As your friendly neighborhood editor, I would suggest, especially in important posts like this, that you lead with your bottom line--in this case, "If you're eligible, go get your booster." And then follow with "Here's why:" and go into your full explanation. Especially in this day of TL:DR, to communicate successfully to many readers, you need to include the recommended action or key point in your lead (lede, for journo freaks).
THANK YOU! I teach middle school science and I ( we) look forward to your blogs. I share them with my students and we discuss them together. You write in a way that everyone in the room understands- not easy. Thank you again and again for doing this- we all benefit!
A wonderfully comprehensive piece that articulates the concerns and questions I've had since the CDC and FDA authorized a 2nd booster for over 50's (hubs and me). I wonder if there is any benefit to alternating mRNA vaccines for the 2nd booster (i.e., if I've received all 3 Moderna doses, should I now go with Pfizer for #4?)
Interesting as in Oct/Nov I had three different vaccines, each two weeks apart. (Flu, DTap and Pfizer) I haven't had any breakthrough infections....but then again I've been staying at home or carefully wearing a well-fitted N99 reusable mask at a few of my grandchildren's performances and small family gatherings. 🤔
I re-read this, and re-appreciated all the work that went into it!
Paul Offit's NEJM opinion today is kind of a bummer. He has been kind of a bummer for a while though, and playing the booster contrarian has become more of an ideological position for him I think. I'll cut and paste the relevant statement he makes about OAS in reference to 4th shots... but he really cherry picks the non-human primate study, which I think is not as balanced or fair as your take here.
Would be nice to have all sorts of vaccine, booster #, infection, and variant-naive cohorts to compare in terms of antibody and immune responses, and then mash them up with future variant exposure... but I like how you bring us back to the main point - which is we are making decisions in real time, and with the available evidence. Offit has positioned himself well for a future I-told-you-so, but how many booster-preventable deaths would have occurred if FDA went with his anti-booster hunch pre-Omicron? Not insignificant. Walensky bailed us out.
Anyway, as a clinician, just want to say I appreciate how hard this post was to organize and present. It helped me avoid some Offit-induced gloom.
Here's Offit from NEJM today:
"And all age groups are at risk for the theoretical problem of an “original antigenic sin” — a decreased ability to respond to a new immunogen because the immune system has locked onto the original immunogen. An example of this phenomenon can be found in a study of nonhuman primates showing that boosting with an omicron-specific variant did not result in higher titers of omicron-specific neutralizing antibodies than did boosting with the ancestral strain. This potential problem could limit our ability to respond to a new variant."
Glad to know that I am not alone in finding Offit’s comments to be counterproductive and annoying. Make that “infuriating”, since he is apparently playing an outsized role in denying additional vaccines to those of us who want them.
I really appreciate the time and mental brain power you took to write this important information up. Yes, most will go over my head, and I really appreciate the "Bottom Line" summation. We have a state COVID vaccination program where a bus comes to our rural mountain community for a one day vaccination opportunity. You bet I will be there to get my booster! I've been fortunate to not have any horrible side effects (knock on wood.) Was a bit concerned because the first shot was the J&J and then I boosted with Moderna. Going to stick with the Moderna for the second booster too. Thanks so much again!
I am 74 and have had 2 Pfizer injections and a Pfizer booster. I am going to get a Moderna second booster. Thank you for your advice. I am A master’s level RN. I expect to have more side effects but I think I might get a stronger immune response.
I'm 60 with high risk health concerns, and I also have decided to get Moderna after three Pfizer. I was a certified health education specialist. It's my understanding that this bit of change may improve immune response.
This is interesting because all my previous vaccinations were Pfizer and wondering if boosting with Moderna might be a better route? Feeling very indecisive other than to go and get the 4th booster! Interestingly neither my husband or daughter got Covid when I did even with the same exposure and they both had Moderna vaccines...or maybe my underlying health conditions were the issue and not the Pfizer vaccine? Who knows!
Thanks for asking that question, Barbara. (1) Why do you think Booster-2 with Moderna (rather than Pfizer) would be likelier to result in more side-effects? (as I understand it, a Moderna booster is half the dose of the initial Moderna dose). (2) More generally, on theoretical grounds, what MIGHT we expect immunologically from a booster of a protein subunit vaccine such as Novavax?
My MD recommended a second booster of Moderna. We thought it would affect my immune system more. I just had that Moderna injection 2 days ago. I had increased body aches and fatigue than I did not have previously. All ok today.
Happy you had only a mild reaction! I had zero reaction to both Moderna and the booster - am I lucky or did it not work so well? Another way of asking this is: If I didn't get fatigue, muscle aches, fever...is that evidence of low cytokine response (and is that good bad or meh?) Nonetheless I'm ready for Booster-2. Also why are some vaccines effective for decades (measles, mumps, polio) and Covid vaccines not (apparently)? Is the reason related to how long the primary infection confers immunity? But then why does having measles confer long-term immunity, but not having Covid? E.g. I had measles before there was a vaccine and doctors have never recommended I get vacc'd or avoid people who might have measles. SO many questions!
Thank you for this timely piece as I am weighing up the need for a 4th booster. I am in my mid 50's, had my booster last October as I have an underlying condition and work in a childcare/school setting. I got Covid in January - took 4 weeks to recover. So is now the time to get my 4th booster? Seems from what you've written the answer is "yes"?
You may not need another booster yet, since having COVID in January would have already helped improve your immunity for a while. Maybe six months after, in July, would be better? I don't really know but that's probably what I would do.
I have a similar question - mid-50's, underlying conditions, Covid/Omicron in January of this year. Traveling internationally in May. Should I get the 4th booster?
Would you please fix the typo in this sentence: “For example, the antibody levels weren’t correlating with severe disease when we would except [expect] they would.”
Got my second booster and now have two Moderna vax, one Pfizer boost and second Moderna boost. Not worried overly about OAS. Wish my health plan would allow me to also get J&J vax since a broad spectrum approach might do more good than harm. Real long term solution is the pan-coronavirus vaccine in development.
You mention the potential for a pan-coronavirus vaccine. Might OAS interfere with its operation in someone who's already been exposed to SARS-CoV-2 (or another vaccine)? Would it be more effective to give multiple separate vaccines (at different times) for different antigens so the immune system won't see them as redundant?
Beyond OAS, I have a question: The cases per 100,000 in my county, as of 4/7/22 were 98.89. One week ago the number was 80.35. Your first interpretation of the numbers chart, suggested that 50 to 99 cases per 100,000 is "orange". This weeks number is a hair breadth away from the "red" zone. Yet, the CDC considers my county 'green', or in the previous classification, "blue". Which guideline presents less risk to the individual? The previous one, or the current one?
Katelyn, You are doing an excellent job of informing everyone of factors to consider. I appreciate your effort.
This comment from a career MIcrobiologist(41 years)
I want to know if they're going to study this guy: https://www.kcrg.com/2022/04/03/man-germany-gets-90-covid-19-shots-sell-forged-passes/
me too :)
This guy's a walking lab experiment. And I was worried about a 4th shot, ha!!
Me too! But we went ahead and did it last Saturday.
Right? Sure seems like an interesting case study as it relates to this topic. Wild!
I know, right? I almost feel like allowing himself to be used as a guinea pig would more than make up for any harm he caused.
A competent judge might even make that the entirety of his sentence, as an alternative to a fine.
It's easy to get into the weeds with all this. Thanks for making it clear without losing critical details.
As your friendly neighborhood editor, I would suggest, especially in important posts like this, that you lead with your bottom line--in this case, "If you're eligible, go get your booster." And then follow with "Here's why:" and go into your full explanation. Especially in this day of TL:DR, to communicate successfully to many readers, you need to include the recommended action or key point in your lead (lede, for journo freaks).
THANK YOU! I teach middle school science and I ( we) look forward to your blogs. I share them with my students and we discuss them together. You write in a way that everyone in the room understands- not easy. Thank you again and again for doing this- we all benefit!
A wonderfully comprehensive piece that articulates the concerns and questions I've had since the CDC and FDA authorized a 2nd booster for over 50's (hubs and me). I wonder if there is any benefit to alternating mRNA vaccines for the 2nd booster (i.e., if I've received all 3 Moderna doses, should I now go with Pfizer for #4?)
The current information appears to be yes, a booster different from your original series may provide broader protection.
Dr. Jetelina addressed this question in a March 31 post (see https://yourlocalepidemiologist.substack.com/p/fourth-dose-q-and-a?s=r) under "Which booster should I get?"
I'm starting to wonder whether chasing with vaccines to completely different viruses (flu, TDAP, MMR) might be a pretty good strategy
Interesting as in Oct/Nov I had three different vaccines, each two weeks apart. (Flu, DTap and Pfizer) I haven't had any breakthrough infections....but then again I've been staying at home or carefully wearing a well-fitted N99 reusable mask at a few of my grandchildren's performances and small family gatherings. 🤔
I re-read this, and re-appreciated all the work that went into it!
Paul Offit's NEJM opinion today is kind of a bummer. He has been kind of a bummer for a while though, and playing the booster contrarian has become more of an ideological position for him I think. I'll cut and paste the relevant statement he makes about OAS in reference to 4th shots... but he really cherry picks the non-human primate study, which I think is not as balanced or fair as your take here.
Would be nice to have all sorts of vaccine, booster #, infection, and variant-naive cohorts to compare in terms of antibody and immune responses, and then mash them up with future variant exposure... but I like how you bring us back to the main point - which is we are making decisions in real time, and with the available evidence. Offit has positioned himself well for a future I-told-you-so, but how many booster-preventable deaths would have occurred if FDA went with his anti-booster hunch pre-Omicron? Not insignificant. Walensky bailed us out.
Anyway, as a clinician, just want to say I appreciate how hard this post was to organize and present. It helped me avoid some Offit-induced gloom.
Here's Offit from NEJM today:
"And all age groups are at risk for the theoretical problem of an “original antigenic sin” — a decreased ability to respond to a new immunogen because the immune system has locked onto the original immunogen. An example of this phenomenon can be found in a study of nonhuman primates showing that boosting with an omicron-specific variant did not result in higher titers of omicron-specific neutralizing antibodies than did boosting with the ancestral strain. This potential problem could limit our ability to respond to a new variant."
(no other studies mentioned)
Paul latched on to OAS… to the point of distraction but still supports the concept of vaccination and boosters, if you dig deep enough in his pieces.
Glad to know that I am not alone in finding Offit’s comments to be counterproductive and annoying. Make that “infuriating”, since he is apparently playing an outsized role in denying additional vaccines to those of us who want them.
I really appreciate the time and mental brain power you took to write this important information up. Yes, most will go over my head, and I really appreciate the "Bottom Line" summation. We have a state COVID vaccination program where a bus comes to our rural mountain community for a one day vaccination opportunity. You bet I will be there to get my booster! I've been fortunate to not have any horrible side effects (knock on wood.) Was a bit concerned because the first shot was the J&J and then I boosted with Moderna. Going to stick with the Moderna for the second booster too. Thanks so much again!
I am 74 and have had 2 Pfizer injections and a Pfizer booster. I am going to get a Moderna second booster. Thank you for your advice. I am A master’s level RN. I expect to have more side effects but I think I might get a stronger immune response.
I'm 60 with high risk health concerns, and I also have decided to get Moderna after three Pfizer. I was a certified health education specialist. It's my understanding that this bit of change may improve immune response.
This is interesting because all my previous vaccinations were Pfizer and wondering if boosting with Moderna might be a better route? Feeling very indecisive other than to go and get the 4th booster! Interestingly neither my husband or daughter got Covid when I did even with the same exposure and they both had Moderna vaccines...or maybe my underlying health conditions were the issue and not the Pfizer vaccine? Who knows!
Thanks for asking that question, Barbara. (1) Why do you think Booster-2 with Moderna (rather than Pfizer) would be likelier to result in more side-effects? (as I understand it, a Moderna booster is half the dose of the initial Moderna dose). (2) More generally, on theoretical grounds, what MIGHT we expect immunologically from a booster of a protein subunit vaccine such as Novavax?
My MD recommended a second booster of Moderna. We thought it would affect my immune system more. I just had that Moderna injection 2 days ago. I had increased body aches and fatigue than I did not have previously. All ok today.
Happy you had only a mild reaction! I had zero reaction to both Moderna and the booster - am I lucky or did it not work so well? Another way of asking this is: If I didn't get fatigue, muscle aches, fever...is that evidence of low cytokine response (and is that good bad or meh?) Nonetheless I'm ready for Booster-2. Also why are some vaccines effective for decades (measles, mumps, polio) and Covid vaccines not (apparently)? Is the reason related to how long the primary infection confers immunity? But then why does having measles confer long-term immunity, but not having Covid? E.g. I had measles before there was a vaccine and doctors have never recommended I get vacc'd or avoid people who might have measles. SO many questions!
Amazing re cap! Man that is a tough topic to summarize & explain and you did it exquisitely!! Thank you
Thank you for this timely piece as I am weighing up the need for a 4th booster. I am in my mid 50's, had my booster last October as I have an underlying condition and work in a childcare/school setting. I got Covid in January - took 4 weeks to recover. So is now the time to get my 4th booster? Seems from what you've written the answer is "yes"?
You may not need another booster yet, since having COVID in January would have already helped improve your immunity for a while. Maybe six months after, in July, would be better? I don't really know but that's probably what I would do.
I have a similar question - mid-50's, underlying conditions, Covid/Omicron in January of this year. Traveling internationally in May. Should I get the 4th booster?
Would you please fix the typo in this sentence: “For example, the antibody levels weren’t correlating with severe disease when we would except [expect] they would.”
Got my second booster and now have two Moderna vax, one Pfizer boost and second Moderna boost. Not worried overly about OAS. Wish my health plan would allow me to also get J&J vax since a broad spectrum approach might do more good than harm. Real long term solution is the pan-coronavirus vaccine in development.
https://www.reuters.com/world/middle-east/second-booster-shields-elderly-covid-protection-wanes-quickly-study-2022-04-06/
Would love your thoughts on this.
You mention the potential for a pan-coronavirus vaccine. Might OAS interfere with its operation in someone who's already been exposed to SARS-CoV-2 (or another vaccine)? Would it be more effective to give multiple separate vaccines (at different times) for different antigens so the immune system won't see them as redundant?
Beyond OAS, I have a question: The cases per 100,000 in my county, as of 4/7/22 were 98.89. One week ago the number was 80.35. Your first interpretation of the numbers chart, suggested that 50 to 99 cases per 100,000 is "orange". This weeks number is a hair breadth away from the "red" zone. Yet, the CDC considers my county 'green', or in the previous classification, "blue". Which guideline presents less risk to the individual? The previous one, or the current one?