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Frank Bures: Vaccination needed after COVID infection?

Frank Bures: Vaccination needed after COVID infection?

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Questions have arisen about the need for a COVID vaccination if you already had a primary or natural infection. At this point in our learning from the virus, we aren’t sure. We’ll cite a few opinions from experts to illustrate the somewhat differing views. The essential problem in giving a definitive answer is that we only have the ability to measure part of our immune system’s reaction to the virus by calculating antibody levels. There’s a WHOLE lot more to it than that.

The CDC’s official position as of June 15, 2021, is, “Yes, you should be vaccinated regardless of whether you already had COVID-19. That’s because experts do not yet know how long you are protected from getting sick again after recovering from COVID-19. Even if you already recovered from COVID-19, It is possible — although rare — that you could be infected with the virus that causes COVID-19 again. Studies have shown that vaccination provides a strong boost in protection [antibody levels] in people who have recovered from COVID-19.”

Here are some excerpts from an article written by Jennifer Pisano, M.D., infectious disease specialist at the University of Chicago. “Q: Do I need the vaccine if I’ve already had COVID-19? A: Absolutely. While we know recovering from a COVID-19 infection means you will have circulating antibodies in your system, we are still learning about how the immune system handles the antibody response after a natural infection. We’re not sure how protective the antibodies are from different kinds of [variant] infections.

“With natural immunity, after being infected with a virus, the immune response can be variable [immensely, per patient!]. We don’t have clear data on how antibody response to a mild infection [disease reaction] compares to a severe infection. … We do know the vaccine is very protective in most people.”

She acknowledges there can be rather rare “breakthrough” infections after both shot and sickness, but it’s mild. Also, a recent CDC study analyzed breakthrough infections in those patients and found the viral load (the number of viruses in noses and throats) was quite low. This helps the people around you who are still susceptible and means less chance for spreading it. She also admits she was nervous about her possible reactions to the shots, which were significant for shot one, but not the second.

A May 24, 2021, NPR article follows the same thought patterns with interviewed experts advocating the vaccine post infection. A Virginia Tech epidemiologist pointed out that in some, the second infections were much worse, even causing deaths, like a Nevada person reported last summer. “The scant research on re-infection has shown mixed outcomes, but a small study from March showed more severe cases among 33 Brazilian health workers with recurrent COVID, including one fatality.”

An interesting contrast of experts came from the Cleveland Clinic, a Mayo Clinic sized group in Ohio. One opinion derived from the paper from June 5, 2021, is not yet published but in “preprint.” It analyzed 52,238 of their employees over 5 months who were previously both infected and vaccinated, had prior infection, were only vaccinated, or not vaccinated. The first 3 groups all had essentially no infections, but in the unvaccinated the infections increased. This led to their conclusion that those with prior infections “are unlikely to benefit from COVID-19 vaccination.”

Second, in a May 28 Health and Wellness Tips article from that clinic, infectious disease expert Kristen Englund, M.D., said, ”Even though you’ve had COVID-19, it is still very important for you to get the vaccine. … We don’t know how long your immunity will last after you’ve had a natural COVID-19 infection.” She points to a phenomenon yet to be fully understood that many so called “long hauler” COVID patients with persistent illness seem to recover from these lasting symptoms after post infection vaccination.

Some groups are wondering if the previously infected only need one of the two mRNA vaccine shots because of a big antibody and B cell response from it. But that still doesn’t account for the difficult to measure T cell immunity. We’re a long way from understanding that whole aspect, which is as crucial as the antibody side.

There don’t seem to be any medical reasons to avoid a vaccination post infection to date. There have been no detrimental reactions or deaths. So, like much in this continually evolving viral saga it’s a yes-no proposition, but more yes than no. Don’t be timid. Roll up your sleeve, and get your shot for your own and others’ good. It kind of reminds me of the time my friend asked me to get out of the car and see if the turn signal was working. I told him yes-no-yes-no-yes …

Dr. Bures, a semi-retired dermatologist, since 1978 has worked Winona, La Crosse, Viroqua, and Red Wing. He also plays clarinet in the Winona Municipal Band and a couple dixieland groups. And he does enjoy a good pun.


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