• Our recommendation is to get vaccinated as soon as you and your family are eligible.
• If you are considering vaccination, please do so now rather than waiting. Covid-19 will be spreading through Hawai’i for possibly years to come and it will eventually reach all of us. Being vaccinated is the most effective way to keep you and those who are close to you or who work with you from getting infected and especially from being hospitalized, on a ventilator or dying from Covid-19.
• Covid-19 is constantly changing and new variants will be spreading. Getting your updated bivalent booster gives you the best available protection against the most common variants currently in Hawai’i.
• If you have questions about the vaccines, please contact us and we will do our best to answer your questions and give you the information you might need to make the best decision for yourself and your family.

• The Pfizer and Moderna vaccines are the same type of vaccine and are very similar in their effectiveness and potential adverse events. They both use small pieces of RNA that instructs the cells in the area of the vaccination to make a protein that stimulates our immune system to prevent or weaken future covid infections. Both vaccines are effective in preventing Covid-19 infections and especially effective in preventing hospitalizations and deaths due to Covid-19. Both vaccines have a very low risk of a condition called myocarditis that may occur more often (but still very rarely) in teens and young adults after vaccination. This condition is a usually mild and temporary inflammation of the heart muscle.
• The Novavax vaccine is a different type of vaccine. The Novavax vaccine uses lab-made proteins and a naturally-found substance called an adjuvant to stimulate our immune system to prevent and weaken future infections. This vaccine is also effective and safe. It has been in limited use in the US but has been used safely in several other countries. The technology for the Novavax vaccine is not new and is safely used for other established vaccines. It may also have a low risk of a condition called myocarditis. This condition is usually mild and temporary inflammation of the heart muscle. 
• The Johnson&Johnson/Janssen vaccine is a different type of vaccine. KPHC does not carry the J&J vaccine at this time. It is also effective at preventing infections and especially effective at preventing hospitalizations and severe cases of Covid-19. There is a very rare risk of blood clots after the J&J vaccine, especially in adult women under age 50.
• If you are undecided, we recommend to discuss which vaccine may be best for you with your healthcare provider. All four vaccines provide excellent protection against severe Covid-19. The CDC currently recommends the mRNA vaccines (Moderna or Pfizer) as preferable to the J&J vaccine due to higher efficacy and lower risk of serious adverse events.
• KPHC currently has the Moderna, Pfizer and Novavax vaccines available.
• If you prefer the J&J vaccine, please check with www.hawaiicovid19.com for more information on where J&J may be available.
• More information on the newly available Novavax vaccine
  • Is for 12 and older onlyIs only for people who have not yet gotten their primary vaccine seriesHas been approved for use as a FIRST booster dose at least 6 months after you completed your primary series with any approve vaccine.Is NOT interchangeable with other vaccines for the primary series; NOT to be given as a second dose to anyone who has already gotten Pfizer or Moderna and do not give an mRNA vaccine after a dose of Novavax. Ok to give as a first booster dose after completing any approved Covid-19 primary series.Immunocompromised people are not recommended to get a third primary vaccine dose at this timePrimary doses are to be give 3 to 8 weeks apart. 3 weeks for 65+ or those who are immunocompromised or in high-risk situations and 8 weeks for otherwise healthy adults. The 8-week interval may reduce the risk of rare vaccine-associated myocarditis, especially in young adult males and it may provide an improved immune response to vaccination compared to the 3-week interval. Persons who received Novavax for their primary vaccine series may receive an mRNA bivalent booster after 2 months OR a Novavax booster dose after 6 months. Pain at the injection site occurs in most Novavax recipients. Fatigue, muscle pain, and headache occurred in 20-30% after the first dose and 40-50% after the second dose with very low rates of fever after either dose. There were no cases of anaphylaxis or thrombosis reported after vaccination and 1 case of Guillain-Barre in the Novavax clinical trials. There may be a slightly increased risk of myocarditis after the Novavax vaccination, mostly in young adult males and most commonly after the second dose. The degree of risk, if any, is not yet fully understood. Was not tested in pregnant women, however, for the women who became pregnant after vaccination, there were no signs of increased risk for the mother or fetus.
  • Has been used in many other countries, including Canada, under the brand names Covovax and Nuvaxovid.
• How is Novavax different for existing covid vaccines?
  • Novavax uses lab-made spike proteins, combines them with a naturally found chemical called an adjuvant to boost immune response. It does not contain any RNA (like Moderna and Pfizer) or viral particles (like J&J)
• Does Novavax work better than current vaccines?
  • Clinical trials on Novavax show that it is very effective against the pre-Omicron strains in preventing infection and serious Covid infections. Its effectiveness against current Omicron strains is not well established, but trials are ongoing. It is probably similarly efficacious as current vaccines. The duration of protection compared to the current vaccines is not yet clear. It is likely that there will be a Novavax Omicron-specific booster at some point.
• Is Novavax safer than the current vaccines?
  • The adverse events and reactions in the Novavax clinical trials show the vaccine is likely very safe, though long term monitoring is necessary to identify rare adverse events that may not have shown up in the trials. The technology of the Novavax vaccine is not new and is being used safely in some established vaccines. Like most vaccines, reactions appear to be mostly mild and of short duration. Novavax appears to have a lower risk of fever compared to the mRNA vaccines. Myocarditis in young adult males appears to be a rare adverse event associated with Novavax and may occur about a week or so after the 2nd vaccine dose, though the degree of risk, if any, is not well understood. The mRNA vaccines have a similar concern that is better understood. The longer 8-week vaccine interval between doses is recommended to reduce the risk of myocarditis. There were no cases of anaphylaxis or blood clots in the Novavax trials. 
• Who should get Novavax vaccine?
  • Patients 12 and older who had a contraindication to the previously available Covid-19 vaccines with no contraindications to Novavax or patients who are reluctant to receive the other available Covid vaccines. 
  • Patients who have completed an approved Covid-19 primary vaccine series for whom the bivalent booster is not available or recommended or who prefer to receive Novavax as a booster can do so at least 6 month after completing their primary series. Novavax should not be used as a second booster for someone who has already received an mRNA booster dose.
• Who should NOT get Novavax?
  • Anyone with a contraindication to Novavax, such as a severe allergy to the components of the vaccine or anyone who had myocarditis after the first dose of Novavax vaccine. People who developed MIS-C or MIS-A prior to vaccination or who have had myocarditis should be cleared by their cardiologist or medical team before vaccination with any Covid-19 vaccine

• Yes, one dose of Pfizer, Moderna or Novavax vaccine does not provide significant protection against Covid-19 infection. Two doses and a booster dose when eligible provides the best available protection against the current Omicron strains.
• Vaccine protection is not immediate, your body has to respond to the vaccine to stimulate your immune system. Waiting until you are exposed or feeling sick is too late for the vaccine to provide protection for that infection.  Completing your vaccines at least 2 weeks before exposure provides the best protection.

• Yes, vaccination is still recommended. We don’t know how long immunity after an infection lasts. Some early studies have shown that mild infections may lead to less long-term immunity. Other studies have shown that those with prior infection who get vaccinated may have enhanced protection against Covid variants. The immunity from vaccines appears to be stronger and last longer than the immunity after an infection.
• We recommend waiting about 3 months after your infection before getting your next dose of Covid vaccine. Waiting for 3 months after your covid infection allows your immune system to sort itself out to provide for a optimal immune response to your vaccine. If you are at high risk for covid-19 complications or if you live or work with high risk people, it is probably best to NOT wait 3 months for your next vaccine dose.     
• A large, recent study on older Americans has shown that repeated Covid-19 infections increases the risk of organ damage and death within 6 months after an infection, so while an infection may provide you with temporary protection, it is still important to get vaccinated to reduce the risk of repeat infections.
• If you had heart inflammation due to your Covid-19 infection, check with your medical care provider before getting vaccinated.

• If your reaction was mild to moderate, you can still get vaccinated. If you had a serious allergic (anaphylactic) reaction to a vaccine or to one of the ingredients in the vaccines, discuss with your doctor or nurse before you get vaccinated or before your second dose. You may not be able to get vaccinated at this time, or you may be advised to wait until other covid-19 vaccine options are available.
• Before you are vaccinated, you will be asked about any allergies you might have to food or medicines. Please let your nurse or vaccine administrator know about any allergic reactions you have had.
• If you had a serious adverse event or were diagnosed with myocarditis after the first dose of either the Pfizer or Moderna vaccines, let your vaccine provider or medical care provider know before you get your second dose.

Yes, your risk of an allergic reaction to the vaccine is low. You will be asked to stay around after vaccination for 30 minutes to monitor for any allergic reactions.

• Yes, vaccination is STRONGLY recommended for pregnant women. Studies show that vaccinated pregnant women pass protective antibodies to their infant through their umbilical cord before birth and through their breast milk after birth.
• Studies show that there is no increased risk of miscarriage after vaccination
• Covid-19 INFECTIONS are known to increase the risk of injury to pregnant women and their children, so vaccinating may be a safer choice for you. If you think you might be pregnant, optional pregnancy testing is available at our clinic.

• No, there is no charge associated with the vaccine at this time, but this may change at any time. You will not be asked to pay any out-of-pocket costs for the vaccine at this time, whether you have insurance or not. If you are establishing care at KPHC, there may be charges associated with your medical visit. KPHC has staff that can assist you with applying for Quest or for sliding-fee discounts. KPHC will not refuse service to anyone based on their ability to pay.
• If anyone calls, messages or emails you offering you vaccines for sale or asking for any personal financial or credit card information, DO NOT give any information. Go to www.hawaiicovid19.com for official state vaccine information.

• Yes, if you are immunosuppressed, the vaccine is still recommended and there is no evidence of increased adverse events after vaccination.
• The Covid-19 vaccines available are not “live” vaccines, so you cannot get or spread Covid-19 after vaccination.
• If you are receiving Methotrexate, Cyclophosphamide or Janus Kinase Inhibitor medication or high dose steroid medications, please contact your care provider or specialist to discuss vaccination recommendations.
• If you have moderate to severe immunocompromising condition, you may not have developed a strong protective immune response to 2 doses of an mRNA vaccine (Pfizer or Moderna) or to 1 dose of the J&J vaccine. An additional/third dose of mRNA vaccine or second dose of J&J vaccine about a month after completing your primary series is recommended If you meet any of the following
  • on treatment for solid tumors or blood cancer like leukemia,
  • on immunosuppression after an organ transplant,
  • had a stem cell transplant within last 2 years,
  • on immunosuppression treatment or high-dose steroids for other conditions,
  • have a moderate to severe immunocompromising disease,
  • or if you have advanced or untreated HIV
  • Your care provider may recommend an additional dose if you have other conditions that may suppress your immune system
• The Novavax vaccine does not currently have a recommendation for third primary dose of immunocompromised vaccine recipients
• See below for more information on covid-19 vaccine additional doses and boosters.

No, the vaccines do not contain the Covid-19 virus and there is no way for your body to create the Covid-19 virus after vaccination.

• No, the mRNA in the Pfizer and Moderna vaccines does not contact your DNA and cannot alter your DNA. The mRNA is quickly broken down by your cell’s normal metabolism.
• The mRNA in the vaccine is similar to a small part of the RNA in the virus that causes Covid-19 and almost all of the vaccine mRNA stays in the muscle area where it is injected.
• A single Covid-19 infection results in far more viral genetic material moving throughout your body. A covid-19 infection can result in from 1 billion to 100 billion individual viral particles in your body, each with a full viral RNA.
• So, a natural Covid-19 infection is much more likely to cause severe illness, death or long-term disability, and it will result in a far greater amount of foreign RNA spreading throughout your body for a much longer period than the vaccine, and the duration of your post-infection immunity may not last very long.
• Vaccination will introduce far less RNA into your body than an infection. The vaccine RNA will almost entirely stay in the area of your injection and will be broken down soon after, and will result in more sustained immune protection from severe Covid-19 disease.

• Almost all adverse reactions to the vaccines are brief and mild, usually lasting 1-2 days. The second dose of vaccine is more likely to cause some temporary adverse events. The booster dose has a slightly lower rate of adverse events.
• For Adults and teenagers
  • mRNA vaccine (Pfizer or Moderna)
  • most people (80-90%) experience soreness at the injection site,
  • about half (50%) of people experience headache and fatigue (feeling tired),
  • about a quarter (25%) had muscle aches, chills and/or joint pain,
  • about 10% or less had fever, nausea, diarrhea and/or swelling at injection site.
  • about 1% or less had lymph node swelling
  • Some people may experience a rash at the injection site several days to a week or more after vaccination.
  • About 1 out of every 500 people who get vaccinated may have an adverse event such as a non-severe allergic reaction or persisting vomiting lasting for 1-2 days
  • About 1 out of every 250,000-500,000 people who get vaccinated may have a severe allergic reaction (anaphylaxis).
    • Novavax vaccine
      • Pain at the injection site occurs in most Novavax recipients.
      • Fatigue, muscle pain and headache occurred in 20-30% after the first dose and 40-50% after the second dose.
      • There were very low rates of fever after either Novavax dose in the clinical trials
      • There were no cases of anaphylaxis or thrombosis reported after vaccination and 1 case of Guillain-Barre in the Novavax clinical trials.
      • There may be a slight increased risk of myocarditis after Novavax vaccination, mostly in young adult males and most commonly after the second dose. The degree of risk, if any, is not yet fully understood
      • The Novavax vaccine not tested in pregnant women, however for the women who became pregnant after vaccination, there were no signs of increased risk for the mother or fetus.

• For young children 6months to 4 years, the dose of the vaccine is lower than for older kids and adults. The Pfizer vaccine for 6month to 4 year old children is only 1/10^th the dose of the vaccine for older kids and adults and the Moderna vaccine for 6months to 5years old is 1/4^th the adult dose.
  • The most common reactions in small children are pain/fussiness and fever which may last up to 2 to 3 days. The Moderna vaccine has a slightly higher rate of fever and pain compared to the Pfizer vaccine.
  • Some children may feel tired after the vaccine or have a headache, feel achy or have a reduced appetite
  • In the clinical trials for both Moderna and Pfizer in small children, there were no episodes of myocarditis or deaths following vaccination
  • Vaccines and infections that cause fever can potentially cause febrile seizures, or seizures associated with fever.

• For teenagers and young adults about 1 out of every 100,000 receiving their first dose and 4 to 5 out 100,000 receiving their second dose of Pfizer or Moderna may have develop inflammation of their heart muscle called myocarditis. This is more likely to occur in males rather than females.
  • Teenagers and younger adults may have a slightly higher incidence of fainting after vaccination. This may be due to anxiety around the vaccine and fainting occurs with other vaccines as well. Make sure you have eaten and are well hydrated before going for vaccination. You should be sitting down when you get vaccinated and during the 15 to 30 minute observation period after vaccination.

• Side effects and reactions are not a sign of illness, they are a sign of your immune system responding to the vaccine and helping your body to be ready to quickly stop future infections.
• Very rarely some people may experience more serious adverse events after vaccination such as anaphylaxis (severe allergic reactions), Blood clots, Guillain-Barre Syndrome (numbness or tingling in arms and legs) or myocarditis (inflammation of the heart).
  • The risk of anaphylaxis is about 1 in every 250,000 to 500,000 doses and occur usually in people who have had other allergic reactions. All of our vaccines are done with trained medical staff on site and we observe all vaccine recipients for 15 to 30 minutes after their vaccines to monitor for any immediate allergic reactions.
  • Blood clot events were noted to rarely occur in about 1 per 1,000,000 recipients of the Johnson & Johnson/ Janssen vaccine, especially in young adult women. KPHC does not administer the J&J vaccine and in accordance with the CDC, we recommend other vaccines such as the Pfizer, Moderna or Novavax vaccines as preferable to the J&J vaccine due to this risk.
  • Guillain-Barre Syndrome (GBS) was found to occur very rarely after the J&J vaccine. There is no increased risk of GBS after the mRNA vaccines (Pfizer or Moderna) and no increased risk was noted in the clinical trials of Novavax. KPHC does not administer the J&J vaccine. GBS can be caused by viruses, bacteria or other inflammatory conditions unrelated to vaccines.
  • Myocarditis was found to occur rarely after mRNA vaccination, especially in male teenagers and young adults. Episodes are usually mild and resolve on their own but can sometimes require hospitalization and can sometimes cause prolonged or more serious cases. Myocarditis can be caused by viruses (including Covid-19), bacteria, fungi, parasites, autoimmune conditions such as lupus, illicit drugs and some medications. These types of myocarditis are usually much worse and cause much more disability and higher risk of death. In accordance with the CDC, we recommend an 8-week interval between the first 2 doses of covid vaccine in teens and young adults up to age 39 to reduce the risk of myocarditis. The risk of myocarditis due to the Novavax vaccine is not yet well understood.

• Chest pain, shortness of breath and palpitations (feeling like your heart is skipping beats or fluttering)

• The seriousness of myocarditis and pericarditis depends on the underlying cause and severity.
• Myocarditis caused by some viruses, including Covid-19, or chronic illnesses can be very serious and dangerous.  About 4-7% of people who get myocarditis due to a virus infection or chronic disease die and another 4-9% will require transplant.
• Myocarditis after vaccination is generally much milder and is caused by an immune reaction to the vaccine, not because of infection or damage to the heart. The inflammation is temporary and like other types of inflammation, will generally resolve after a few days. A very small number of people with vaccine-associated myocarditis can have longer or more severe symptoms.

• If you have any symptoms of myocarditis after vaccination, you should inform your care provider immediately for evaluation. You should have a discussion with your care team and provider before getting your second dose.

• Unvaccinated children are more likely to get covid and to spread covid than vaccinated children. Children in poorly ventilated spaces such as at home or in classrooms or playgroups without consistent mask use are much more likely to become infected and to spread infection. Vaccinated children are less likely to spread Covid-19 to others in their home and at school.
• Unvaccinated children are more likely than vaccinated children to be hospitalized
  • For children 5-11years old who are not vaccinated, their rates of hospitalization are 1.4 times higher than for those who received their primary vaccine series. For teenagers the risk of hospitalization for unvaccinated is twice as high as vaccinated. For adults the risk is 3 to 4 times higher for unvaccinated. During the height of Omicron, unvaccinated kids from 5-11 years old were almost 3 times more likely to be hospitalized than fully vaccinated, and unvaccinated adults during Omicron were over 12x more likely to be hospitalized than vaccinated adults.
• Unvaccinated children are more likely to die from a Covid infection.
• From March 2020 through June 2, 2022

• 0-17 years old: total pediatric Covid-19 associated deaths: 1,806 deaths 
• By comparison, since the start of the pandemic, there have been 32 confirmed deaths in children attributed to the flu, compared to 1,806 due to Covid-19.
• Covid-infected children can develop a serious complication after their infection called Multisystem inflammatory Syndrome in Children (MIS-C)

• MIS-C is a severe inflammatory condition that can arise in children about a month after infection that includes high fevers, rashes, eye and mucus membrane inflammation and potential heart damage and dangerous blood clots
  • MIS-C affects about 1 in every 3-4,000 children infected with the original Covid-19 and with Delta, the rate appears to be lower with Omicron
  • MIS-C can occur after an asymptomatic covid infection
  • Total known cases throughout the pandemic so far: 8,525
  • Average age: 9 years
  • 60-70% are admitted to the ICU
  • Total deaths due to MIS-C: 69 (0.8% of cases)
  • Those that recover can have lifelong cardiac complications or other complications such as amputations from blood clots
  • MIS-A is similar to MIS-C mostly affecting young adults and up to 50% of cases have heart involvement
• Children can have long-haul Covid. About 7-8% of children who develop Covid-19 infections continue to have symptoms 3 months after their acute infection, including fatigue, headaches, insomnia, difficulty concentrating, joint pains, and cough. Infected children also have a high risk of myocarditis that may last for months and possibly longer.
• Vaccination of kids will help reduce the risk and spread of new covid variants. Every infection allows for millions of new viruses to grow, each new virus has the potential to mutate into a new variant. As we saw with the delta variant, new variants have the potential to change the course of the pandemic.
• Compared to the flu, children hospitalized for Covid-19 are more likely to have a longer hospitalization, be more likely to be in the ICU, and require mechanical ventilation. Over the last 2 years, Covid-19 has killed over 1,800 children and teens, Flu has killed 7 kids over the same time period. Death rates for children hospitalized with Covid-19 are similar to those for Influenza.

• Yes.
• Clinical trials for 5-11-year-olds showed that most vaccine reactions were mild and brief. Systemic reactions occurred less often and were less severe in 5-11-year-olds compared to 16-25-year-olds.
• Among 5-11 year old, after the second dose
  • 70% of kids had pain at the injection site
  • 20% of kids had redness
  • 15% had swelling
  • 6.5% had fever
  • 40% had fatigue
  • 30% had headache
  • 10% had chills or muscle pain
  • 5% or less had diarrhea, joint pains or vomiting
• There were no reports of anaphylaxis, no reports of myocarditis and no reports of Bell’s Palsy after vaccinations in the 5-11yo trials. The risk of myocarditis after vaccination is lower that the risk of myocarditis from a covid-19 infection.
• Millions of doses of Covid-19 vaccine doses have been administered to 12-15 years old children in the US with no safety concerns.
• No treatment or vaccine is 100% without any risk of adverse events. It is important to be informed about the risks and benefits of any preventive intervention or medical treatment, so decisions can be made with the best available understanding.

• Yes.
• For small children 6 months to 4/5 years old, researchers looked at the clinical effectiveness at preventing infections and also looked at the antibody response of children who were vaccinated compared to the antibody response of older kids and adults after they were vaccinated. Both the clinical observations and the antibody studies showed a good response to the vaccine. The studies were small, so it is too early to determine exactly how effective the vaccines will be for kids 6 months to 4 years old at preventing infections or preventing serious Covid-19 infections, hospitalizations and deaths.
• The current vaccines were designed to target the original Covid-19 virus and they are less effective at preventing infections due to the current Omicron variants, however they are still very effective at preventing hospitalizations and deaths due to Covid-19. It is still possible for a fully vaccinated person to become infected, but the risk of infection is lower and the risk of severe illness after vaccination is also very, very low.

• For some mild diseases, such as Roseola and Fifth disease, natural infection is generally safe and the risk of vaccination outweighs the benefit, so vaccines are not recommended or even available at this time for those conditions
• Covid -19 is not a mild disease. It is also not like the flu. Consider that in a typical year before Covid, the flu kills between 40-200 U.S. children every year. After the Covid-19 mitigation efforts were in place (masks, social distancing, lockdowns and gathering restrictions, etc), flu cases dropped dramatically and in the 2020-21 flu season there was only 1 reported pediatric death in the U.S. During that same time, despite the same mitigation environment, Covid-19 infected millions of kids, leading to the deaths of over 700 children 0-17 years old.
• From March 2020 through June 2, 2022
  • Total pediatric Covid-19 deaths in the US: 1,806 deaths 
  • By comparison, since the start of the pandemic, there have been 32 confirmed deaths in children attributed to the flu, compared to 1,806 due to Covid-19.
  • There have been over 8,500 cases of MIS-C in the US, 60-70% required hospitalization and 69 have died.
• Not vaccinating children while allowing mitigation efforts to stop, would cause far more cases with many more hospitalizations, deaths and long-term or life-long disability. These vaccines are safe and while there will be rare serious adverse events, the vaccines will prevent deaths and suffering in this age group.
• It is our responsibility as adults to protect our children, children have the right to access treatments that can prevent life-threatening illnesses.

• Yes, vaccination is recommended after recovery from infection. It is recommended (but not required) to wait 3 months after your child was infected to get their next dose of vaccine.
• Milder infections may result in shorter immunity after infection. Vaccination can provide a more substantial and durable immunity.
• It is very difficult to predict how protected a person is after infection. We have had multiple cases of reinfection in adults and children. We recently had a child with reinfection and hospitalization 3 months after an initial mild infection.
• Antibody responses after vaccination are more consistent after vaccination compared to after infection
• We don’t know the risks of reinfection. We know that in older adults, each covid infection may increase the risk of organ injury and death within 6 months of each repeat infection. Having a covid infection may provide you with some protection against reinfection, but it may not protect you from severe infections. Most of us have had the flu at some point in our lives, but any time you get the flu, it could develop into a severe illness and cause death. Covid-19 repeat infections could also be deadly.

• Covid-19 vaccination after MIS-C should be considered in consultation with your child’s doctor once all of the following criteria are met
  • Clinically recovered with normal cardiac function
  • At least 90 days since their MIS-C diagnosis
  • The child is in an area of high community spread of Covid-19 or otherwise, have a higher risk of exposure or transmission
  • MIS-C occurred prior to any Covid-19 vaccination
• Vaccination after MIS-C may be considered without meeting all of the above criteria in specific high-risk situations as long as cardiac function has normalized in consultation with your care provider.

• Antibody level testing is not recommended. Antibody levels may not correlate with protection from infection. Antibody tests check for only one part of your immune protection. You may still have excellent protection from infection even though you might have a negative antibody test.
• Other infections can sometimes cause false positive Covid-19 antibody tests.

• The dose recommended for the age at the time of vaccination is recommended.

No, the Covid-19 vaccine is not a required vaccination for public schools at this time.

Yes, there is no requirement to separate or delay other vaccines. We recommend getting the flu shot and covid shots together rather than delaying one or the other. There is a slightly higher risk of fever when receiving the flu and covid shots together.

• The mRNA in the Pfizer and Moderna vaccines is a copy of a small portion (about 10%) of RNA of the virus that causes Covid-19. This small piece of mRNA allows your muscle cells at the injection site to make proteins that are identical to one of the proteins in the Covid-19 virus, the spike protein in this case. These proteins cause your body to make an immune response that can stop a future infection before it can cause infection or severe illness. The mRNA in the vaccine is only able to make this one, single protein. The vaccine mRNA does not make any of the other proteins that the Covid-19 virus requires to grow and spread.
• The vaccine mRNA and proteins never enter the nucleus of your cells and do not combine with or change your DNA.
• Just like the mRNA that your body makes naturally, the vaccine mRNA quickly breaks down and becomes inactive.
• By comparison, an infection with Covid-19 will flood your airway with between 1 billion and 100 billion virus particles and each virus contains much longer and more complex RNA compared to the vaccine that instructs the virus on how to overwhelm the infected cell with massive amounts of virus.
• We will all eventually be exposed to Covid-19 and are likely to become infected. A covid-19 infection will send billions of virus genetic material throughout your body. The small amount of mRNA in the vaccine will almost entirely stay in the muscle where it is injected.

• Children 6 months to 4 years old who completed their Pfizer or Moderna primary vaccine series are NOT recommended to get a booster dose at this time
• Children 5-11 years old who completed their Pfizer (5-11 years old) or Moderna (6-11 years old) ARE recommended to receive 1dose of Pfizer or Moderna bivalent booster dose at least 2 months after their last dose of covid vaccine.
• Children 12-17 years old who completed either a Moderna, Pfizer or Novavax primary vaccine series ARE recommended to receive 1 dose of Pfizer or Moderna Bivalent booster at least 2 months after their last dose of covid vaccine.
• Adults 18+ years old who completed either a Moderna, Pfizer, Novavax or J&J primary series and either have or have not received any monovalent boosters ARE recommended to receive 1 dose of Pfizer or Moderna Bivalent booster at least 2 months after their last dose of vaccine.
• Adults 18 + years old who have completed a primary Covid-19 vaccine series, but have not gotten any booster doses yet can receive a single dose of either the Pfizer or Moderna bivalent boosters or a single dose of the Novavax monovalent vaccine as a booster.

• If you are at least 5 years old and have a moderate to severe immunocompromising condition AND if you completed 2 doses of the Pfizer or Moderna vaccines, it is recommended that you receive an additional/third dose of vaccine at least 28 days after your 2nd dose. If you received the J&J vaccine, you are eligible for a booster dose after 2 months. A third dose of J&J is not recommended at this time.
  • Conditions approved for the third dose are: On treatment for tumors or blood cancer, on immunosuppression after transplant, had a stem cell transplant within last 2 years, on immunosuppression treatment or high-dose steroids, have a moderate to severe immunocompromising disease, advanced or untreated HIV
• The third dose is not considered a booster, it is an additional primary course dose and is recommended for people with specific immunocompromising conditions that put them at risk for not developing an immune response to the 2-dose vaccine series. It is given 28 days after your second dose of vaccine and is approved for both Moderna and Pfizer recipients.

• If you have one of the conditions listed above and it has been at least 28 days since you got your second dose of Moderna or Pfizer vaccine, you should get a third dose now.
• If you got J&J as your single dose, you should get a dose of an mRNA vaccine, either Pfizer or Moderna, 1 month after your single J&J dose. If you did not receive a 1-month additional dose after your first J&J vaccine, you can receive 2 doses of mRNA booster at least 2 months apart

• 5 or older can get their updated bivalent booster dose at least 2 months after their last dose of covid vaccine
• 18 and older who have not yet gotten a booster and who are unable to get the bivalent booster or who refuse to receive a bivalent booster may receive a single dose of Novavax monovalent vaccine as their booster at least 6 months after their primary series.
• If you received a vaccine from outside of the US that has not been authorized by the FDA, as long as the vaccine is approved by the World Health Organization, you are eligible to receive an mRNA booster as above

• 5 years old should only receive the Pfizer bivalent booster
• 6-17 year olds can receive either the Pfizer or Moderna Bivalent booster
• 18+ years old who completed their primary series can receive either the Pfizer or Moderna Bivalent booster.
• 18+ years old who are not eligible for the bivalent booster or if the bivalent booster is not available or if a person would not otherwise get a booster can receive a single dose of Novavax monovalent booster at least 6 months after their primary series.

• In general the recommendation is to stay with the same vaccine you received for your primary series, however National Institutes of Health studies have shown the mixing and matching vaccines for boosters resulted in a strong immune responses for all combinations.

Clinical trials on vaccines try to find the lowest dose that provides an effective immune response with the least risk of adverse events such as pain or fever. Once your body responds to the primary vaccine series, a low dose of vaccine may provide an adequate boost to your immunity.

• No, in the studies done on boosters, the local (redness, swelling and pain) and systemic (fever, headaches, fatigue) reactions generally occur LESS frequently than they do with the primary vaccination series. And the reactions tend to be less severe.
• The risk of severe events such as myocarditis or thombotic events is not increased with boosters compared to the primary vaccine series based on current information.

• No. The booster dose is not mandated at this time. If you received 2 doses of either Moderna or Pfizer or a single dose of J&J, you are considered fully vaccinated.
• Individual employers or private entities may require booster vaccines

• No. The current vaccines continue to be effective, especially against hospitalizations. With Omicron, the effectiveness of the original Covid-19 vaccines and booster vaccines against mild to moderate infections is reduced, however the updated bivalent booster provide a strong boost in immunity that targets both the original virus strains AND the current Omicron variants.

• Studies in the US and in other countries have shown that vaccine efficacy declines about 6 months after vaccination, leading to increased infections and hospitalizations in vaccinated persons who are in close contact with someone with Covid-19. Especially with Omicron infections. Efficacy is still good, especially against hospitalization and death.
• Booster doses appear to provide a big immune “boost” against Omicron infections and severe illness.
• Booster doses may reduce asymptomatic and milder infections as well and prevent spread of infection by vaccinated people, helping slow the pandemic and reduce hospitalizations.

• Booster studies in the US show a significantly lower risk of local and systemic adverse events after the booster compared to the primary vaccine series and those events tended to be less severe. There was no increase in serious adverse events with the boosters compared to the primary series of all vaccines.

Yes, the bivalent boosters from Pfizer and Moderna have been updated to provide a better immune boost against both the original Covid-19 virus PLUS the Omicron variant.

• Not really. Antibody tests only measure one part of your immune response to vaccination, called humoral immunity. There is a second type of immune response called cellular immunity that is an important part of your protection that is not easy to measure. Antibody levels do correlate with protection from infection, but cellular immunity also provides significant protection, especially against severe illness. So even if you have no antibodies on an antibody test, you are likely still protected by your cellular immunity.
• Some antibody tests check for antibodies to a different part of the virus than the vaccine triggers, so a positive antibody test may indicate a prior infection, but not vaccine protection.
• Antibody tests also may not be sensitive enough to detect protective antibodies levels, leading to false negative tests or they may detect antibodies for coronaviruses other than Covid-19, leading to false positive results.

• Once you get your updated bivalent booster, there is no longer a recommendation for an additional booster.
• If you got a booster dose or multiple booster doses prior to mid-September, 2022, you probably got the original monovalent booster.  It is recommended that you get one dose of the updated bivalent booster at least two months after your last booster dose.

• It isn’t clear at this point. The annual flu shot is necessary because protection from the flu shot tends to decrease over the course of a year or so, and because the flu virus changes year to year, so last year’s flu shot may not work against this year’s flu.
• If the Covid-19 virus stays fairly stable and if the current vaccine and booster works against future variants and if the immune protection from the shot seems to last for a long while, then an annual Covid-19 shot won’t be necessary. If the Covid-19 virus changes it’s spike protein too much allowing the virus to sneak past our immunity or if a new variant arises that the vaccine does not work well against, or if we start seeing a lot of breakthrough infections with severe illness then an annual Covid-19 shot may be recommended.

• A covid-19 infection does provide some protection from a subsequent infection, but it is not clear how long that protection will last and we have seen several repeat infections among KPHC patients and staff. Studies comparing post-infection immunity to post-vaccination immunity show that the vaccine provides better immunity than infection alone and vaccine protection may last longer than post-infection protection.
• A prior breakthrough infection is not a contraindication to a booster dose and if you are at high risk of severe illness, a booster dose may provide you with significantly increased longer-lasting protection.
• It is recommended to wait 3 months after you became infected to get your next dose of a covid-19 vaccine. If you are at high risk for severe covid infections or if you live or work with others at high risk, then it is probably best to go ahead and vaccinate as soon as possible rather than waiting 3 months.

• The booster dose will increase your antibody levels and will likely reduce your risk of getting infected and your risk of spreading Covid-19 to others, but how much protection and how long that protection will last are still not clear at this time.
• Boosting decreases your risk of hospitalization and severe illness and death due to Covid-19.

The most effective protection would be for the high-risk person to receive a booster dose, and for everyone else in the home or social circle to get fully vaccinated and booster doses when they are eligible.

• If you experienced an immediate allergic reaction after your prior dose of Pfizer vaccine, you should not receive the booster.
• If you experienced expected local or systemic reactions to a prior dose such as pain, fever, redness, nausea after vaccination, you can still receive the booster.
• If you experienced myocarditis after a prior dose of Pfizer vaccine, you can receive the booster as long and your inflammation has completely resolved. Consultation with your care provider or cardiologist is recommended. If you have a history of myocarditis or pericarditis unrelated to the vaccine, check with your care provider or cardiologist before getting your booster.
• If you experienced Guillain-Barre Syndrome or Bell’s Palsy after a prior dose of vaccine, you can still receive the booster.

Yes, it is no longer recommended that you wait for 90 days after you completed your plasma or antibody treatment before receiving your booster dose. You can receive it at any time that you would normally be eligibile.