Letter to the Editor

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Dear Editor,

I am encouraged by recent advances in prevention and control of the SARS­2 virus pandemic including new indications for highly effective vaccines to prevent Coronavirus Disease 2019 (COVID19).

First, for certain persons who were vaccinated with an RNA (Pfizer and Moderna) and for all persons who received the (Johnson and Johnson/Jansen) vaccine, a booster dose is highly recommended to give better protection. Any of the three vaccines can be used for the booster dose. Those 65 and older, those exposed through group living settings, and those occupationally exposed are those who benefit most. Persons who are immunocompromised require 3 and sometimes 4 doses to mount a protective response. Multiple doses of vaccines are not unusual as most vaccines require multiple doses to be highly effective.

Second, children 12­17 years have been recommended to receive Pfizer vaccine against CoViD19. Among this age group, over 16,000, or approximately 1 in 8 Oklahoma children have tested positive. To date in Oklahoma, only about one­third of children in this age group have been fully vaccinated against COVID19, far below the national average. Influenza vaccine and vaccine against CoViD19 can be given concurrently. Vaccination decreases the need for quarantine after exposure to someone with CoViD19.

After the US Food and Drug Administration recommended Pfizer pediatric vaccine for children 5­11 years of age, the Centers for Disease Control and Prevention recommended vaccination for all children in this age group on Nov. 2. In Oklahoma, almost 10,000 children 5­11 years of age (1 in 10) have tested positive. Prevention of personal illness, transmission to classmates, teachers and family are all important reasons to vaccinate children of this age.

Still, the group with the highest cumulative incidence of disease (about 20,000/100,000 (2 in 10) are those 18­54 years of age. In the most recent Oklahoma State Epidemiological Report, this group constituted 54% of new cases and 37% of new hospitalizations. Not surprisingly, this age group has a lower rate of complete vaccination ranging from 36 to 52%. Vaccination is highly recommended for this age group.

Some have suggested natural immunity following infection is preferred to vaccination. However, a recent published study indicates that vaccination provides better protection than natural immunity. Among persons hospitalized with symptoms compatible with CoViD19, those who had evidence of previous infection 3­9 months previously were 5.5 times more likely to test positive for SARS­2 virus than those who had been vaccinated during a similar time­frame www.cdc.gov/mmwr .

I echo local, state, national and international experts: please get vaccinated against COVID19 and get your influenza vaccination too. Visit your county, Indian Health Service, Veterans Administration, or other provider to get your vaccine.

Joe P Bryan, MD

Retired US Navy, Department of State and Centers for Disease Control and Prevention