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2nd Covid Shot – What You Need To Know

Vaccine roll-out hasn’t exactly been what we’ve come to expect of our country’s public health infrastructure. Perhaps our shock comes from a sense of entitlement from the decades of having our expectations exceeded by governmental operations, nationally and internationally. Now that we no longer take our country’s public health as much for granted, especially with regard to emergency vaccine roll-out, here are a couple of Covid-19 vaccine take-aways.

1. Side Effects May Be A Little Stronger, But Don’t Worry

Many people who had little to no reaction to the first vaccine dose are reporting that the second one packs more of a punch.

Greg Poland, M.D., an infectious disease expert at the Mayo Clinic in Rochester, Minnesota, and director of Mayo’s vaccine research group, had only mild symptoms after his first dose. But the second dose gave him chills and a temperature of 101.

“I took one Tylenol and went to bed and woke up the next morning 90 percent improved, and by midday I was back to normal,” Poland says. “This is not an indication of something going wrong; it is an indication of a vigorous immune response.”

There is no live-virus in any of the Covid vaccines, so you can’t get COVID-19 from being vaccinated.

Participants in clinical trials of both vaccines had experiences similar to Poland’s. In Pfizer’s clinical trial, for instance, 31% of participants ages 18 to 55 reported a fever after the second dose, compared to only 8 percent after the first one. Fatigue, chills, headache and muscle/joint pain were also more common after the second injection for both vaccines.

The good news is, older adults were less likely to experience vaccine reactions, the data shows. Among those age 55 and up in the Pfizer trial, 22 percent experienced fever after the second dose, and 3 percent had a temperature after the first dose.

Schaffner recommends not making any big plans for the day after your scheduled vaccine appointment.

2. Avoid Pain Relievers Before Your Shot

If you’ve been hearing stories about second-dose side effects, you may be tempted to take a pain reliever before your appointment.

That’s not a good idea, according to the U.S. Centers for Disease Control and Prevention (CDC), unless you’ve been advised to do so by your doctor. Pain relievers taken preemptively ahead of a shot could dampen the effectiveness of the vaccine, Poland and Schaffner say.

However, it’s OK to take acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug like Advil or Motrin if you actually have symptoms after your shot.

3. The Timing Between Doses Does NOT Need To Be Exact

The second dose of the Pfizer shot is supposed to be given 21 days after the first; for Moderna, the recommended interval between doses is 28 days.

Don’t worry if you can’t get your 2nd dose at the exact interval. You should not get the 2nd dose earlier than the recommended interval, but it is okay if the 2nd dose is delayed a little. In fact, the newest data our of Israel indicates that a single dose (1 shot) of the Pfizer vaccine reduces the incidence of Covid infection by 75% and reduces symptomatic Covid by 85%! This is truly incredible and makes me personally think that perhaps we should be delaying everyone’s 2nd dose in order to get more people access to their 1st shot sooner. This is still a controversial argument, but this new data may change the CDC’s position on this.

4. 2nd Dose Should Be From The Same Manufacturer

Doctors are already hearing from patients asking if they can get their second dose from a different manufacturer, often because they realize the other type of vaccine is offered at a location that’s more convenient. But the CDC recommends against it: The Moderna and Pfizer vaccines “are not interchangeable with each other or with other COVID-19 vaccine products,” the CDC says. “The safety and efficacy of a mixed-product series have not been evaluated.”

The CDC does allow the mixing of Pfizer and Moderna shots in “exceptional situations,” such as when the vaccine used for someone’s first dose is no longer available due to a supply shortage, or if it’s unclear which vaccine they got for their first dose.

5. A Rash At The Injection Site Isn’t A Reason To Skip Your 2nd Dose

If you experienced a rash at the injection site 3 to 10 days after getting your first shot, that doesn’t preclude you from getting your second shot, the CDC says, although it recommends getting it in the other arm.

A small number of people have developed such rashes, sometimes called “COVID arm,” after vaccination. Doctors say it’s likely a mild allergic reaction that can be treated with an over-the-counter antihistamine such as Benadryl.

In guidance released Feb. 10, the CDC says the reaction is not believed to represent a risk for a more severe allergic reaction when you get your second dose.

6. Temporarily Avoid Other Vaccines

It might be time for your shingles or Tdap vaccine, but you should hold off if you are between COVID-19 vaccine doses. Because there’s no data on the safety and efficacy of COVID vaccines administered at the same time as other vaccines, the CDC recommends avoiding other immunizations in the two weeks before and after both doses. Holding off also helps prevent confusion about the cause of a reaction if you experience one.

The CDC does allow exceptions in circumstances where avoiding the vaccine would put you at risk, such as a tetanus shot after a wound or a hepatitis shot during an outbreak.

As a physician, I would not put off your Pneumonia shot (Pneumovax or PPV), as bacterial pneumonia can be one of the serious complications of viral lung infections, and the pneumonia shot is usually well tolerated.

7. Full Immunity Is Not Immediate

The CDC states that it takes 2 full weeks after your second dose for your body to build full protection to the virus. However, everyone is unique, and our immune systems are not one-size-fits-all. Like I said above, a single dose of the vaccine appears to reduce symptomatic Covid by 85%, and 75% of all Covid infections. Certainly the 2nd dose will provide further protection, but I strongly suspect that this is the case even one week after the 2nd shot. Regardless of whether we can say one week or two, after that, you should have about a zero chance of developing severe disease if you are exposed to someone with COVID-19. The CDC also says you no longer have to quarantine if you’re exposed to someone with COVID-19 — as long as you meet these criteria: you don’t have symptoms and it hasn’t been more than three months since your second vaccine dose.

One possible exception is immunocompromised people. They will get some level of immunity, he says, “but they may not reach the 95 percent because their immune system is already somewhat compromised, no matter how strong these vaccines are.”

8. Still Need to Wear A Mask

Experts are divided about whether it’s OK to hug your grandchild or gather socially with other vaccinated people after you’re fully immunized. But they agree you should continue to wear a mask and practice social distancing in public. For one thing, there’s an exceedingly small and probably non existent chance you could get sick even after you’ve been vaccinated. Based on the most recent data out of Israel, it appears that vaccinated people do not transmit Covid. This would mean that vaccinated people would not be able to get others sick and would therefore not have to take the same precautions that unvaccinated people must take to protect themselves and others.

Until this data has been replicated elsewhere and confirmed to be accurate, it is theoretically possible that vaccinated people could still carry the virus and silently transmit it to others who haven’t been vaccinated, even if there were never symptoms. I want to clarify the word “carry,” which actually means that if you are exposed to the virus, you can still have the virus replicating in your nose and respiratory tract for a period of time, even though the virus can no longer penetrate your defenses and infect your body otherwise. So, we have not yet been able to rule out the possibility that vaccinated people can transmit the virus without even having an infection. This would not be an asymptomatic infection, it just involves having some live viral particles in the mucous membranes of the nasopharynx and respiratory tract.

And there’s one more reason. Until the country reaches herd immunity — the point when a significant portion of the population becomes immune to a disease — it’s important for everyone to wear a mask to stop the spread of the virus, Schaffner says. “If we have some people walking around maskless and others not, people left and right are just going to discard their masks,” he says. “We are not ready yet for that for society. Let’s all stick to masks a little longer until we get the all clear.”

*Covid vaccine take-aways credited to Michelle Crouch of AARP, with commentary by Dr. Justin Groode.

Justin Groode MD | Patient Advocate Alliance LLC