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Simultaneous administration of a COVID-19 mRNA booster shot and the seasonal influenza vaccine slightly increased the risk of systemic reactions during the following week compared with a booster shot alone, but most of the reactions were mild, a retrospective cohort study shows.
"So the CDC continues to recommend that COVID-19 vaccines may be administered without regard to timing of other vaccines, including the COVID-19 booster and flu vaccination at the same visit," added Hause, the lead author.
In an invited commentary, Kathyrn Hall, PhD, MPH, Brigham and Women's Hospital, Boston, Massachusetts, and colleagues also argue in favor of concomitant administration of a COVID-19 booster and influenza vaccine.
To probe the safety of simultaneous vaccination, Hause and her colleagues turned to v-safe, the large CDC vaccine surveillance self-report registry. Of nearly one million participants in the smartphone-based monitoring system, 92,023 received a seasonal influenza vaccine together with either the Pfizer BioNTech or the Moderna booster between September 2021 and May 2022. The booster was defined as the third dose of the COVID-19 mRNA vaccine given at least 5 months after the second dose.
In the week following dual vaccination, 58.9% of respondents who received the Pfizer BioNTech COVID-19 booster plus the flu shot and 68.6% of those who received the Moderna COVID-19 booster shot plus the flu shot reported mild to moderate reactions.
The slight increase in reactions to the paired vaccinations had little health impact with the Moderna booster and none with the Pfizer BioNTech COVID-19 booster, as measured by normal daily activities, an inability to work or attend school, or the need for medical care, telehealth, a clinic or emergency visit, or hospitalization.
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"FDA has consistently over-interpreted the performance of the bivalent formulation when given as a booster. Now it seems to have gone beyond the science and decided it has some kind of magic power as a first dose," John Moore, an immunologist at Weill Cornell Medical College, wrote in an email to NPR.
The main concern is that the protection people got from their last shot has been fading, not just against getting infected but also possibly against getting seriously ill. So Hotez says people as young as 50 should be able to get a second bivalent booster if they want one.
He added: "Historically, when you look at the monovalent vaccines, the protection starts to wane after four or five months. We don't know if that's the case with bivalent boosters. But you don't want to find out the hard way."
"The concern is that if we continue to give boosters against a virus that's not circulating when we do see the next variant you may not develop a vigorous immune response to that new viral variant," Poland said.
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