Sandy Klein is eagerly anticipating her upcoming European Cruise next month. Despite being 78 years old, she considers herself to be in good health. However, as a resident of Palm Beach, she wonders if it’s necessary to get a COVID booster before her trip.
She explains, “I don’t want to risk getting sick during my vacation, or even worse, ending up in the hospital.”
This summer travel season is projected to be one for the books, with a significant increase in people traveling. Consequently, the risk of contracting COVID-19 rises as well.
Although COVID is still circulating, most people who get infected experience symptoms similar to those of a bad cold or flu, according to doctors. However, these symptoms—such as fever, body aches, sore throat, and cough—can easily ruin a trip or force individuals to miss important family gatherings.
Due to either vaccination or prior infection, most people have some level of immunity. So the question remains: is it worth getting a COVID booster?
Key factors to consider for getting a booster
Doctors advise that individuals should make their decision about getting a booster based on their activity levels during the summer months, as well as their age and overall health.
Dr. Sergio Segarra, the chief medical officer at Baptist Health’s Baptist Hospital in Kendall, explains, “It ultimately depends on how much risk you’re willing to take because COVID is still out there.” He notes that only about 4% to 8% of patients in his hospital are there for COVID, and none are in intensive care. Immunity from vaccination or prior infection appears to have reduced the severity of the disease for most individuals.
However, he adds, “But if you have underlying health issues or are over 50, getting the booster might be advisable. Additionally, the decision depends on your travel destination. Airports and cruise ships are crowded places, whereas remote locations offer a different risk level. For most people who are traveling, if you don’t want to spend a few days feeling miserable, I would recommend getting the booster.”
Diminishing immunity over time
Booster uptake in Florida has been low, with only 11.7% of individuals of all ages having received one, according to data from the Centers for Disease Control and Prevention (CDC). Research has shown that immunity acquired from either prior infection or vaccination gradually wanes over time and becomes less effective against new strains.
In the coming fall, vaccine manufacturers will release updated COVID booster shots that target the XBB 1.5 strain—the predominant coronavirus strain in the United States since late 2022. The new booster formulation will exclude the original coronavirus strain, which is no longer in circulation. Some doctors believe this update will optimize the immune response.
In addition to mRNA vaccines, the vaccine maker Novavax is also expected to release an updated booster targeting XBB.1.5. Novavax’s COVID shots use a protein-based vaccine.
Furthermore, there is hope for a nasal spray option, although it may not be available until 2024. India approved a nasal COVID-19 vaccine in September, and China began administering an inhalable version in October.
Waiting until the fall can be tricky, especially when an existing booster is currently available, even if it doesn’t target the most current strain.
Eligibility for a booster
Currently, the mRNA bivalent booster is the only available COVID shot for adults, and it can be administered to individuals aged 6 and older. The bivalent booster combines an antigen that targets the original strain of the virus with another designed for the BA.4 and BA.5 variants, which were circulating at the time the shot became available. The latest data shows that the effectiveness against symptomatic XBB infection—which is not the strain the vaccine was designed for—is about 43% for people 50 and older.
Dr. William Schaffner, an infectious disease professor at Vanderbilt University, emphasizes that “if you expect perfection from vaccines, you will be disappointed.” He likens COVID vaccines to influenza vaccines, explaining that they require regular updates to stay effective. However, vaccines still significantly reduce the risk of severe outcomes from COVID, according to research, and the latest CDC data indicates that they continue to provide some protection against mild infections.
Regarding timing, the CDC recommends waiting four months between shots. This applies to individuals aged 65 and older who are eligible for a second bivalent booster.
Schaffner adds, “If more than four months have passed since you had COVID or received a shot, your immunity is not at zero. You still have some protection, but the level of protection depends on factors like your age, the strength of your immune system, and any underlying health issues. The older you are, the higher your risk becomes.”
Choosing the timing for your booster
Schaffner advises against waiting for the fall if you believe you are at risk.
He explains, “If you are planning to travel, it’s best to get the booster that’s available now. Come October, you will be eligible for the new booster.”
If you decide to get boosted before traveling or attending a special event, you may want to time it to ensure optimal protection. According to Dr. Leanna Wen, a professor at George Washington University’s Milken Institute School of Public Health, the booster is most effective approximately two weeks to a month after administration. Protection against infection begins to decrease after a month. However, Wen notes that some individuals would still value even a small, temporary reduction in infection risk. She wrote in a column in The Washington Post, “Still, if you would value even a few weeks of added protection, then this strategy may be for you.”
If you choose not to get boosted, Wen recommends wearing masks in crowded places. It’s also important to make necessary preparations for traveling. According to Dr. Segarra at Baptist Health South Florida, individuals over the age of 65 should travel with Paxlovid, as it is still recommended for mild to moderate symptoms and serves as a useful tool to have.
Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].
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