Coronavirus (COVID-19) Precautions

If it feels challenging to keep up with seemingly ever-changing vaccination recommendations, you are not alone.

Just this month, the Centers for Disease Control and Prevention (CDC) approved an updated version of the COVID-19 vaccine, which it recommends for everyone 6 months and older.

But what’s different about this updated COVID-19 vaccine? Should everyone get another COVID-19 vaccination? And does the vaccine’s brand matter?

We called on Ad Interim Chief Infection Control Officer Amy Spallone, M.D., to answer our questions on how to best navigate these updated vaccine recommendations. 

What is the difference between this year’s COVID-19 vaccine and the ones from earlier years?

It is important to note that this updated vaccine is not a booster and should not be referred to as a “booster shot,” because it is not boosting existing immunity.

The updated COVID-19 vaccine, recently approved by the Food and Drug Administration (FDA), was designed to build new immunity to variants that are currently circulating in our communities.

Overall, this updated vaccine has demonstrated protective effectiveness against the most common variants in the U.S., including EG.5, FL.1.5.1, and others in the XBB variant family. The updated vaccine should also be effective against BA.2.86, although this variant has not caused a significant number of infections in the U.S. to date.  

The updated COVID-19 vaccine is the only COVID-19 vaccine that's available this fall.

If you previously received a certain brand of COVID-19 vaccine or booster, is it OK to get a different brand of this COVID-19 vaccine?

If you received an mRNA vaccine, it’s preferable to stay with an mRNA vaccine. As long as you’re getting another mRNA vaccine, it doesn’t matter whether you’re getting the Spikevax (Moderna) or Comirnaty (Pfizer) vaccine.

However, if you cannot receive mRNA vaccines because of hypersensitivity, such as an allergy, Novavax’s COVID-19 vaccine is recommended as an alternative. 

Is it OK to get this new COVID-19 vaccine as your first COVID-19 shot if you have never been vaccinated before?

Yes. In fact, the CDC recommends that essentially all adults who are not immunocompromised should get one dose of these updated 2023-2024 shots from Moderna or Pfizer, regardless of their prior COVID-19 vaccination history. 

For our patients who are moderately to severely immunocompromised and previously unvaccinated, the CDC recommends three doses of the updated COVID-19 vaccine.

Is it still important to get a COVID-19 vaccine?  

We know from real-world experience with past variants that people with prior immunity from vaccines, infections, or both, still have protection against severe COVID-19 infection.

Vaccination also remains the best protection from COVID-19-related hospitalizations and death, and they may also reduce your chances of suffering from Long COVID symptoms, which can develop following an acute infection.

With multiple, closely related variants in circulation right now, making sure you’re updated on an updated vaccine will enhance our immune profile against current and newly emerging variants.  

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A new COVID-19 subvariant called XBB1.5 is on the rise across the U.S.  

Early reports indicate that it is much more contagious than previous variants, and may be better at avoiding the immune system’s defenses. To learn more, we went to Chief Infection Control Officer Roy Chemaly, M.D.  

1. How is the XBB1.5 subvariant different from previous strains of COVID-19? 

XBB1.5 contains more mutations that allow it to better avoid the human immune system’s defenses. That means even if you’ve been fully vaccinated and boosted and/or had a previous COVID-19 infection, XBB1.5 may be able to find a way around that to cause an infection anyway. So, it is more transmissible than any other variant. That’s what initially got our attention. 

The XBB1.5 subvariant is able to bind to human cell receptors much more efficiently. So, while previous variants took about 4 to 6 weeks to spread widely enough to become one of the most frequently found strains among confirmed cases, this one only took a couple of weeks.

As of Jan. 9, COVID-19 caused by the XBB1.5 subvariant accounted for about 25% of confirmed new cases in the U.S. 

2. Does the XBB1.5 subvariant make people sicker than previous variants?

It’s too early to say for sure, but XBB1.5 doesn’t appear to cause more severe illness than previous COVID-19 strains. It’s probably not going to be as bad as the delta variant since we’re not seeing higher rates of severe infection or hospitalization so far.

3. Do you anticipate a surge in cases caused by XBB1.5?

It’s too early to tell yet, but there are indications that this one might not be as bad. The worst surge by far was from omicron. I don’t think this one will be the same. 

I suspect that any surge we get from the XBB1.5 subvariant will be closer to the type we had with BA.4 and BA.5 this past summer. Both produced slow increases in the number of cases and then equally slow declines.

4. Do the current COVID-19 vaccines provide protection against XBB1.5? 

Absolutely. Getting a COVID-19 booster is still highly recommended. But remember: the goal of COVID-19 vaccines and boosters is not only to prevent infection. That would be unrealistic. The goal is to prevent severe infections that require hospitalization. And the current vaccines and boosters should still do that against the XBB1.5 subvariant.

5. Why should cancer patients and their caregivers pay particularly close attention to XBB1.5?

XBB1.5 is highly transmissible — and possibly the most transmissible subvariant so far, based on lab studies. That’s due to the specific mutations this one acquired, which make it much more contagious.

That’s why patients should make sure they’re fully vaccinated and boosted. That way, if you do catch it, you may still get sick, but you probably won’t die or be hospitalized. And even partial protection against severe infection and hospitalization is better than none.

6. Do the COVID-19 treatments work against XBB1.5? 

Yes, the oral or IV drugs we use to treat COVID-19, such as paxlovid and remdesivir, still work.

The monoclonal antibodies used to prevent infection, such as EVUSHELD, don’t work as well against XBB1.5. 

7. Any special guidance for immunocompromised people?

Because XBB1.5 is very contagious — and the flu, RSV and other respiratory viruses are still circulating — anyone who is immunocompromised should be extra vigilant about masking right now. Give yourself an added layer of protection by wearing a face mask any time you’re out in the community. 

Your first and best line of defense right now against COVID-19 is the vaccines, including the new bivalent boosters. But your second line of defense is masking. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

You might know that flu season got off to an earlier start than usual this year or that the respiratory syncytial virus (RSV) is making a serious comeback. You may have even heard people call this a “tripledemic” of viruses. But you may be wondering why, or what — if anything — you should do about it.

We checked in with Chief Infection Control Officer Roy Chemaly, M.D., to find out what patients and their families should know about protecting themselves from COVID-19, flu and RSV this year.

Why has there been such an uptick in the number of flu and RSV infections this year? 

It wasn’t unexpected. Any time you have large numbers of people taking effective steps to reduce the spread of one particular disease, you’re going to see much lower rates of other diseases in that same category. 

That’s why we saw so few cases of the flu, RSV and the common cold these past few years. Masking, social distancing, and good hand hygiene don’t just protect you from COVID-19. They protect you from a lot of other things, too.

The downside is that people haven’t been exposed to any of these germs recently, so they’re more vulnerable to them now that people have set aside a lot of those pandemic practices. And when those viruses do come back around, they tend to be more transmissible and cause more severe infection.

Is there any way to distinguish between the symptoms of RSV and those of the flu or COVID-19?

No. All of these viruses can cause many of the same symptoms, including:

• fever
• headache
• body aches
• runny nose
• cough
• sore throat
• sinus congestion

So, you can’t differentiate between them based solely on symptoms. There’s too much overlap.

The only way to definitively diagnose or rule out one of these viruses is to get tested. While you can use an at-home test for COVID-19, you’ll need to see a doctor to be diagnosed with the flu or RSV. You’d also need to be tested by a doctor for strep throat, a bacterial infection that can be treated with antibiotics. It shares some of these same symptoms, too, and is also going around.

What should cancer patients do if they have these symptoms?

Don’t go to the emergency room unless you have to. Many of these facilities are already overwhelmed right now with upper respiratory infection patients. So, you don’t want to go there unless you’re having trouble breathing, feeling short of breath or have a severe cough that’s getting worse instead of better. 

Test yourself at home for COVID-19, and if you test positive, contact your care team to see if they want you to start any anti-viral therapies. We have effective treatment options now for both the flu and COVID-19.

Can people get vaccinated against RSV?

No. Not yet. Maybe by the end of next year. A few companies have vaccines in development right now, but no RSV vaccine has been approved by the Food and Drug Administration (FDA) yet.

How should cancer patients and their families approach the holidays in this tripledemic? Is it safe to travel?

COVID-19 is becoming endemic now, just like the flu and the common cold. But it’s still circulating, along with the flu, strep and RSV, so it’s wise to be cautious.

It’s OK to travel and visit with family and friends, as long as you take reasonable precautions. That means you should get your bivalent COVID-19 booster now, or as soon as you’re eligible if you haven’t already. And get your flu shot, too. The vaccines may not prevent you from getting an infection, but they will reduce your risk of developing a severe infection or needing to be hospitalized.

You should also continue to do whatever you normally would to protect yourself. If you’ve been told to avoid crowds or practice social distancing, for instance, keep doing that. And you should still be wearing a mask at any large gathering, even if you’ve been vaccinated for both the flu and COVID-19. 

Are there any special steps that immunocompromised individuals should take to protect themselves against COVID-19, flu and RSV?

No. We’ve known for years that RSV can hit cancer patients hard, especially those who just received stem cell transplants or are immunocompromised for some other reason. We see it all the time during the winter.

But anyone can get sick from these viruses. Our patients can just get very sick. So, there should be no difference between how they conduct themselves over the holidays and how they live during the rest of the year.

Caregivers can reduce the risk for their immunocompromised loved ones by ensuring they get fully vaccinated and that anyone who comes into close contact with them does, too.

If you have any questions or concerns, talk to your doctor.

Any other advice to help people avoid the flu, COVID-19 and RSV this year?

Don’t get close to anyone with a cough, cold or other flu-like symptoms at holiday functions. Those people shouldn’t be there.

It’s also important to stay home if you’re sick. I know it’s hard to miss out on get-togethers — especially for the holidays — when it feels like forever since they’ve even been an option, but don’t make things worse by going anyway and infecting all your friends and loved ones.

Do your best to protect both yourself and others by getting vaccinated against the flu and COVID-19. Then, make plans based on the amount of risk you’re willing to accept and enjoy yourself.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Last updated Jan. 31, 2023

If you or someone you know has had COVID-19 recently, you may have heard of PAXLOVID. Maybe you’ve even heard about a so-called COVID-19 rebound in people who’ve taken this antiviral therapy.

So, what is PAXLOVID and why does the Centers for Disease Control and Prevention (CDC) recommend it for people who are immunocompromised? We asked Chief Infection Control Officer Roy Chemaly, M.D., what patients with cancer need to know about the antiviral treatment for COVID-19.

What is PAXLOVID, and who can receive it?

PAXLOVID is the brand name for a combination antiviral medication that can lessen symptoms in patients who have mild or moderate COVID-19. It is intended for those who are in the early stages of infection and are at risk of getting severely worse.

Patients with cancer are eligible to receive PAXLOVID with a prescription from their doctor and they will need to start it within 5 days of the onset of their COVID-19 symptoms. If you are in the hospital, more aggressive therapy may be needed to help you fight the infection.

How does PAXLOVID work to fight an infection?

PAXLOVID contains nirmatrelvir, which works to inhibit the SARS-CoV-2 virus from replicating in the body. It also contains ritonavir, which boosts the effects of nirmatrelvir, helping it work better. The combination of these antiviral medications helps reduce the risk of hospitalization for people who have mild-to-moderate COVID-19.

What are the side effects of PAXLOVID?

Some people report having a metallic or otherwise altered taste in their mouth when taking PAXLOVID. Your doctor also should consider the health of your kidneys and liver before prescribing it. For most people, reported side effects have been mild.

If you have cancer, your doctor will consider all of the medications you are taking to ensure there are no interactions between medicines used to treat COVID-19 (such as PAXLOVID or dexamethasone) and cancer-related therapies like prophylactic antimicrobials and other medicines.

Why do some people need a second round of PAXLOVID treatment?

PAXLOVID is the first oral antiviral medication to be authorized for emergency use by the Food and Drug Administration (FDA) for the treatment of COVID-19. That makes it an investigational medication. Your doctor may prescribe it based on your COVID-19 symptoms and response to the medication.

Some people experience a relapse of COVID-19 – sometimes called a COVID-19 rebound – even after taking an entire course of PAXLOVID. For instance, after Dr. Anthony Fauci tested positive for COVID-19, he received two courses of PAXLOVID to help him stay out of the hospital.

What else can I do to protect myself?

Vaccination should be considered the first line of prevention against COVID-19. However, some patients with cancer may be unable to mount a protective response with COVID-19 vaccines and remain at risk for severe COVID-19 should they become infected.

For people who are eligible to receive it, PAXLOVID should be a treatment option they discuss with their doctor.

Schedule your COVID-19 vaccine or booster at MD Anderson.

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