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Special Reports > Exclusives


HOW BAD IS IT TO GET A BOOSTER WHILE YOU HAVE COVID?


— SOME PEOPLE MAY NOT KNOW THEY ARE INFECTED WHEN THEY GET BOOSTED

by Sophie Putka, Enterprise & Investigative Writer, MedPage Today December 17,
2021


MedpageToday

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Last week, our colleague at MedPage Today got her booster shot. She was ready
for the vaccine's side effects -- fatigue, aches, maybe even a fever. What she
didn't expect was a sickness that would last for days, and a positive rapid
antigen test for COVID-19.

In retrospect, it made sense. She remembered a tickle in her throat the day of
her booster shot, but she had just figured it was her body's response to a busy
weekend. After deciding to get tested, she found out she'd been in contact with
someone who had tested positive.



Thankfully, it appeared to be a mild infection. But what happens when someone
gets a booster shot when they are already infected with SARS-CoV-2? MedPage
Today talked to infectious disease and microbiology experts to find out.

Whether you get inadvertently infected with the virus right before or right
after getting boosted, an infection may cause symptoms, but isn't likely to
interfere with the booster's effects, said Amesh Adalja, MD, an infectious
disease physician at Johns Hopkins School of Public Health in Baltimore.

"I suspect it's not going to be a major effect other than that you might be
contending with more symptoms from the vaccine and from the infection that you
have at the same time," he said. "It could be more unpleasant than normal."

In fact, your chances of getting infected with SARS-CoV-2 are almost as high up
to 6 days after getting a booster shot as with no booster, according to a study
published in JAMA Internal Medicine. "If you only got your booster a day ago,
then you might as well not have it at all," said Benjamin tenOever, PhD, a
professor in the microbiology department at NYU Grossman School of Medicine.



When going in for a booster shot, vaccination site staff may ask if you're
feeling symptoms of COVID-19. This isn't because the infection and the booster
interact, but rather to protect everyone at the vaccination site. However,
Simone Wildes, MD, an infectious disease physician at South Shore Health in
South Weymouth, Massachusetts, said that while an infection close to or around
the time of vaccination isn't uncommon or particularly harmful, it makes more
sense to wait until antibody levels fall after an infection, and then get a
booster.

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The CDC initially recommended waiting 90 days after an infection to get
vaccinated. But guidelines have since changed to reduce the chances that someone
might skip the vaccine or booster altogether after waiting, she said. According
to the updated guidelines, "People with COVID-19 who have symptoms should wait
to be vaccinated until they have recovered from their illness and have met the
criteria for discontinuing isolation."



Despite both the infection and vaccine potentially leading to symptoms that
occur in response to a virus, the immune response to a vaccine, including the
booster, and the immune response to the virus itself are different processes.

Immune Response to mRNA Vaccines

After receiving a first inoculation, a few cells in the body will pick up the
injected mRNA, and begin to run what tenOever compared to a software program to
produce the spike glycoprotein characterizing SARS-CoV-2. Antigen-presenting
cells "are going to see this very strange-looking structure on the surface of
muscle cells in your shoulder and they're going to manage a response to it, and
that response takes some time," he said.

In those 2 to 3 weeks in which the immune response post-vaccine grows stronger,
"antigen-presenting cells will teach your immune system how to recognize this
foreign protein, which in this case, is spike," he added.



The mRNA that went into your arm also teaches the immune system to recognize the
foreign spike protein in muscle cells, via immunoglobulin G -- but not in the
mucosa, where it would use immunoglobulin A. Without this mucosal immunity,
tenOever explained, SARS-CoV-2 can infect the upper respiratory system after
exposure to the virus, but for the most part, can't get any further in a
vaccinated person.

Immune Response to SARS-CoV-2

If you are infected right around the time of the booster, not only are you
missing mucosal immunity, but you also lack the advantage of the learning
process the immune cells undergo in the weeks following vaccination. "The longer
the time between your booster and seeing an actual virus, the better off you
are, because you've given your immune system that much more time to explore
different spaces and ways to stop the virus," tenOever said.



But if you do happen to get an infection and recover, the immune learning
process is refined in a way that the mRNA vaccine can't induce. "When you get
infected, what happens is the virus obviously now starts killing cells and
destroying cells and making a giant mess and losing lots of inflammation. But it
also allows your immune system to recognize other components," he noted, such as
nucleocapsid protein, which is inside the virus, unlike the spike proteins.

How to Tell the Difference Between the Two

Adalja said that though fever, muscle aches and pains, and headaches can come
with both immune response scenarios, vaccine side effects are distinguishable
from the symptoms of a breakthrough infection -- to an extent.

"Upper respiratory symptoms would be one clue," Adalja explained. These include
a sore throat, congestion, and the loss of taste and smell.

"And then the other aspect would be if it's prolonged," he added. While side
effects from the booster may only last a day or two, a long stretch of illness
likely means an infection.



"That's the key thing," said Wildes. "If you're having the symptoms for more
than 72 hours, then we strongly recommend that you reach out to your healthcare
provider and get tested, because it shouldn't be going beyond that point with
the vaccine for most people."

Hybrid Immunity

Because the body builds such a robust response system after infection, immunity
from infection can be highly protective -- but is even more so with vaccination.
In a study in Nature, researchers found that vaccinated people with previous
infection better neutralized SARS-CoV-2 than did their vaccinated counterparts
with no previous infection. A preprint study out of Israel suggested that hybrid
immunity may last longer than vaccine-induced immunity, but both decline over
time.

So, how long does hybrid immunity fend off reinfection? "If [natural immunity]
happened with a Delta variant, it may not be sufficient against the Omicron
variant. But then again, the booster might not be sufficient against it either,"
said Adalja. "So, I think that's an open question."



If it was the case that you got enough immunity from a natural infection alone,
then we wouldn't be advocating for vaccines in these individuals as well, noted
Wildes. "It's not well sorted out because what happens is, different people
develop different levels of antibodies."

What to Expect

In any case, an infection that occurs before a booster shot has time to build up
the body's full defenses would likely be mild. This, of course, depends on other
factors: age, comorbidities, and immunocompromised status. It is still possible
to get a serious illness, and to spread the virus to others, experts said.

The bottom line is developing a breakthrough infection right before or right
after a booster shot is possible, and the resulting hybrid immunity confers some
extra protection. And, as with all responses to the virus, it varies from person
to person.

But the most important thing, experts emphasized, is to get vaccinated in the
first place, and to get a booster when appropriate.

"Just get your booster," said Wildes. "I want to make sure that the word gets
out that the data are clear: the two-dose vaccine is not going to be effective
against the Omicron variant, which is already here."

 * Sophie Putka is an enterprise and investigative writer for MedPage Today. Her
   work has appeared in the Wall Street Journal, Discover, Business Insider,
   Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021.
   Follow

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14 Comments Please enable JavaScript to view the comments powered by Disqus.

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