Is it time for another COVID booster?

February 18, 2022 — Is spring time for a boost again?

The first COVID-19 booster shot is now in the rearview mirror for millions of Americans — for the 28% who have it, at least — but new data finds it to be less effective after about 4 months. The CDC has already recommended a second booster for immunocompromised people.

So, is the next logical step a new booster for every other adult?

The consensus among public health officials seems to be: not so fast.

During the White House’s COVID-19 briefing Wednesday, White House medical adviser Anthony Fauci, MD focused on the issue of the hour. Citing data, he said that “a single booster injection continues to provide a high level of protection against serious diseases caused by Omicron” in people who are not immunocompromised.

Fauci pointed to CDC research that found vaccine efficacy dropped to 58% after two doses of mRNA vaccines — Moderna or Pfizer — after 4-5 months. After a booster dose, the vaccine is initially 91% effective to prevent hospitalizations. But that drops to 78% in Months 4 to 5. “Yet the level of 78 [%] is still a good protective area,” Fauci said.

“The future need for an extra boost, or a fourth injection for mRNA or a third injection for [Johnson & Johnson]is monitored very carefully in real time,” he said, adding that the recommendations will be updated as necessary.

Wait for the data

Other public health officials and agencies are following Fauci’s advice: Wait for the data.

“At this time, CDC does not have a fourth dose/second booster dose recommendation for most Americans,” said Scott Pauley, a CDC spokesperson.

In a preprint study, not peer-reviewed this week, researchers at Sheba Medical Center in Israel followed 274 health care workers after a fourth dose of either the Moderna or Pfizer vaccine. They found that the second booster restored antibody levels to the same peak levels after the third dose, but was not good at preventing mild or asymptomatic Omicron infections.

Breakthrough infections were common. The researchers said their results suggest there is a need for “next-generation vaccine development.”

Considering the path of the pandemic

Decisions about second booster shots require us to look at the big picture, says William Schaffner, MD, an infectious disease specialist at Vanderbilt University Medical Center in Nashville. Right now, he says, hospital admissions have fallen and “even deaths, a lagging indicator,” are declining, although not to the same extent in all parts of the country. Still, he says, things are moving in the right direction.

During the White House briefing Wednesday, CDC Director Rochelle Walensky, MD, said federal officials are “cautiously optimistic about the trajectory we are on,” noting that the current 7-day daily average of cases is about 147,000. The number of hospital admissions, 9,500 per day, is down about 28% and the 7-day average of daily deaths is about 2,200, down about 9% from the previous week.

The hope, Schaffner says, is that this combination of the Omicron spread, with many getting natural immunity to that infection, along with vaccination, will cause a continued drop in cases. “If that’s the case, we won’t need a booster any time soon.”

But that scenario also assumes that we will not see a new care variant, he says.

Then, ”as we go from pandemic to endemic, we can determine the interval at which a booster is needed and what the composition is [of it] will be,” Schaffner says. But for now, “I don’t think a fourth dose — a second booster — is in the works for the foreseeable future. [for those not immunocompromised]if everything goes the way it goes.”

“What you can’t see is all my fingers are crossed,” he says.

Booster Goals

It’s difficult to give definitive answers about boosters for the general population without enough data, agrees Alejandro Balazs, PhD, a virologist and principal investigator at the Ragon Institute of Massachusetts General Hospital, MIT and Harvard.

The crucial question: “Are we trying to stop the transmission or just a serious illness?”

Amesh Adalja, MD, an infectious disease expert and senior scientist at the Johns Hopkins Center for Health Security, agrees: “If the goal is protection from serious illness, hospitalization and death, aiming to boost populations with a high risk [but not others] makes sense since the standard regimens hold up in the general population.”

Even if antibody levels decline after vaccinations, your memory T-cell and B-cell responses can persist, making it possible to fight off the virus, Balazs says. “The antibodies can prevent the infection from settling.”

Boost now, data later?

Despite the lack of data, doctors say their patients are now asking about second boosters.

“At this point, it’s impossible to predict whether additional booster doses will be needed for healthy people,” says Aaron Glatt, MD, chief of infectious diseases at Mount Sinai South Nassau in Oceanside, NY.

Can premature boosting by healthy people have a downside? “I see no immediate damage” [to that]† However, I’m not so sure of the benefit,” Schaffner says.

“The only damage is hypothetical,” Adalja says, “and it’s that continuing to boost first-generation vaccines targeting the ancestral strain of the virus can jeopardize the immune system’s ability to fully respond to new variants.” attenuate.”

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