Traveling this summer: Is it time for a COVID booster?

Sandy Klein looks forward to her European Cruise next month. At 78, she considers herself healthy. Still the Palm Beach resident wonders if she should get a COVID booster before her trip.

“I don’t want to spend my vacation sick — or worse, in the hospital,” she said.

This summer travel season has been forecasted to be one for the record books, and with so many people on the move, the risk of getting COVID-19 rises.

COVID still is circulating and people do seem to be picking up the virus during travel. However, for most people who get COVID now, the symptoms are more like a bad cold or flu, doctors say. Still, those symptoms — fever, aches, sore throat and cough — are enough to ruin a trip or force you to miss a family reunion.

Most people have some level of immunity, either from a shot or the virus itself. So is worth getting a COVID booster?

How to decide whether to get boosted

Let your activity over the summer months guide your strategy, along with your age and health, doctors say.

“It’s really a matter of how much risk you are willing to take because there is still COVID out there,” said Dr. Sergio Segarra, chief medical officer at Baptist Health’s Baptist Hospital in Kendall.

Segarra says only about 4% to 8% of patients in his hospital are there for COVID, but none are in the intensive care. He says the immunity gained from vaccination and prior infection seems to have lessened the severity of the disease for most people.

“But if you have health issues or are over 50 you might want to get the booster,” he said. “Also, it depends on where you are going. Airports are congested and cruise ships are close quarters. If you are going to a remote place, that’s different. For most people who are traveling, if you don’t want to spend a few days feeling miserable, I would recommend it.”

Immunity wears off

Booster uptake has been low in Florida — only 11.7% of all ages have received one, according to data from the Centers for Disease Control and Prevention. If you already had COVID or a vaccine, research has shown that immunity wears off over time and becomes less effective against new strains.

This fall, most likely the end of September, vaccine manufacturers will be releasing updated COVID booster shots to target  XBB 1.5, the predominant coronavirus strain in the United States that first arrived in late 2022. The new booster formulation will drop the original coronavirus strain, which no longer is in circulation. Some doctors believe that will optimize the immune response.

Along with mRNA vaccines, a third vaccine maker, Novavax, likely also will be an option for an updated booster that targets XBB.1.5. Novavax’s COVID shots are a protein-based vaccine.

Some scientists are hoping for a nasal spray option as well, although that could take until 2024. In September, India approved a nasal COVID-19 vaccine, and in October, China began administering an inhalable version.

Waiting for fall can be tricky, though, particularly when there’s currently a booster available even if it’s not targeted at the most current strain.

Who is eligible for a booster

At this time, the only COVID shots available to adults are the mRNA bivalent booster. Anyone 6 and older can get one. The bivalent booster blends an antigen aimed at the original strain of the virus with another designed for the BA.4 and BA.5 variants, which had been circulating when the shot became available. The latest data shows the effectiveness against symptomatic XBB infection, which isn’t a strain it was made to target, is about 43% for people 50 and older

“If you expect perfection from vaccines, you will be disappointed,” said Vanderbilt University infectious disease professor Dr. William Schaffner. “Just like with influenza, they need to keep updating them. They will never be perfectly up to date because it takes time to develop vaccines, package them, and get them into arms.”

Sometimes it can feel as if vaccines are pointless in avoiding infections, Schaffner acknowledges. However, research shows vaccines reduce severe outcomes from COVID, and the latest CDC data indicates they still offer some protection against mild infections.

When considering timing, the CDC recommends waiting four months between shots. That also applies to people 65 and older who are eligible for a second bivalent booster.

“If it has been more than four months since you had COVID or a shot, your immunity is not down to zero,” Schaffner said. “You still have some protection but it’s a matter of who you are, how robust your immune system is, how old you are, and do you have any underlying issues. The older you are, your risk goes up.”

Timing your booster

If you believe you are at risk, don’t wait for the fall, he says.

“If you are going to travel you should get the booster available now,” he says. “Come October you will be eligible for the new booster.”

If you decide get boosted before travel or a special event, you may want to time it for optimal protection.

The booster is most effective roughly two weeks to a month after getting the shot, according to Dr. Leanna Wen a professor at George Washington University’s Milken Institute School of Public Health. After a month, protection against infection begins to drop, she said. “Still, some people would value even a small, temporary reduction in infection risk,” she wrote in a column published in The Washington Post.

If you decide not to get boosted, Wen advises masking in crowded places. And making preparations can be important when traveling. Anyone older than 65 should travel with Paxlovid, says Segarra at Baptist Health South Florida. “It’s still recommended for mild to moderate symptoms and a good tool to have.”

Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].