UPDATE: I got my booster October 7th, based on my level of occupational exposure. It felt about the same as my second shot - aches came on earlier, and arm was pretty sore. The night of 10/8, I did finally have some chills which resolved with Tylenol, and the worst insomnia I’ve ever had (which eventually resolved when I finally used some of the sleep hygiene techniques with which i counsel patients). On 10/9, I woke up feeling 100% better!
My posts recently have focused mostly on vaccination lately, for obvious reasons. This post...is still about that. At least, partially.
The big news is, of course, boosters. The Vaccines and Related Biological Products Advisory Committee (VRBPAC) delivered recommendations to the FDA, who then authorized booster doses for the Pfizer-BioNTech vaccine (more on Moderna and J&J below). The FDA then submitted recommendations to the CDC's Advisory Committee on Immunization Practices (ACIP).
Before I get into that, let's back up a bit. There has been a lot of back and forth on this in recent weeks, so there has definitely been some confusion as a result.
First, nomenclature: Booster vs. third dose.
A third dose is just that: a scheduled third dose. For a segment of the population, the Pfizer vaccine (and possibly others) will be a three-dose regimen instead of two because two doses isn't enough. This, according to the FDA, applies to those:
Undergoing treatment for solid tumors and blood cancers
With organ transplants taking immunosuppressive therapy
With advanced or untreated HIV infections
With moderate or severe primary immunodeficiency syndromes
Who received CAR-T-cell or hematopoietic stem cell transplants within the past two years or if still taking immunosuppression therapy
Why? The above categories are folks that are immunocompromised, and may not mount the same immune response to COVID-19 with just two doses (but new studies show an improvement after a third dose!). They are also more susceptible to severe illness from COVID-19 itself. This is also why those who do not fall into these categories should get their two-dose regimen of vaccines, because we may not know who around us is immunocompromised, but they deserve to be protected.
A booster, on the other hand, is meant to get already-established vaccine-mediated immunity (which, as I've discussed recently, is more reliable than infection-mediated immunity and is still "natural" despite what pseudoscience would mislead you to believe) even closer to 100%.
So who gets a booster?
This is where there was a bit more discussion. First, regardless of these recommendations, the main priority is still to get everyone primarily vaccinated - everyone needs to get their two-dose regimen (or three, if you're immunocompromised) as soon as possible, worldwide.
ACIP made its recommendations to the CDC, and the CDC took those recommendations and expanded them just a bit wider.
Eligibility for boosters extends to:
People >65 years old
People 18-64 with increased risk due to underlying medical conditions
Chronic kidney disease
Coronary artery disease
Pregnancy/recent pregnancy (within 42 days)
Smoking (or former smoker)
People 18-64 with occupational or institutional exposure
Hospital/healthcare facility workers, group home residents, prisons, shelters, teachers
This is where the CDC differed from the ACIP recommendations, in an attempt to anticipate risk and try to mitigate that for these potentially at-risk populations
This does NOT mean the primary vaccine series is ineffective. It is VERY effective! But in these populations, especially those with higher exposure, a booster may provide that extra protection needed against the higher risk.
EUA of Boosters for Moderna and possibly J&J is still coming. VRBPAC is meeting to discuss boosters for those companies' vaccines on October 14th and 15th, respectively. They are also going to discuss mixing vaccines for the booster doses. In the meantime, keep wearing masks in crowded areas or where you don't know everyone's vaccination status, and keep taking precautions. The pandemic is still not over.
Vaccines For Kids!
There is not much information on this yet, but on October 26th, VRBPAC is going to discuss vaccinations for kids aged 5-11, based on data they have collected over the last several months. Finally! Our children have been unprotected for so long, and while mortality rates among kids are significantly lower, they DO still get sick or hospitalized (some very severely) and some die. More will spread it to other family members (inadvertently). All this from a disease that is PREVENTABLE. In addition, despite rumors by disinformation-mongerers, there have been no deaths attributable to the COVID vaccines (VAERS reports have been thoroughly investigated, but correlation is not causation), in any age group. You know what has killed a relatively small number, but still a preventable number of children? COVID-19 infection.
A New Treatment: Bringing the hammer down on COVID-19
Introducing Molnupiravir (named after Thor's hammer, Mjolnir). A preprint paper has come out by Fischer et al in which they performed a Phase 2a trial of molnupiravir (at multiple doses in different subgroups) vs. placebo. It appeared to get symptomatic, confirmed COVID-19 cases to undetectable viral loads in about five days. A press release regarding a Phase III trial announced that it reduces risk of hospitalization or death by about 50% compared to placebo. It works by disrupting the genetic code of the virus (not the human in which it is in), as long as it's given early. According to the release, it showed good effect against all the known variants. The results were promising enough that the trial was essentially stopped early and the placebo group was given the medication as well.
I'm always wary when a trial is stopped early, regardless of what intervention it is, but there is a reason trials do that sometimes. That said, I look forward to the full data being released regarding adverse effects and the trial's methods, just like I do with any of these treatments.
This is wonderful news if the trial data holds up to review. It is still not a substitute for vaccination, which is >90-95% effective at preventing hospitalization and death. Get vaccinated!
Vaccines for Kids: