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Should you get a third dose of COVID vaccine? – Medical Xpress

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They’re cancer patients. Transplant recipients. People with lupus, rheumatoid arthritis, HIV/AIDS, sickle cell disease, kidney failure and Crohn’s disease. Plus millions of others who have conditions or take medications that weaken their immune systems.

That makes them—millions of teens and adults—what doctors call .

And that puts them at much higher risk of serious illness if they get COVID-19, which is why many states prioritized them for vaccination early this year.

Now, most of them are now eligible for even more protection.

The FDA and CDC have just approved and recommended an additional dose of mRNA COVID-19 vaccines as part of a primary series for moderately and severely immunocompromised people.

The additional dose should be the same mRNA COVID-19 vaccine as the first two shots the person received before, and should be administered at least 28 days after completion of the initial primary series of two shots. Specifically, those who have had two doses of the Pfizer vaccine can get a third dose of that vaccine, and those who have had two doses of the Moderna vaccine can get a third dose of that vaccine.

This is not considered a “booster shot,” but rather an additional dose to the recommended use of COVID-19 vaccines in these individuals. It’s being recommended because they have likely not produced an adequate immune response after getting the first two doses of COVID-19 vaccine.

Currently there is not data to support giving a dose of mRNA COVID-19 vaccine to immunocompromised people whose previously received the one-dose Johnson & Johnson/Janssen vaccine. A recommendation for immunocompromised people who got that vaccine is still being developed.

Immunocompromised people are more likely to get severely ill from COVID-19, are at higher risk for prolonged viral infection and shedding of the virus, are more likely to transmit the infection to people they live with, and show a lower immune response to vaccination compared to non-immunocompromised people, says Pamela Rockwell, D.O., a Michigan Medicine family physician and associate professor at the University of Michigan Medical School.

She represents the American Academy of Family Physicians on the CDC advisory panel that just approved the new recommendation.

“As COVID-19 surges across the country, vaccinated people who are immunocompromised and have completed a two-dose series of either the Pfizer or Moderna COVID-19 vaccine series should obtain a third dose of the same mRNA vaccine that they have already received, at least 28 days from their second vaccine dose. This includes children and adolescents 12 and older who are immunocompromised,” said Rockwell.

“If you aren’t sure if you or your child falls into this group, talk with a trusted health care provider,” she added. “And if you fall into the third-dose group, but you haven’t gotten vaccinated at all yet, or haven’t finished your two-dose series, now’s the time to do it.”

Other steps immunocompromised people should take

Vaccination is not all people in this group should do, she adds.

“It’s important for immunocompromised people to wear masks in public, maintain social distancing of at least 6 feet from people they do not live with, avoid crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider, and to encourage everyone over the age of 12 who interacts with them closely to get vaccinated if they aren’t already,” she said.

“They may not realize how much they are putting you at risk, or that your immunocompromised state puts you at high risk of severe COVID-19,” she added. “Ask them to help protect you.”

Rockwell also encourages people who get a third dose of COVID-19 vaccine to sign up for the CDC’s V-safe system, which will text them occasionally to ask them to report any reactions to the vaccine. This will help collect data that will guide the vaccination process and look for any rare effects.

Surging spread poses risk to immunocompromised people

The new approval couldn’t have come at a better time, given the fact that nearly the entire country is now experiencing high levels of spread of the coronavirus because of the highly contagious Delta variant.

It’s also a reminder of the fact that immunocompromised people remain vulnerable to severe cases of COVID-19 even after they’ve gotten vaccinated.

And some of them may not have gotten vaccinated yet, because their doctors are following recommendations that advise them to wait a certain amount of time after they finish a or get a transplant.

While the overwhelming majority of people hospitalized for COVID-19 right now are unvaccinated adults and children, many of the rest of those in hospitals for COVID-19 care have a condition or take a medication that affects their .

Advanced age can also affect immune response, but the new recommendation is not age-based. And a recent study by a U-M team found that nearly 3% of insured United States adults under the age of 65 take medications that weaken their immune systems. The findings, made using data from over 3 million patients, focused on people taking chemotherapy medications and steroids such as prednisone.

Who’s eligible for a third dose?

Here’s a partial list of the conditions and treatments that could qualify someone for a third dose of COVID-19 .

If you have one of these conditions or are on one of these treatments, or have another condition or take another medication that affects your immune system, contact your health provider or your child’s provider to see what they recommend.

  • Primary immune deficiency diseases
  • Cancers ( or blood cancers like leukemia and lymphoma) currently being treated with any treatment that reduces immune response, or treated in the past two years with a stem cell (bone marrow) transplant or CAR-T therapy
  • Organ transplant for any condition (liver, heart, kidney, lung, pancreas) now taking anti-rejection medications
  • HIV infection or AIDS
  • Chronic use of corticosteroids such as prednisone, especially high doses equivalent or larger than 20 milligrams of prednisone per day
  • TNF blockers such as Remicade, Enbrel, Humira, Cimzia, and Simponi, and other biologic agents that suppress or modify the immune response in order to treat an autoimmune diseases such as lupus, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis or other condition
  • People with end-stage kidney disease and people on dialysis
  • Anyone who has had their spleen removed for any reason

Other options for all at-risk teens and adults

Rockwell said that individuals whose health providers do not yet recommend a third dose for them should refrain from seeking a third dose at this time.

But, she adds, recommendations could change in future to include them as well. The CDC committee she serves on will also examine the issue of booster shots for other individuals.

She also noted another new FDA approval that could help immunocompromised people, and others over the age of 12 who aren’t fully vaccinated and have risk factors for severe COVID-19.

The FDA just approved the use of monoclonal antibody therapy as a preventive therapy, for high risk people who know they’ve been exposed to an infected person or live in a facility where someone has gotten COVID-19.


Explore further

CDC advisers to discuss third COVID-19 vaccine dose for immunocompromised


Citation:
Should you get a third dose of COVID vaccine? (2021, August 17)
retrieved 17 August 2021
from https://medicalxpress.com/news/2021-08-dose-covid-vaccine.html

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FDA panel rejects plan to offer Pfizer booster shots against COVID-19 to most Americans – WAGM

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WASHINGTON (AP) — Dealing the White House a stinging setback, a government advisory panel overwhelmingly rejected a plan Friday to give Pfizer COVID-19 booster shots across the board, and instead endorsed the extra vaccine dose only for those who are 65 or older or run a high risk of severe disease.

The twin votes represented a heavy blow to the Biden administration’s sweeping effort, announced a month ago, to shore up nearly all Americans’ protection amid the spread of the highly contagious delta variant.

The nonbinding recommendation — from an influential committee of outside experts who advise the Food and Drug Administration — is not the last word. The FDA will consider the group’s advice and make its own decision, probably within days. And the Centers for Disease Control and Prevention is set to weigh in next week.

In a surprising turn, the advisory panel rejected, 16-2, boosters for almost everyone. Members cited a lack of safety data on extra doses and also raised doubts about the value of mass boosters, rather than ones targeted to specific groups.

Then, in an 18-0 vote, it endorsed extra shots for people 65 and older and those at risk of serious disease. Panel members also agreed that health workers and others who run a high risk of being exposed to the virus on the job should get boosters, too.

That would help salvage part of the White House’s campaign but would still be a huge step back from the far-reaching proposal to offer third shots of both the Pfizer and Moderna vaccines to Americans eight months after they get their second dose.

The White House sought to frame the action as progress.

“Today was an important step forward in providing better protection to Americans from COVID-19,” said White House spokesman Kevin Munoz. “We stand ready to provide booster shots to eligible Americans once the process concludes at the end of next week.”

The CDC has said it is considering boosters for older people, nursing home residents and front-line health care workers, rather than all adults.

The FDA and CDC will most likely decide at some later point whether people who received the Moderna or Johnson & Johnson shots should get boosters.

During several hours of vigorous debate Friday, members of the panel questioned the value of offering boosters to almost everybody 16 and over.

“I don’t think a booster dose is going to significantly contribute to controlling the pandemic,” said Dr. Cody Meissner of Tufts University. “And I think it’s important that the main message we transmit is that we’ve got to get everyone two doses.”

Dr. Amanda Cohn of the CDC said, “At this moment it is clear that the unvaccinated are driving transmission in the United States.”

In a statement, Kathrin U. Jansen, Pfizer head of vaccine research and development, said the company continues to believe that boosters will be a “critical tool in the ongoing effort to control the spread of this virus.”

Scientists inside and outside the government have been divided recently over the need for boosters and who should get them, and the World Health Organization has strongly objected to rich nations giving a third round of shots when poor countries don’t have enough vaccine for their first.

While research suggests immunity levels in those who have been vaccinated wane over time and boosters can reverse that, the Pfizer vaccine is still highly protective against severe illness and death, even amid the delta variant.

The unexpected turn of events could reinforce criticism that the Biden administration got out ahead of the science in its push for boosters. President Joe Biden promised early on that his administration would “follow the science,” in the wake of disclosures of political meddling in the Trump administration’s coronavirus response.

The FDA panel’s overwhelming initial rejection came despite full-throated arguments about the need for boosters from both Pfizer and health officials from Israel, which began offering boosters to its citizens in July.

Sharon Alroy-Preis of Israel’s Ministry of Health said the booster dose improves protection tenfold against infection in people 60 and older.

“It’s like a fresh vaccine,” bringing protection back to original levels and helping Israel “dampen severe cases in the fourth wave,” she said.

Representatives for Pfizer argued that it is important to start shoring up immunity before protection begins to erode. A company study of 44,000 people showed effectiveness against symptomatic COVID-19 was 96% two months after the second dose, but had dropped to 84% by around six months.

Both Pfizer and the Israeli representatives faced pushback from panelists. Several were skeptical about the relevance of Israel’s experience to the U.S. Another concern was whether third doses would exacerbate serious side effects, including rare instances of heart inflammation in younger men.

Pfizer pointed to Israeli data from nearly 3 million boosters to suggest side effect rates would be similar to those already reported.

Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, said he was supportive of a third dose for adults over 60 or 65, but “I really have trouble” supporting it for anyone down to age 16.

While an extra shot would probably at least temporarily reduce cases with mild or no symptoms, “the question becomes what will be the impact of that on the arc of the pandemic, which may not be all that much,” Offit said.

Biden’s top health advisers, including the heads of the FDA and CDC, first announced plans for widespread booster shots in mid-August, setting the week of Sept. 20 as an all-but-certain start date. But that was before FDA staff scientists had completed their own assessments of the data.

Earlier this week, two top FDA vaccine reviewers joined a group of international scientists in publishing an editorial rejecting the need for boosters in healthy people. The scientists said studies show the shots are working well.

On Friday, U.S. Surgeon General Dr. Vivek Murthy said the Biden administration announcement was not aimed at pressuring regulators to act but was instead an attempt to be transparent with the public and be prepared in the event that boosters won approval.

“We have always said that this initial plan would be contingent on the FDA and the CDC’s independent evaluation,” Murthy said.

The Biden plan has also raised major ethical concerns about impoverished parts of the world still clamoring for vaccine. But the administration argued that the plan was not an us-or-them choice, noting that the U.S. is supplying large quantities of vaccine to the rest of the globe.

The U.S. has already approved Pfizer and Moderna boosters for certain people with weakened immune systems, such as cancer patients and transplant recipients.

Some Americans, healthy or not, have managed to get boosters, in some cases simply by showing up and asking for a shot. And some health systems already are offering extra doses to high-risk people.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Copyright 2021 The Associated Press. All rights reserved.

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'You'll see': Quebec health minister promises bold proposals to solve critical nurse shortage – CTV News Montreal

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QUEBEC CITY —
Quebec Health Minister Christian Dube is promising a plan with bold and original ideas to try to attract thousands of nurses back to the public health network and prevent a breakdown of services.

On Friday, during a scrum with journalists in Lévis, Minister Dube reaffirmed his commitment to doing everything possible to offer nurses a more attractive work environment, different from what they’ve known until now, to convince them to return to the public system.

For years, nurses have complained about the widespread practice of demanding mandatory overtime, which regularly forces them to work exhausting double shifts.

The magnitude of the current crisis, with a shortage of over 4,000 nurses keeping the network from functioning normally, is now pushing the Legault government to pay closer attention to their grievances.

Minister Dube promised to announce new incentives next week, both financial and professional, that he believes will bring back nurses who have opted for early retirement in recent years or who have chosen to practice in the private sector.

He intends to be bold in the way he goes about it, he said.

“You’ll see,” said the minister.

“We’re going to make announcements that might have surprised us a few months or a few years ago, but which will be prompted by the fact that we’ve looked at new ways of doing things with the pandemic.”

While he waits for nurses’ reaction to these soon-to-be-announced short-term incentives, Dube is also planning to implement a more long-term, global reorganization, he said, with “much more structural proposals on the table.”

The day before, the minister had pledged to prevent any service disruptions in the health network, despite the significant shortage of personnel.

He’s also contending with the likelihood the problem will worsen as of October 15, the date by which all health-care staff in Quebec will have to be double vaccinated against COVID-19 to stay on the job.

Those who don’t comply will be suspended without pay for an indefinite period. It’s a scenario that suggests the situation will become even more difficult to manage, as there are an estimated 20,000 unvaccinated employees in the network, at least half of whom provide direct patient care.

This report by The Canadian Press was first published in French on Sept. 17, 2021.

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COVID-19 booster debate in US heads to FDA vaccine advisory committee – National | Globalnews.ca – Global News

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The debate over whether Americans should receive a booster dose of the Pfizer/BioNTech COVID-19 vaccine moves to a panel of independent expert advisers to the U.S. Food and Drug Administration on Friday.

While U.S. health officials, some other countries and vaccine makers have said boosters are needed, many scientists and vaccine experts disagree.

The FDA staff said in documents prepared for the committee this week that the vaccine Pfizer Inc developed with Germany’s BioNTech SE is still very effective at preventing severe illness and death and that the evidence is mixed on whether its efficacy declines over time.


Click to play video: 'COVID-19: Boris Johnson reverses course on vaccine passports for England, announces UK booster program'



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COVID-19: Boris Johnson reverses course on vaccine passports for England, announces UK booster program


COVID-19: Boris Johnson reverses course on vaccine passports for England, announces UK booster program

Pfizer, which is arguing for broad use of a third shot, submitted data from an analysis of over 300 participants in its late stage clinical trial showing that the vaccine’s efficacy diminished by around 6% every two months after the second dose, and that an additional shot boosted immunity.

The FDA’s Vaccines and Related Biological Products Advisory Committee will also consider data from Israel, which has been administering booster doses of the Pfizer/BioNTech vaccine.

It began offering a COVID-19 booster to people as young as age 12 last month, expanding a campaign that began in July for people over 60.

An analysis by Israeli scientists published on Wednesday in the New England Journal of Medicine found that among 1.1 million people age 60 or older who had been fully vaccinated at least 5 months earlier, those who received a booster were less likely to be infected or become severely ill than those who did not get the third shot.

Read more:
Unclear whether U.K.’s booster plan will mean new doses every 6 months, chief says

The Israeli Health Ministry said in documents on Friday that immunity against infection declined during July among all age groups, but particularly among people aged 60 and over who had been vaccinated in January.

Immunity against severe disease dropped in that older group, and such a decline may occur in younger groups aged 50 to 59 as well as 40 to 49, it said. The ministry also said the booster dose did not raise new safety issues.

The booster debate gained urgency as U.S. COVID-19 hospitalizations and deaths surged due to the highly transmissible Delta variant of the virus, mostly among the unvaccinated. But infections among fully vaccinated people have risen and they can spread the virus on occasion, mostly to unvaccinated people.


‘LARGER POPULATIONS MAY TAKE LONGER’

Wall Street analysts see the additional shots ultimately getting approved for a broad population.

“We expect a potential positive FDA support for boosters for elderly ahead of Biden’s rollout, but larger populations may take longer for broad support and approval,” Jefferies analyst Michael Yee said in an email.

Scientists say the strongest evidence for boosters is for older adults and other high risk populations.

“My guess is we are going to end up with a recommendation for booster doses for a certain subpopulation, such as adults older than 65,” said Bill Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health.


Click to play video: 'Immunocompromised offered vaccine booster shot. Who is eligible?'



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Immunocompromised offered vaccine booster shot. Who is eligible?


Immunocompromised offered vaccine booster shot. Who is eligible?

More than 1.9 million Americans have already gotten a booster dose after the government authorized them for people with compromised immune systems, according to the U.S. Centers for Disease Control and Prevention (CDC).

The panel will vote on if safety and effectiveness data support approval of a booster at least 6 months after the second dose for people aged 16 and older. The vote is scheduled for between 2:25 pm ET and 4:45 pm ET.

Eight top health officials in the Biden Administration – including the heads of the FDA and the CDC – said in August they believe booster shots will be needed because emerging data shows that protection against COVID-19 decreases over time.

Read more:
Moderna to take on COVID-19, flu with single booster vaccine

The U.S. is planning a booster campaign for the week of Sept. 20, contingent on backing by the FDA and CDC.

Moderna Inc has also asked for approval of a booster and released data on Wednesday showing that protection from its vaccine also wanes over time. That is not expected to be discussed at Friday’s meeting.

(Reporting by Manojna Maddipatla and Ankur Banerjee in Bengaluru; Editing by Caroline Humer and Bill Berkrot)

© 2021 Reuters

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