In this video, Roger Seheult, MD of MedCram discusses the new bivalent boosters that are currently being offered. These new boosters are called bivalent because they have 2 different mRNAs to code for two different spike proteins because Omicron is so different from the original Wuhan strain of SARS-CoV-2. Whether you should get the vaccine will depend on your individual cases. Medicine is nuanced. This video is here to give you as much information as possible to give you the ability to make an educated and informed decision.
Bivalent boosters
Both Moderna and Pfizer have a bivalent booster that has the Original strain and the Omicron BA.4/BA.5 strain. This bivalent product is only for people who have already gotten the first two shots of the vaccine. This is not a primary series. If an individual has already gotten a booster, then they would need to wait at least 2 months since their last booster. With the EUA (emergency use authorization) for the new boosters, the old boosters will be removed. Pfizer/BioNTech has 15 mcg of the Original strain + 15 mcg of the Omicron BA.4./BA.5 strain making a 30 mcg dose. Moderna has a dose of 25 mcg of the Original strain and 25 mcg of the Omicron BA.4./BA.5 strain making a 50 mcg dose. The Pfizer booster is approved for ages 12+ and the Moderna booster is approved for ages 18 +. The idea behind the bivalent booster was to see if the booster could be more effective by adding the Omicron BA.4 and BA.5 current circulating strains.
Vaccine effectiveness
It is known that overtime a vaccine will wane in its effectiveness. A study looked at this with the end points of effectiveness against symptomatic infection, against any infection and against hospitalization. This study took place throughout the world over several weeks and found that effectiveness against hospitalization was not significantly degraded as compared to the effectiveness against symptomatic infection or against any infection.
Are the boosters safe?
As of now there is no human data on the safety of the vaccine with BA.4 and BA.5 other than what was done in the mouse study. There are about 4 out of 4000 nucleotides that are different with the BA.4 and BA.5 compared to the BA.1. There are studies on a BA.1 vaccine in humans. One could assume that the variants are close enough to have similar results; however, it must be noted that without the human studies we can not say that for sure. They are currently working on human trials with the new bivalent boosters which should be out in October. In the mice studies, it showed that there was a substantial increase in omicron neutralization response to all omicron variants including the BA.4 and BA.5.
From NEJM there was an article on the safety of the vaccines and they found that both the Original and BA.1 vaccines had very similar local and system adverse reactions. These do not include studies with BA.4 and BA.5 as these are forthcoming.
Adverse reactions were looked at for 7 days after injection and the most common were pain at injection site and myalgias. The overall incidence of adverse events considered related to the study vaccination was 6% in both booster groups.
Should I get the booster?
Some reasons to get the booster are if you have sick contacts, work in a high risk area, have medical problems, older age, there is better immunity against current variant. Reasons not to get the booster include no sick contact, work in low risk area, healthy, younger age, may have possible post infectious immunity. Currently there is no BA.4 and BA.5 variant specific human neutralizing antibody data. Whether you get the booster or not, it is an individual choice that needs to weigh both the pros and cons.
LINKS / REFERENCES:
COVID-19 Cases and Deaths by Vaccination Status Dashboard (Texas HHS) | https://www.dshs.texas.gov/immunize/c…
Fact check: New COVID-19 boosters were tested in just 8 mice? Should it matter? (CBS17) | https://www.cbs17.com/community/healt…
Pfizer/BioNTech COVID-19 Omicron-Modified Bivalent Vaccine (CDC) | https://www.cdc.gov/vaccines/acip/mee…
Pfizer and BioNTech Announce Omicron-Adapted COVID-19 Vaccine Candidates Demonstrate High Immune Response Against Omicron (BusinessWire) | https://www.businesswire.com/news/hom…
A Bivalent Omicron-containing Booster Vaccine Against Covid-19 (medRxiv) | https://www.medrxiv.org/content/10.11…
Safety and immunogenicity of SARS-CoV-2 variant mRNA vaccine boosters in healthy adults: an interim analysis (Nature) | https://www.nature.com/articles/s4159…
Bivalent SARS-CoV-2 mRNA vaccines increase breadth of neutralization and protect against the BA.5 Omicron variant (bioRxiv) | https://www.biorxiv.org/content/10.11…
Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant (NEJM) | https://www.nejm.org/doi/10.1056/NEJM…
All coronavirus updates are at MedCram.com (including more discussion on delta variant covid, COVID Delta, COVID children, natural immunity COVID 19, and more).
MedCram Update 46: https://youtu.be/EFRwnhfWXxo
MedCram Update 47: https://youtu.be/H1LHgyfPPQ8
MedCram Update 132: https://youtu.be/9OZZ6_M4OB0
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