[Hac-announce] Fwd: Considerations for your fall booster
Manny Sholem Ratafia
manny at ratafias.com
Fri Sep 2 10:42:51 EDT 2022
Epidemiologist Katelyn Jetelina just sent this out. This is the best
summary on getting the new Pfizer/BioNTech and Moderna COVID vaccines
that I've seen so far. For those who just want the bottom line, I've
pasted in brief highlights.--Manny
Brief highlights:
"This fall, everyone should get a bivalent COVID-19 booster. And,
really, that’s all you need to know: Get a vaccine. Any bivalent
vaccine. This fall.
But, yes, we /can /use scientific data to optimize timing and, thus,
protection.
*
*<2-3 months since infection/vaccination: *Wait.
*
*3-4 months since infection/vaccination:*Consider a booster if
you’re high risk, or have an event. (Get your booster 2 weeks before
this event for optimal protection).
*
*4-6 months since infection/vaccination: *Get your booster at some
point.
*
*6+ months since infection/vaccination:*Get your booster ASAP. This
includes me—I haven’t been infected, and I had my booster last November.
If you’ve only had an entire Moderna series, you may see marginal
benefit from getting a Pfizer bivalent booster (and vice versa)."
"Fight for the things that you care about, but do it
in a way that will lead others to join you."
― Ruth Bader Ginsburg
-------- Forwarded Message --------
Subject: Considerations for your fall booster
Date: Fri, 2 Sep 2022 13:55:09 +0000
From: Katelyn Jetelina from Your Local Epidemiologist
<yourlocalepidemiologist at substack.com>
Reply-To: Katelyn Jetelina from Your Local Epidemiologist
<reply+16inwn&a13t&&1224da3bf1b5ac7dd10ce04cccefede0c1fd6dafde667cdffb13d201f84c701b at mg1.substack.com>
To: manny at ratafias.com
Considerations for your fall booster
This fall, everyone should get a bivalent COVID-19 booster. And, really,
that’s all you need to know: Get a vaccine. Any bivalent vaccine. This
fall. But, yes, we can use scientific data to optimize timing and, thus,
protection. How long after infection/last vaccine should you booster?
Open in browser
<https://substack.com/app-link/post?publication_id=281219&post_id=71414663&utm_source=email>
<https://substack.com/redirect/2/eyJlIjoiaHR0cHM6Ly95b3VybG9jYWxlcGlkZW1pb2xvZ2lzdC5zdWJzdGFjay5jb20vcC9jb25zaWRlcmF0aW9ucy1mb3IteW91ci1mYWxsLWJvb3N0ZXI_dG9rZW49ZXlKMWMyVnlYMmxrSWpvME5qYzVPVE1zSW5CdmMzUmZhV1FpT2pjeE5ERTBOall6TENKcFlYUWlPakUyTmpJeE1qWTVNelVzSW1WNGNDSTZNVFkyTkRjeE9Ea3pOU3dpYVhOeklqb2ljSFZpTFRJNE1USXhPU0lzSW5OMVlpSTZJbkJ2YzNRdGNtVmhZM1JwYjI0aWZRLkFPNVdRQllPVm9wRHc2VDk3U0RMUDBtWVZOeEhveHUwZTloSERZaWl3em8iLCJwIjo3MTQxNDY2MywicyI6MjgxMjE5LCJmIjp0cnVlLCJ1Ijo0Njc5OTMsImlhdCI6MTY2MjEyNjkzNSwiZXhwIjoxNjY0NzE4OTM1LCJpc3MiOiJwdWItMCIsInN1YiI6ImxpbmstcmVkaXJlY3QifQ.zhznOKsbCiz25BLEEagvcE_ShzGJE69olc1nd4tE82I?>
/Si quiere leer la versión en español, pulse aquí
<https://substack.com/redirect/c8253727-1474-45e0-aceb-00c938cfdb78?r=a13t>./
------------------------------------------------------------------------
Considerations for your fall booster
<https://substack.com/redirect/2/eyJlIjoiaHR0cHM6Ly95b3VybG9jYWxlcGlkZW1pb2xvZ2lzdC5zdWJzdGFjay5jb20vcC9jb25zaWRlcmF0aW9ucy1mb3IteW91ci1mYWxsLWJvb3N0ZXI_dG9rZW49ZXlKMWMyVnlYMmxrSWpvME5qYzVPVE1zSW5CdmMzUmZhV1FpT2pjeE5ERTBOall6TENKcFlYUWlPakUyTmpJeE1qWTVNelVzSW1WNGNDSTZNVFkyTkRjeE9Ea3pOU3dpYVhOeklqb2ljSFZpTFRJNE1USXhPU0lzSW5OMVlpSTZJbkJ2YzNRdGNtVmhZM1JwYjI0aWZRLkFPNVdRQllPVm9wRHc2VDk3U0RMUDBtWVZOeEhveHUwZTloSERZaWl3em8iLCJwIjo3MTQxNDY2MywicyI6MjgxMjE5LCJmIjp0cnVlLCJ1Ijo0Njc5OTMsImlhdCI6MTY2MjEyNjkzNSwiZXhwIjoxNjY0NzE4OTM1LCJpc3MiOiJwdWItMCIsInN1YiI6ImxpbmstcmVkaXJlY3QifQ.zhznOKsbCiz25BLEEagvcE_ShzGJE69olc1nd4tE82I?>
<https://substack.com/redirect/eba8116b-f224-4c8b-9716-9c7089236a7d?r=a13t>
Katelyn Jetelina
<https://substack.com/redirect/eba8116b-f224-4c8b-9716-9c7089236a7d?r=a13t>
Sep 2
<https://substack.com/app-link/post?publication_id=281219&post_id=71414663&isFreemail=true&submitLike=true&token=eyJ1c2VyX2lkIjo0Njc5OTMsInBvc3RfaWQiOjcxNDE0NjYzLCJyZWFjdGlvbiI6IuKdpCIsImlhdCI6MTY2MjEyNjkzNSwiZXhwIjoxNjY0NzE4OTM1LCJpc3MiOiJwdWItMjgxMjE5Iiwic3ViIjoicmVhY3Rpb24ifQ.o8-PkUwflEx4oVhVe17lOfFeBibPqY8W71bU3bpYFrc>
Comment
<https://substack.com/app-link/post?publication_id=281219&post_id=71414663&utm_source=substack&utm_medium=email&isFreemail=true&comments=true&token=eyJ1c2VyX2lkIjo0Njc5OTMsInBvc3RfaWQiOjcxNDE0NjYzLCJpYXQiOjE2NjIxMjY5MzUsImV4cCI6MTY2NDcxODkzNSwiaXNzIjoicHViLTI4MTIxOSIsInN1YiI6InBvc3QtcmVhY3Rpb24ifQ.AO5WQBYOVopDw6T97SDLP0mYVNxHoxu0e9hHDYiiwzo&utm_source=substack&utm_medium=email>
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This fall, everyone should get a bivalent COVID-19 booster. And, really,
that’s all you need to know: Get a vaccine. Any bivalent vaccine. This fall.
But, yes, we /can /use scientific data to optimize timing and, thus,
protection.
How long after infection/last vaccine should you booster?
The aspect of timing is, to me, the most tricky part. It really depends
on your last infection and/or vaccine /and/risk tolerance.
/*Infection: */If you’ve been previously infected, the “official” CDC
guidance says you can get your vaccine immediately following recovery
from symptoms or, at maximum, defer up to 3 months after infection. We
do not /have /to wait 3 months after infection. We won’t “exhaust” or
“overwhelm” our immune system, but by delaying we get the biggest bang
for our vaccine buck.
This week a really great preprint
<https://substack.com/redirect/20423ea3-b017-4f27-9dc8-970ecac58af7?r=a13t>found
a booster doesn’t add much benefit within 2 months (60 days) of
infection. While it increases neutralizing antibodies (our body’s first
line of defense that prevents infection and transmission), it will not
broaden the memory of B cells (our second line of defense and long
term-memory). So wait at least 2 months.
Unfortunately, beyond that, we don’t know the optimal timing.
The same is true with /*previous vaccination*/. The “official” guidance
says to wait 2 months after last vaccine. And that makes sense given
this latest preprint. However, we may benefit from a longer delay. It’s
not random that the UK recommends 12 weeks (3 months) between doses.
How much longer to delay should take into account: individual risk (age,
comorbidities); degree in which you don’t want to miss an event (because
you’re sick) or an event is high risk (wedding, family vacation); and/or
not wanting to be sick in general (for example, if someone depends on
you). I recommend the following:
*
*<2-3 months since infection/vaccination: *Wait.
*
*3-4 months since infection/vaccination:*Consider a booster if
you’re high risk, or have an event. (Get your booster 2 weeks before
this event for optimal protection).
*
*4-6 months since infection/vaccination: *Get your booster at some
point.
*
*6+ months since infection/vaccination:*Get your booster ASAP. This
includes me—I haven’t been infected, and I had my booster last November.
Does it matter if you had a BA.1, BA.2, or BA.5 infection?
A previous Omicron infection (BA.1 or BA2) /does/protect well against
BA.5. By now we have real world data from Portugal
<https://substack.com/redirect/84977b9e-c07c-40d2-912c-bf3d57659d64?r=a13t>,
Qatar, and Denmark
<https://substack.com/redirect/6bbefa18-e7ef-424a-a522-05e221a8b550?r=a13t>.
But, regardless, everyone will benefit from a bivalent booster in one
way or another.
First, a booster will increase neutralizing antibodies, at least
temporarily, to help prevent infection and transmission. It’s not
perfect, but we hope this will last for 6 months.
Second, a booster will help your secondary line of defense differently,
depending on type of previous infection:
*
/*BA.1 infection*/: An infection during the first Omicron wave
(December, January, February) means you likely had a BA.1 infection.
In the Omicron family, BA.1 is farthest from BA.5 (see tree below).
This means your B-cells can be updated to remember BA.5.
Image
<https://substack.com/redirect/84dc9a12-db8d-45a2-a899-ff67c511ebce?r=a13t>
*
/*BA.2 infection*/: BA.2 is closer to BA.5. This means your B cells
looks more like BA.5 than, for example, BA.1. Because it’s close,
the booster will solidify BA.2 immunity /and /widen protection to
other BA.2//variants. The booster will also provide immunity to BA.5
for future protection.
*
/*BA.5 infection*/: A booster will reactivate your B cells. This
will theoretically ensure longer term protection against BA.5.
Mixing and matching
If you’ve only had an entire Moderna series, you may see marginal
benefit from getting a Pfizer bivalent booster (and vice versa). But, to
be honest, the science is mixed and isn’t very strong. So, my official
recommendation is to just get the vaccine that is most easily accessible.
There is one case in which I think it /does /matter: If you’re a male
and under the age of 30, your risk of myocarditis is higher. I would go
for a Pfizer, as it has less RNA than the Moderna vaccine and will
theoretically decrease risk.
What about a Novavax booster?
About 14,000 Americans have gotten the Novavax primary series, thus far.
Novavax says that their bivalent booster should be authorized for
emergency use soon. The Novavax series works great. But, I wouldn’t
necessarily wait for it. As I’ve written before
<https://substack.com/redirect/26d1ed12-1efd-4b65-a6b6-791fc51f31db?r=a13t>,
mixing your mRNA primary series with Novavax just doesn’t show the
additional benefit we hoped it would.
Kids under 12
For those 5-11 years old, the bivalent vaccine should be coming by the
end of the year. If your child is eligible now for their third dose, I
personally wouldn’t wait for the bivalent. I would get them up-to-date
now so they are fully protected in school. They can get the updated
booster once it’s available.
For those under 5, the plan is not clear. We’re still waiting on dose 3
data for Moderna (I am expecting this any day), but this data will be
for BA.1 dose 3 (not a BA.5 bivalent vaccine). No word yet on a fall
booster after the primary Pfizer series (which would equate to dose 4).
As a parent, I will keep tabs on this.
What about mixing with other vaccines, like the flu vaccine?
You can the flu vaccine (and other routine vaccines) and bivalent
booster at the same visit. It’s recommended to administer in different
arms.
There have been studies
<https://substack.com/redirect/e49e2f7e-a584-4915-9d32-43fd85e65a78?r=a13t>on
the safety and effectiveness of the co-administration of these two
vaccines. In one database, about 454,000 people got the flu and COVID-19
vaccines during the 2021-2022 flu season. Both vaccines worked great if
they are co-administered. Generally, the rate of side effects was the
same or a little higher; however, no specific safety concerns were
identified.
<https://substack.com/redirect/dbbc77ca-50d9-46b6-9f0d-1a132407c141?r=a13t>
(CDC)
The CDC recommend
<https://substack.com/redirect/fadca5cd-85d4-43eb-8191-8c574eda4c0d?r=a13t>s
spacing the COVID-19 booster with Jynneos (monkeypox vaccine),
especially in young men, 4 weeks apart. If there is need for Jynneos in
terms of an outbreak, don’t wait! But consider delaying the booster
after Jynneos. This is based on the fact that myocarditis is higher
among the second generation monkeypox vaccine (called ACAM2000), and we
don’t know why. We haven’t seen these safety signals with Jynneos (third
generation monkeypox vaccine), but we are proceeding with caution.
Bottom line
I’ll be in line for my booster soon. And I couldn’t be more excited. Be
sure you get yours in the coming months, too. It will help in one way or
another.
Love, YLE
------------------------------------------------------------------------
In case you missed it:
*
Fall boosters ACIP meeting: Cliff notes
<https://substack.com/redirect/461827c3-0ef5-4c73-8824-3a7da82f4073?r=a13t>
*
Fall boosters: An update
<https://substack.com/redirect/690befe3-50d0-4962-8e8f-911478777834?r=a13t>
------------------------------------------------------------------------
/“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina,
MPH PhD—an epidemiologist, biostatistician, wife, and mom of two little
girls. During the day she works at a nonpartisan health policy think
tank, and at night she writes this newsletter. Her main goal is to
“translate” the ever-evolving public health science so that people will
be well equipped to make evidence-based decisions. This newsletter is
free thanks to the generous support of fellow YLE community members./
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