What the IBD Community Needs to Know About Getting a COVID-19 Booster

Now that many of us with inflammatory bowel disease (IBD) are several months out from receiving two doses of the mRNA COVID-19 vaccines, the Centers for Disease Control and Prevention (CDC) has approved a booster dose of an mRNA COVID-19 vaccine for all adults 18 and up who received a second dose of the Pfizer or Moderna vaccine at least six months ago or the single-dose Johnson & Johnson vaccine at least two months ago.

What Does This Mean for People With IBD?

Several months of data on COVID-19 outcomes have shown that people with IBD are not at a greater risk of worse outcomes simply due to the condition. But many of us take immunosuppressive medications, which creates additional concerns for increased risks of infection.

According to recent studies (ICARUS-IBD, PREVENT COVID, CORALE-V IBD, and CLARITY IBD), however, many people with IBD who received mRNA vaccines mount immune responses comparable to the general population, in spite of us being on immune-modifying medicines.

To better understand what boosters mean for the IBD community, I spoke with two gastroenterologists: Harry Thomas, MD, of Austin Gastroenterology in Texas, and Meenakshi Bewtra, MD, MPH, of Penn Medicine in Philadelphia.

Do People With IBD Need a COVID-19 Booster?

“Real-world studies of ICARUS, CLARITY, CORALE-IBD, and PREVENT COVID have not shown that medications used to treat IBD are blunting the overall response to the COVID vaccine,” Dr. Bewtra says. Nevertheless, because immunity has been shown to naturally wane over time, people with IBD, like all other U.S. adults, are now eligible to receive booster vaccine doses. She and Dr. Thomas both say that it’s in the best interest of those with IBD to get a booster dose to protect ourselves and our loved ones.

In terms of booster side effects, Thomas says there is some anecdotal evidence that if patients didn’t experience the usual headaches, arm soreness, low-grade fevers, or chills with the initial two doses, there may be some of that with the third dose. He says this is a normal response to a vaccine and nothing for patients to worry about.

Questions From the IBD Community

If I need a booster dose of an mRNA vaccine, does that mean the vaccines aren’t working well enough to prevent COVID-19?

That is simply not true, says Thomas. The vaccines are working very well to prevent severe illness, hospitalization, and death. However, with the Delta variant, there has been reduced protection against mild and moderate COVID-19.

Bewtra adds that getting a booster protects us from any possibility of waning immunity, and that has nothing to do with the vaccines not working well — the vaccines continue to have very high efficacy rates against hospitalization and death.

If I’m being recommended a booster, does that mean I should get my antibody levels checked to see if I need a third dose?

“Unless getting spike protein antibody levels checked is part of a protocol for a research study you are part of, do not get antibody levels checked,” Bewtra says. “We don’t yet fully know what antibody levels mean, and we have to consider that there may be other factors contributing to the onset of this virus in some patients versus others.”

Do I need to get a flu shot if I’m getting an additional dose of a COVID-19 vaccine? If so, can I get them at the same time or should I space them out around my biological therapies?

A flu shot is recommended for everyone 6 months and older, Bewtra says. “A COVID-19 vaccine will not protect you against the flu and vice versa. However, we do know that if you contract both viruses, you can become much sicker than you would have with either infection alone. So it is best to protect yourself against both.”

Bewtra went on to say that patients can get both vaccines at the same time. “You do not need to space them around your biological therapies. That being said, however, some people may have reactions (or even more reactions if they get multiple vaccines at one time), so if you are able to space them out, that may be more comfortable,” she says.

The most important thing, she adds, is to get vaccinated and stay on the medications that are working for you.

Should I mix and match vaccines?

According to Bewtra, there is no specific information about mixing and matching vaccines for people with IBD. This is a decision that should be based on what each of us is comfortable with and what our physicians recommend.

Final Thoughts From an Informed Patient With IBD

And I am, of course, almost always asked about my views as an informed patient: "Tina, as a patient advocate, are you planning to get a booster shot? What do you recommend?"

I’m certainly no doctor, but I’ve had many conversations with my IBD specialist as well as other care providers for the many autoimmune ailments that I have. I recently received the booster dose of the Pfizer vaccine. While I am part of the ICARUS study, and do know that I’m mounting a response to the first two doses of the Pfizer vaccines, there is still so much unknown about this virus.

I have also received a flu shot. I chose to space the COVID-19 vaccine out by a couple weeks from the flu shot and took my biologic the week in-between. I was completely fine with both vaccinations and just had a sore arm for a couple days.

My doctors have asked me to protect myself as much as possible by wearing a mask, especially if I will be traveling via flight or train to conferences or to see my family. Many of my family members have gotten infected with breakthrough cases of COVID-19, and it’s something I want to make sure I have maximal protection from as we go into another winter season.

And last but not least: "Will we still have to hunker down or can we go out more with our friends and families? Can we travel more and return to work or school?"

“The whole idea behind the booster dose is to help us return to greater normalcy in the setting of new variants like the highly contagious Delta variant,” Thomas says. “We have to spend our ‘COVID-19 risk dollars’ wisely and live our lives, too. We have to do whatever it takes to protect ourselves, vaccines included, but we cannot forget to mask up, socially distance, and wash our hands for at least 20 seconds.”

As far as the holiday season goes, Bewtra shares the CDC's guidance, which includes masking and avoiding large indoor gatherings, to protect ourselves as much as possible. “Boosted, vaccinated, or not — none of these are 100 percent effective when community virus levels are high, so folks should not feel safer if they have gotten the booster. They still need to wear a mask, avoid indoor mixed-company gatherings without masks, avoid crowded outdoor gatherings without masks, etc.”

After much back and forth these past few months, I have to say, it’s reassuring to hear that it’s safe and recommended for those of us with IBD to get a booster dose. Bewtra and Thomas have calmed my nerves to hear that a booster dose may bring us a bit closer to the normalcy we are all seeking in this pandemic.

Having taken the booster dose myself, I truly believe that protecting myself is the best way to protect others, too. To me, that looks like not only taking the vaccine but washing my hands and wearing a mask when around others. And my personal preference is to continue to take precautions by not attending large gatherings (indoors or outdoors) or dining indoors at this time.

My hope is that our IBD community is able to take charge to protect ourselves and our loved ones by being proactive and getting vaccinated and boosted against the novel coronavirus as recommended by our physicians.

Alongside that, I hope we continue to wear masks and wash our hands, so that even if we are asymptomatically carrying the virus, we won’t get anyone sick or vice versa. Please discuss with your physicians what’s right for you in terms of exposure to others during travel and gatherings this holiday season, so we can prevent an uptick in cases.

Own your Crohn’s. Own your ulcerative colitis. And be proactive about your health by arming yourself with the education you need on viruses and vaccines.