In episode 485 of The Whole View podcast, Stacy and Dr. Sarah answer listener Kate’s questions about the covid-19 vaccine booster shots. They first discuss the rationale for the booster shots, then dive into new data on how the immunity we get from the covid-19 vaccines has proven more robust than immunity from natural infection, how much our neutralizing antibodies can go up following a booster shot, and the safety profiles of the Johnson & Johnson/Jansen, Pfizer/BioNTech and Moderna boosters.
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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
- Data suggest that the number of symptomatic covic-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!
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Recommended Reading and Listening
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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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