Which COVID-19 booster should I get?

Last week, the CDC’s decision to approve a huge American area booster adds another layer of decision for the general public to navigate. To summarize the points: If you are over 65 years old High-risk health, Work and live in a highly exposed environment, Or if you get Johnson & Johnson, you are eligible for a booster shot after waiting for the specified period (2 months from J & J, 6 months from mRNA) from the last dose. If you are immunocompromised and have already taken a third dose, you are eligible for booster immunity. Beyond that, the CDC and FDA take a fairly pragmatic approach to which boosters they should actually get.

For now, Recommended by CDC Use the same vaccine for all shots, but it is not binding. In fact, you can get any vaccine available. So how do you need to decide?

Whatever booster you get, you’ll be better protected from COVID. Still, preliminary evidence and some scientific first principles are Mixing vaccine techniques may result in stronger reactions..Vaccine and infectious disease experts said popular The person who received the Johnson & Johnson vaccine had clear advice, but in most cases the message is: Don’t sweat the decision.

If you get Johnson & Johnson, there is a simple answer

“The only thing that makes a difference to my mind is whether I got Johnson & Johnson first,” says Monica Gandhi, an infectious disease specialist at the University of California, San Francisco. “At that point, I think there is a clear second dose of getting the mRNA.”

Other infectious disease researchers say the same thing, with varying degrees of self-confidence. There are practical and theoretical reasons to think so. J & J is based on a different technology than the mRNA vaccine and appears to stimulate the immune system in different ways. For example, J & J seems to be doing a better job of activating T cells, a durable tool in the arsenal of the immune system that protects against severe illness. “Specific value of [J&J technology] Is T cell priming and can be efficiently boosted by mRNA, “said Martina Sester, an immunologist at Saarland University.

“I think mRNA boosting gives a higher level of protection compared to [a second] Johnson & Johnson Boost, “she says.

It is demonstrated in the real world. NS A study from Sweden published in early October After the initial dose of the AstraZeneca vaccine, which uses the same technology as J & J, mRNA administration was found to significantly enhance protection against symptomatic COVID compared to the two AstraZeneca vaccines. Importantly, that study measured real-world results, but other booster studies focused primarily on antibody-like blood reactions, which do not necessarily lead to real-world efficacy. Hmm. (Created by Sester Some of those other studies, And her unpublished study suggests “essentially the same results” after J & J. )

In Germany, where Cester works, there is no need to make a decision: TGerman government especially recommends Following J & J, mRNA was administered.

The advice is also along the safety line. J & J is associated with severe blood clots, which are the most serious side effects of COVID vaccines, but the risk of developing them is very rare. The CDC records about 7 cases out of 1 million women between the ages of 18 and 50 who received it. (COVID, which most people are likely to be exposed to someday, results in a fairly high rate of blood clotting.) However, if you are in that demographic, you can skip the question altogether and get the mRNA vaccine. It makes sense.

The answer is not very clear if you first get the mRNA vaccine

mRNA vaccines, especially Moderna, Better tolerate serious COVID Over time than J & J, some FDA advisors have wondered if people under the age of 65 without high-risk health need even boosters.

And it seems that a strong reaction can be obtained by boosting either mRNA with either mRNA. Alternatively, Shane Crotty, an immunologist at the La Jolla Institute for Immunology, said: The available evidence suggests that the mRNA boosters were “equivalent”.

NS Study from NIH This is one of the few that works with a combination of multiple boosters, starting the mRNA vaccine, Any The vaccine doubled the antibodies in the blood within 15 days. “”[The] The point of takeaway is that all vaccines work, “said Kirsten Lyke, lead author of the paper and immunologist at the University of Maryland.

But she also thinks there is something to be said to boost with another vaccine technology. “I’m surprised to follow mRNA [J&J]Actually, it worked very well, but the broadcast time has not increased. “

On the safety side, switching from mRNA to J & J makes sense for some. But under 25 years old The risk of mild heart inflammation after mRNA vaccination is negligible, but if it does occur, it usually disappears quickly. (((COVID will carry again There is an increased risk of more severe symptoms. This may suggest that people in that demographic need to be backed by J & J. However, Cester believes that the extra immune response produced by the mRNA vaccine probably outweighs that small risk. “I wouldn’t recommend it unless you know other data,” she says.

Don’t sweat the small differences

However, there is an important thing to remember here. Booster vaccines are recommended because they are known to prevent outbreaks and serious illnesses. For you as an individual, it’s much harder to say what a slight difference in average antibody production means.

Gandhi says he’s heard of people wondering if higher antibody doses can be obtained by using higher doses of Moderna, but the level of antibody a person has is not necessarily stronger. Does not correlate with protection. “It doesn’t matter if you’re 50 [micrograms] “30 in Modana or 30 in Pfizer or 100 in Modana,” she says. “It doesn’t matter because you don’t need crazy antibodies.”

“In the end, it’s important to get some kind of vaccine boost, no matter what,” says Cester. “Other vaccines other than COVID-19 are constantly switching between different brands and different vaccine principles, and we haven’t even investigated whether they work and induce antibodies.”