Understanding Boosters
Greetings from my “me-tober”—where I’m taking a break from writing my newsletter and recharging my battery.
It’s working!
So much so that I enthusiastically said “YES” to:
record a video *explainer* about boosters shots with Yahoo News (you can listen here), and
answer live questions from viewers this morning about boosters and the vaccine for kids with News Channel 12 in New York (you can listen here).
It may sound strange, but to me, talking is fun, easy, and relaxing. It’s the writing that is hard (but also deeply satisfying)—hence the brain rest this month!
So today I’m thrilled to introduce you to my dear friend Kavita Patel, MD, who will provide a handy Q & A about booster shots.
Dr. Patel is a primary care physician at Mary's Center in Washington, DC, and was a Director of Policy in the White House under President Obama. She is a medical contributor for NBC News/MSNBC and a fellow at the Brookings Institute. She also is a mom of two young kids, has a wicked sense of humor, and has been a great support for me over the last 19 months.
Everything you Need to Know About Boosters...and Then Some
I am thrilled to be able to write for the incredible Dr. McBride, and I am hopeful that this will be the first of several newsletters. I also hope to bring you a newsletter myself on a number of topics including mental health and how to find meaning in your life (you know—the small stuff!)
It has been an incredible week with the FDA and CDC’s action on boosters with many folks now wondering “When can I get a booster and which one should I get?” If you are asking yourself the same questions, we have answers for you!
How Do I Know I Need a Booster?
Moderna or Pfizer recipients who are over 65 and who are at least 6 months from the second shot need a booster now. If you have a chronic condition or live and work in a setting where you are at high risk for getting severe COVID-19, you can also get a booster shot if it has been 6 months since your second shot.
All J & J recipients need a booster 2 months after their initial vaccine.
What kind of chronic conditions qualify for a booster?
People with the chronic conditions found here and qualify for a booster 6 months after their initial vaccine series. As you can see, it’s a LOOONG list, so when in doubt, ask your physician.
Why do people with certain conditions need a booster and not others?
There is growing evidence that your immunity from your initial shots decreases over time (as expected) and that certain people are at a much higher risk of being hospitalized or dying if they were to get COVID-19. The image below from the CDC website illustrates that many conditions can place someone at risk, including mental health conditions such as depression or schizophrenia.
I meet the criteria for needing a booster, so which one should I get?
When deciding what booster to get, there are now several choices. You absolutely can stick with the original vaccine you received and that has been shown to be safe and effective. But a recent study from the NIH has received a great deal of attention because it has shed new light on a strategy that might be right for you: mixing and matching vaccines.
The most benefit was for those with a primary J&J shot. A Moderna booster gave the greatest benefit (56.1 fold increase in IgG (type of antibody); 76.1 fold increase in neutralizing antibodies). Pfizer also worked very well (32.8 fold increase in IgG; 35 fold increase in neutralizing antibodies).
After the primary Moderna series, there was equal benefit from either a Moderna or Pfizer booster.
After the primary Pfizer series, the greatest benefit was from a Moderna booster. But a Pfizer booster helped quite a bit.
A caveat to this study: the Moderna booster in the study was a 100 microgram (similar to the first and second shot), but the recommended booster that was authorized by the FDA is half of that dose (50 micrograms).
Naturally some additional questions might follow about mixing and matching: Who should mix and who might want to stick with their original vaccines? So here are some examples that may or may not apply to you:
A young male with underlying medical conditions who had a primary J & J vaccine. The most protection he would get is from a Moderna booster. But there’s a small but real risk for myocarditis (inflammation of the heart) linked to the Moderna vaccine. Concerned about that, he chooses J & J for his booster.
A middle-aged woman and practicing nurse had a primary J&J vaccine. If she were to get a J&J booster, there is a very small risk of getting blood clots. For her, a mRNA booster may make the most sense because she’s not at high risk for myocarditis and she has seen the data that shows a mRNA vaccine can give her a great immune response.
An elderly person who had a primary Pfizer series, but the local pharmacy only has both Moderna and Pfizer in stock. The difference between the mRNA vaccines is pretty small, so either vaccine would be a fine choice. But because the idea of mixing vaccines might offer a bit more protection, he chooses Moderna for the booster.
What side effects can I expect from a booster shot?
The side effect profile for boosters is similar to those experienced during the initial vaccine series: fatigue, arm soreness and localized reactions. If you did or did not experience symptoms, you may still want to plan for an easier 48 hours after your shot—just in case you do have side effects and need to rest.
So far, about 12.9 million Americans have received a booster shot and the majority of them have received Pfizer which we would expect since the availability of a Pfizer booster has been longer than Moderna or J & J.
The big picture is this: the primary vaccine series still does an excellent job of protecting us from the endpoints we care most about: death and severe disease. If you are healthy you can feel good that you don’t need a booster right now and that as we get more shots In arms we are closer and closer to the end of this public health emergency.
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