New booster on horizon as COVID-19 numbers tick up
Q: I would like to know about the new COVID-19 variant called Eris. Will there be a new booster for it? Also, I've read you'll get better immune response if you get all of your COVID shots in the same arm each time. Is this true?
A: From the earliest days of the pandemic, health authorities have kept a watchful eye on the emergence of variants of the coronavirus that causes COVID-19. More specifically, they have tracked what are known as variants of interest. These are mutated forms of the original coronavirus that, due to small changes to the genetic code, become more successful at breaking into and infecting host cells.
Among the newest of these is a variant called EG.5, which has come to be known as Eris. It is now the dominant variant in many parts of the world, including the United States. The Centers for Disease Control and Prevention reports that, as of Aug. 21, Eris made up close to 21% of all new COVID-19 infections in the U.S. That's a marked increase over the previous month. However, in terms of symptoms and severity of disease, Eris does not appear to be significantly different from previous variants.
Eris, along with a handful of other variants that are under close scrutiny at this time, is a descendant of the XBB strain of the coronavirus. That strain is the target of the newest generation of coronavirus booster shots. The new coronavirus booster, which still needs regulatory approval from the FDA, is expected to become available sometime this fall. To simplify what has often been a confusing process, the U.S. is shifting to an annual model for COVID-19 boosters for all age groups.
As for your question about which arm to choose for your coronavirus vaccine, new research suggests the decision may play a role in immune response. A recent study found that immune response may indeed be stronger when the COVID-19 vaccine goes into the same arm each time.
Researchers arrived at this conclusion by analyzing data from 303 individuals receiving the original two-dose coronavirus vaccine series. Those who got both shots in the same arm had levels of T cells that were 75% higher than those who switched arms for the second shot. T cells, which are a type of white blood cell, play a crucial role in immune response. Sometimes known as "killer T cells," they roam throughout the body and attack suspected pathogens.
The researchers suspect the link between vaccine location and higher T cell numbers is due to the proximity of the armpit. T cells are present in lymph nodes, including those located in the armpits. When the immune cells in those lymph nodes are repeatedly stimulated by the vaccine, this could lead to a more robust immunological response. Proving whether this is actually the case will require a larger and longer study. But in the meantime, there is no harm in picking one arm in which to receive all of your COVID vaccines.
Hearing tests
Q: My wife's insurance company is suggesting that she get a hearing test. She is only 51, and her hearing is fine. Does she really need to get this screening?
A: Although hearing loss is often associated with growing older, it can begin at any age. In some cases, it begins as early as the 30s and 40s, and it increases over time.
Hearing loss, which can occur in the outer, middle or inner ear, falls into a few major categories. In conductive hearing loss, sound is unable to move from the outer or middle ear into the inner ear. This can often be repaired medically. Sensorineural hearing loss refers to damage to the nerves involved in hearing. This type of hearing loss is irreversible. Some people have a combination of the two. This is known as mixed hearing loss. Age-related hearing loss is associated with physical changes to the hearing apparatus that occur as we grow older.
Additional causes of hearing loss can include injury, high fever, diabetes, viral infections such as measles or mumps, stroke, certain medications, repeated exposure to loud noise and heredity. An obstruction, such as a buildup of wax in the outer ear or fluid in the middle ear, can also diminish hearing.
It is recommended that young adults have a hearing test when they reach their mid-20s. The results provide a baseline against which future tests can be measured. Once someone reaches their 50s, it's a good idea for an annual hearing test to become part of their preventive care. You can arrange this via your health care provider or seek out an audiologist.
The most common form of hearing test, known as a sound test, checks someone's response to a range of sounds, tones, pitches, volumes and spoken words. Another type of test, known as a tympanometry test, evaluates the movement of the eardrum. This is used to check for infection, the buildup of wax or fluid, and for damage, such as a hole or tear, to the eardrum.
The initial indications of age-related hearing loss, which affects about one-third of older adults, can be subtle. Speech becomes a bit difficult to understand, particularly when there is background noise. This leads to the need for repetition. Softer and higher voices become more difficult to hear. Words that include high-pitched "s" and "th" sounds seem muffled. Some people with age-related hearing loss begin to develop the ringing sound of tinnitus. The volume settings on electronic devices can be a useful gauge in the onset of hearing loss. If you find yourself consistently turning up the volume, it can be an indicator that something is amiss.
A decrease in hearing can separate someone from the world around them. It can make it more difficult to communicate, to process information and to participate in group activities. Diminished hearing has also been linked to an increased risk of cognitive decline. Even if your wife's hearing is perfectly fine, it's a good idea for her to have a hearing test to set a baseline for the future.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.