfortunately, with the newer variants, and given the fact that this person has had it twice the newer variants, you can get reinfected. So the fact that you’ve had it twice already is a sign that you could benefit from more immunity and especially as these variants change. So I would recommend getting the booster.

Speaker 1 (39:49)

Okay. Our next person is asking, could you speak about myocarditis and pericarditis as a side effect in young males?

Speaker 2 (39:57)

Yes. So myocarditis and pericarditis, we did see it in the younger male group, between age twelve to 17. But when we did see it as related to the vaccines, it was mild and self resolving, meaning these individuals returned back to normal, back to normal cardiac function. However, the actual COVID-19 infection actually increased risk for myocarditis in those young males, I believe almost 17 times, according to one study, and many of those cases were far more severe and had more lasting damage. So, ironically, even though there is that higher association in that group, you’re actually protecting yourself from myocarditis if you just look at the numbers, because if you get the actual virus even a mild or asymptomatic case. We saw heart inflammation even in young college athletes who are some of the fittest individuals in the world. You have to look at it kind of with a grain of salt. I saw another interesting study, and I think it’s an official recommendation by the CDC, too, is that in these young males, if you space out the doses so rather than doing them three weeks or four weeks apart, that risk of myocarditis drops significantly.

Speaker 2 (41:18)

So if that’s a concern, you can still get the vaccinations, but you can space it out six to eight weeks, and then that risk is far lower, but it is quite low even to begin with, if that gives some peace of mind.

Speaker 1 (41:34)

That’s so interesting. Our next question we’ve got lots of questions today for you, doctor Parikh.

Speaker 2 (41:40)

Good to keep them coming.

Speaker 1 (41:42)

I certainly will. Our next question says, if I’m vaccinated with the Bivalent in September, can I travel safely in December?

Speaker 2 (41:52)

Yes, you can. So usually the vaccines take about two to four weeks, actually. Sorry, two weeks for full protection. For Pfizer, it’s about one week. Moderna. I have the two. So if you get it now, you will be good to travel in December and then the flu vaccine. Also, I would recommend getting if you’re planning to travel in December.

Speaker 1 (42:17)

Sounds good. Someone is asking for clarification. She says, did you say someone older than 65 should have the pneumonia shots every five years?

Speaker 2 (42:27)

Yes, that is the current recommendation. Every five years, because they wain in their immunity over time.

Speaker 1 (42:37)

Okay, great. Thank you. Actually, this is the first year I’m going to get a pneumococcal vaccine, so I’m listening very carefully as well.

Speaker 2 (42:47)


Speaker 1 (42:48)

So our next question says, is there a website you can recommend that I can go to to learn more about the different pneumococcal vaccines?

Speaker 2 (42:56)

Yeah, the CDC website, I think, is the best because there are so many different types. I think they lay it out very well about who is eligible for which one and at what age. So I would recommend that.

Speaker 1 (43:11)

Well, our next question is one that I find fascinating. It says if you’re taking allergy shots hang on, I just lost it for a second. How long should you wait in between allergy shots before getting the COVID vaccine, the booster, flu or pneumonia?

Speaker 2 (43:27)

Yeah, this is a common question that comes up every day in my own practice. So technically you can get all of them on the same day. That’s perfectly fine. Some of my patients who are kind of on a build up schedule, and they want to do their allergy shot on one day and the other vaccines on another day only just so they can see if you have a reaction, what you reacted to. Right. But if you’re someone who doesn’t really react or you’re on maintenance shots, you can technically get them all at once. So there’s kind of no right answer. The most important thing is just getting everything regularly and in a timely fashion.

Speaker 1 (44:08)

Okay, great. Thank you so much. Our next question is what I’m sure a lot of people wonder about. How does the unvaccinated person pose a risk to those vaccinated and unvaccinated?

Speaker 2 (44:20)

Yeah, so the unvaccinated person definitely poses a risk in the sense that, one, they’re more likely to get sick than someone who’s vaccinated, and they’re also more likely to be sicker or carry a higher viral load. So they’re probably more likely to even spread it as well, even though yeah, of course, anyone can spread something if they’re symptomatic. But if you’re unvaccinated, you may be carrying a higher viral load because you don’t have that immunity to kind of dampen the surge of the virus.

Speaker 1 (44:55)

Okay, thank you. I’m trying to figure out how to ask this next question. It’s written, I think there’s a typo in it, but I’ll do my best here. Is there a pneumonia vaccine that is appropriate for over eight years old?

Speaker 2 (45:10)

For over eight years, yes. So there are if we had the slide up. But it depends on what that individual has. So basically, if they have asthma or other conditions like cystic fibrosis or that cerebral spinal fluid leak, and then again, if you go to the CDC website, they lay it out very nicely about at what age and with which medical conditions, who should receive which shot.

Speaker 1 (45:37)

Okay. Oh, the person clarified the question for me. This, obviously is still listening. Should a child with asthma over eight years old get the pneumococcal vaccine?

Speaker 2 (45:48)

Okay. Yeah. So at age eight, if they’ve already had their routine prevnar vaccinations, the ones before age five, they don’t necessarily need to. Unless you’re noticing that that child is getting sick a lot, not just with lung infections, but also sinus infections, ear infections, then they really should see an immunologist and do an immune work up. Because often when I do that immune work up, I’ll find that their pneumococcal immunity has waned. And then I will give them a pneumovax or pneumonia vaccine. It really depends. Definitely over 18 is recommended in all asthmatics to get vaccinated again, but at age eight, it really depends on if they’ve done that initial series and if they’re getting sick. If they’re getting sick, then they may need another booster and they should see an immunologist to see why that immunity has faded.

Speaker 1 (46:41)

Well, thank you so much.

Speaker 2 (46:42)


Speaker 1 (46:42)

It’s hard sometimes to speak to individual cases on a webinar because you don’t know their history, but thank you so much for that answer. And the listener just said thank you as well.

Speaker 2 (46:55)


Speaker 1 (46:57)

Sometimes I wish we could hear from the people that are asking, well, I appreciate that. Thank you as well. So the next person is asking, does the pneumonia vaccine help with secondary complications of COVID and prevent those issues?

Speaker 2 (47:13)

Yes, it absolutely does. Because, one, even if you do get sick, you’ll get a much milder form of the virus, so you’re less likely to get the COVID pneumonia or blood clots or things that may land you in the hospital or worse. So those are all the severe complications that we’re trying to protect. There’s even some evidence that some of the vaccines may help with long COVID. Yale is studying that right now. And just anecdotally speaking, I have a patient who had been suffering with Long COVID who got sick early in 2020. And after they received their Omicron booster, their symptoms have improved dramatically just in the last week or two. So we don’t know if it’s a coincidence or if it was that booster, but that was the only thing that changed, so there might be something there.

Speaker 1 (48:03)

Okay, and our last question for today, we’re getting to all of them, which is highly unusual, but I’m thrilled. We’ve really pretty much answered this, but let’s just every once in a while, I think there’s still value. Instead I’m saying the same thing more than once. And this is pneumonia vaccine being recommended before age 65.

Speaker 2 (48:24)

Okay, yeah. So it is recommended before age 65 in certain conditions. So basically, anyone 18 and up who has certain chronic conditions like heart disease, diabetes, asthma, it’s recommended age 18 and up, COPD. And then even if you’re a smoker who hasn’t had all these other medical problems diagnosed yet, just being a smoker or using tobacco products is a reason to get it. That’s one of the guidelines. So, absolutely there are scenarios where before age 65, you would qualify.

Speaker 1 (49:02)

Dr. Parikh, we’re so grateful for all of your expertise today. We have two people that have just written in and said, thank you for your expertise, thank you for your answers. So I know that people have been so eager to hear the evidence based answers to these questions, and I’m so grateful that you could be with us today. Thank you so much.

Speaker 2 (49:23)

Yes. No, thank you. I’m very I’m happy to help and give good information and sorry, one thing I forgot in the last question. Also, all children under age five, of course, need to get their pneumonia vaccines.

Speaker 1 (49:37)

Thank you so much. I’d also like to thank our listeners for joining us today as we look ahead. Our next webinar will be on Tuesday, October 18, and we’re going to be looking at age based guidance for food allergy care with national experts in the field. There’s a new tool out there that is just absolutely amazing. So I would really urge you to join us because this is going to be a very exciting webinar with some great new information. You can register for this on our homepage allergy asthma network. Scroll to the bottom of the homepage to register as well as view any of our previous webinars. Please remain on the line for two to three minutes to complete an evaluation survey. And it really only takes that long, and we really do appreciate that. So thank you again for joining us today. This is Sally Schoessler. For the staff at Allergy and Asthma Network. We wish you a healthy fall season as we look at ways to stay healthy so we can all breathe better together.