64 Comments

I love your newsletter. As a physician I am all in on boosters for at risk adults and elderly. However, I am still in the “wait and see”mode for children because of lack of real world effectiveness data and potential risk data . Covid is a disease which very rarely causes serious illness in children.

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There's been evidence in the literature that COVID does, indeed, cause serious illness in kids (https://www.cdc.gov/mmwr/volumes/71/wr/mm7116e1.htm). Overall, the safety profiles for the mRNA vaccines look pretty good.

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I agree there has been evidence of serious illness in children it was still extremely rare and mostly associated with delta not omicron. This is also my experience an ENT when on call who covers Savannah’s Children ICU.

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I'll dig for it (it's late now) but I recall seeing a retrospective review of pediatric hospitalizations comparing Delta (certainly a problem) and Omicron, and finding more pediatric admissions with the latter.

An ENT on call in the PICU? Really? I heard of such but never experienced it! :-)

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Yes The Children's hospital in Savannah has 24 hour ENT on call coverage and it includes all the ICU's. Also I was in the past on the staff for ENT in Atlanta for CHOA (Children's healthcare of Atlanta) who also provided 24 hour call for all their ICU's. As a Ressident in training at Harvard the Otolaryngology department provided 24 hour in house ENT coverage for Boston Children's Hospital. What planet do you practice on Creager?

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Texas. A long time ago. For reference, I got “counseled “ when I decided to start bringing a pharmacist on cardiac transplant rounds. I was accused of not knowing the meds. A long time ago.

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Dec 20, 2022·edited Dec 20, 2022

I do wonder, Phillip, if Paul Offitt will be proven correct. This week’s update on TWIV suggested he will. That the three dose series is all that is needed to prevent severe illness and death and we cannot chase variants.

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I think we need to keep moving beyond worrying about just hospitalization and death, and waiting for real world data on these most fearful outcomes. My decisions for myself and daughter, and recommendations to patients, have always been informed by the parallel damage that goes on internally, even in mild cases, unseen except through MRIs of children’s lungs post covid, or endothelial harm sent in path samples in the cardiovascular system and beyond.

We have millions of adults disabled by long Covid - cognitive problems, shortness of breath, autonomic dysregulation. When parents tell me they worry about unknown or speculative long term risks of vaccination, I assure them that those risks are so much less than the unknown long term risks of covid in children. The science is potentially chilling for a not insignificant number of kids.

Childcare workers and teachers are among my most reinfected patients, and I’ll borrow Dr. Jetelina’s use of the words “atrocious” and “unacceptable” when I see the community damage being done by unvaccinated sick kids being sent in to day cares and schools.

The myopic thinking, the disregard for community, the lack of basic scientific literacy is hard to overcome, and it shows in our children’s vaccination rates. And I’m disappointed by many of my colleagues. Even fellow Philadelphian Paul Offit seems to only consider risks of hospitalization and death for the individual vaccine candidate in his arguments against boosters.

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Paul's a bit of a contrarian but also, a lot of his statements have been taken out of context for making some specific point. I wish he'd revisit some of his thoughts.

Completely agree with your comments. Thank you.

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There's been a lot of discussion about variant chasing. If we're seeing decent cellular immunity against different elements of the virus besides spike-targeted vaccine elements, AND if we're not seeing as much damage to T-cells by direct viral attack, we might do well with a 3-dose series.

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In my experience, as a grandparent and a physician, getting the booster is hard! So add the "pandemic is over" widespread belief/narrative, to the fact that vaccines tend to be administered in pharmacies now and children under 2 have to see a provider and most pediatric/family medicine offices aren't offering the vaccine and/or booster. Lack of knowledge and inconvenience and the downplaying of risk of infection are all working to lower uptake. IMO. In my state, public health has been largely dismantled, the "pandemic is endemic" narrative the official theme of our local --very hardworking and quite good--health department and yet I'm seeing so much disease. So discouraging.

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founding

YLE - quick question, but crucial -- is there a decent set of data debunking the (considerable) hysteria among certain folks about post vaccine health issues, including lost pregnancies, deaths, kidney issues, etc? What are the experts showing the layfolks to counter the (DeSantis) narrative? Help.

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There is a lot of literature.

Miscarriage and vaccines: https://www.nature.com/articles/s41467-022-33937-y

https://www.thelancet.com/action/showPdf?pii=S2666-7762%2822%2900104-1

Deaths: https://apnews.com/article/fact-check-excess-deaths-covid-died-suddenly-793316776380

Renal function/disease: https://nephcure.org/nephcure-covid-19-resources/covid-19-vaccine-faqs/

As for DeSantis, I consider him an opportunistic organism. He's trying to take advantage of the negative press in the right-leaning media, and online misinformation. Early on he was a proponent of vaccines.

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DeSantis is like many others who were initially in favor of the vaccines, but then later turned against them. This includes some of the most prominent critics. One of the most well known is the former president of the Australian Medical Association, who pushed really hard for the vaccines while in a position of authority. Then her and her partner got severe and lasting vaccine injuries from COVID shots. She recently revealed this and is highly critical of the shots now. She is not facing the usual scorn, since she has held high level medical and legislative positions.

With FDA approved medications, real world experience has many times resulted in those medications being pulled from the market for dangers not apparent to the FDA when they first approved the medications.

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I am still working on a comprehensive reply to your earlier questions (no, I've not forgotten). I've been unable to find documentation of "severe and lasting vaccine injuries" from COVID vaccinations, but I don't know what vaccines she got. There has been a long history of discovering that drugs we once thought were safe having been discovered to have issues we we amass new knowledge. That's the nature of the game. That doesn't negate the fact that the best way to avoid severe illness, hospitalization, and death from COVID-19 remains getting vaccinated, and maintaining the recommended booster series.

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Dec 20, 2022·edited Dec 20, 2022

Try searching directly with local pharmacies (Walgreens or CVS) for under 5 boosters. When I searched vaccines.gov I also was only shown a few, distant options. I was willing to travel if needed, so when I clicked on Walgreens to schedule and input my child's age and ZIP, there was actually a much closer location that had it available. I fear the government website is not comprehensive. Hope this helps someone!

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How old is your kid? Pharmacies won't vaccinate kids under 3. We just have to keep waiting for county run vaccine clinics (all of which just shut down in my area until January.) It's so frustrating.

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CVS Minute Clinics in our state vaccinate anyone over 18 months.

What CVS's Minute Clinics do may vary by state. Other pharmacies running *clinics* (as opposed to just a pharmacy counter) may also vaccinate under-3s.

When I found out I could vaccinate my 18mo-3y/o at a local pharmacy *clinic*, I was both relieved and mildly frustrated (that I hadn't figured out earlier that pharmacy clinics might have more generous vax policies than pharmacies themselves typically do).

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This is SO HELPFUL! Thank you - I have to drive 45 min but I can get my toddler boosted this year!!

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Glad to hear it – and good luck! :-)

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SJ- my child is 3 but as Midge commented below the ages vaccinated can vary by state and pharmacy/clinic policy. I'm sorry you're having a tough time locating a booster. I wish you luck!

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It would definitely be interesting to dive deeper into the low uptake and see how much if it can be attributed to lack of information/availability as opposed to knowing it's available, having access to it, and just choosing not to get your child vaccinated.

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author

I would, too. I haven't seen any data on this yet. This would really require focus groups or an intensive survey to parents, which takes time. I'll keep my eye out.

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The more you look for info about the children's vaccine, the blurrier it gets.

Like, I don't see how anyone would be more likely to get it once they realize Pfizer's regimen was based on a trial with 10 kids and with confidence intervals at 0% efficacy against infection on the low end, or that countries like the UK (clearly not an anti-vax country) don't even give under 5s any covid vaccine.

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I feel like there's been a real failure of addressing any legitimate concerns about the vaccine so the weaknesses of the childrens' vaccine just aren't really addressed. Just leaves a bunch of hand-wringing about low uptake

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In Denmark, shots are now banned for almost everybody under 50. Other nations are starting to cut back also. And not many nations are giving the shots to 6 month old infants like in the U.S. I'd be interested in seeing some risk/reward analysis for very young children.

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I doubt that I wrote that Denmark banned COVID shots for all people of any age. I'm aware of your new comment because I got an e-mail about it, a great feature of this platform. But I can't find my comment that you replied to.

From that fact check Danish authorities said: "Children and adolescents only very rarely have a serious course of illness due to COVID-19 with the Omicron variant, which is why the offer of primary vaccination for children between five and 17 years will not be a general offer, but can be given after a specific medical assessment."

But why stop the shots for kids if they do any good at all? No answer to that question.

Children in the U.S. are still mandated to get shots. No shots, no school. Get shots for your 6 month old infant, says the CDC. And get all the boosters they say, seldom used in Denmark now.

Danish public health has a completely different opinion on the shots compared to the U.S. This is even more evident from this headline: "Denmark becomes the first country to halt its Covid vaccination program." That happened in April 2022. https://www.cnbc.com/2022/04/28/denmark-the-first-country-to-halt-its-covid-vaccination-program.html

Almost nobody is getting COIVD shots in Denmark for months now.

But did COVID and the severe effects it causes really go down in Denmark enough to justify turning away from the shots? It sure does not look that way. So I'm suspicious that the real reason is vax injuries, and Denmark authorities do not want to talk about it.

To make my case that, take a look at the chart of Denmark daily confirmed deaths (per million) compared to the U.S. - link below. It's been very similar to the U.S. for months now. Denmark reached 80% of its population with at least one shot in December 2021. Despite that, their biggest daily spike up in in COVID deaths was in March 2022. By the time they reached the 80% vax rate in Dec. 2021, they had a bit over 3,000 COVID deaths after 2 years of the pandemic. Now they have over 7,000 deaths one year later.

https://ourworldindata.org/coronavirus/country/denmark

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I work as a vaccinator at a health department. We advertise heavily and have offered vaccines for this youngest age group as soon as they were available. We get great turnout for adults but only a handful of this age group. That’s only a snapshot of my community but I just don’t see the demand at all, even in the setting of availability and communication.

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People should check with their local health departments. I work as a vaccinator with one, and we offer the bivalent COVID vaccine for this youngest age group.

Also, my youngest son tested positive for Type A influenza this past week and was incredibly ill: 7 days of 102-103 fevers, had to go in to be checked for secondary infection, and he had the flu vaccine in September. I’ve never been fond of the phrase “just the flu,” having lost a healthy family member in their early 40s to it years ago. My nurse friends still in the hospital are reporting severe cases of Flu A in otherwise healthy children.

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What state (as in geography, haha!, are you in? They are not available in NC.

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NY, not the City.

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From that CDC report which you linked: "COVID-19 mRNA Vaccine Safety Among Children Aged 6 Months–5 Years — United States, June 18, 2022–August 21, 2022"

This is the final sentence of the 2nd paragraph of the summary:

"CDC’s v-safe call center contacts registrants who indicate that medical care was received after vaccination and encourages completion of a VAERS report." Oops, that's not a complete sentence. Looks like the proof reader, if there was one, missed that.

One interesting thing about this report is it gives some details from the V-Safe data. The CDC kept the V-Safe data secret for 2 years, until the lawyer for a major anti-vaxer got a judge to force the CDC to release the data.

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The nearest site vaccines.gov shows me is 20+ miles away and none will do kids under 3, but I called the health department that got us our first 2 shots directly and they scheduled us for tomorrow. It will be half an hour of driving each way again.

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For those interested in reading some new studies on COVID vaccines, there are 2 linked in this article. One of them is about the bivalent booster. The more COVID vaccines taken, the higher the risk of catching COVID. Unvaccinated are at the lowest risk for catching COVID.

I've met many people who did not get COVID until after they got the shots. President Biden got his first COVID shot in December 2020 saying at that time you will not get COVID if you get the shots. He got COVID in July 2022.

Quotes from the writer:

"People who had received three or more shots were more than three times as likely to be infected as those who hadn’t received any."

"The authors spun the results as positive by noting that the vaccinated people they studied had 37 percent fewer overall deaths as unvaccinated people. But that finding is almost certainly an artifact of what is called “healthy vaccine user bias.” People who are vaccinated tend to be healthier overall than those who are not, and physicians sometimes withhold vaccines from people near death because they don’t think those patients will benefit. The clinical trials that Pfizer and Moderna conducted showed no evidence that their mRNA vaccines reduced the overall risk of death - and deaths overall are far higher than normal this year in highly mRNA vaccinated countries."

The article:

"Two new studies show mRNA-jabbed people have a much higher risk of getting Covid than unvaccinated people"

https://alexberenson.substack.com/p/urgent-two-new-studies-show-mrna?utm_source=post-email-title&publication_id=363080&post_id=91933445&isFreemail=false&utm_medium=email

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founding

"People who are vaccinated tend to be healthier overall than those who are not,..."

This is an unwarranted assumption without evidence supporting it. In fact, those who are unvaccinated tend to be younger (and, therefore, healthier) than those vaccinated (see https://www.census.gov/library/stories/2021/12/who-are-the-adults-not-vaccinated-against-covid.html). "Adults who had not received any doses of the COVID vaccine differed from those who had received at least one dose of a COVID vaccine across several measures. They were younger, on average, than those who had been vaccinated. Roughly 75% of the unvaccinated were under age 50. Among the vaccinated, less than half were under age 50."

Though I do not have documentation, I suspect that those who are less than healthy are motivated to be vaccinated MORE than those who are entirely healthy, as those who are less than healthy may feel more at risk from the consequences of contracting a SARS-CoV-2 infection than those who are healthy.

As for the seeming paradox of the claim that those who are vaccinated are more likely to become infected than those who are unvaccinated, this article discusses that misunderstanding in some detail. https://www.factcheck.org/2022/06/scicheck-vaccinated-people-not-more-susceptible-to-covid-19-than-unvaccinated/.

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Good points. But from your census link there was also this: "Survey respondents who had received at least one dose were twice as likely as the unvaccinated to have a college degree or higher." So those who took the shots were much more likely to have a college eduction, and likely also a higher income. I found plenty of evidence that college educated people are healthier than those who do not go to college. I bet if I look, I can find evidence that more affluent people are generally healthier than those less affluent, and that college educated people make more money.

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Good points. Thanks for your comments. From the census study you sent me regarding those without the vaccines:

"They had lower levels of education, on average, than those who were vaccinated. Survey respondents who had received at least one dose were twice as likely as the unvaccinated to have a college degree or higher."

College education is associated with better health. Also, college educated people make more money. So 2 factors - college educated and a greater income are associated with better health. Seems like that could cancel out the younger age factor of the unvaxed. And maybe that is some of the basis for the statement you said had no evidence: "People who are vaccinated tend to be healthier." I'll try to learn more about that statement.

In the 2nd link you sent included the Walgreen study. I looked at the Walgreen May 11 analysis. In that study they did not report data on the education or income level. So those factors worked in favor of the vaxed but were unaccounted for.

Walgreens:

"Given the recommendation for all three COVID-19 vaccines available in the United States to include at least two doses (or one dose and one booster), patients reporting only one dose (7.51% of patients) were excluded."

Walgreens excluded the one dose people from their analysis, but I found on The Gateway Pundit site that Walgreens did report positivity data on that group. The one dose people were more likely to get infected.

In the Cleveland Clinic study from the link I shared we see that those with one dose were more likely to be infected than the unvaxed. By ignoring the one dose group did the Walgreen analysis boost the effectiveness of the vaxed?

Walgreens:

"Bivariate analyses were limited to patients who reported receiving their last vaccine or booster within the last five months in the vaccinated group."

So Walgreens limited the bivariate analyses to the one vaxed group that is most likely to show a benefit compared to the unvaxed. Why did they do that?

"After stratifying by age, no significant differences were found in positivity by vaccination status among patients aged 5-11 (5.34% vs 5.62%, p=0.5665), 12-17 (4.11 vs 4.40, p=0.5738), and 65+ (5.72 vs 5.25, p=0.4888)."

Why did Walgreens not report on the other age groups? If those other age groups showed a benefit, I bet Walgreens would have reported it. By writing it up this way, it seems likely the other vaxed age groups were more likely to be infected. This seems to run counter to your idea that the mostly younger unvaxed people have an advantage and thus should be infected less.

Walgreens:

"However, in early 2022 the data indicated a lower positivity rate among unvaccinated individuals compared to those who have received at least 1 dose of vaccine"

While reporting a lot of details, Walgreens chose to not tell readers the raw positivity rates at the time they did their analysis, which was the whole reason for doing their analysis. It's like we will explain why you should ignore our raw data, so we will not tell you the raw data numbers you should ignore. So then I had to start searching for the numbers Walgreens did not want to report and found them on the Gateway Pundit.

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Thanks. I'm still catching up.

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Hi YLE, I am a physician in an FQHC. I have noticed some severe febrile URIs which are negative when tested for COVID/FLU or strep, and too short a time course for anything else really (2-4days). I know the drill but am wondering about the accuracy rates for rapid COVID tests with the new variants. Any information on that?

I’m worried that some elders may not get treatment rapidly enough with our current testing

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The lateral flow tests are being tested by the manufactures for specificity against new variants. The reports I've seen are they remain specific. I've heard anecdotes of RSV in younger adults, and seniors can become reinfected with RSV. Consider this in treatment, although this is sorta supportive only.

If they're covered, consider sending off a PCR during the office visit. Some labs are doing multi-assay PCR for flu, COVID and RSV, from what I've heard. Note, I'm no longer really clinical.

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Interesting, but I am not surprised by the numbers. I know a lot of people who decided not to get their older kids and teens vaccinated. I live in a blue area, in the capital of a blue state, and within walking distance of three hospitals, so I don't think it is political or due to the word not getting out that the vaccine is recommended for kids. The schools have definitely been advocating for it, and we have had several vaccine clinics in the schools, including before the Fall 2022 school year.

I have heard several parents say they are not getting it for their daughters because they are worried about the effects on their reproductive systems, which doesn't seem to have any bearing in facts, but I understand the concern over side effects we might find out years in the future. My own daughter had an exam yesterday and asked about her recent onset of heavy and irregular periods. The doctor said that it coincided with my daughter getting COVID this summer, so that is likely the culprit. I don't know if there is truth to that, and the doctor was not at all concerned and said it would probably return to normal soon. So if the vaccine does indeed have effects, it sounds like COVID itself might have similar?

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There have been a couple of studies looking at reproductive issues associated with the vaccines. This comes to mind: Muhaidat, Nadia et al. “Menstrual Symptoms After COVID-19 Vaccine: A Cross-Sectional Investigation in the MENA Region.” International journal of women's health vol. 14 395-404. 28 Mar. 2022, doi:10.2147/IJWH.S352167, with symptoms resolving on less than 2 months. This represents another example where public trust, eroded by a series of processes, including when there was not consistent messaging between national medical leaders and national political leaders, and fueled by intentional misinformation for reasons I cannot fathom, provided a narrative that resonated with peoples' uninformed or preconceived notions and took hold.

COVID can, indeed, be blamed for any number of things. Listening to a cardiology podcast yesterday, I heard a cardiologist state that any onset of new atrial fibrillation in a post-COVID patient, and for that matter, any electrocardiogram changes, or contractility changed that couldn't be ascribed to preexisting cardiovascular disease, he was labeling as a post-COVID syndrome. NOT a post-vaccine syndrome, but one that was caused by the viral infection, because myocarditis is so much more prevalent in post-COVID than in a vaccine-induced scenario. Statistically, the number is insignificant for post-vaccine, and the number of deaths or transplants associated with it are very low.

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Has there not been a lot of discussion about three months being too soon for a booster after infection. I’d like ti know if there is research that shows the ideal waiting period.

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The data are really all over the place and vary by individual. Some people are manifesting solid immune response with neutralizing antibodies for 6-7 months, some for as little as 2-3 months, and some infections, notably BA.5, resulted in little initiation of neutralizing antibodies directly. So far, the recommendation remains for 3 months since last infection.

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The CDC website still says says "(Children 6 months to 4 years are not recommended for a booster.)" in their guidelines. Am I missing something?

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It hasn’t been updated. No idea why. I looked today and saw the same thing. But I work as a vaccinator for a health department, and we have the bivalent boosters for that age group.

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Yeah I saw on another page the correct updated guidelines. Very strange!

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Thank you! I have been waiting for this update and so curious why it has been barely a blip on the news. For what it's worth, we drove 2 hours in Florida to get the Moderna primary series....twice.....and I don't regret it. But that can't be the model for public health...

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For adults who have had a COVID-19 infection, what is the current recommendation for wait time before getting the bivalent booster shot? Assuming up to date on all other shots.

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Per CDC: “If you recently had COVID-19, you may consider delaying your next vaccine dose (primary dose or booster) by 3 months from when your symptoms started or, if you had no symptoms, when you first received a positive test.”

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Thanks, interested to know advice on this other than CDC

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That's the consistent advice we've been meting out since vaccinations began. It's still valid. CDC is the right place to seek advice of this sort.

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Where are you on Instagram?

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author

Your Local Epidemiologist. I try and do a Q&A every Monday (and answer as many questions as I can on Tuesdays). Other than that, everything on this newsletter is on IG

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For adults who have had a COVID-19 infection, what is the current recommendation for wait time before getting the bivalent booster shot? Assuming up to date on all other shots.

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3 months from first symptoms, or if asymptomatic, from your first positive test.

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