Who Should Get the Updated COVID-19 Vaccine?

Who should get the updated COVID-19 vaccine? How does it differ from the first vaccines and what does the research say about the effects of all of them? Ligita Jančorienė, Professor at the Faculty of Medicine of Vilnius University, Head of the Santara Clinic of Infectious Diseases, infectious diseases physician, discussed the matter on the Vilnius University (VU) podcast Mokslas Be Pamokslų.

At the end of 2019, the first case of the then-unknown coronavirus was reported in China, and the World Health Organization (WHO) declared COVID-19 an international health emergency on 30 January 2020. In 2022, we are almost three years into the pandemic. However, according to Prof. L. Jančorienė, COVID-19 could barely be called a pandemic today. Historically, she said, other pandemics have lasted 2-3 years, after which the viruses would revert to what we now call a “seasonal virus.” The reason we call the now circulating viruses like that is that the public acquires immunity both after exposure and after vaccination.

“We are now in that transitional phase where a pandemic moves into the circulation of a seasonal virus,” the doctor said.

However, at the end of October this year, the WHO announced that it was too early to lift the highest level of alerts for the COVID-19 crisis, as the pandemic remains a health emergency of international concern, despite the progress made in the management of the disease in recent years. According to Prof. L. Jančorienė, this is due to the fact that the behavior of the virus, its changes and its impact on human morbidity are still being actively monitored. Furthermore, observed are not only humans but also animals, looking at how the virus “jumps” between animals and humans.

“We are already hearing about several new strains of the virus but they are not yet a threat as at the beginning of October, around 98% of cases were the omicron strain. However, in Singapore, a new strain has led to an increased incidence of respiratory infections, and some other continents identified other new strains with certain mutations,” the Professor said.

What should we expect in the winter?

Attention should be paid not only to SARS-CoV-2 but also to influenza, says Prof. L. Jančorienė.

“We have not had a significant incidence of influenza for several years. The prognosis is that influenza infection could rear its head, and people’s immunity to influenza is a little weakened. There hasn’t been any very active vaccination since the last flu season. So herd immunity will be decreased, which could lead to more severe cases of the disease,” the doctor said.

According to her, recently published data show that influenza and respiratory syncytial virus (RSV), which has been circulating for a long time and is well-known to the medical community, can combine and work together.

“We see a lot of elderly people in the hospital who are more severely affected by respiratory syncytial virus infection. The presence of the two viruses together can lead to new signs of infection, a stronger, more severe manifestation of the disease,” says the doctor, adding that a person can develop several diseases at the same time.

With fewer and fewer requirements, here’s a reminder on how to watch out for COVID-19

The incidence of COVID-19 is now declining, and there are fewer and fewer restrictions in place to reduce the spread of the infection in society. However, the pandemic has taught us to protect ourselves by disinfecting and washing our hands and wearing a mask.

“I have recently travelled in both the United Kingdom and the United States, and I have seen a lot of people wearing masks, especially in vehicles where crowding is more common. So the person wearing a mask can clearly identify the reason why they are wearing it. Obviously, wearing a regular medical mask, washing your hands, and avoiding contact with people with respiratory infections are really effective and valid measures to protect against the currently circulating strain of omicron,” she said.
But just as important, she says, is to know your medical history: What chronic diseases you have, whether you are receiving immunosuppressive treatment, and to assess your age risk.

“There are still beds in the hospital for people with COVID-19, but only those who really need help are admitted. Our patients are at risk. There are no exceptions where a young, healthy person comes in and gets sick enough to risk intubation and require intensive care treatment, which is what we saw in 2020 when vaccination and public immunity were very low, just a few percent, and deaths from COVID-19 infection among young, relatively healthy people were higher. Now there are no such cases,” says Prof. L. Jančorienė.

Who should get the updated COVID-19 vaccine?

Updated COVID-19 vaccines adapted to coronavirus omicron subtypes BA.4 and BA.5 have reached Lithuania. According to Prof. L. Jančorienė, it is best to assess when the last case of the disease occurred and accordingly calculate the timing for the next vaccination.

“The first recommended vaccination is for those who did not get COVID-19 in 2022. If a person became ill in early 2022, it is very likely that they contracted the first strain of omicron that was circulating at that time, and, therefore, it would be appropriate for them to get vaccinated against the currently circulating omicron strains BA.4 and BA.5.
The rules state that an otherwise healthy person could be offered a vaccination six months after the previous vaccination or nine months after the illness. So it’s definitely not time to vaccinate part of the population yet. The only exception is people at risk. The recommendation should be slightly personalized depending on each person’s situation,” the doctor explained.

How is the current vaccine different from those that came before?

The new vaccines differ from the previous vaccines in that they are adapted to the omicron strain. According to Prof. L. Jančorienė, the first adapted vaccine to reach Lithuania, as well as other European countries, was designed to protect against both the original strain of the virus, which was detected in the Chinese city of Wuhan in 2019, as well as the omicron sub-variant BA.1. However, these preparations did not provide additional protection against the newer BA.4 and BA.5 sub-variants that have become dominant worldwide.

So now Lithuania, like other countries, has an even more adapted vaccine with the classical genetic information of the virus and the omicron sub-variants BA.4 and BA.5.

“The main purpose of the vaccine is to protect against severe cases of disease and death. The vaccine does not guarantee protection against the disease. If a person is not seriously ill, that is the main achievement. We can certainly not be as scared now as we were at the end of 2020 when we saw an infinite number of ill people of all ages. And sometimes it was not clear why the person was so seriously ill, and there was no way to help. And now immunity protects us from these complications,” the Professor said.

Listen to the full interview with Professor Ligita Jančorienė of the VU Faculty of Medicine on the VU podcast Mokslas Be Pamokslų.