I know this is very very rare, but I know a woman who had bad reactions to the first two Pfizer shots. After the second one, she could not work for four days. However, she is in a high risk job, so she got the third shot. Now, she has autoimmune vasculitis.
Yes, this is anecdotal, but if I have very high protection from hospitalization/death with two shots, I would like to see more data before I get a third.
Seems like someone in that situation of having a bad reaction to the initial vaccination but wanted a booster may want to ask their physician about getting a different vaccine as the booster to avoid the bad reaction.
Itâs not just about surviving.
Yes, I suggested that above.
Jumping back into this thread after months away.
Booster trials:
My RN daughter who is part of the original Moderna trial was just yesterday offered to be part of their booster trials(one of many trials). Original shots in July â20.
She gets the booster shot tomorrow. She had a symptomatic breakthrough infection last month and missed 10 days of work due to symptoms and per the trial. She also had a strong reaction to the original second shot and missed work. Sheâs expecting a strong reaction to the booster. (This is my fierce public health nurse youngest who spends her days with the unhoused on the streets of the city. ) Iâm so proud of her and her commitment to helping the rest of us stay safe.
We will get our Moderna boosters as they become available. Today we got this yearâs flu shot. My arm is a little red and warm , like somebody slapped me. Next week is pneumonia.
Unfortunately, this is not what preprints I saw as delta was taking off were saying. All the defensesâ response took a hit from delta, but the sharpest fall-off was in natural immunity. Pfizer did best, but the response was still pretty threadbare. Look for the study about the 8-fold drop in antibody concentration, I think from July or so.
For me, this is the most reassuring piece of research to come out in a long time:
One-year Risks and Burdens of Incident Cardiovascular Disease in COVID-19: Cardiovascular Manifestations of Long COVID | Research Square (h/t Eric Topol)
âŠbut it should be hella scary for a lot of other people. This is a massive long-term study of Covid patients at a VA hospital, some of whom where hospitalized, some not, some in the ICU, against very large control sets. Looks at effects one year on.
The immediate news, when you look at the data presented here, is that mild (nonhospitalized) covid = increased risk of all sorts of longterm cardiovascular ailments, but (to my mind) not increased alarmingly â in the range of 25-30% for a lot of them â unless youâre looking at thrombosis or myocarditis. But the actual risk of all those problems remains quite low unless youâre somehow predisposed. So hooray for vaccines. The numbers for those who wind up in the ICU and survive, however, are terrifying. What this study says to me is that if you wind up in the ICU and get out, you should expect to be fragile and sick for a long time, hope you have some devoted people looking after you, and have your affairs in order anyway.
Thatâs the first picture to show up. However, if you read through to the supplemental data, youâll see the patient characteristics, and thatâs also good news for me, very scary news for a whole bunch of other people.
Imagine a VA hospital. Imagine whoâs there. Thatâs whoâs in the study. They are:
-nearly all men
-mostly white
-nearly all overweight or obese
-half smoke or used to
-a third are diabetic
-their blood pressureâs not great
-a good chunk of them have kidney disease
-theyâve got a mean age of 61
-theyâre not severely disadvantaged in life, but you wouldnât call them privileged people
If this is what the mild cases look like there, Iâm much less worried about longterm effects of picking up a delta case by going back into work at my Death Star state university after Iâve had my booster. Iâm a bit younger than these guys, infinitely healthier, vaxed, no plans to fly or do a lot of sitting still in the foreseeable future, no one vulnerable at home to pass it on to. I wonder about migraine and cerebrovascular events, but iirc migraineâs a problem in the other direction, vasodilation. I can imagine feeling less than 100% for a good while afterwards, but disability looks pretty remote. However, that portrait of the study participants looks like a whole lot of people in this country, and makes the kidsâ first name for the disease â boomer remover â sound pretty accurate.
Interestingly, the three groups â mild, hospitalized, ICU â look very similar. The sicker groups are marginally in worse shape starting out, and marginally less white, marginally more male. But itâs very much all one cohort, given the variables theyâre looking at.
The main thing Iâm left wondering about is viral load in mild delta (vaxed) vs. mild wt (unvaxed), which is what these VA guys wouldâve had. We know the delta/vax spike is fast and high and drops off again fast, usually, as the antibodies show up, but I donât know what that looks like next to wt viral load graphs. And I donât know how important the height of that initial peak is, as opposed to âhow long and severe is the acute phase of the illnessâ,when it comes to longterm effects. I guess we wonât know about that second one for a long time.
The previous poster was referring to people who had previous infection and vaccination, not previous infection alone, in terms of strength of immune response.
Also, what I have seen about vaccine protection is that Pfizer seems to have greater dropoff in effectiveness versus Delta than Moderna or J&J.
Yes, I was referring to infection with Covid, followed by full vaccination. Millions of people got Covid before vaccines were available. I would never suggest infection instead of vaccination.
Because immunity following âinfection plus vaccinationâ looks so good, I am curious about immunity following âvaccination plus infectionâ.
The quote below is from a JAMA article reporting about a study published in Nature, along with other studies: Study Suggests Lasting Immunity After COVID-19, With a Big Boost From Vaccination | Infectious Diseases | JAMA | JAMA Network
The breakthrough deaths are occurring mostly in elderly people. While I can understand wanting to wait just a little longer for the booster dose of Moderna, I cannot even imagine for one minute being okay with my elderly parents getting Covid. Modernaâs stats for preventing symptomatic Covid are very good. Waiting just a little bit longer for the reduced dose seems prudent (unless this gets very delayed). Being okay with elderly folks getting a breakthrough case (even though they had 2 doses of Moderna) does not. JMHO.
I am not okay with my parents taking any unnecessary risk, although the choice is ultimately up to them. I simply do not know whether getting a third shot now is less risky than other options.
When Modernaâs half dose third shot is approved, DH and I will probably suggest that my parents get it. However, they may still want to wait as a third shot will likely only raise their resistance to infection for a few months. They may want to save those months for a time when they are going to travel, attend a wedding, have grandchildren living with them in the summer, etc.
I would also like to see studies which compare age/comorbidity matched cohorts with two shots vs three. Does the third shot actually improve outcomes? Would the same age/vulnerability patients who get Covid and have a bad outcome after two shots do better if they had had three shots? Should we just keep boosting the entire elderly population every 3-6 months in perpetuity?
I sincerely apologize because I think Iâve upset several posters with my questioning of third shots. I just realized that I thought we were in the âInside Medicineâ thread, but this is actually the âAnyone gotten a booster shot?â thread. In the future, Iâll take my musings back to Inside Medicine. Best wishes!
While there is apparent widespread belief that COVID-19 vaccination only lasts a few months, is that really the case? It does not seem like that is the most obvious explanation, compared to the Delta variant having greater infectiousness due to higher viral loads. Indeed, it does appear that (at least with Moderna and J&J) vaccine-derived immune response is durable for longer than a few months.
A +1 dose may be helpful to some people in increasing immune response to a higher level, but that is not contingent on the quickly waning immunity belief that seems to be widespread here.
How are folks signing up for the Moderna booster? I have a friend who qualifies for the booster according to her doc, but she canât sign up on the CVS site since the Moderna booster is not yet available. This is in MA.
they are claiming âimmunocompromisedâ by checking the Yes box (even if not true) and it allows one to make an appt for a 3rd dose. (Technically, there are no âboostersâ yet, just third doses of Pfizer and Moderna.)
My husband just got his third moderna shot at walgreens this morning - we are NJ - he had to check off immunocompromised. His oncologist told him he needed to get it.
Of course Covid vaccine protection lasts more than a few months. The vaccines are incredibly effective. The question here is effective against what? Protection against serious disease/hospitalization is very high for longer than six months, and some of that protection likely lasts a lifetime.
In the quote above, I was referring to protection against infection as measured by a positive PCR test. That protection will not always be as high as it is immediately following the shot. After you get a vaccine, or get infected with a virus, the body pumps out antibodies to clear the invader. Once the threat passes, antibody production stops, although the factories remain, ready to start up again if the virus is seen again. If we kept pumping out antibodies to everything indefinitely, our blood would turn into a sludge of unnecessary antibodies.
My parents may travel overseas. They may want a third shot a few weeks before this trip so that they have active antibodies circulating, which would give them the lowest risk of any infection. However, they already have a greatly lowered risk of any infection, and far less chance of serious infection or hospitalization because they got the first two shots.
I hope that is more clear.
There is an FDA approved third shot for Pfizer, under emergency use authorization for:
individuals 65 years of age and older;
individuals 18 through 64 years of age at high risk of severe COVID-19; and
individuals 18 through 64 years of age whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19 including severe COVID-19.
There is no FDA approved third shot for any vaccine other than Pfizer, for any reason, in the US. The FDA advisory board is scheduled to make a recommendation about Modernaâs third shot (which is 1/2 of the dose given for the first two Moderna shots) on October 14-15.
correct, but the term âboosterâ generally refers to a different dosage from the 1st.
Pfizerâs third jab is approved (under Emergency) for the exact same dosage as #1 and #2.
Moderna is not yet âapprovedâ but a third dose is currently being offered by national pharmacy chains to anyone who wants to claim they are eligible (as being âimmunocompromisedâ), in the exact same concentration at #1 and #2. (I know quite a few otherwise healthy folks who have already gotten the full dose 3rd Moderna jab.) In the meantime, Moderna has applied for approval of a true booster, which would be half the dosage of its first two.
But the point is that anyone could get a full dose 3rd Moderna jab today, or wait until approval of the half-dose booster.
(Not up on what J&J is doing.
They can, but Iâm not sure why they can, as this has not been approved by the FDA. I honestly donât know why pharmacies are giving them, but Iâm not faulting people for getting them. If anyone had a bad reaction to one or both of the first two, I would seek advice from a rheumatologist, infectious disease doc or endocrinologist before getting a third.
Most boosters that adults receive periodically like flu or Td / Tdap are the same dosage as previous ones, although adult Td / Tdap may be different dosage from child DTaP.
J&J applied for EUA for a booster. There is no mention from J&J or any other source that the booster dose would be any different from the first dose.