Should You Get the Flu Shot and COVID Booster at the Same Time?

The flu season is approaching. There is also a good possibility of another surge of COVID cases this fall and winter. The new bivalent COVID booster, which protects against the original Wuhan strain as well as the Omicron strain, is now available. Many Americans are wondering whether it is ok to get both shots at the same time.

Do you need another COVID booster?

Despite the idea that the pandemic is past us, over the past 28 days COVID has been responsible for an average of 435 deaths per day in the US. The numbers are expected to increase significantly over the fall and winter if Americans do not stay up to date on their COVID shots. I got the new bivalent COVID booster last week.

When are you up to date on your COVID booster?

You are up to date with your COVID shots if you have completed a COVID-19 primary series and received the most recent booster dose recommended for you.

Recommendations for COVID shots are based on your age, the vaccine you first received, as well as the time since your last dose. If you are immunocompromised, you have different recommendations.

Ages 12 and up can get a new bivalent booster with the added Omicron protection.

There is a good tool to determine if you are up to date on this link: Stay Up to Date with COVID-19 Vaccines Including Boosters | CDC Scroll down to "Find Out When You Can Get Your Booster".

Can you get the flu shot and the COVID booster at the same time?

Yes. If you want to get the shots at the same time, you can. Previous studies looking at the traditional COVID booster given with the flu shot showed no negative effect from having both shots at the same time. Experts in the field agree that it's perfectly fine to roll up each of your sleeves and get a shot in each arm during the same visit. It is recommended that you get the shots in separate limbs.

If you don't have the time to go for two separate appointments, or just don't want the hassle of going twice, you should definitely get them both at the same appointment.

Do you have to get them at the same time?

No. If you prefer to get them at separate appointments, that is also fine.

If you decide to separate them, you should go ahead and get the new COVID booster now, provided it has been 2 months since your last booster. Then you can schedule your flu shot a little bit later. That is what I chose to do. I had the COVID booster last week. I usually get my flu shot within the week before or after November 1st, so I will do that again this year. I have had it at the same time every year for more than 35 years straight!

The primary concern with separating the appointments is that you might forget to go back for your flu shot! If you think you might forget, you should seriously consider having them at the same appointment.

If you have any questions about the flu or COVID shots, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

It’s Time to Get Your Flu Shot

Fall is the time of year for getting our flu shots. I've had mine every year since I started medical school in 1985. I hope that you will all plan to get your flu shots this year.

Why do you need a flu shot every year?

There are 2 main type of flu viruses, influenza A and B viruses. Within those two types, there can be hundreds of different strains, which are constantly changing. A different strain of flu is responsible for causing the flu from one year to the next.

Also, immunity wanes over time.

How do they decide which strain to use to make the flu shot?

In the US, all flu shots are quadrivalent, which means they protect against four different flu viruses. Each year, scientists use research to predict which strains will be most common during the upcoming season. The shots are made to fight those strains.

Why are people 65 and older recommended to have a different type of flu shot?

People 65 and older are at higher risk of developing serious complications from the flu compared to younger adults. In recent years, between 70- 85% of seasonal flu-related deaths and between 50-70% of flu-related hospitalizations have happened in people 65 and older. This is at least partially related to changes in the immune system with age.

Specialized flu shots have been developed to help increase the immune response to the shot by using higher doses or special immune boosters. These shots are recommended for people 65 and older. For more information use this link: Flu & People 65 Years and Older | CDC

Who should get the flu shot?

Everyone 6 months and older in the US should get a flu shot every year with rare exception. To see more information about who should and who should NOT get a flu shot, use this link: Who Needs a Flu Vaccine | CDC

Can the flu shot give you the flu?

No. Flu shots given with a needle are made with either inactivated (killed) viruses, or with only a single protein from the flu virus. The nasal spray flu "shot" contains live viruses that have been weakened so that they will not cause illness.

Some people do have about 12-24 hours of feeling achy or even having a slight fever after a flu shot. This is due to the immune response to the vaccine, not a flu infection. These brief symptoms are nothing compared to having a true influenza infection.

Why do some people still get sick with flu symptoms even though they got a flu shot?

There are a few reasons why someone might still get flu symptoms despite having had the flu shot:

• There are lots of other viruses that can cause a flu-like illness that spreads in the community during the typical flu season, including multiple cold viruses and even COVID-19. Flu shots only protect against influenza, not other respiratory illnesses.
• Some people get exposed to the flu virus shortly before getting the flu shot, or in the 2 weeks after the shot, when your immune system is still building its response to the shot. This exposure can result in an infection before protection from the shot takes effect.
• Flu shots can vary in how well they work from year to year. Some years, the flu viruses that are spread in the community do not match those in the vaccine because the prediction was not accurate. Luckily, with the ability to protect against 4 different strains, the flu shots are usually effective. If it does happen, flu vaccination can still reduce the severity of illness, even though it may not prevent the infection entirely. If you have any questions about the flu shot, please log into your account and send us your question. We are here to help.

If you have any questions about flu shots, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Rocky Mountain Spotted Fever

Rocky Mountain spotted fever (RMSF) is a bacterial disease spread through the bite of an infected tick. It is one of the deadliest tick-borne diseases in the Western Hemisphere. Early recognition and treatment are keys to successful recovery.

How common is RMSF?

It is relatively rare. There are usually fewer than 20,000 cases of RMSF per year in the US.

How is RMSF transmitted to humans?

The bacteria that causes RMSF (Rickettsia rickettsii) is spread by several species of ticks in the US, including the American dog tick, the brown dog tick, and the Rocky Mountain wood tick.

If a tick is attached to your skin for 6-10 hours, you may pick up this infection. This is significantly less time than it usually takes to transmit Lyme disease.

RMSF primarily occurs in warm weather when the ticks that spread the disease are most active.

Where is RMSF most common?

Although it was first identified in the Rocky Mountains, RMSF cases occur throughout the U.S., most commonly in North Carolina, Tennessee, Missouri, Arkansas, and Oklahoma. It also occurs in parts of Canada, Mexico, and in Central and South America.

What are the signs and symptoms of RMSF?

Signs and symptoms may start between 2 and 14 days after tick exposure. Early signs and symptoms are nonspecific, including fever and headache. But this infection can rapidly progress to a serious, life-threatening illness. Symptoms include:

• Fever, chills, body aches
• Rash –
  • Usually starts 2-5 days after fever begins.
  • The appearance of the rash can vary quite a bit over the course of the illness. It can be red splotches, or pinpoint dots that are red or purple.
  • It usually starts on the wrists and ankles, then can spread all over, including to palms and soles.
  • It is not itchy.
• Headache, which can be severe
• Nausea, vomiting, stomach pain, lack of appetite

How is RMSF diagnosed and treated?

RMSF can be hard to diagnose because the initial symptoms are nonspecific and similar to many other infections. There are blood tests that can be done to look for evidence of RMSF. Unfortunately, the results of these tests can take a long time to come back.

If your doctor is strongly suspicious that you have RMSF, they will recommend antibiotic treatment immediately, even before the test results come back, because people who are not treated within the first 5 days of developing symptoms can develop serious complications and even die from this infection.

Doxycycline is the most effective antibiotic for the treatment of RMSF. It is recommended for adults and children. The risks associated with RMSF infection are so high, and new research shows no evidence of tooth staining when doxycycline is used in children to treat RMSF, so it is the preferred treatment, even for kids. Use of antibiotics other than doxycycline increases the risk of severe illness and death.

What are the possible complications that can happen from RMSF?

This infection damages the lining of blood vessels, particularly smaller blood vessels. This can lead to several complications if the infection is not treated early. These complications include:

• Encephalitis – Inflammation of the brain
• Meningitis – Inflammation of the spinal cord and spinal fluid
• Inflammation of the heart or lungs
• Kidney failure
• Serious damage to blood vessels leading to gangrene in arms or legs.
• Death – If not treated, the death rate is about 80%.

Can RMSF cause long-term health problems?

Yes. Because of the complications, some patients who recover from RMSF can be left with permanent health problems or disability. These include:

• Amputations – Arms, legs, fingers, or toes may need amputation.
• Hearing loss
• Paralysis
• Mental disability

Any permanent damage that is present is caused by complications of the acute infection. There is no chronic or persistent infection with RMSF.

How can you prevent RMSF?

Preventing tick bites and checking for ticks on people and pets daily is key. We talked more about this 2 weeks ago. If you missed that article, check your email or use this link: Preventing Tick Bites - eDocAmerica.

If you have any questions about Rocky Mountain Spotted Fever, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Lyme Disease

Lyme disease is the most commonly reported tick-borne disease in the U.S. It is caused by a bacteria called Borrelia burgdorferi. The name Lyme disease came from the location in which it was originally identified, Lyme, Connecticut. It can become a very serious infection if not treated, but most cases of Lyme disease can be treated successfully with a few weeks of antibiotics.

How is Lyme disease spread?

The bacteria that causes Lyme disease, Borrelia burgdorferi, is spread through the bite of infected ticks. Ticks that may be infected include the blacklegged tick (also called deer tick) in the northeastern, mid-Atlantic, and north-central U.S., and the western blacklegged tick on the Pacific Coast.

In most cases, the tick must bite and remain attached for 36-48 hours or more before the bacteria can be transmitted to humans.

Most people are infected through the bites of immature blacklegged ticks, call nymphs, which are tiny and difficult to see. Nymphs feed during the spring and summer months. Adult ticks can transmit Lyme disease, but they are much larger and are more likely to be discovered and removed before they have had time to transmit the bacteria. Adult ticks are most active during the cooler months of the year.

Where is Lyme disease most common?

Lyme disease is most common in the northeastern U.S. down to Virginia and the north-central U.S.

What are the signs and symptoms of untreated Lyme disease?

Lyme disease may evolve through stages, which can sometimes overlap. The first stage includes the first 30 days after the tick bite. It is considered early, localized Lyme disease. Symptoms at this stage can include:

• Fever and/or chills
• Joint and muscle pain, stiff neck
• Headache, fatigue, swollen lymph nodes
• An expanding circular rash (bull's eye or target appearance) called erythema migrans
  • The rash occurs in approximately 70-80% of infected individuals
  • Often noticed at the site of the bite but may appear on any area of the body
  • Expands gradually over several days
  • Does not always have the "classic" appearance

If Lyme disease is not treated, it can progress to cause more severe symptoms, which can include:

• Erythema migrans rash on multiple areas
• Paralysis of facial muscles (also called Bell's palsy)
• Areas of numbness, tingling, or nerve pain
• Interruption of the electrical system of the heart
• Swelling and severe pain in joints, especially the knees
• Inflammation in the brain and/or spinal cord (meningitis or encephalitis)

How is Lyme disease diagnosed?

If your doctor suspects you may have Lyme disease, a blood test is done to make the diagnosis. Sometimes the test is negative in early disease because your body hasn't yet made enough antibodies to the bacteria. If your test is negative and your doctor is suspicious of Lyme, they will likely recommend repeating the test after a few weeks.

The antibodies do not go away after you are treated, so the test can be positive for years, even though you no longer have Lyme disease.

How is Lyme disease treated?

Lyme disease is treated with antibiotics. There are several different antibiotics that can be used. The exact treatment regimen recommended can be different depending on the stage of the infection and which body systems are affected.

If you have symptoms concerning for Lyme disease, you should see your doctor for testing and treatment if necessary.

What is chronic Lyme disease?

In the majority of cases, Lyme disease is successfully treated with oral antibiotics. Rarely, patients can sometimes have symptoms of pain, fatigue, or difficulty thinking that last for more than 6 months after they finish treatment. This condition is called Post-Treatment Lyme Disease Syndrome (PTLDS). We don't know why some patients have these prolonged symptoms. Some experts believe that the infection can trigger an auto-immune response, which can also happen with many other infections.

Although the symptoms may be prolonged, this does not mean that the Lyme bacteria is still present or active. In rigorous controlled studies, patients with PTLDS treated with prolonged antibiotic treatment, including IV antibiotics, showed no benefit when compared with placebo treatment.

The term "chronic Lyme disease" has been used to describe people with different illnesses, some with PTLDS and some of whom have no evidence that they have ever had Lyme disease currently or in the past. For these reasons, experts in the field do not support the use of the term "chronic Lyme disease".

Many research studies are currently attempting to learn more about PTLDS as well as other conditions that mimic the symptoms of PTLDS without evidence of previous Lyme infection.

For more information about Lyme disease, use this link:

Lyme Disease | Lyme Disease | CDC

If you have any questions about Lyme Disease, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Preventing Tick Bites

Last week, we talked about tick bites.  Today we will focus on ways to protect yourself from ticks and the diseases they carry.

Where do ticks live?

Ticks live in grassy, brushy, or wooded areas, or sometimes on animals.  They prefer areas that are humid, and protected from the hot sun, but this does not mean they are never in dry and sunny spots.  Spending time outdoors doing activities like camping, gardening, hiking, hunting, all will potentially expose you to ticks.  Many people get ticks in their own yard.

What time of year should you be worried about tick bites?

Ticks are most active during the warmer months, April through September.  But with warming climate, tick exposure can now occur year-round in most parts of the U.S.

How can you reduce your risk of getting a tick bite?

If you plan an outdoor activity, particularly one that will be in a heavily wooded area, here are some precautions you can take before or during your outing to protect yourself:

• Wear long-sleeved, light-colored clothing, with tightly woven fabric.  The ticks will have less skin to target, and you can see them easier on the light-colored fabric.  Tuck your pant legs into your socks, shoes, or boots so that ticks cannot easily get under your pant legs. 

• If you are walking through woods or grassy fields, stay near the center of trails.

• Take steps to keep ticks out of your yard.  There is a link below that will help you.

• Treat clothing and gear with products containing 0.5% permethrin or buy pretreated products.  Permethrin can be used to treat boots, clothing, and camping gear.  Read the product label to be sure you use it properly.

• Use insect repellants with 20% or more of DEET on exposed skin, or clothing if they are not treated with permethrin.  Permethrin and insect repellants with DEET are readily available in sporting goods stores.

What should you do after you return from outdoors?

• Check For Ticks - They could attach anywhere.  Check your hair, body folds, inside your belly button, behind your knees, along your beltline, in or behind your ears, underarms, back, and between your legs (really everywhere!).  If you can't see all these places, get someone to help you check.

• Check your child's body for ticks.

• Check your clothes and gear as well.  You should wash clothes in hot water and/or put them in a hot clothes dryer for 15 minutes, which will kill the ticks.

• Check your pets for ticks.  You should also talk with your veterinarian about tick prevention products for your pets.

• Take a shower soon after you have been on hikes or working in the yard.

• You may find ticks that are crawling on you or your clothing and not yet attached.  Put them into a ziptop baggie or flush them down the toilet.  If you find a tick that is attached, refer to last week's Health Tip for the best way to remove the tick.  Or use this link:  Tick Removal | Ticks | CDC

Use this link to find more information on avoiding ticks and preventing tick bites:

Avoiding Ticks | Ticks | CDC

If you have any questions about preventing tick bites, please log into your account and send us your question. We are here to help.

 
Dr. Anita Bennett MD - Health Tip Content Editor