TWV Podcast Episode 485: Covid-19 Boosters for Adults

On this episode of The Whole View podcast, we are updating the covid-19 science yet again to discuss the super important topic of boosters for adults. I go through a quick refresher of how the immune system responds to vaccines (with lots of references to our other vaccine shows — if you haven’t already listened to those!), and I explain why boosters are so important, and actually a very well-studied, and utilized practice in immunology. Stacy and I discuss how we both have our booster shots coming up and we look forward to reporting back on our side effects and if they were worse or less than our second shot.

Speaking of side effects, I also go through the studies for boosters and report on the expected and common side effects that were experienced with each booster in the clinical trials. The bottom line is that getting a booster shot helps to stay ahead of any potential waning immunity. Plus, booster shots also offer greater protection against variants of concern (with data on Omicron still being collected, it is definitely an additional reason to be looking towards the enhanced protection of boosters!)

If you enjoy the show, please review it on iTunes

Listener Question from Kate

I wanted to say I listened to every covid-19 vaccine podcast. It was so good. And I got J&J. I am so grateful for the research and thought and time y’all put into it to help give me peace of mind and educate myself. I was in bed sick for 7 days recovering from the vaccine. And I am interested in the booster. And I am wondering if y’all are going to do another podcast on it. I am positive y’all probably got death threats which is just horrifying. But for folks like me who want to know the science balanced with a holistic mindset, it’s a true gift what you give to this holistic community. Okay I’m tearing up over here. Yes I had a rough week recovering from the vaccine. And I know I needed to get it. And I don’t regret it. But there’s not much talk about the booster. Would love your research and findings. Thank y’all for the work you do. Truly. So so thankful. – Kate

Key Takeaways

• Data suggest that the number of symptomatic covid-19 break-through infections increases over time following vaccination, but is this due to waning immunity? There certainly is some science to show that antibody levels do decrease over time, but this is expected and may or may not translate to waning immunity. Alternative explanations include the fact that the earliest to get vaccinated were also at the highest risk for severe covid-19, the emergence of more transmissible variants of concern like the Delta variant for which the symptomatic breakthrough infection rate is higher, and human behavior. Or, it could be all of the above!
• There is still some excellent rationale for booster shots!  When we receive an additional dose of a covid-19 vaccine, it triggers our memory B cells (the antibody-making cells responsible for “remembering” a pathogen so we can mount an immune response to it more quickly next time) to multiply, which increases the amount of antibodies in our blood. In addition, the booster shot triggers a process called affinity maturation, where our B cells learn to make even better antibodies (by gaining mutations in the lymph nodes, which is pretty cool) that can bind more strongly to their antigens. Win-win!
• Getting a booster shot helps to stay ahead of any potential waning immunity. Plus, booster shots also offer greater protection against variants of concern. Basically, we can make up for our antibodies binding more weekly to a covid-19 variant by having a whole lot more antibody in our blood available to bind to the virus!
• Clinical trials show we get at least a 10-fold boost in serum neutralizing antibodies with a third dose of any of the 2-dose regimen vaccines (Moderna, Pfizer/BioNTech, AstraZeneca/University of Oxford, and Sinovac) or a second dose of the Johnson & Johnson/Janssen.  And early data from Pfizer shows that this boost last longer than the increase in antibodies following the second dose. The Moderna booster causes a 23-fold to 44-fold increase in neutralizing antibodies! That’s great!
• An important study showed that people who had recovered from a covid-19 infection within the last 3 to 6 months had a 5.49-fold higher chance of getting re-infected than the likelihood that people who had received an mRNA vaccine within the last 3 to 6 months would get a break-through infection. This is compelling data showing that the immunity we get from vaccination is stronger than the immunity we get from natural infection.
• The safety profile of the covid-19 vaccine booster shots is comparable to the first shot for the Johnson & Johnson/Janssen and the first two shots of the Pfizer/BioNTech and Moderna vaccines, which includes similar levels of side effects and also a very low chance of rare serious adverse events. For the Johnson & Johnson/Janssen vaccine, there is a very small chance of Guillain-Barré Syndrome, especially in men aged 50–64 years, or immune thrombotic thrombocytopenia, especially in women aged 18 to 49. For the mRNA vaccines, there is a very small chance of myocarditis, especially in young men aged 12 to 29. The risk of a serious adverse event from any of the covid-19 vaccines is much lower than the risks associated with covid-19 infection.
• In young men, the risk of developing myocarditis after covid-19 infection is about 450 cases per million infections, whereas the chance of developing myocarditis after either dose of the mRNA vaccines is only 77 per million people.
• We’ll continue our conversation next week with more discussion on the mix and match studies and the safety and efficacy data for children aged 5 to 11!

Recommended Reading and Listening

• The Covid-19 mRNA Vaccines
• TWV Podcast Episode 440: Covid-19 Vaccines Part 1 – mRNA Vaccine Technology
• TWV Podcast Episode 441: Covid-19 Vaccines Part 2 – Pfizer/BioNTech vs Moderna
• TWV Podcast Episode 443: Covid-19 Vaccines Part 3 – FAQs
• TWV Podcast Episode 444: Covid-19 Vaccines Part 4 – Myth Busing
• TWV Podcast Episode 454: J&J and AstraZeneca Covid-19 Vaccines
• TWV Podcast Episode 455: Covid-19 Vaccines – Real World Data and Updated Studies
• TWV Podcast Episode 468: The Delta Covid-19 Variant

Citations

Barda N, Dagan N, Ben-Shlomo Y, Kepten E, Waxman J, Ohana R, Hernán MA, Lipsitch M, Kohane I, Netzer D, Reis BY, Balicer RD. Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting. N Engl J Med. 2021 Sep 16;385(12):1078-1090. doi: 10.1056/NEJMoa2110475.

Boehmer TK, Kompaniyets L, Lavery AM, Hsu J, Ko JY, Yusuf H, Romano SD, Gundlapalli AV, Oster ME, Harris AM. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data – United States, March 2020-January 2021. MMWR Morb Mortal Wkly Rep. 2021 Sep 3;70(35):1228-1232. doi: 10.15585/mmwr.mm7035e5.

Bozio CH, Grannis SJ, Naleway AL, Ong TC, Butterfield KA, DeSilva MB, Natarajan K, Yang DH, Rao S, Klein NP, Irving SA, Dixon BE, Dascomb K, Liao IC, Reynolds S, McEvoy C, Han J, Reese SE, Lewis N, Fadel WF, Grisel N, Murthy K, Ferdinands J, Kharbanda AB, Mitchell PK, Goddard K, Embi PJ, Arndorfer J, Raiyani C, Patel P, Rowley EA, Fireman B, Valvi NR, Griggs EP, Levy ME, Zerbo O, Porter RM, Birch RJ, Blanton L, Ball SW, Steffens A, Olson N, Williams J, Dickerson M, McMorrow M, Schrag SJ, Verani JR, Fry AM, Azziz-Baumgartner E, Barron M, Gaglani M, Thompson MG, Stenehjem E. Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity – Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep. 2021 Nov 5;70(44):1539-1544. doi: 10.15585/mmwr.mm7044e1.

Callaway E. COVID vaccine boosters: the most important questions. Nature. 2021 Aug;596(7871):178-180. doi: 10.1038/d41586-021-02158-6. PMID: 34354274.

Fowlkes A, Gaglani M, Groover K, Thiese MS, Tyner H, Ellingson K; HEROES-RECOVER Cohorts. Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance – Eight U.S. Locations, December 2020-August 2021. MMWR Morb Mortal Wkly Rep. 2021 Aug 27;70(34):1167-1169. doi: 10.15585/mmwr.mm7034e4.

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Krause PR, Fleming TR, Peto R, Longini IM, Figueroa JP, Sterne JAC, Cravioto A, Rees H, Higgins JPT, Boutron I, Pan H, Gruber MF, Arora N, Kazi F, Gaspar R, Swaminathan S, Ryan MJ, Henao-Restrepo AM. Considerations in boosting COVID-19 vaccine immune responses. Lancet. 2021 Oct 9;398(10308):1377-1380. doi: 10.1016/S0140-6736(21)02046-8.

Mizrahi B, Lotan R, Kalkstein N, Peretz A, Perez G, Ben-Tov A, Chodick G, Gazit S, Patalon T. Correlation of SARS-CoV-2 Breakthrough Infections to Time-from-vaccine; Preliminary Study. medRxiv 2021.07.29.21261317; doi: 10.1101/2021.07.29.21261317

Self WH, Tenforde MW, Rhoads JP, Gaglani M, Ginde AA, Douin DJ, Olson SM, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Mills L, Lester SN, Stumpf MM, Naioti EA, Kobayashi M, Verani JR, Thornburg NJ, Patel MM; IVY Network. Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without Immunocompromising Conditions – United States, March-August 2021. MMWR Morb Mortal Wkly Rep. 2021 Sep 24;70(38):1337-1343. doi: 10.15585/mmwr.mm7038e1.

Thomas SJ, Moreira Jr. ED, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Pérez Marc G, Polack FP, Zerbini C, Bailey R, Swanson KA, Xu X, Roychoudhury S, Koury K, Bouguermouh S, Kalina WV, Cooper D, Frenck Jr. RW, Hammitt LL, Türeci Ö, Nell H, Schaefer A, Ünal S, Yang Q, Liberator P, Tresnan DB, Mather S, Dormitzer PR, Şahin U, Gruber WC, Jansen KU, C4591001 Clinical Trial Group. Six Month Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine. medRxiv 2021.07.28.21261159; doi: 10.1101/2021.07.28.21261159

Presentation Slides for CDC from Vaccine Booster Studies:

• BNT162b2 [COMIRNATY® (COVID-19 Vaccine, mRNA)] Booster (Third) Dose
• Safety and Immunogenicity of a 50 μg Booster Dose of Moderna COVID-19 Vaccine
• Booster Dose of Janssen COVID-19 Vaccine (Ad26.COV2.S) Following Primary Vaccination