By Fenit Nirappil
The Washington Post

The Food and Drug Administration approved new mRNA coronavirus vaccines Thursday, clearing the way for shots manufactured by Pfizer-BioNTech and Moderna to start hitting pharmacy shelves and doctor’s offices within a week.

Health officials encourage annual vaccination against the coronavirus, similar to yearly flu shots. Everyone 6 months and older should receive a new vaccine, the Centers for Disease Control and Prevention recommends.

The FDA has yet to approve an updated vaccine from Novavax, which uses a more conventional vaccine development method but has faced financial challenges.

Our scientific understanding of coronavirus vaccines has evolved since they debuted in late 2020. Here’s what to know about the new vaccines.

– – –

Why are there new vaccines?

Coronavirus keeps evolving to overcome our immune defenses, and the shield offered by vaccines weakens over time. That’s why federal health officials want people to get an annual updated coronavirus vaccine designed to target the latest variants. They approve them for release in late summer or early fall to coincide with flu shots that Americans are already used to getting.

The underlying vaccine technology and manufacturing process is the same, but components change to account for how the virus morphs. The new vaccines target the KP.2 variant because most recent covid cases are caused by that strain or closely related ones.

Covid is less dangerous overall than it was earlier in the pandemic because our bodies have become used to fighting the virus off and nearly everyone has some degree of immunity from receiving shots or getting sick. A new shot is meant to shore up existing defenses.

“It’s an opportunity to mitigate or to reduce that risk even further rather than just relying on what happened in the past,” said Robert Hopkins Jr., medical director of the National Foundation for Infectious Diseases and a physician in Arkansas.

– – –

Who needs a new coronavirus vaccine?

The United States differs from other countries in recommending an updated coronavirus vaccine for everyone except young infants, rather than just those at heightened risk for severe disease because they are 65 and older and people who are moderately to severely immunocompromised or have serious medical conditions.

Health officials rejected a more targeted recommendation, some contending it’s easier to tell everyone to get vaccinated rather than try to define what makes a person high-risk. Most Americans have a risk factor for severe covid, such as being overweight or having diabetes.

Critics of this approach, including Paul A. Offit, a pediatrician and director of the Vaccine Education Center at Children’s Hospital of Philadelphia, worry that it detracts from the urgency of vaccinating vulnerable people who have a harder time mounting an immune response to coronavirus.

– – –

Do the vaccines prevent infection?

You probably know by now that vaccinated people can still get covid. But the shots do offer some protection against infection, just not the kind of foolproof protection you get from highly effective vaccines for other diseases such as measles.

The 2023-2024 vaccine provided 54 percent increased protection against symptomatic covid infections, according to a CDC study of people who tested for the coronavirus at pharmacies during the first four months after that year’s shot was released.

“People who get vaccinated are much less likely to get infected in the first place,” said David J. Topham, director of the University of Rochester Translational Immunology and Infectious Disease Institute. “We’d love vaccines to be perfect, but Mother Nature is pretty damn smart.”

A nasal vaccine could be more effective at stopping infections outright by increasing immunity where they take hold, and one is being studied in a trial sponsored by the National Institutes of Health.

If you really want to dodge covid, don’t rely on the vaccine alone and take other precautions such as masking or avoiding crowds. But if you want to carry on with life as normal, a new vaccine lowers your risk of getting covid – at least in the short term.

– – –

Do the vaccines help prevent transmission?

You may remember from early coverage of coronavirus vaccines that it was unclear whether shots would prevent transmission. Now, scientists say the answer is yes – even when vaccinated people get sick.

That’s because the vaccine creates antibodies that reduce the amount of virus entering your cells, limiting how much the virus can replicate and make you even sicker. When vaccination prevents symptoms such as coughing and sneezing, people expel fewer respiratory droplets carrying the virus. When it reduces the viral load in an infected person, people become less contagious.

That’s why Peter Hotez, a physician and co-director of the Texas Children’s Hospital Center for Vaccine Development, said he feels more comfortable in crowded medical conferences where attendees are probably up to date on their vaccines than in a crowded airport.

“By having so many vaccinated people, it’s decreasing the number of days you are shedding virus if you get a breakthrough infection, and it decreases the amount of virus you are shedding,” Hotez said.

– – –

How long does vaccine protection last?

CDC data shows the effectiveness of the 2023-2024 vaccine against emergency room visits and hospitalizations declined sharply more than four months after receiving it. But the risk of hospitalization still remains low for most people, which made it harder for the CDC to compare outcomes for people who received an updated shot with those who did not.

The CDC usually recommends a second dose for those at greatest risk, rather than everyone.

Vaccines create antibodies that target the spike protein of a virus that enters a cell, but the spike protein is often evolving to overcome them or avoid detection. Other elements of the immune response, such as killer T cells, are more durable and recognize the additional parts of the virus that are not mutating.

“Once the virus gets in, they can kill off infected cells,” Topham said. “They can slow the infection down. They can prevent it from spreading throughout the body. It shortens your disease.”

– – –

Do vaccines prevent long covid?

While the threat of acute serious respiratory covid disease has faded, the lingering symptoms creating a condition known as long covid remain a concern for people who develop mild cases. The CDC says vaccination is the “best available tool” to reduce the risk of long covid in children and adults. The exact mechanism is unclear, but experts theorize that vaccines help by reducing the severity of illness, which is a major risk factor for long covid.

– – –

When is the best time to get a new coronavirus vaccine?

It depends on your circumstances, including risk factors for severe disease, when you were last infected or vaccinated and plans for the months ahead, and it’s best to talk these issues through with a doctor.

If you are at high risk and have not recently been vaccinated or infected, you may want to get a shot as soon as possible while cases remain high. The summer wave has shown signs of peaking, but cases can still be elevated and take weeks to return to low levels. It’s hard to predict when a winter wave will begin.

If your priority is to avoid getting sick ahead of the holidays or a major event such as an international vacation, you could time your vaccine to receive it a month ahead of the event to increase your protection against infection.

Health officials have yet to advise how long to wait to get a new vaccine if you were infected or received a shot this summer, but usually the guidance is between two and four months.

Manisha Juthani, Connecticut’s public health commissioner, said people who recently had covid could time their next vaccine several weeks before a holiday when they will be exposed to a lot of people, whether that’s Halloween, Thanksgiving or end-of-year celebrations.

– – –

Where do I find vaccines?

Coronavirus vaccines are sold as a commercial product and are no longer purchased and distributed by the federal government free. That means they won’t be as readily accessible as they once were, but they shouldn’t be too hard to find.

While major pharmacy chains should stock coronavirus vaccines, availability at doctor’s offices might take longer. Finding shots for infants and toddlers could be more difficult because many pharmacies do not administer them and not every pediatrician’s office will stock them given low demand and limited storage space.

Updated coronavirus vaccines are supposed to have a longer shelf life this year, which eases the financial pressures of stocking them.

CDC plans to relaunch its vaccine locator when the new vaccines are widely available, and similar services are offered by Moderna and Pfizer.

– – –

Are coronavirus vaccines free?

Most insurance plans are required to cover recommended vaccines under the Affordable Care Act, but some may not cover shots administered by out-of-network providers. Officials say billing code errors and failure to updates systems that led to improper charges last year should mostly be resolved, but if you are still getting charged for vaccines, you or your provider should contact your insurance company or appeal to the agency that regulates your plan.

The federal Bridge Access Program, which provided free coronavirus vaccines to people without health insurance, ends this month. People might be able to find other assistance through federally qualified health centers, local health departments or nonprofits.

– – –

Can you get your covid and flu shot together?

Public health officials encourage receiving covid and flu shots in the same visit as a way to increase vaccination rates and say no serious side effects associated with co-administering the vaccines have been identified.

But if you are someone who will get both vaccines no matter what, it could be beneficial to space them apart. Flu shots are best administered in September or October, so it might make sense to get a flu shot first with a coronavirus vaccination shot later.

Coronavirus vaccine manufacturers are working on combination flu/coronavirus shots to protect against both viruses with a single needle prick. Moderna reported promising results from trials that keep it on track to go to market as early as fall 2025. Pfizer-BioNTech reported mixed results from its trials, a setback.

By Serina DeSalvio, St. Louis Post-Dispatch

ST. LOUIS — Long COVID is on par with heart disease in terms of its severity, but vaccination reduces risks of long COVID by nearly 70%, say researchers at Washington University.

In a recent study, researchers found that the risk of contracting long COVID has decreased since the start of the pandemic. With each new variant of the virus, the risk has gone down — and if you’re vaccinated, the risk has been even smaller over time — but it still isn’t zero.

“You may have forgotten about your COVID infection, but it hasn’t forgotten about you,” said Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University and senior author on the study.

The U.S. is experiencing an upswing in COVID cases in most states. Updated vaccinations are important for protecting the public from illness, especially chronic disease that can require a lifetime of symptom management, Al-Aly said.

A person’s immunity to COVID declines after two or three months after exposure to the virus, whether that comes through a vaccine or an infection, said Dr. Daniel F. Hoft, director of St. Louis University’s Center for Vaccine Development. Booster shots are meant to help increase immunity once it starts to wane, he said. The newest booster shot for COVID is set to come out in mid-September.

“Data like this (study) will be important for booster recommendations going forward,” Hoft said.

Al-Aly said he saw long COVID in patients who would come to him with COVID symptoms long past the infection’s end. He would hear of ongoing brain fog and fatigue, or new symptoms popping up in patients no longer testing positive for the virus.

He knew that long COVID needed to be addressed by biomedical researchers to help his patients — so he became that researcher in 2020. His lab has published more than 30 high-profile studies since then, focused on the long-term health impacts of COVID infection.

“At that time, it was about seeing patients suffering,” he said. “Starting this research was a sort of visceral reaction. We wanted to know what they were going through.”

This study, published in the New England Journal of Medicine, took his team about a year. Much of that time was consumed wrangling the data, which came from over 5 million patients whose medical information is retained by the U.S. Department of Veterans Affairs.

More than 441,500 of these patients experienced COVID infection between 2020 and 2022. The patients were broken up into five cohorts in this study, by vaccination status and time frame.

The rest of the 4.7 million patients’ data acted as controls, since these individuals never tested positive for COVID between 2020 to 2022.

Comparing data from patients across COVID variant “eras” (starting with pre-delta, then delta and omicron) revealed clear decreases in the risk of long COVID over time. Ten percent of patients, all unvaccinated, in the pre-delta — or earliest — era experienced long COVID.

In the later omicron era, only 7.76% of unvaccinated and 3.5% of vaccinated people experienced long COVID.

The decreased risk has been attributed to both molecular changes to the virus and to vaccination status — with vaccination status playing a much larger role, accounting for about 70% of the reduction between eras, researchers found.

“The vaccine does two things,” Al-Aly said. “It reduces the risks of severe COVID-19, which we know leads to long COVID. And it reduces the viral load, so there is less virus in a vaccinated individual that gets infected than an unvaccinated individual.”

The study also looked at the disease burden, or the seriousness of the illness, of long COVID throughout the three eras. Al-Aly gave the example that, while both migraines and cancer are serious health concerns, cancer has a higher disease burden because it is more likely to result in later complications or death.

The measure used to quantify disease burden is a “DALY,” or “disability-adjusted life year,” which tracks the number of healthy years of life a person could lose to a disease. This allows physicians to create a ranked list, based on severity, of thousands of diseases. In that ranking, long COVID and heart disease are tied.

“The burden of long COVID is actually on par with the DALY burden of heart disease,” Al-Aly said.

Al-Aly said that we likely won’t need to employ any of the “Draconian measures” used at the start of the pandemic to control long COVID. Vaccination is the best way for individuals to protect themselves, he said.

“The key message here is that vaccines work for the reduction of long COVID,” he said. “But the remaining risk is still significant, even with the vaccine, so we shouldn’t trivialize it.”

---

©2024 STLtoday.com. Distributed by Tribune Content Agency, LLC.

Rong-Gong Lin II | (TNS) Los Angeles Times

LOS ANGELES — The risk of developing long COVID — enduring, sometimes punishing symptoms that linger well after a coronavirus infection — has decreased since the start of the pandemic, a new study found, with the drop particularly evident among those who are vaccinated.

But the dip does not mean the risk of developing long COVID has vanished. And given the rise in new infections, particularly during periods like now, when data indicate transmission is elevated, even a lower rate of prevalence means many Americans risk developing symptoms that can last months or years after their initial infection clears.

“We have people in the clinic here with long COVID, and they’re significantly affected, and some of them are profoundly disabled,” said Dr. Ziyad Al-Aly, chief of research and development at the Veterans Affairs St. Louis Health Care System in Missouri.

The study, published Wednesday, July 17 in the New England Journal of Medicine, found that 10.4% of people who were infected early in the pandemic suffered from long COVID symptoms a year after their acute infection.

But during the Omicron era, which began in mid-December 2021 when that variant became the dominant version of the coronavirus circulating worldwide, 3.5% of vaccinated people suffered from long COVID a year after their infection, as did 7.8% of unvaccinated people.

“It’s good news,” said Al-Aly, a coauthor of the study. “Long COVID is on the descent. It’s declining and has gone down over the course of the pandemic.”

But it’s still a concern that long COVID rates remain as high as they are, Al-Aly said, especially as COVID “is still affecting millions of people.”

“Three-point-five-percent is not zero,” Al-Aly said. “That’s still three to four individuals out of 100 of a disease that could be, in some instances, devastating.”

The study was based on health records held by the U.S. Department of Veterans Affairs, which had data on more than 441,000 veterans who were infected with the coronavirus between March 1, 2020, and Jan. 31, 2022, and monitored for a year after their infection to track whether they experienced long COVID. The other coauthors are Yan Xie and Taeyoung Choi, who are also affiliated with the VA St. Louis Health Care System.

Whenever someone is infected with the coronavirus, there is a chance they will develop long COVID — a catchall term used to describe a wide array of serious symptoms that can result in chronic disability, according to the U.S. Centers for Disease Control and Prevention. Some individuals have suffered from long COVID continuously since they were infected in the pandemic’s earlier days, while others have seen their symptoms resolve within months.

Long COVID symptoms include fatigue that interferes with daily life, brain fog and post-exertional malaise, in which symptoms worsen with physical or mental effort. Long COVID can also cause a fast-beating or pounding heart, dizziness when you stand up, depression and anxiety.

Millions of American adults and children have suffered or are still suffering from long COVID.

There are a few potential reasons why long COVID is rarer than it once was.

First, the coronavirus — officially known as SARS-CoV-2 — has changed significantly since it was first identified in December 2019.

“We still call it COVID, but in truth, COVID has really shifted shapes on us, like, multiple times,” Al-Aly said.

That would explain why “the risk has actually declined even among unvaccinated individuals,” Al-Aly said. “So even without being touched by vaccines, just the virus itself has mellowed over time.”

But as the study found, getting vaccinated did further reduce the risk of developing long COVID.

“Vaccines do two things: They first reduce the severity of infection,” Al-Aly said.

Second, “they actually help your immune system get rid of the virus faster,” Al-Aly said. “They enhance the ability of the immune system to clear the virus … and so there is less virus to wreak havoc” on organs and bodily systems.

One leading theory of the root cause of long COVID is that the coronavirus persists in the body long after an acute infection is over, Al-Aly said. So, if getting a vaccine helps the immune system get rid of the virus faster, that could lessen the chance of developing the syndrome.

“We know vaccine immunity wanes with time,” Al-Aly said. “Definitely keep up to date on your vaccination.”

The severity of long COVID varies from person to person. Some might experience mild cognitive dysfunction or fatigue, but can still accomplish daily tasks like taking their children to school or walking the dog. Others can suffer such “debilitating fatigue that they’re really, really, really profoundly disabled by it — they cannot get out of bed … they cannot literally perform their activities of daily living,” Al-Aly said.

Long COVID can emerge, persist, resolve and reemerge over a period of weeks or months, according to the CDC.

There are other data suggesting that long COVID’s incidence has declined since earlier in the pandemic. Based on survey data, the prevalence of long COVID among U.S. adults was 7.5% in early June 2022, but had decreased to roughly 6% in early January 2023, according to a report published last summer by the CDC. Since then, the “prevalence remained unchanged” to mid-June 2023, shortly before that report was published.

About 1 in 4 adults who reported having long COVID when surveyed said they had significant limitations on their typical activities — highlighting “the importance of COVID prevention, including staying up to date with recommended COVID-19 vaccination,” the report said.

COVID and long COVID remain a more significant public health threat than the flu. People sometimes get long-term complications after battling the flu, Al-Aly said, “but there are definitely a whole lot more COVID cases than the flu. So you’re much more likely, probabilistically, to get COVID than the flu.”

Even at this point, more people are dying from and being hospitalized with COVID than the flu, Al-Aly said. The CDC estimates that there have been at least 25,000 flu deaths nationally since the start of October, compared with at least 46,000 COVID-19 deaths reported over the same period. Updated death estimates for the past flu season will be available this autumn.

Besides getting vaccinated, other ways to help avoid long COVID include testing when you’re sick to see if you have COVID. A confirmed diagnosis can help higher-risk people get a prescription for Paxlovid, antiviral pills that can help lessen the severity of infections and potentially reducing the risk of long COVID, Al-Aly said.

Other steps include wearing a mask in higher-risk situations. Al-Aly said he wears an N95 mask on planes, and masks strategically in higher-risk settings. He’s also more on guard about masking when there’s an uptick in COVID, as there is now nationally. And dining at restaurants outdoors remains less risky than dining indoors.

___

©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.