Answering Your Vaccine Questions (RSV and more…)

In August, we wrote about Health Canada’s approval of a long-awaited vaccine for RSV (respiratory syncytial virus), known as Arexvy, which is for those aged 60 and older. RSV largely impacts those who are young (especially those under age 2) as well as those over age 60. In older adults who become hospitalized with this lower respiratory tract infection, the risk of death is 1 in 9. Although age alone increases risk due to aging lungs and the immune system, those with underlying medical conditions are at an even greater risk. 

Now that we have Arexvy available, we are getting many questions about timing with other vaccines that adults are updating this fall. RSV is a seasonal virus that begins its greatest spread in the fall and winter months, just like influenza. With the new COVID booster now available, this is also the time for many to be receiving it as it has been 6 months since many received their previous dose.  For those who have not yet had pneumonia or shingles vaccines, these are also ones to consider. Here are answers to some of the questions we have been receiving. Note that this is general advice and is not to replace guidance from your own healthcare team.

Is Arexvy being provided through the government?

Arexvy will be provided to all long-term care residents at no charge this fall.  All other adults aged 60 and over will either need to pay out-of-pocket or use their coverage through a private plan.  A prescription from your family’s physician’s office will be needed. It will primarily be dispensed by community pharmacies, where patients may also receive the injection if requested on the prescription by the prescriber.

How long does the protection from Arexvy last?

Arexvy provides protection for at least 2 seasons. Further ongoing research will inform us if the protection lasts even longer.

Can I get more than one vaccine at a time?  I am due for the influenza vaccine, COVID booster, and RSV this fall.

Any non-live vaccines can be given together according to the National Advisory Committee on Immunization (NACI). All the vaccines mentioned above are non-live. COVID boosters have commonly been given at the same time as the influenza vaccine in the last two seasons. When giving two vaccines, they would be given in separate arms. Although not commonly done, if multiple vaccines are needed at the same time, it is possible to receive more than one vaccine in the same arm,  if they are at least 1 inch apart. We have seen this done when a person has limited opportunity to be vaccinated or may be leaving on vacation and needs multiple vaccines before travel. Studies reported no concerns when Arexvy was given at the same time as the annual flu shot. Another consideration is that some vaccines may cause redness and soreness at the injection site along with some general aches and pains or even a low-grade fever. For this reason, some people prefer to separate vaccines to not compound this impact on the same day. Others want to assess how a new vaccine makes them feel and for that reason want to separate it from others. What is important to realize, is that by separating all vaccines you may not make the time to return and get them all done. This is why doing two at a time has become a common practice. Regardless of what preference you and your healthcare provider choose, it is safe and effective to receive vaccines together. Arexvy has the same adjuvant (vaccine booster) as Shingrix, but only half the amount, so you may have a similar reaction to it.

Do I need to delay my treatments for my autoimmune condition, such as biologics, when getting a non-live vaccine for RSV, pneumonia, shingles, COVID, or flu?

It is not necessary to hold or delay most biologic/advanced treatments. We would suggest not administering a new vaccine within a few days of a biologic injection or infusion, so if you feel unwell you can determine which was causing your symptoms. The exception to this is methotrexate, which can be held for two doses after receiving the flu shot for best effectiveness. This should only be done in a person whose condition is stable and not flaring. We only have data to support this suggestion for the flu shot, although some clinicians may advise holding methotrexate for other vaccines as well. The other exception is for people receiving a specific type of biologic that suppresses B-Cells called rituximab or ocrelizumab. When receiving these treatments, the timing for the best vaccine benefit is 2 weeks before an infusion or 5 months after the previous infusion.  If a person is on prednisone, vaccines will be most effective when the dose has been below 20mg per day for at least 2 weeks.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

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