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    Lisa Bywaters
    28/Oct/2021
    Health InformationMSK articles

    COVID booster shots and 3rd doses – what’s the deal?

    22 February 2022 – This article was written in October 2021. In December 2021, the Australian Government approved and recommended booster shots for all eligible people aged 16 and over. You can find the latest advice on booster vaccines on the Department of Health website.

    There’s been a lot of talk in the media recently about boosters and third doses of the COVID-19 vaccines. And the nurses on our Help Line are certainly taking lots of calls about it! So we thought we’d answer some of your questions about this next step in the vaccination rollout.

    Honestly, most of us thought that once the majority of Australians were double vaxed, it was smooth sailing ahead. That everything was sorted. Job’s done. Time to ‘get on the beers’ and return to normality. 🍻

    But this virus is tricky, and we’re still learning so much about it. Including how to protect ourselves from it.

    Fortunately, we can look overseas for information. With Australia’s vaccine rollout months behind countries like the UK, US and Israel, we can learn a lot from their experiences and the data they’re collecting.

    We know that after two doses of the vaccines, healthy people have a greatly reduced risk of developing severe COVID or ending up in hospital. Which is fantastic news. Yay for vaccines!

    However, we’re seeing that some people with weakened immune systems (immunocompromised) have caught COVID, even though they’re fully vaccinated.

    Although we don’t know exactly why this happens, it appears that people who are immunocompromised have a varied response to the vaccine. They do gain immunity, but it’s generally not to the same extent as the general population. And how much immunity they gain depends on their underlying health condition and the medications they’re using.

    That’s why the Australian Technical Advisory Group on Immunisation (ATAGI) has recently recommended a 3rd dose of the vaccine to severely immunocompromised people so that they can reach a level of immunity that’s protective. You can check out their list of immunocompromising conditions and therapies here. The Australian Rheumatology Association has also updated their COVID-19 information to include information about third doses. And if you want to know if you need to get a 3rd dose – because the information can be a little confusing – talk with your GP or specialist about your situation.

    It’s worth pointing out that the use of additional doses to increase the vaccine’s effectiveness in immunocompromised people isn’t a new thing. It happens with other vaccines, for example, the annual flu shot to boost immunity to the influenza virus. Instead of one flu shot, some people require two.

    When it comes to the general population – again using overseas experiences and data – we’re seeing that about 6 months after the 2nd vax, the protection from the vaccines seems to be waning.

    A booster shot may be needed if immunity to the virus does start to decrease. The Therapeutic Goods Administration (TGA), in consultation with ATAGI, has assessed the Pfizer vaccine for safety and effectiveness as a booster. As of 27 October 2021, it was provisionally approved for use in those aged 18 and over. The first in line to get it will be those who received their vaccines firsts – way back in February 2021 – so that’s aged care residents, frontline health and quarantine workers. The government is waiting on further advice from ATAGI as to when the rest of the population will receive boosters.

    Booster shots may also be required in the future as we see different variants of the virus emerge. Again, as we see with the annual flu vaccination, it’s tweaked each year to keep up with changes to the influenza virus. This may be what happens with the COVID vaccine.

    At this stage, the Pfizer vaccine is the only one put forward as a booster. So what does that mean if you received a Moderna or AstraZeneca vaccine for your first two doses?

    We’re not sure. Several studies are investigating this very question. It’s possible that mixing different vaccines might broaden your protection. But the research is ongoing, and it’s just too early to say. So it’s a matter of ‘watch this space’.

    Finally, it’s essential to recognise that being vaccinated doesn’t stop people from getting COVID. But it significantly reduces the risk of severe disease and hospitalisation. That’s why we need to be vigilant and do all the COVID-safe things we’ve been doing since this whole thing started:

    • wash your hands
    • cover your coughs and sneezes
    • wear a mask (when required)
    • physical distance
    • check in
    • stay home when sick
    • get tested
    • and stay safe.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    Lisa Bywaters
    13/May/2021
    Health InformationMSK articles

    Worried about the COVID vaccine? Me too

    22 February 2022 – Note: This article was written in May 2021 when we were still apprehensive about the vaccine rollout. Much has changed since then! The majority of the eligible Australian population have now received two doses of a COVID-19 vaccine, and many have received their booster. For the latest info about the COVID-19 vaccines, visit the Australian Government, Department of Health website.

    I was having lunch with friends last week. Two of us have recently turned 50, so of course the discussion turned to our eligibility to get the COVID vaccination (the fun never ends when you hit the big 5-0!).

    I was surprised to find I wasn’t the only one starting to feel a little worried about being vaccinated. For months now, most people I know have been gung-ho, and ready to roll up their sleeves for the COVID vaccination.

    So what’s changed?

    Our confidence.

    We all know that in order to reach herd immunity – in Australia and globally – and reduce the spread of COVID, mass vaccination is our best option.

    But many of us are losing confidence in the vaccination rollout, and are starting to become anxious about potential risks, especially around the AstraZeneca vaccine.

    Our confidence in the Federal and state/territory governments has eroded over the past year. Petty squabbling between our governments, snap borders closures, lockdowns, problems with hotel quarantine, changes to vaccination targets, and the lack of choice when it comes to which vaccine we receive have made us question everything. Even the speed with which vaccines were created has made a lot of people worry.

    The issue of rare blood clots associated with the AstraZeneca vaccine, which saw use of this vaccine paused in several countries, and the Australian Technical Advisory Group on Immunisation (ATAGI) recommending Pfizer over AstraZeneca for those under 50, has been just another blow to our confidence.

    On top of all of this has been the poor communication from our governments. Information has been very brief, lacking the detail that many of us want, or too complicated, especially around the issue of blood clots. And so many became hesitant about vaccination. Even though we knew it’s the best way out of this pandemic.

    Our concerns are valid. Our choice will have an impact on our health and our lives.

    So what can we do to deal with our hesitancy? We need to become better informed so we’re making decisions based on fact, not fear or misinformation.

    Things to know about getting vaccinated:

    Don’t believe everything you read or hear – on socials, in the media, from your neighbour. There’s been a lot of incorrect, biased and out-of-date information shared. The Australian Government COVID vaccine info, and your state/territory health websites are important places to start for accurate information. Then it’s a matter of discussing this information with your GP or specialist about your specific set of circumstances, and asking the questions that matter most to you.

    Getting vaccinated reduces your risk of becoming seriously ill or dying if you do get the virus. Being vaccinated also reduces the risk of passing the virus on to others if you do become infected. Read this article for more info: Mounting evidence suggests COVID vaccines do reduce transmission. How does this work? 

    We can’t choose which vaccine we receive. Unfortunately we currently only have the Pfizer and AstraZeneca vaccines available for use in Australia. With the recent side effect of blood clots associated with AstraZeneca, the Australian Technical Advisory Group on Immunisation (ATAGI) has stated that the Pfizer vaccine is preferred for people under the age of 50 who have a higher chance of developing this side effect. For those 50 and over, you will receive the AstraZeneca vaccine.

    About those blood clots. We’ve seen media reports of people hospitalised for thrombosis with thrombocytopenia syndrome (TTS) after receiving the AstraZeneca vaccine. And as someone who’s 50 and will receive this vaccine, the news coverage is scary. However it’s important to also be aware that the majority of people who experienced this side effect survived. Some were hospitalised and even spent time in intensive care – which is not nothing. But the weight of the evidence to date supports that your risk of developing severe illness or dying from COVID is greater than the risk of developing TTS.

    Although the vaccines appeared quickly, researchers and manufacturers didn’t skip steps. The difference between developing the COVID vaccines, and past vaccines, is that we had so much genetic information about the virus very early on. We also had technologies in place, and government funding around the world, for work to begin as soon as possible.

    Out of the large number of potential vaccines on the radar in 2020, only a small number made it through clinical trials. Many of the others fell by the wayside due to safety and efficacy issues.

    The ones that did make it through then had to jump through the hoops of the Therapeutic Goods Administration (TGA) in Australia, and similar organisations around the world. Read the TGA info on the vaccine approval process and their safety monitoring system.

    The Australian Rheumatology Association recommends that people with rheumatoid arthritis, systemic lupus erythematosus (SLE) and other autoimmune inflammatory rheumatic diseases get vaccinated.

    Finally
    Although in Australia we’ve been extremely lucky to have very low numbers of people being infected or dying from COVID, this could change, as we’ve seen in other parts of the world. So we can’t afford to become complacent. Whether you choose to be vaccinated or not, we all still need to adhere to the safety precautions we’ve become so familiar with:

    • wash your hands regularly and thoroughly with soap and water
    • use hand sanitiser when you don’t have access to soap and water
    • cough or sneeze into your arm or a tissue; put the tissue in the bin and wash/sanitise your hands
    • avoid touching your face
    • clean surfaces regularly
    • physically distance yourself from others
    • stay home if you’re sick
    • get tested.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    CONTINUE READING
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    Lisa Bywaters
    18/Feb/2021
    Health InformationMSK articles

    To be or not to be vaccinated, that is the question

    10 August 2021 – Please note: This information was correct at the time of writing. But COVID-world has a rapidly changing landscape, so for the most up-to-date information about vaccines, visit the Australian Government, Department of Health website. 

    Did you know that the second person in the world to get vaccinated against COVID-19 (outside of a clinical trial) was William Shakespeare? The UK was the first to roll out the Pfizer vaccine, and 81 year old William was the second in line to get the jab.

    Obviously the media (and people like me) couldn’t let that go by without a joke or two! So after the jab there was a chorus of “Is this a needle which I see before me?”, and “All’s well that ends well’, and the vaccines will lead to the “Taming of the Flu.” And really when it comes to it, it’s all “Much ado about nothing”.

    OK, silliness over ?.

    Obviously you can’t open a paper, watch the news or look at social media and not know that the COVID-19 vaccines are coming to Australia very soon. In fact the first shipment of the Pfizer/BioNTech vaccine arrived earlier this week.

    There’s a lot of confusion and concern out there, so we’ve answered some of the FAQs we’re being asked. We’ve also included links to other great resources to help you understand these new vaccines and what they mean for you and your family.

    What are the two main vaccines?

    In Australia the Therapeutic Goods Administration (TGA) has so far approved the use of the Pfizer/BioNTech vaccine and the AstraZeneca/Oxford vaccine.

    There are other vaccines in the pipeline which may be available later in 2021. However this article will focus on the two main vaccines that the Australian Government will begin rolling out in the next month or so.

    It’s important to note that these vaccines are for adults only at this stage, and that children and pregnant women were not part of the clinical trials. That means we don’t have the information to ensure the vaccines are completely safe for these populations at this stage. If you’re pregnant, breastfeeding or planning a pregnancy, read the federal government’s decision making guide for more information and discuss your specific situation with your doctor.

    How do they work?

    We’ve all heard of DNA (deoxyribonucleic acid). It’s the genetic material that carries all the information (or genetic code) about how all living things look, develop and function.

    However for many types of viruses – including influenza and coronaviruses – their genetic code is stored in their RNA (ribonucleic acid). It provides all the instructions for how the virus works.

    Since very early on in the pandemic, scientists have had the genetic code for SARS-CoV-2 (the virus that causes COVID-19). This has made an incredible difference to how quickly vaccines were able to be developed, trialled and ultimately administered.

    By now we’re very familiar with the spiky, crown-like surface of the coronavirus SARS-CoV-2. These spike proteins are what allows it to penetrate and enter our cells, where it proceeds to take over. The virus then instructs our cells to become a virus making factory and before you know it, you’ve got COVID-19.

    Researchers have used the genetic code of SARS-CoV-2 that specifically relates to these spike proteins to develop their vaccines.

    With the Pfizer/BioNTech vaccine they used the genetic code to create their own synthetic RNA. This synthetic RNA contains information of the spike protein only, not the virus itself. So it can’t give you COVID-19. The RNA information is wrapped inside a fatty coating or envelope to protect it. This stops the body from breaking it down as soon as it’s been administered.

    The AstraZeneca/Oxford vaccine is known as a ‘viral vector vaccine’. It adds the genetic information about the spike proteins into another virus or a ‘vector’, in this case a genetically modified virus that normally causes the common cold in chimpanzees but not humans.

    Despite the differences in the Pfizer/BioNTech and AstraZeneca/Oxford vaccines the body’s response is the same. Our cells again become factories – but this time they only make the spike protein (not the actual virus). The presence of this protein in our body triggers our immune system to mount an attack, which creates antibodies that are ready for if/when the real SARS-COV-2 comes knocking.

    Are they safe?

    The information we have to date is that these vaccines are safe to use. Our TGA has rigorous checks and balances in place before any drug (including vaccines) become available to the Australian population.

    We also have the benefit of observing the rollout in large populations such as those in the UK and US, and monitoring for any unusual side effects or concerns.

    Even after our vaccines are being rolled out across Australia, the TGA will continue to monitor for any issues.

    How are they administered?

    Like many of the vaccinations we get, the COVID-19 vaccinations will be injected into your upper arm. Both require two doses approximately 12 weeks apart. It’s important that you receive both doses.

    After you’ve been vaccinated you’ll stay where you are for about 15 minutes to ensure you’re feeling ok afterwards.

    What if I have a weak immune system?

    If you have a medical condition, or take medications that mean you have a weakened immune system, you should still be able to receive these vaccinations. Remember the vaccines aren’t using live viruses.

    The vaccines may help prevent you getting COVID-19, or prevent you getting a more serious case.

    Read the latest information from the Australian Rheumatology Association: COVID-19 information. And talk with your doctor if you have any concerns at all.

    Do I have to get vaccinated?

    COVID-19 vaccinations are voluntary. You choose whether to have one or not.

    Can I choose which one I get?

    Yo will not be able to choose which vaccine you receive.

    Australia has secured fewer doses of the Pfizer/BioNTech vaccine (20 million doses), compared to AstraZeneca/Oxford vaccine (3.8 million doses delivered from offshore facilities, and 50 million to be produced onshore this year).

    The Australian Government, working with the state/territory governments, has a comprehensive strategy for vaccine rollout, prioritising those at greatest risk of being exposed to SARS-COV-2, or having worse outcomes if they develop COVID-19. This includes frontline health care workers, quarantine and border staff, aged and disability care workers, and aged and disability care residents.

    From then on vaccinations will be a phased process, dealing with each group of vulnerable people. You can find out more about the vaccination rollout here.

    You can also use the Australian Government’s Vaccine Eligibility Checker to find out which phase of the rollout you’re eligible for.

    Do I have to pay for my vaccinations?

    No, they’re free.

    The Medicare Benefits Schedule has been amended to cover GP’s costs associated with the COVID vaccinations. That means you’ll be bulk billed for your consultation and vaccination, and won’t need to pay a thing.

    Will it make me immune from catching or spreading COVID-19?

    We’re not sure.

    The vaccine trials were studying whether the vaccines stopped COVID-19 symptoms or reduced the severity of symptoms, not whether it protected people from getting infected with the virus. So the vaccines may not protect people from catching the virus if they’re exposed to it, but hopefully it will reduce the impact of symptoms.

    We also don’t know if someone who gets vaccinated and later develops COVID-19 – but has no symptoms (asymptomatic) – is able to spread the virus to others. We just don’t have enough data.

    That means that unfortunately the vaccinations won’t be a ‘get out of jail free’ card. We’ll still need to do all the things we’ve been doing for the last year – wash our hands with soap and water regularly, use hand sanitiser, practise physical distancing, wear a mask if required, and get tested and isolate if you feel sick.

    What are the side effects?

    Some people (not all) may feel a bit off colour for a day or two. They may experience flu-like symptoms (muscle and joint pain, headache, chills), and/or pain and redness where they received the injection. This is your immune system responding to the vaccine, not to the virus. The best thing to do is look after yourself, find a comfy position on the couch and watch your latest binge-worthy show.

    Can I catch COVID-19 from these vaccines?

    No, as the vaccines aren’t live.

    Do I still need to get a flu vaccination this year?

    Yes, if you normally get a flu shot each year, plan to do it again.

    Influenza viruses are different to SARS-COV-2, and so the vaccinations are different.

    However it’s important that you allow 14 days between a flu vaccination and either dose of the COVID-19 vaccination. Your doctor can give you more information and help you make sure your timing is right.

    Will getting vaccinated make everything go back to ‘normal’?

    If by normal you mean, pre-COVID craziness, it’s very unlikely. Apart from the potential for being asymptomatic and possibly spreading the virus even after vaccination, there’s still a lot of unknowns. Even though it feels like it’s all been going on forever, in the life of a new virus and the work needed to get it under control, we still have a ways to go. The only way to do that is to stop the spread of the virus.

    When it comes to vaccination, the World Health Organization has stated that “a substantial proportion of a population would need to be vaccinated, lowering the overall amount of virus able to spread in the whole population”. What ‘substantial’ means exactly isn’t clear, and numbers from 50-80% of the population have been thrown around from a variety of sources.

    But it’s not all cause for gloom. This time last year we were just entering the pandemic and there was so much we didn’t know. But science has made amazing strides, collaboration between researchers and big pharmaceutical companies has been unprecedented and we’ve learned so much about ourselves as we’ve led much smaller, intimate lives.

    Yes, we’re still in the middle of this pandemic, but we’ve come so far and grown so much. And for that we should all be proud and continue moving forward – one step at a time.

    Contact our Help Line

    If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    Lisa Bywaters
    13/May/2020
    Health InformationMSK articles

    A vaccine for COVID-19

    Just the shot in the arm we need?

    It’s seems crazy when you think about it, COVID-19 has had such a life changing effect on us, but unless you’re a healthcare worker, you probably don’t even know someone who’s had it. Yay for the success of our pandemic plan, but it also means most of us are still susceptible to it.

    But we can’t stay in iso forever. Apart from all of the obvious reasons, we’ve run out of jigsaws, eaten all of the banana bread and we’re over video chatting to our friends about doing nothing.

    It appears that the only way we can get back to our normal lives is if there’s an effective vaccine against COVID-19. So far the info we’re hearing from scientists developing vaccines these vaccines is encouraging. We’re even hearing that one may be available as early as September this year! But what are vaccines, how do they work and what are the chances we’ll have a vaccine for this virus any time soon?

    Your immune system

    To understand how vaccines work, it’s important to understand a little about your immune system. It’s designed to protect you against harmful diseases and infections caused by foreign bodies (also called pathogens) such as viruses, bacterium and other microbes. When your body detects the presence of a pathogen, your immune system mounts an attack to try to defeat it.

    Side note: For those of you who have an autoimmune condition like rheumatoid arthritis, lupus or ankylosing spondylitis, your immune system has gone a little bonkers and has attacked your own body instead of a potentially harmful pathogen. This really sucks. But we can help. Contact our Help Line on 1800 263 265 weekdays.

    Vaccines

    Vaccines work by introducing your immune system to a virus or bacteria. This allows it to learn how to protect you from the pathogen before you meet it out in the world. A vaccine is a weakened or inactivated version of the pathogen. It causes your body to create antibodies – these are the soldiers in the battle against the foreign invader. They have one target and one target only…the specific virus or bacteria that you were vaccinated against. If it ever encounters it, it latches on and destroys or disables it.

    Well that’s the immune system and vaccines in the smallest of nutshells. Watch this short video How do vaccines work? for more info.

    Now it’s time to look at COVID-19 and the efforts to create a vaccine against it. You may be wondering why a vaccine rather than a treatment? That’s a good question, and there’s a LOT of work going into finding effective treatments for COVID. But to treat someone, they already need to be infected. And because this virus is highly infectious, that person can go on to infect many others. So it’s preferable that we prevent this and any subsequent spread of disease is prevented altogether.

    We know a lot about COVID-19

    Even though there are still so many unknowns, we do know a lot about this virus. If you compare it to other new viruses or disease outbreaks, we’re so much further ahead, which is really good news. We knew the genetic makeup of this virus within a couple of months of the outbreak. Researchers used this info to develop tests for diagnosing COVID and to start working on potential vaccines and treatments. So we’ve come a long way in a very short time.

    Types of vaccines

    Just as there are different types of pathogens, there are different types of vaccines. The type of vaccine developed will depend on characteristics of the pathogen and how it affects people

    Types of vaccines include:

    • A weakened, live version of the virus. We use this type of vaccine to prevent diseases such as measles, mumps, chicken pox and rubella. Note: people who have suppressed immune systems can’t use live vaccines.
    • An inactivated vaccine (e.g. flu vaccination). Chemicals are used to destroy the virus before being injected however it’s not as effective as a live vaccine, which is why we have regular boosters.
    • Vaccines that target specific parts of the virus, rather than the whole thing. This is used for diseases such as shingles, whooping cough and tetanus.

    Creating a vaccine

    A great article by The Conversation (31 March) outlined the steps involved in creating a vaccine for COVID-19:

    1. Basic understanding of the virus.
    2. Scientists decide which approach to use from the list above – i.e a live vaccine, an inactivated vaccine etc.
    3. Initial safety testing is carried out in animals to help us understand how it may affect people.
    4. Clinical trials being using people. There are three phases:
      • Phase I – testing on a small number of people, to see how safe it is, and if it has any side effects,
      • Phase II – testing on several hundred people to test for efficacy – or see if it works how it’s meant to work
      • Phase III – testing on several thousand people for efficacy and safety.
        If the vaccine can show it’s safe and provides effective protection against the virus, it will then go on to the next stage.
    5. Regulatory approvals.
    6. Production. This will involve a lot of work to create the quantities of vaccine we need to vaccinate large populations, and to ensure the vaccines are produced safely and with great attention to quality control.

    For more information read: Coronavirus vaccine: here are the steps it will need to go through during development.

    And….after all that we need to actually vaccinate people on a global scale! – which will take a great deal of planning and coordination.

    So when will we have a vaccine?

    The short answer is we don’t know. Most scientists say between 12-18 months. There are some who are more optimistic and say by the end of the year. With over 100 vaccines being researched around the globe, it may well be sooner rather than later. However we need to be mindful that we can’t rush this at the expense of safety.

    So until a vaccine does appear we need to get comfortable with our new normal. We need to continue with our physical distancing, maintain high levels of hygiene, stay active, eat well, managing our mental health and follow the restrictions that are in place where we live. This will eventually pass, but it will take time.

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