To Vaccinate or Not---The Rat Flu Odyssey Continues

[bobz]

I figure if, probably when, case rates start to paint the NYT map in dark colors again, and assuming that happens more than 6 months after the last big booster rush happened, there will be another booster wave, and the decision to get another jab will be unambiguous for most of us.

[bodywhomper]

Eric Topol wrote an essay this morning about a 2nd booster and his recommendation: https://erictopol.substack.com/p/a-n...-a-new-booster

“I would recommend the 2nd booster if you are more than 4-6 months from your 3rd shot, you are age 50+, you tolerated the previous shots well, and you are concerned about the BA.2 wave where you live, or that it’s getting legs as you are trying to decide. Or if you are traveling or have plans that would put you at increased risk.

It can certainly be deferred, but the question is when is the right time, and whether an Omicron-specific vaccine will have any advantage over a 2nd booster directed at the original strain. The data from 2 animal models (macaques and mouse models) suggests there may not be advantage of the Omicron-specific vaccine but that may not correlate with its effect in people. From my discussions with FDA, it is not likely the Omicron-specific vaccine will be available before late May or June. So you can factor that uncertain added benefit and timeline into your decision.

It’s also fine to wait if there’s a low level of circulating virus where you live and work. Israel will have more follow-up data soon, and for all age groups, so in the weeks ahead we’ll know more about the magnitude, age range (such as age less than 50) and durability of the benefit.

If you had 3 shots and an Omicron breakthrough infection, there’s little need for getting a 2nd booster at this point. You’ve got some hybrid immunity and you can save an extra shot, if or when there’s ultimately supportive evidence for a later time.

If you haven’t had your 1st booster, you’re long overdue to get it. It was lifesaving vs Delta for people age 50+ and vital for maintaining high level of protection vs severe disease from the Omicron family of variants.”

[old goat]

At this point everyone should be able to find a highly qualified expert to give them the advice about another booster that they want to hear.

[riser4]

At this point everyone should be able to find a highly qualified expert to give them the advice about another booster that they want to hear.

Lulz

[Trackhead]

What downside do you think there perhaps could be?

My point is, some of the evidence for efficacy/benefit remains marginal for under 50 cohort at this point in time. Probably isn't a downside, but Americans love prescriptions, even if the benefit is marginal. We want to feel like we're doing something, despite the evidence. This plays out about 40 times a day in urgent care with people requesting Zithromax on day 2 of a viral upper respiratory infection. Or people requesting Tamiflu on day 5 of influenza. A fourth shot is not a perfect analogy, but in some ways is similar and reflective of our current view of "zero covid".

Don't get me wrong, I don't want that shit again, but I also think the covid pandemic has turned us/the scientific community/pharma into an anxious society (for good reason) that has lost some perspective.

[Trackhead]

At this point everyone should be able to find a highly qualified expert to give them the advice about another booster that they want to hear.

Cue Joe Rogan.

[Core Shot]

And now they’re pushing vax for infants.

Interesting debate between y’all on the fourth shot.

And yet. Let’s start jabbing toddlers. Who were never at risk.

Oh well.

I got the flu earlier this month. Was worse than Covid last april

#ymmv #anecdotes.

[jono]

My point is, some of the evidence for efficacy/benefit remains marginal for under 50 cohort at this point in time. Probably isn't a downside, but Americans love prescriptions, even if the benefit is marginal.

Appreciate the link. Have you seen anything that's randomized or sets out to calculate efficacy of a fourth dose? What I'm reading there and in the study design doesn't give a lot of confidence that they were able to avoid selection bias in the small sample, since the study group was all volunteer and the control group wasn't. Early days yet, of course.

I'm a couple of weeks from making a decision on this, largely leaning on Topol's considerations: upcoming travel, potentially (technically?) compromised, almost 50yo, but unable to secure that holy grail of definite omicron exposure. So I've got one eye on those trials to see if I'd rather top off with something more specific if omicron #2 (3? 8?) can be better addressed that way. But that won't be ready in 2 weeks, so maybe I'll grab that half-moderna they owe me.

[jono]

And now they’re pushing vax for infants.

Interesting debate between y’all on the fourth shot.

And yet. Let’s start jabbing toddlers. Who were never at risk.

Oh well.

I got the flu earlier this month. Was worse than Covid last april

#ymmv #anecdotes.

I don't know if you care, but if toddlers are the least at-risk from adverse effects then getting it over with may be safest.

If you're gonna worry about myocarditis in teenagers you gotta keep your eye on the Real risks. Remember why they replaced the birds, man.

[The AD]

And yet. Let’s start jabbing toddlers. Who were never at risk.

You mean sort of like how we vaccinate babies/toddlers for a host of other infectious diseases? What makes Covid different in your opinion?

[Todd Zander]

Hey core shot, have you stayed overnight in a hospital setting with an infant/toddler on O2 with rsv?

[old goat]

My point is, some of the evidence for efficacy/benefit remains marginal for under 50 cohort at this point in time. Probably isn't a downside, but Americans love prescriptions, even if the benefit is marginal. We want to feel like we're doing something, despite the evidence. This plays out about 40 times a day in urgent care with people requesting Zithromax on day 2 of a viral upper respiratory infection. Or people requesting Tamiflu on day 5 of influenza. A fourth shot is not a perfect analogy, but in some ways is similar and reflective of our current view of "zero covid".

Don't get me wrong, I don't want that shit again, but I also think the covid pandemic has turned us/the scientific community/pharma into an anxious society (for good reason) that has lost some perspective.

IME it's doctors more than patients that feel the need to do something, anything. Remember bloodletting, cupping? Or the modern equivalent--chemo for terminal cancer patients that has no hope of meaningfully extending their lives and every chance of making them spend their last days being sick. Doctors don't learn how to talk to people when a drug or an operation won't help--whether situation is trivial, like a cold, or dire, like metastatic cancer.

[PNWbrit]

My point is, some of the evidence for efficacy/benefit remains marginal for under 50 cohort at this point in time.

Yes. But the new EUA is for over 50.

[uglymoney]

Yes. But the new EUA is for over 50.

Go get it.

It sounds like you haven't been exposed, or don't think you have been, and want to have the best protection possible. Everything I read last night and this morning made it sound like a variant specific vaccination isn't due till late May or June at the earliest. Remember when Moderna was saying it would be ready by March? Also, even if you go get the booster, it sounds like a variant specific vaccine will be available this fall to all of us, along with our annual flu shots.

Frankly, if the Omicron variant hadn't run through our house like a freight train, I'd be getting it also, just because. But it did, and I'm not going to get it. I think my decision is as informed as can be expected from a punk ass lame kneed layman like me who didn't even manage to get a college degree, and so is yours.

[Core Shot]

I don't know if you care, but if toddlers are the least at-risk from adverse effects then getting it over with may be safest.

If you're gonna worry about myocarditis in teenagers you gotta keep your eye on the Real risks. Remember why they replaced the birds, man.

I keep forgetting birds aren’t real.

It’s hard to keep up.

[Ted Striker]

I figure if, probably when, case rates start to paint the NYT map in dark colors again, and assuming that happens more than 6 months after the last big booster rush happened, there will be another booster wave, and the decision to get another jab will be unambiguous for most of us.

Switch that to west coast, and you read my mind.

[Ted Striker]

Hey core shot, have you stayed overnight in a hospital setting with an infant/toddler on O2 with rsv?

He stayed at a Holiday Inn Express

[skiJ]

guys -

Please remember, in a pandemic it's all about what we do as a society to control the disease ; it is broader and bigger than the individual ;
so, while it may be rare for toddlers to develop 'severe covid ( hospitalization) ', vaccinating toddlers may protect others who they come in contact with. And
If we are talking about daycare toddlers, some have experienced first-hand how crazy that has been for the last two years
( were I they parent of a toddler I would want to maximize their immunity ).

I read a bunch of the studies when this was the rage from November - February, and the trials showed Good antibody response from six months to two years, but then a not-optimal response from two years to four years.
That's Why they delayed the application from February until April.


I appreciate several of the recent thoughtful posts - Thank you.

my contribution might be a comment an old county doctor said to me as he was facing a series of health challenges including losing his cognitive capacity to dementia ( ultimately classified as Alzheimer's at eighty-one. )
a year earlier, my father said,
' There are worse things than dying... '

He had seen a lot in eighty years - including forty years in Medicine.

Thank you. skiJ

[skiJ]

also, please remember the post last year of the man who sat at the hospital overnight with his daughter as she repeated, "hurts" over and over again as they waited for her fever to break...

children may be the least likely, BUT a sick toddler. . .

( I don't wish that for anyone )


thanks. skiJ

[funkendrenchman]

Hey core shot, have you stayed overnight in a hospital setting with an infant/toddler on O2 with rsv?

I have. That was a couple nights I'd like to forget.

[Trackhead]

Yes. But the new EUA is for over 50.

I’m aware of that.

[::: :::]

https://arstechnica.com/science/2022...s-study-finds/

The mRNA-based COVID-19 vaccines made by Pfizer/BioNTech and Moderna have proven highly effective at priming our immune systems to fight the pandemic coronavirus—preventing substantial amounts of infection, severe disease, and death throughout several waves of variants. But, despite their similar design and efficacy, the two vaccines are not exactly the same—and our immune systems don't respond to them in the same way.

An early hint of this was some real-world data that found startling differences in the effectiveness of the two vaccines, despite both shots performing nearly identically in Phase III clinical trials—95 percent and 94 percent. Amid last year's delta wave, a Mayo Clinic study found that Pfizer's effectiveness against infection dipped to 42 percent while Moderna's only fell to 76 percent.

According to a new study in Science Translational Medicine, such differences might be explained by evidence that the two vaccines spur the immune system to produce slightly different antibodies against SARS-CoV-2.

Both vaccines generate strong levels of neutralizing antibodies, which can bind to the virus and prevent it from infecting cells. But, according to the study, the vaccines generated different antibody profiles overall. Specifically, the antibody response to the Pfizer/BioNTech vaccine skewed to a class of antibodies called IgG and IgM, which are often found in the blood. The Moderna vaccine, meanwhile, generated relatively elevated levels of IgA antibodies, a class of antibodies generally found on mucosal surfaces, such as the respiratory tract—where SARS-CoV-2 infections begin. Additionally, the Moderna vaccine spurred relatively higher levels of antibodies that activate immune cells called natural killer cells. It also generated higher levels of antibodies that activate immune cells called neutrophils to ingest and kill (phagocytize) invading germs.

The study, led by Harvard immunologist and virologist Galit Alter, identified the differences by comparing the antibody profiles of 28 people vaccinated with the Moderna vaccine and 45 people vaccinated with the Pfizer/BioNTech vaccine. The numbers were small, and the participants were largely healthy young female medical workers, which is not representative of the population overall. The study also didn't look at immune responses over time. Instead, the researchers looked at antibody profiles about a month after each participant received a second vaccine dose.

Still, "despite these limitations, these data provide evidence for potential nuanced differences in the quality of the humoral immune response induced by SARS-CoV-2 mRNA vaccines," Alter and her colleagues wrote. Though both vaccines produce strong immune responses overall, these slight antibody differences "might provide insights into potential differences in protective immunity conferred by these vaccines," they concluded.

Alter and her colleagues will have to do more research to determine if these differences are linked to differences in protection and vaccine effectiveness. And they'll also need to do more research to understand what exactly is causing the differences. The Pfizer/BioNTech and Moderna vaccines are not only made with different formulations of components—they are also given at different doses and different time intervals between doses. Moderna's vaccine is given as two 100 microgram doses four weeks apart, while the Pfizer/BioNTech vaccine is given as two 30 microgram doses three weeks apart.

Those factors could alter how the immune system responds to the vaccines. But digging into those differences could help researchers create "tunable" mRNA vaccines that generate specific antibody responses to provide the strongest protection. In the meantime, the findings make a case for people to mix-and-match mRNA vaccines boosters, particularly if they've started with doses of the Pfizer/BioNTech vaccine. Switching to a different vaccine for a future booster could diversify antibody responses, providing broader protection.

[bodywhomper]

Article from the first study giving a few people covid (via Topol Twitter): https://www.nature.com/articles/s41591-022-01780-9

Viral load is not correlated with symptoms. Shedding occurs at high levels regardless of symptoms

[KQ]

When I was on the west side of the state on Tuesday I met up with 3 friends for dinner. Halfway through dinner one of them tells us she's unvaxxed. Nice.

[NW_SKIER]

When I was on the west side of the state on Tuesday I met up with 3 friends for dinner. During the halfway through dinner one of them tells us she's unvaxxed. Nice.

So did you get up and leave? If not, then you should consider taking some time to consider how your judgements of someone you just called your friend makes you the problem.

Never ceases to disappoint me how polarizing this topic is. Getting vaxxed does not, and will not ever give you the right to treat others as less than. Get over yourselves.