Vaccine Booster Question for the physicians. Mix and match RNA vax benefit?

NorsemenUnited wrote:

It seems there’s medical consensus that a J & J stab combined with a Moderna or Pfizer booster will lead to superior immunity.

I’m twice vaccinated with Moderna, scheduled to have a booster next week. I’ll have access to both the 1/2 dose Moderna boost and the Pfizer vax? Is there any evidence that mixing and matching RNA shots is superior? In my case, which vaccine booster do you get, docs?

I’m 50 and healthy, but in a high exposure workplace.

I don't have any advice to give on this matter, but you do realize like 90 percent of the replies you're going to get will be from antivax lunatics? This is the wrong place to ask. I wish you the best

I’ve been reading this board since it began. I can handle the trolling from the 17 year old 19 minute 5kers and the 32 year old who live in their parent’s basements. There are also some smart people on these boards and there’s not much out on mixing and matching RNA stabs, so I thought it was worth a “shot.”

NorsemenUnited wrote:

It seems there’s medical consensus that a J & J stab combined with a Moderna or Pfizer booster will lead to superior immunity.

I’m twice vaccinated with Moderna, scheduled to have a booster next week. I’ll have access to both the 1/2 dose Moderna boost and the Pfizer vax? Is there any evidence that mixing and matching RNA shots is superior? In my case, which vaccine booster do you get, docs?

I’m 50 and healthy, but in a high exposure workplace.

The studies that showed superiority of the mix and match protocol were in people who got either the J&J or Astra Zeneca first, then took an mRNA dose.

You got the Moderna vaccine, which has held up pretty consistently and generates pretty durable response, even at 6 months. I don’t think you can go wrong here, but you’re best option is to probably stick with Moderna.

Basically any mRNA booster should be fine is the consensus...

Here's a paper looking at neutralizing titers from all the combinations.

https://www.medrxiv.org/content/10.1101/2021.10.10.21264827v1.full.pdf

The Atlantic summarized it here:

https://www.theatlantic.com/health/archive/2021/10/mix-match-booster-covid-vaccine/620395/

What if we got Pfizer first? I got Pfizer but it seems to me that Moederna is the superior vaccine.

Scientists, should everyone get a booster with Moderna is what I'm wondering? It seems that way to me.

rojo wrote:

What if we got Pfizer first? I got Pfizer but it seems to me that Moederna is the superior vaccine.

Scientists, should everyone get a booster with Moderna is what I'm wondering? It seems that way to me.

I’m not a scientist (I’m a pulmonary and critical care doctor) so take my advice with a grain of salt.

There is no “measuring stick” for how strong the immune response is. The study the NIH did (posted earlier) measured antibody levels, but even the authors said (in the last paragraph) higher antibody titers doesn’t mean “better” immunity, and that their study was not designed to answer the OP’s (or your question) of what the best combo is. They just wanted to show that antibodies spiked after a combination.

The Atlantic article (kind of) misinterpreted that when they said Pfizer-Moderna was a “better” mix than Pfizer-Pfizer. The paper didn’t demonstrate that the higher antibody titers were actually statistically significant, nor did they have a monitoring period to measure incidence of break through infections. It just says “combinations cause antibodies to spike”.

I got Pfizer, and took a Pfizer booster. I don’t think you could wrong either way. You might end up being right, and it sounds logical to vary the stimuli you give your immune system. You could also make the argument that if you already had one vaccine with no side effects or allergic reaction, why take a new one? You don’t know if you’re allergic to that one. (VERY VERY minor concern).

By the way, efficacy of immune response to a vaccine is measured in incidence of breakthrough infections not antibody levels. There are T cell and memory cell responses not measured in the circulating antibody levels so it’s not as simple as “more antibodies=more immunity”.

NorsemenUnited wrote:

It seems there’s medical consensus that a J & J stab combined with a Moderna or Pfizer booster will lead to superior immunity.

I’m twice vaccinated with Moderna, scheduled to have a booster next week. I’ll have access to both the 1/2 dose Moderna boost and the Pfizer vax? Is there any evidence that mixing and matching RNA shots is superior? In my case, which vaccine booster do you get, docs?

I’m 50 and healthy, but in a high exposure workplace.

In Canada , a large percentage have mixed doses on first 2 . AZ stock ran out , so the common mix is AZ and Pfizer.

I love that your disclaimer is that you’re a pulmonary doctor, so you may not be qualified to speak with authority on the matter. A guy who does some fire suppression work for my institution speaks with certainty on all matters related to not getting vaccinated.

Enjoy your blood clots and cardiac arrest, you arrogant old ignorant sheep 🖕🖕🖕

1. There is no covid

2. Your an idiot for watching the news

3. You will die from the jab 🖕

If I got two jabs seven months ago to get 95% protection for a disease with a 99% survival rate, and am now being told I already need a booster, I might wonder if I was lied to. That feeling of wonder may deepen when I'm told I need another booster six months from now, and another one after that, and....

NorsemenUnited wrote:

I love that your disclaimer is that you’re a pulmonary doctor, so you may not be qualified to speak with authority on the matter. A guy who does some fire suppression work for my institution speaks with certainty on all matters related to not getting vaccinated.

Just trying to stay in my lane…

I’ve had ideas about and made predictions / statements about COVID early on that were wrong. And since I’m not a researcher, immunologist or virologist, I’m still learning about it too.

I think the mere presence of boosters as a recommendation is fueling more distrust. Before COVID, the most common coronaviruses were the ones that cause the common cold (there’s 4 of them, or more accurately 4 classes of them). We know the immunity to those is not lifelong, and that they mutate into new variants every year. That’s why you’ll never hear anyone say “I had a cold in 2013, so I’m immune for life”.

Immunity wanes, and new variants emerge.

Once we get >90% of the population immune either by vaccination or natural infection, COVID might become a run-of-the-mill endemic coronavirus. We’re not there yet.

Just chiming in to note that the ratio of intelligent discourse : anti-vax drivel on this thread is higher than expected (so far)

So are the boosters the same ‘strength’ ad the original vaccine or a lesser dose? Should JJ people get a different booster or simply one dose of the original M or P?

Clay wrote:

So are the boosters the same ‘strength’ ad the original vaccine or a lesser dose? Should JJ people get a different booster or simply one dose of the original M or P?

For Pfizer, the third dose is the same.

If a J&J recipient takes a J&J booster, it’s also the same dose.

If a J&J recipient takes a Pfizer booster, it’s a full dose.

If a J&J recipient chooses a Moderna booster, it’s a half dose.

The FDA and CDC desperately need to hire new staff that know how to communicate with the public. Or at least an editor for their press releases… it’s like the nerds from The Big Bang Theory are writing this stuff. In this 3-page document, you have to go to the next-to-last paragraph to find the answer the public is probably most curious about. I’m almost certain the people who got the J&J vaccine are the most likely to want to mix and match. They could at least make it searchable.

To what degree does it help? 50% or more?

dio wrote:

To what degree does it help? 50% or more?

I’m guessing you mean how much the likelihood of a breakthrough infection is? It wasn’t studied that way. They measured immune response (they’re collecting data on breakthroughs now).

I’ll look through the studies from Israel again and see if there’s any follow up yet. They have a couple of months more data than we do.

This study shows that antibody levels are good enough to assume protection:

Earle KA, Ambrosino DM, Fiore-Gartland A, et al. Evidence for antibody as a protective correlate for COVID-19 vaccines. Vaccine 2021;39:4423-28

This one looked at breakthroughs in 4 months after Pfizer. About 0.4%.

www.nejm.org/doi/full/10.1056/NEJMoa2109072

Covid-19 Breakthrough Infections in Vaccinated Health Care Workers.

So if you combine the antibody level rose after a booster, with the information from earlier studies on breakthrough infections, you can reach the conclusion that it’s very helpful. But you can’t reach a specific protection % without monitoring for several months.

Just stick with the far superior Moderna. The Pfizer is bogus.