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Second reminder of the COVID-19 vaccine: should I get one?

AAt this point, COVID-19 vaccines have been available for well over a year in the United States. But vaccines weren’t designed to prevent SARS-CoV-2 infection, and vaccine-generated immunity wanes, so the virus continues to mutate and become even more transmissible — and even infect people. vaccinated. Boosting with another dose of vaccine can boost that immunity again, so public health officials authorized a first booster shot for most people last year. But as new variants of the virus continue to emerge, it’s time to consider another booster dose for the general population. Already, this second booster is recommended for certain people at high risk of COVID-19 disease who could benefit from the reinforced protection provided by the additional blow.

Experts, however, are not comfortable with a strategy of simply adding booster after booster of the same vaccine. So they’ve launched studies to see if there’s a better way to optimize vaccines and if current versions of vaccines are the best ones to rely on in the face of a still-mutating virus. Here’s what we know so far.

Who can benefit from a second booster shot?

For most adults in the United States, being up to date with your COVID-19 vaccines right now means getting vaccinated and then getting a booster dose a few months later. For Pfizer-BioNTech or Moderna injections, this involves two primary doses and a booster; if you have been vaccinated with the Johnson&Johnson-Janssen vaccine, this is a starting dose and a booster.

Children aged 12 to 17 can be boosted, but only with the Pfizer-BioNtech vaccine; Moderna and Johnson&Johnson boosters have not yet been approved for this age group.

For some people, such as people over 50 and people with health conditions that prevent them from mounting a strong immune response, health officials have already recommended a second booster dose four months after the first. This, in part, is based on data from Israel, which showed that adding a second booster in January for people over 60 and for healthcare workers reduced the risk of death from Serious COVID-19.

At a recent meeting of members of the independent Food and Drug Administration (FDA) advisory committee, experts reviewed studies investigating the potential benefits of adding another booster dose. For example, they looked at research showing that the immunity generated by the first booster wanes after a few months – Israeli studies show that rates of serious illness in boosted people begin to rise, although they remain lower than rates in unboosted people. people. They also took into account US laboratory studies confirming that the levels of anti-virus antibodies produced after a booster dose begin to decline after several months, decreasing about sixfold during this period.

Additionally, any added benefit of a second booster must be weighed against the potential side effects, which include inflammation of heart tissue, especially for young people receiving the Pfizer-BioNTech or Moderna vaccines, and the risk of clots. blood tests for people receiving the J&J vaccine. shoot. This means that continuing to boost every four months or so with the same vaccines is not a sustainable way to deal with COVID-19, especially if the virus continues to mutate.

After reviewing all the studies available so far, the committee concluded that there was not yet enough data to recommend a second booster for the general population. While a second booster can boost a person’s antibody levels against COVID-19 and protect them against more serious illnesses, that protection doesn’t last as long as health officials would like. So for the vast majority of the American population, this second booster is not necessary, at least not yet.

If I am authorized, when do I need to get a second reminder?

For now, those eligible to receive a second booster dose include people over 50 and certain groups of people with weakened immune systems. If you are immunocompromised and have received the Pfizer-BioNTech vaccine as a primary (i.e. three doses) and a booster dose, you can now receive a second booster, or fifth dose, four months after the first booster if you are 12 or older. If you are immunocompromised and have received the Moderna vaccine as a primary and first booster, you can receive a second booster dose if you are 18 years of age or older.

A second booster won’t necessarily protect you from SARS-CoV-2 infection, but if you are infected, it can reduce your risk of becoming seriously ill and even going to hospital for COVID-related symptoms. -19.

When will the rest of the population be able to get a second booster?

As for the rest of the population, the situation is not so clear. There is no doubt that booster shots increase antibody levels. It is also well established that antibodies are an important, but not the only, contributor to a strong immune defense against SARS-CoV-2. Studies show that each dose of currently approved COVID-19 vaccines builds up a person’s T cell response – a group of immune system cells that tend to remember specific viral infections and remain ready the next time they meet them. In fact, research suggests that T cells are primarily what protect vaccinated and boosted people from serious disease if infected. Understanding the extent to which a second booster might continue to improve this T-cell response could help health officials decide whether this extra dose is needed for people who are not at greatest risk for severe disease – the lymphocyte response T is, in fact, currently under scientific investigation.

The questions scientists are now trying to answer involve determining the strength of the vaccine-induced immune response, the duration of protection, and whether the current vaccine is the best way to generate it. At the moment, the injections used as a second booster dose are the same as those for the original vaccine and do not appear to push protective antibody levels any higher than they were after the first booster.

Should I wait for a variant-specific booster injection?

So far, booster shots have consisted of another dose of the original vaccine. But with new variants like Omicron and its BA.2 subtype now responsible for almost all recent infections, health experts are considering changing the COVID-19 vaccine strain, the same way they change flu strains. each year for the flu vaccine.

The drugmakers behind the most successful vaccines to date have already developed and are testing new versions for the Beta, Delta and Omicron strains. These companies are also testing combinations of these injections to identify a combination that could be used as a booster to generate a longer lasting and broader immune response. But the results of those studies won’t be available until the summer at the earliest, so health officials are unlikely to recommend additional booster shots for the bulk of the U.S. population before those results are analyzed.

For now, only certain groups are eligible to receive a second booster, because their risk of developing serious illness is higher if they are infected, even if they are vaccinated and boosted. For the rest of us who are vaccinated and boosted, making individual decisions about whether to continue wearing masks in crowded indoor environments and avoiding environments where we may be in close contact with many people, continues to be the best way to limit our exposure. and the risk of COVID-19, at least until more data becomes available.

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