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  • Writer's pictureAlan Frischer, MD, MPH

Who Should Get the COVID Vaccine

Who should…or shouldn’t…get vaccinated against COVID-19? I’m asked this question many times every day. With so much confusing information out there, let’s clarify this.

First of all, why are we vaccinated for any disease in the first place? We are naturally protected from infectious diseases by our immune system, which destroys disease-causing germs (pathogens) when they enter our body. If our immune system is not quick enough or strong enough to prevent pathogens from taking hold, we become ill. Vaccines help our immune system stop this from happening by providing a controlled exposure to a pathogen. Our immune system is trained and strengthened so that it can fight quickly and effectively should we be exposed to the actual disease pathogen in the future. Vaccines protect us from dangerous diseases like COVID-19, they protect the elderly and vulnerable who have other conditions, and they help to control epidemics. Statistically, vaccines are one of the most effective health interventions we have.

What about children? Not yet. The vaccine has not been fully tested in children. The Pfizer vaccine is approved for those 16 years and older, and the Moderna vaccine is approved for those 18 years and older. Trials are underway to determine the safety and efficacy in children.

What about those with suppressed immune systems? This was not specifically investigated in the initial vaccine trials, and there are no studies yet evaluating how effective the vaccine is for this population. However, those with suppressed immune systems are not excluded from getting the vaccine. Since the vaccine does not contain live virus, there is no risk of getting COVID-19 from the vaccine. However, it is possible that those with suppressed immune systems will experience less benefit from the vaccine, and will need to remain especially vigilant against exposure to the disease.

What about those who have already had COVID-19? We still don’t know just how strong the natural antibodies from having the illness are, and for how long these antibodies last. Therefore, the vaccine is a good idea for those who have had COVID. The recommendation is to get the first dose four weeks after the onset of symptoms, or four weeks after a positive COVID test, whichever comes first.

What about pregnant women, or those who are breast-feeding? The American College of Obstetricians and Gynecologists (ACOG) recommends that you be vaccinated. However, the data is limited, so it is a good idea to speak with your own ob-gyn doctor. It does appear that vaccinated women can pass antibodies to the infant through nursing, and in this way give the baby some level of protection.

And, lastly, the most commonly asked question: What about those with allergies? If you have had non-severe allergic reactions to foods, oral medications, latex, animals, insects, or environmental triggers, you can safely be vaccinated. A non-life threatening allergic reaction could include hives, or lip swelling. A very small number of people develop a severe allergic reaction to the COVID-19 vaccine. When the airway, such as the tongue or throat, swells and makes breathing difficult, it is considered an anaphylactic reaction.

If you have ever had an anaphylactic reaction from any cause, you will want to consult with a health care professional before becoming vaccinated. For vaccines in general, the risk of anaphylaxis is about one in a million. For the two currently approved COVID vaccines, the risk is higher, approximately one in 100,000. This is precisely the reason why we are all required to sit for 20 minutes after vaccination. Every vaccine site is prepared to use epinephrine, which is an extremely effective treatment, in such an emergency.

It is difficult to know precisely who might have an allergic response. The risk from mRNA vaccines is related to polyethylene glycol (PEG). If you are allergic to polysorbate, which is not actually in the vaccine but is closely related to polyethylene glycol, then you should avoid the vaccine.

Note that other reactions to the vaccine, including arm pain, headache, body ache, fatigue, or low-grade fever, are quite common, and are NOT allergic reactions. Do not let these side effects prevent you from following up with the second shot. Of course, if you developed anaphylaxis from the first vaccine, do not get the second one.

COVID-19 can cause severe medical complications, and during this past year, it has killed over one-half million people in the United States alone. In a significant percentage of cases, symptoms last well beyond the disease itself. We cannot predict how a specific individual will react to this disease. And, if you become ill or even if you are asymptomatic, you will be highly contagious to your family, friends, and anyone who comes into contact with you. Even if your own case is not severe, those who catch it from you may well be vulnerable to a serious case.

If you are still unclear as to whether to be vaccinated, I urge you to contact your doctor to discuss this extremely important issue.

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