Here are some who need and probably don’t need booster shots for COVID: Shots

The United States is preparing a COVID-19 vaccine booster shot, but it’s not entirely clear who needs it.

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The United States is preparing a COVID-19 vaccine booster shot, but it’s not entirely clear who needs it.

Emily Elconin / Getty Images

Doctor for the past few weeks. Bogma Titanji I was full of questions about the COVID-19 vaccine booster. Even experts seem confused, she says.

“Sometimes my colleague, who is a doctor, asks me,’What should I do?’” Says an infectious disease specialist at Emory University.

The message from the public health authorities was very upset, she says, which caused confusion. “How is everyone supposed to navigate all this information?” Titanji says. “It’s a lot.”

The messaging mayhem began last month when the Biden administration, along with White House Chief Medical Advisor Dr. Anthony Fauci, said he wanted to roll out booster shots to all adults about eight months after the first course of the mRNA vaccine. I did. Surgeon General Bibek Mercy and Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, spoke in support of the plan.

But just last week, some scientists at the Food and Drug Administration Publish a review of Lancet Outline why you don’t need a public booster.

And on Thursday, when the FDA finally approved the Pfizer-BioNTech Vaccine Booster, it was only for certain adults (adults over 65 and other adults at high risk of severe COVID-19). After controversial debate within the advisory board, the CDC endorsed the plan and Spell out More about who needs to take a shot and who only wants to consider taking a shot.

Opinions that contradict all these twists and turns have confused many. Who should they listen to? Need a booster shot? What does science really say?

Who needs boosters most urgently?

There is much consensus on the two groups that will most benefit from receiving different vaccines.

In the case of immunodeficiency, or if a strong immune response to the vaccine cannot be initiated, a third dose of mRNA vaccine is required to protect against severe illness and hospitalization. FDA already approved This extra shot returned in August. And Titanji says science is clear. “People in this group may not have started a proper immune response after the first two doses of the vaccine,” she says. “So they will benefit from the third shot.”

The second group is adults over the age of 65. Both the FDA and the CDC Advisory Board, which met on Thursday, agreed with the group to win boosters.Several the study For the elderly, protection against severe COVID-19 has been shown to weaken over time. Not so many. However, the concern is that it will become less and less effective over time.

For example, CDC report On Wednesday, the defense against hospitalization for people over the age of 65 dropped from about 85% to 70% with the Pfizer vaccine and from about 90% to 85% with the Modana vaccine in the last six months.

“People over the age of 65 are at increased risk of developing severe infections and may be admitted to the hospital,” says Titanji. “The further away from the second dose, the greater this risk. Therefore, this group can also benefit from additional doses.”

The COVID-19 vaccine booster is available to people with a depressed immune system, such as Mark Turney, 66, a kidney transplant patient who was shot at Pfizer-BioNTech COVID-19 booster at Hartford Hospital in Hartford, Connecticut. Is required.

AFP via Joseph Prezioso / Getty Images

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AFP via Joseph Prezioso / Getty Images

The COVID-19 vaccine booster is available to people with a depressed immune system, such as Mark Turney, 66, a kidney transplant patient who was shot at Pfizer-BioNTech COVID-19 booster at Hartford Hospital in Hartford, Connecticut. Is required.

AFP via Joseph Prezioso / Getty Images

What about people with underlying illness?

The FDA has approved Pfizer Booster for those who are “at high risk for serious COVID-19.”Theoretically, this is Specific underlying conditionsThere is an increased risk of developing very bad cases of COVID-19, such as diabetes and chronic lung disease. The CDC recommended giving boosters to people aged 50-64 with underlying illness. But it’s an option for young adults. Before getting a booster, you need to assess the risk and in some cases consult your doctor.

The data presented by the CDC Advisory Board suggest that although the data are preliminary, the vaccine may be slightly less effective in adults with underlying disease.Study from England Indicated Its decline is greatest in older people (aged 64 and older) who are at high risk for severe COVID-19, including transplant recipients, cancer patients, and people with severe heart and lung disease.

So if I’m healthy and young (ie under 65), do I need a booster right now? I’m worried about the Delta variant and want the best protection I can get.

Given the mixed messages from the government, some young and healthy people may want to go see if they can get a booster. In fact, some have already done so. But there is plenty of evidence that you don’t have to.

scientist Booster shots are recommended When there is convincing evidence that the first dose of the vaccine does not provide sufficient preventive effect. Several recent studies have shown that the opposite is true for healthy adults with mRNA vaccines. The vaccine is still working very well against the delta variant as well.

For example, CDC data released Wednesday show that the ability of mRNA vaccines to prevent severe illness has not changed significantly in the last six months. Both Pfizer and Moderna vaccines provide over 90% protection for people under the age of 65.

“In a young population with no comorbidities or additional risk factors, the vaccine continues to provide strong protection against serious illnesses,” said Titanji.

Now, when it comes to the prevention of mild to moderate illness, protection is weakened. The CDC data show that the ability of these vaccines to prevent symptomatic infections has declined over the past six months. In the case of Pfizer, it decreased from 90% or more to about 65%, and in the case of Moderna, it decreased from 90% or more to about 75%.

Therefore, booster shots may provide a little extra protection against getting sick and having to stay home to recover, immunologists say. Deepta Bhattacharya At the University of Arizona, but it is still unclear how long this additional protection will last. And it doesn’t change the risk of you dying or getting to the hospital.

“When will the question be? necessary Booster vs. When I want “One,” says Batacharya. “I think that’s the difference we need now. Getting a booster to stop a cold or a mild flu-like illness isn’t about worrying about whether you can survive the illness. It’s another thing. “

What is the conclusion? According to microbiologists, two doses of the mRNA vaccine are actually still working as intended. Maria Elena Bottazzi At Baylor College of Medicine.

“It’s also important to remember that these vaccines are designed and licensed to ensure that they reduce very serious illnesses and deaths,” she says.

Are Boosters Safe, Especially for Young Adults and Teens?

Currently, there is little direct data to answer this question, says Titanji. Last week, Pfizer released data on about 300 patients in all adults over the age of 18. “These are very few,” she says.

That said, scientists expect the booster safety profile to be close to the safety profile of the original course of the vaccine, she says. “Looking at how safe the first and second doses of the vaccine were, we tend to think that the third dose will remain fairly safe,” says Titanji. “But if we’re deploying it as a policy that extends to millions of people, we need to show that it remains safe.”

In particular, there are concerns that booster shots may increase some of the serious side effects observed during the first steps of vaccination, such as heart inflammation (myocarditis) caused by an immune response and Guillain-Barré syndrome. I have.

Both side effects are extremely rare. For example, the incidence of myocarditis is about 40 out of 1 million people vaccinated against CDC between the ages of 12 and 29. Report.. However, the percentage is highest among men aged 12 to 17 years. Still, Pfizer does not provide safety data for teens under the age of 18, says Emory University epidemiologist Natalie Dean.

“I’m very hesitant about vaccination, so I think we need to make sure we have data for this age group before making a decision,” says Dean. “I don’t understand the value of rushing that decision, especially given the relatively low risk of serious illness in this population.”

Is there any benefit to waiting for a booster?

Probably if you are healthy and under 65 years old. The reason is as follows. Currently, the only boosters available use the same viral variants found in the first two doses of the vaccine. That is, the booster shot encodes part of the original variant of SARS-CoV-2.

However, it is not the variant that is causing the surge in the United States, nor is it the variant that is likely to cause the surge in the future. Some scientists, including members of the FDA’s advisory board, raise the question of whether it is better to wait for boosters designed for one or more variants, known as multivalent vaccines. Did. The goal is to train the immune system to recognize and attack future mutations that may occur.

“It’s definitely the future of COVID vaccines,” says Botazzi of Baylor College of Medicine. “In fact, our vaccine center is focusing on the development of multivalent vaccines to see if they can broaden the immune response.”

Last week, Moderna Release Findings from studies on divalent booster shots containing mRNA from both the beta variant and the original version of SARS-Cov-2. In a small study of only 80 people, divalent boosters showed an average of about 46-fold increase in antibody levels. By comparison, the company reported that boosters with delta only, original variant only, or beta variant only boosted levels by only 17 or 11 times. Nature medicine..

What if I’m young and healthy, but working in another front-line profession like health care or education?

The FDA has approved Pfizer booster shots for people with “frequent institutional or occupational exposure” to the coronavirus. This may increase the risk of developing severe cases of COVID-19. This includes health workers, teachers, and other front-line workers. The CDC states that the group may “want” boosters and must consider individual circumstances and risk levels.

This recommendation is controversial for the following reasons: Recent data The CDC shows vaccines that are well tolerated by this group of serious illnesses.

But give these workers a little extra protection Any Infectious diseases may help the FDA’s advisers pointed out on Friday as a society as a whole.

“They may have a breakthrough infection that doesn’t necessarily arrive at the hospital, but they’ll be away from work when they need to deal with a pandemic,” said Titanji of Emory University. I will. ”