Give me a boost…

Today, I got my booster vaccine shot. I tried signing up for a “booster” but all of the websites only asked for initial or second dose requests. I figured if I wasn’t able to get the shot today, I could at least figure out where/how to get it. I spoke with the pharmacy assistant who seemed very confused as to why I needed a booster and where she was supposed to put my “sticker” on my vaccination card (it only had a spot for two shots). Flustered, she told me to explain myself to the pharmacist saying, “Hopefully, she’ll know what to do.” Not very reassuring! When I finally spoke to the pharmacist, she asked, “Are you immunocompromised?” When I told her yes, and then what medication I took, she signed off on something and told me to wait to be called. Very simple.

There were 3 people waiting. They asked if I was getting my first vaccine, too. All three of these people were getting their first dose. One just had a baby and wanted to keep the baby safe. The other two were a married couple. It was an interesting conversation. They were people who did not believe the virus was a big concern. The husband stated he “believed it was a virus intended to wipe out nursing homes because the government was tired of paying medicare rates”…….(let that one digest)…….(take as much time as you need)…….Ok….back to reality.

I asked what made them come for the vaccine now. The answer? They just lost a perfectly healthy 30 year-old relative to the virus. They are worried about their college-age daughter. Apparently, their daughter also didn’t believe her parents would ever get the vaccine and won’t get one until they do. The father told me he didn’t sleep all night after learning about his relative passing and his fear for his daughter spurred him to make an appointment. It’s a shame what happened to their young relative. I’m still reeling from my father’s death due to COVID.

As with the previous vaccine, I questioned whether or not I needed the vaccine booster shot. If I am being totally honest, I DO NOT WANT ANOTHER VACCINE, but I’ve lost too much. I need normal. I want my school to stay open. I want to feel safe. I want to make sure I don’t pass anything on to my mom. Vaccines save lives. Are their risks? Yes, but with many things in my life, I weigh my options to make the best decision I can. What I did not do was go to the facebook posts claiming to know all. I called my rheumatologist the day after booster shots were approved. She told me to get it and that I did not have to wait the 8 months as suggested by the CDC. She quoted the ACR recommendations, so I thought I would list them here.

The American College of Rheumatology released the following:

“The American College of Rheumatology has issued an updated version of its COVID-19 Vaccine Clinical Guidance for Patients with Rheumatic and Musculoskeletal Diseases following recent recommendations from the CDC that certain immunocompromised patients receive a third dose of an available mRNA vaccine. Based on evidence published to date, the task force continues to feel the benefits of the COVID-19 vaccine outweigh the potential for vaccine harm for most rheumatology patients.

The updated recommendations include guidance on timing third vaccine doses and immunomodulatory medications, a preference for the use of mRNA vaccines in patients who have not yet been vaccinated, and a notation of the FDA emergency use authorization (EUA) for post-exposure prophylaxis with monoclonal antibody treatment for patients who are exposed to COVID-19, including most vaccinated rheumatology patients.

Key recommendations include:

• A third dose of Pfizer-BioNTech COVID-19 vaccine (age 12 years and older) or Moderna COVID-19 vaccine (age 18 years and older) is recommended at least 28 days after the second dose of an mRNA vaccine for patients on immunosuppressive or immunomodulatory therapy, except for hydroxychloroquine. Attempts should be made to match the additional mRNA dose type to the type given in the mRNA primary series; however, if that is not feasible, using the alternative mRNA vaccine is permitted.
• Providers should counsel their patients to hold certain immunomodulatory or immunosuppressive medications for one to two weeks after booster vaccination if disease activity allows. Exceptions to this guidance were made for glucocorticoids and anti-cytokine therapies, which would include most biologic agents. The task force did not achieve consensus on whether anti-cytokine medications such as tumor necrosis factor (TNF) inhibitors and others including IL-17, IL-12/23, IL-23, IL-1R, IL-6R antagonists meaningfully impair vaccine response that would warrant their temporary interruption. For that reason, no recommendation was made as to whether to temporarily hold or to continue these treatments at the time of booster vaccination until additional evidence accrues.
• Patients on rituximab or other anti-CD20 medications should discuss the optimal timing with their rheumatology provider before receiving a third dose. Some practitioners measure CD19 B cells as a tool with which to time the booster and subsequent rituximab dosing. For those who elect to dose without such information, or for whom such measurement is not available or feasible, the recommendation is to provide the third dose two to four weeks before the next anticipated rituximab dose (e.g., at month 5.0 or 5.5 for patients who receive rituximab every six months).”

I believe that I am privileged to live somewhere that has the vaccine readily available. I’m still devastated that my father died before the vaccine was approved. I’m nervously awaiting my side effects. After my second dose, I experienced high fever, body aches, and serious fatigue. I’m prepped with lots of Gatorade, tea, and a good book on Audible. I saw the worst side of COVID-19. I always think “It can’t happen to me” but it happened to two people I loved with all my heart. I’m not going to let it take more from me.

I’m 5 hours in and feel some pretty serious fatigue and a whole lot of funky, but I’m not worried. I’ll see you all on the other side.