Dear Dr. Roach: How effective are COVID vaccines for people taking immunosuppressive prescriptions? Will we be tested for a desired level of antibodies and maybe get a booster sooner than other people?
C.J.
The degree of benefit from a COVID-19 vaccine in people with weakened immune systems due to disease or medication is likely to depend to a large extent on the degree of immune suppression. There are not large studies yet, so I can’t comment on the vaccine effectiveness in this group. There will be some benefit in preventing illness, and probably greater benefit in preventing severe disease, hospitalization and death among people who get the vaccine compared with people who don’t. Most people should get the vaccine, although this depends on a person’s exact situation, and only their own doctor can give a personalized answer.
However, the degree of protection, even in a person with an immune system unaffected by medical conditions or treatments, is not perfect. As I write this, there are reports of people who have been vaccinated getting ill and hospitalized with COVID-19. There are no absolute guarantees in life, certainly not in medicine. Consequently, it’s important for everyone, but particularly for those with immune system issues, to continue to be vigilant after immunization. Masks should still be worn in public places, and social distancing observed, especially with people who are not immunized.
I expect that as we gain more experience, the role of antibody titers and booster shots will become clearer. For now, there is no recommendation to check antibodies or give booster vaccines.
Dear Dr. Roach: My sister has a urinary tract infection. Should she get a COVID shot?
J.S.
The only condition that is absolutely a reason not to get a COVID-19 vaccine is a history of a severe allergic reaction, such as anaphylaxis, to the vaccine or a component of the vaccine. In all other cases, one has to balance the risks and the benefits.
For a person with a severe urine infection with high fever, it is probably prudent to postpone the vaccine for a few days until the fever is gone and they are feeling better. If they have mild UTI (the discomfort may be much worse than “mild,” but I really mean no fever or systemic symptoms, such as low blood pressure), then it is perfectly reasonable to get the vaccine, especially if postponing it means waiting a long time to get another appointment.
Dear Dr. Roach: I know this may sound like a silly question, but let me ask something that I know many men have wondered. From a medical standpoint, is it better for men to wear briefs or boxer underwear?
D.B.
Men should wear what they are comfortable with, and from a medical perspective, the one clear difference is that boxer shorts are associated with improved fertility. Spermatogenesis is more efficient at cooler temperatures, and boxer shorts allow the system men have for temperature control to work more efficiently. Men who are planning on becoming fathers should consider boxers.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
