Iti Salun-At Yo

Summer’s end signals Fall preparations

Errol Buntuyan, M.D., FAAFP

Hard to believe we are already in the month of September which signals the end of summer. As the pumpkin spice and cinnamon flavors emerge from our favorite cafēs and dessert shops, so does the usual preparation for the upcoming Fall and the viral season of illnesses we anticipate every year. Normally this time of year, we prepare for the influenza season and start recommending people to get the flu vaccine.

The 2022 vaccines for influenza have just arrived on Maui and they are now readily available at many clinics throughout the island. Often times, people tend to wait until later in Winter to receive the flu vaccine because the influenza season usually lasts from October to March.

This year is exceptionally different. For most of the year, Omicron and its subvariants have yielded milder symptoms resembling more of the common cold and influenza. Since the start of the pandemic we were safe to assume these symptoms were all due to COVID because influenza cases disappeared due to our lockdown and isolation precautions. We have, however, already seen a rise in positive influenza cases emerge earlier late this spring and early summer. We also saw the emergence and spread of the Monkeypox virus over the last few months. Monkeypox vaccines are available through Mālama I Ke Ola Health Center in Wailuku for those who qualify in high-risk exposure groups.

Needless to say, as this COVID pandemic transitions to an endemic, the viral landscape of illnesses has yielded unpredictable developments. Influenza is already here on Maui. So get your flu vaccine!

This month the FDA approved the Emergency Use Authorization of the new Bivalent COVID mRNA booster vaccine. Both Pfizer and Moderna are manufacturing this Bivalent booster. This new vaccine booster was developed to include Omicron spike proteins in addition to the original mRNA vaccine formula with ancestral spike proteins we have used for initial doses and prior boosters.

At least 77.3 percent of Hawai‘i residents completed the initial COVID vaccination series. Only 44.8 percent had the first booster and even less (11.6 percent) received the second booster. On Maui, the numbers are lower with only 71 percent having completed the primary series, 42 percent with the first booster and 9 percent with the second booster.

With this new Bivalent COVID vaccine booster, the CDC recommends everyone over the age of twelve should receive it to obtain the best protection from Omicron infection, risks of severe illness and hospitalization. Getting boosted also protects from suffering the symptoms of long COVID such as fatigue, brain fog and cough.

The CDC recommends everyone stay up to date with COVID-19 vaccination, including all primary series doses and boosters for their age group.

Four COVID-19 vaccines are approved or authorized in the United States to prevent COVID-19: Pfizer-BioNTech, Moderna, Novavax and Johnson & Johnson’s Janssen (J&J/Janssen). It’s recommended the J&J/Janssen COVID-19 vaccine only be considered in some situations. The CDC does not recommend mixing products for your primary series doses. If you received Pfizer-BioNTech, Moderna or Novavax for the first dose of your primary series, you should get the same product for all following primary series doses. Novavax is not authorized for use as a booster dose at this time.

Ages 6 months through 4 years should receive all COVID-19 primary monovalent series doses. Boosters are not yet recommended for this age group.

Ages 5 years to 11 years old should receive all primary monovalent series doses and updated COVID-19 monovalent boosters if eligible. Children ages 5 through 11 years who received a Pfizer-BioNTech primary series must also get Pfizer-BioNTech for a booster.

Ages 12 and up, after getting the original monovalent vaccine series completed, the only booster available will be the new Bivalent booster. People ages 12 years and older can no longer get the original (monovalent) mRNA as a booster. Teens ages 12-17 years may get a different product for a booster than they received for their primary series, as long as the booster is Pfizer-BioNTech. People ages 18 years and older may get a different product for a booster than they received for their primary series.

For ages 50 and up, even if you had the two prior monovalent vaccines as boosters, you are now eligible to get this new Bivalent booster if it has been at least two months since your last COVID vaccine shot.

If you have not received any COVID vaccinations yet, you can start with the primary monovalent vaccine to complete the primary series and then be eligible for the new Bivalent booster.

Below is the CDC link regarding booster questions:
With both the flu season already here and with the Omicron variant actively circulating in our community, it will be interesting to see what the upcoming Fall and Winter seasons will yield. Will there be yet another COVID subvariant developing? How sick will people be feeling should they get exposed and infected? How many will get infected with influenza? How many will get sick with both viral illnesses?

Many people are now no longer wearing masks nor as vigilant about practicing the basic safety precautions (social distancing, masking, hand sanitizing). These safety precautions literally took the number of influenza infection to zero cases in 2020 and 2021. Both viruses are out there and we have the influenza vaccine and the new COVID boosters ready to protect us from being severely sick if we get exposed and infected. Take care of yourselves and each other and get updated on your vaccinations for these Fall and Winter seasons.

Errol Buntuyan, M.D. is a Family Medicine Practitioner and the Physician in Charge of Maui Primary Care at Kaiser Permanente. Born in Quezon City and raised in Southern California, he has been practicing medicine on Maui since 2007. Dr. Buntuyan promotes whole food, plant based nutrition, regular physical activity, stress mindfulness and sleep hygiene as keys to optimum health and wellness. He enjoys cooking, playing tennis and travel.