San Antonio Express-News (Sunday)
Wondering about extra jab, a too-soon jab, a leaky jab
Q: My wife and I are grateful to have recently received our second Moderna vaccine. Would you see any difficulty in adding the J&J vaccine at my own expense? It seems that the different vaccines vary in how they protect against different strains, and I’d like to double up (or even more) if there are no major risks.
A: The Moderna vaccine appears to be nearly 95 percent effective in preventing COVID-19, and probably even more effective in preventing severe COVID-19 resulting in hospitalization or death. I do not know whether giving a second course of a different vaccine will lead to an even higher degree of protection, nor whether it might lead to worse side effects.
What is most critical right now is to get the vaccine administered to as many people as possible to stop ongoing transmission. That means prioritizing those who haven’t had it, particularly those at higher risk. Soon, however, there may be enough vaccine to consider studying whether additional vaccination will be helpful.
I can’t think of a historical case where multiple types of vaccines given together led to improved outcomes, but we do seem to be living through a historic event.
Q: My husband thought his second shingles shot was in January, but it was in February, and he took his COVID-19 vaccine only one week apart from the shingles vaccine. He didn’t have any reaction to either COVID shot. Were those two kinds of vaccines taken too close, canceling out the effectiveness? I am worried he won’t have the protection from both vaccines to get immunity.
A: There is no data on administering other vaccines along with the COVID-19 vaccine, so it is recommended to leave a buffer of two weeks between vaccines. However, if a vaccine really needs to be given near the same time, it can. The Centers for Disease Control and Prevention stated: “If COVID-19 vaccines are administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.”
Q: I was receiving my second injection of the Moderna COVID vaccine when I felt wetness on my arm and hand. It appears some or all of the vaccine leaked. I felt the needle enter my arm and then the wetness. The nurse stated the vaccine entered my arm. He wiped down my arm. I did NOT have a sore arm nor any other side effects. After the first injection I had a sore arm and fatigue. So, am I fully vaccinated? Should I receive another injection?
A: It is not uncommon for a small amount of the vaccine to leak out of the arm after injection. Recommendations from experts state that if at least half of the vaccine went in, the dose does not need to be repeated. Presumably the nurse noted only a small amount of leak, but I can’t say for sure what happened or how much went in.
A small proportion of the vaccine can look like a lot on the outside of your arm. If you are really worried that you didn’t get enough of the vaccine, I would discuss with the person in charge of the administration site the possibility of getting another dose.
Q: I am a 77-year-old female. I am current on all vaccines, but I do have a question about the pneumococcal vaccine. My current physician recommends that I get one. I thought that I had gotten that vaccine a few years ago from my physician who retired. We are unable to find in my medical file that it was given. That was also a time when they were switching to all computer access charting. I also got no confirmation from the pharmacy that sometimes gives my vaccines.
My physician recommends I get another one since we have no record or proof of it being administered. Is it safe to get it again if I have had it? I am willing to do so, but I’d like a second opinion. I just completed my Moderna COVID-19 series, so I would get the pneumococcal vaccine in three months.
A: There are two kinds of pneumococcal vaccines. These protect against pneumonia and other serious diseases, such as meningitis and bacteremia, from the bacteria Streptococcus pneumoniae, also called pneumococcus. They are sometimes referred to as pneumonia vaccines, but pneumococcal vaccine is more correct.
I am pretty sure your doctor is recommending the pneumococcal polysaccharide vaccine, which protects against 23 different subtypes of pneumococcus. This one is called PPSV-23, or known by its brand name, Pneumovax. The other, the pneumococcal conjugate vaccine, protects against 13 types (PCV-13 or Prevnar).
Recently, the Advisory Committee on Immunization Practices, which makes recommendations about vaccine use, downgraded its recommendation about the PCV-13 from universally recommending it to all 65-year-olds to instead having a discussion about whether it’s appropriate on an individual basis. Since children have started routinely getting the PCV-13, there is a lot less invasive pneumococcal disease of the subtypes protected by the PCV-13.
In your case, the choice is whether to give the PPSV-23 again, possibly for a second time — or not, meaning you might not have ever gotten it. In my mind, the balance of risks is strongly in favor of giving the vaccine. Getting it twice is not harmful. It’s a well-tolerated vaccine, with generally far fewer side effects than the Moderna vaccine you just took. I’ve had patients get it twice with no ill effects.
Q: Can you advise me on using melatonin? I am 69 years old, and I try to do all the normal things to encourage sleep, like avoiding screens and caffeine, and going to bed at the same time each night. I will take a 3 mg tablet and then if it doesn’t work, I will get up an hour later and take another. What do you think? My doctor says it’s OK to take with my medicines.
A: Melatonin is one of the safest sleep aids available, but, unfortunately, it is ineffective for many people.
Oddly, the use of lower doses often has better results than higher doses. Especially for older adults, I recommend doses of 0.5 to 1 mg. These are harder to find than higher doses, but you may be able to split a larger tablet.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell .edu or send mail to 628 Virginia Dr., Orlando, FL 32803.