I’m in my late 40s and have had the same number of inoculations as my parents in their late 70s - 3. The difference is they had 3x Pfizer and I had 2x AZ and 1x Pfizer, although when we all got omicron a couple of months ago they seemed to do a bit better. I was just obviously very happy they weren’t disabled by the virus, and happy we all made recoveries quickly. They’ve been actively trying to get a 2nd booster while I’m just really happy we’ve kind of already had one by contracting the virus. Still… I’m not about to turn down another immunisation (that ain’t my bag, baby).
I’m approaching 70. I got my first booster last October, and when I went to the doctor last Monday I got my second booster. All Pfizer; my only reaction to the last one was soreness at the injection site and a little exhaustion the next day.
Now I just need to arrange for my second shingles shot.
Nomenclature question. Was the second shot (the one we had about a month later) after the very first Covid shot called a booster? Me, I’d have just called it the second shot. My husband says it was a booster.
You’re correct. There’s the first shot, then the second shot, then the first booster and finally, the second booster (if warranted).
The first two shots of the Pfizer and Moderna vaccines are just part of the normal sequence. (Many vaccines have a schedule of individual inoculations that were determined by trials to provide the acceptable threshold of immunogenicity; these aren’t ‘boosters’, which are additional inoculations to ‘boost’ immunogenicity after it wanes with time.) Arguably, the third shot for these should probably also be considered a part of the initial sequence and these should be three shot schedules based upon immunogenicity studies although lacking good correlates of protection (serological measurements that correspond to some threshold of immune response) it is not really clear when the ‘initial’ immunogenicity threshold is achieved and when that starts to wane. The emergency of immune-escaping variants complicates this as fully vaccinated and boosted people are still getting repeatedly infected by ‘Omicron’ variants, and we can expect this to continue as more novel variants emerge.
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Yes, I’m guessing that when the dust settles, the primary covid immunization schedule will be three doses of mRNA or possibly J&J followed by a dose of mRNA.
And everything after that will be deemed a booster.
But the dust hasn’t settled, and the third shot is currently called the first booster. (or the second, if your first was J&J.)
Maybe, or maybe they’ll just stick with the “two shots and N boosters” mentality. The ‘problem’ with the SARC-CoV-2 vaccines is that although the Phase I/II/III trials were all done comprehensively the imminent need for the vaccine precluded doing long-term efficacy studies, which were essentially done in real time in the entire vaccinated population. There may have been some more optimal spacing of injections (say two months instead of a two or three weeks between the first two shots, or another shot at three months, or whatever) but the threat of the pandemic meant deploying the vaccines under an EUA as soon as essential safety and immediate efficacy was demonstrated. With the new variants the question is kind of moot—we’ll probably be deploying boosters and updated vaccines for the foreseeable future in an ad hoc fashion to respond to emerging variants.
One thing that is clear is that we will not ‘boost’ our way out of the pandemic; the boosters are propping up immunogenicity for people who have underlying conditions or immunodeficiencies but they are not fundamentally resulting in durable immunity. What is probably needed is the mythical Holy Grail of a ‘generic’ betacoronavirus vaccine that provides broad protective immunity. Influenza researchers have been trying to develop this for several decades for Influenza A with very limited success and no deployable vaccines but immune system research is advancing by leaps and bounds so it may be possible and the effort should be funded because the impacts of this virus, even at technically endemic levels, have severe economic and social impacts.
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Me too. There was an article last week reminding us that for most of us under 50 the advice is still just one booster for now but it might be just as well to skip a second booster for now given the reasonable odds that one or more of the second gen vaccines/boosters might be available in the fall given where they are in development now.
I think you are looking at this from an American point of view. Many countries, including up here in America’s Hat, followed extended dosing. I went at the earliest approved interval, which was 8 weeks and then 6 months for the 3 doses.
Yeah, with any luck we’ll get a lot of good data about optimal dosing from the natural experiment of every country having done it differently.
I do expect, after the dust settles, that we’ll have a dose that comes at least 3 months after the initial one or two doses.
Well, you might hope that would be the case but there was little in terms of organized protocols and tracking, and without well defined trial populations to compare or correlates of protection it is difficult to suss out an optimum schedule. The two shot sequence for either mRNA or adenovirus vaccines seems to work well enough to prevent severe illness and a ‘booster’ at a minimum of three month intervals gives a prompt response to infection that minimizes symptoms and the active viral shedding period but it is clear now that even four or more shots does not provide durable immunity and is evaded by more recent variants to the extent of causing significant symptoms.
I suspect a 1-3-6 month schedule is probably the sweet spot but frankly there are so many people who haven’t even received a full sequence or any vaccination at all that the focus should really be getting shots in arms worldwide than trying to find some hypothetical optimum spacing for peak immunogenicity that is going to wane and be evaded over time anyway. There is also a need to trace (as best possible) the sources of new variants and try to at least forecast and forestall new waves of contagion as long as possible.
And remember, as bad as this is, this is T-ball epidemiology compared to the major leagues of a virus with an infection fatality rate in the double digits. If a smallpox-like pandemic emerged in today’s world with the lack of global coordination and cooperation, we’d be truly fucked despite rtPCR testing, genetic sequencing, and mRNA technologies.
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My understanding is that the third mRNA dose significantly increases the cellular immune response and broadens the immune response. Whereas the fourth just provides a temporary boost in antibodies.
So I think this should always have been a three shot series, and will eventually be described that way.
Could it be more like a flu shot with a different formulation each year?
I am just under the age criteria for the second booster, but we’re taking our first international trip in three years in June, so I’m thinking I might fudge it and get the second booster. I want to be at max protection while traveling.
They are working on Omicron specific boosters now.
If by ‘cellular immune response’ you mean helper T-cell response (the cells that ‘signal’ the immune system to release cytotoxic T-lymphocytes to directly attack antigen-expressing virions) that is probably true, but again the lack of having good correlates of protection it is difficult to make definitive causal links. The third does certainly does prompt a temporary inflammatory response that is at least as acute as the second dose; I haven’t seen any careful serological studies of the fourth or subsequent doses but anecdotally people seem to have fewer expressed symptoms from those shots, so I suspect that the mRNA vaccines should be a three dose series with the booster just keeping the immune system prepped for a prompt response. The J&J single-shot with a ‘booster’ seems to produce an equally or more durable response than Moderna and Pfizer even though the initial efficacy is lower (albeit that may be driven in part by differences of how protection was assessed in the trials) and the Oxford/AstraZeneca trials revealed that their vaccine provided good initial protection with a half-normal first dose and full second dose.
Of course, all of the progressively more immune-evasive variants have confounded all attempts to really characterize vaccine efficacy against the original ‘wild-type’ and ‘Alpha’ variants, and there are a bunch of pre-prints floating around that never make it through peer review so it we are in a real ‘fog of war’ regarding the vaccine enduring effectiveness, which is kind of to be expected since this is really the first time we’ve been able to see a vaccine-pathogen ‘arms race’ from the inside of a pandemic with genomic sequencing tools. Hopefully we’re collectively producing lessons learned about how to get and use better data and conduct useful studies but I’m not particularly optimistic that we really have a good handle on the immunology of SARS-CoV-2 at this point.
The problem with that strategy is that while influenza definitely comes in complementary seasonal waves in the Southern and Northern hemispheres, and influenza strains are ‘neatly’ divided into hemagglutinin and neuraminidase (HA and N) antigen groupings that are readily identifiable in a serology test, SARS-CoV-2 has more sporadic and difficult to anticipate patterns of contagion and seems prone to pretty radical genetic shift and recombination. What you see from the CDC and WHO regarding ‘new’ variants is typically at least four to six weeks behind what is actually spreading, and predicting what a dominant variant will look like in a year or even six months is a fool’s errand; six months ago ‘Omicron’ was just a spooky rumor and officials were declaring the pandemic over, and now we’re seeing all kinds of indicators that infection is rising again with hospitalization likely to soon follow. What is really needed is a vaccine that doesn’t just recognize the fungible spike proteins but also goes after the envelope and other proteins that might be more stable from variant to variant so that a ‘generic’ vaccine will be highly protective against unknown emerging variants as well as those currently circulating.
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Got the second booster today. We’re going to be spending some time with older relatives (75-90 years) in a couple of weeks, so just to be safer.
I had 2 last spring/summer. Am 60. Do I need a third?
In general, a third shot is recommended for anyone over the age of 12 if it has been more than five months since the second shot. Some exceptions apply.
When I initially responded to this thread, I said I was waiting a few months until (hopefully) the booster protects against more variants. I changed my mind. Covid is increasing in my area (New England) so I went and got the second booster two days ago.