Advisers to the Centers for Disease Control and Prevention on Thursday unanimously recommended booster doses of the Moderna and Johnson & Johnson coronavirus vaccines for tens of millions of Americans, despite evidence that the vaccines remain highly protective against serious illness and death in most people under 65.
The committee advised that people who have been immunized with the Johnson & Johnson vaccine should receive a booster dose of a coronavirus vaccine two months or longer after the first dose.
The recommendations now go to Dr. Rochelle Walensky, director of the C.D.C., for her approval, after which they become the agency’s official clinical advice to public health officials and health care providers nationwide.
Among Americans initially immunized with the Moderna or Pfizer-BioNTech vaccines, adults over 65, adults aged 50 years to 65 years with certain medical conditions, and those who reside in long-term care settings should receive a single booster dose six months or longer after the second dose, the committee said.
For adults aged 18 to 49 years with certain medical conditions, and adults whose jobs regularly expose them to the virus, the committee members opted for softer language, saying they may choose to get a booster after considering their individual risks.
The panel also endorsed the so-called mix-and-match strategy — whether people fully immunized with one company’s vaccine should be allowed to switch to a different one for their booster. Limited evidence strongly suggests that booster doses of one of the two mRNA vaccines — Moderna or Pfizer-BioNTech — more effectively raise antibody levels than a booster dose of the Johnson & Johnson vaccine, the committee noted.
The experts emphasized that people who have received two mRNA vaccine doses or a single Johnson & Johnson vaccine should still consider themselves fully vaccinated. Federal health officials said they would continue to study whether those who have weak immune systems and have already received a third dose of a vaccine should go on to get a fourth dose.
Some advisers were concerned that young and healthy Americans who don’t need a booster might choose to get one anyway. “Those that are not at high risk should really be thoughtful about getting that dose,” said Dr. Helen Talbot, an infectious disease expert at Vanderbilt University.
The final votes aligned with the Food and Drug Administration’s authorizations on the vaccines, but contrasted sharply with discussions earlier in the day. The panel heard that in adults under 65, even those with chronic conditions, the Moderna vaccine remained highly protective against severe illness and showed only a small decline in effectiveness over time, if any at all.
The Johnson & Johnson vaccine showed less efficacy than the Moderna vaccine overall, but the data were too limited to determine whether there might be a decline over time.
The purpose of the vaccines is to prevent illness severe enough to require medical attention and not to prevent infection, said Dr. Wilbur Chen, an infectious disease physician at the University of Maryland. “It might be too much to ask for a vaccine, either a primary series or the booster, to prevent all forms of infections,” he said.
In the first major presentation in the meeting, representatives from Moderna presented evidence in support of a booster of 50 micrograms, half the dose given in the initial rounds.
But the data were of “very low certainty,” said Dr. Kathleen Dooling, a C.D.C. scientist. Moderna researchers also did not assess the clinical outcomes, she said.
What to Know About Covid-19 Booster Shots
The F.D.A. has authorized booster shots for millions of recipients of the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines. Pfizer and Moderna recipients who are eligible for a booster include people 65 and older, and younger adults at high risk of severe Covid-19 because of medical conditions or where they work. Eligible Pfizer and Moderna recipients can get a booster at least six months after their second dose. All Johnson & Johnson recipients will be eligible for a second shot at least two months after the first.
Yes. The F.D.A. has updated its authorizations to allow medical providers to boost people with a different vaccine than the one they initially received, a strategy known as “mix and match.” Whether you received Moderna, Johnson & Johnson or Pfizer-BioNTech, you may receive a booster of any other vaccine. Regulators have not recommended any one vaccine over another as a booster. They have also remained silent on whether it is preferable to stick with the same vaccine when possible.
The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.
The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.
Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.
If cleared, the smaller dose may need to be delivered from the same vials now used for initial immunization. Some panelists noted that this may increase the risk of contamination and incorrect dosing, and complicate data gathering. (Moderna has been testing vials that deliver smaller volumes to alleviate this problem, according to a former government official.)
The panel also heard data in support of a second Johnson & Johnson dose. Scientists from the company said they had estimated the rate of blood clots following vaccination — a particular concern in young women — at 15.1 cases per million following the first dose and 1.9 cases per million after the second.
Data for the Johnson & Johnson vaccine were of very low quality, Dr. Dooling also noted.
C.D.C. scientists said at the meeting that the vaccines are generally safe, with the exception of uncommon and mostly mild heart problems in young men. The risk of the condition — called myocarditis, an inflammation of the muscle — is highest after the second shot of an mRNA vaccine, and highest in males 18 to 24 years old.
In males under 20, the condition may affect more than 100 males in every million vaccinated. Studies have shown that the risk of heart problems after a bout of Covid-19 is much higher.
Some panelists said they worried about the risk of blood clots in young women who get a second dose of the Johnson & Johnson vaccine, and the risk of myocarditis in young men after a third dose of an mRNA vaccine. Perhaps young women should be directed to mRNA vaccines and young men to the Johnson & Johnson vaccine, Dr. Talbot said.
“We’re in a different place in the pandemic than we were earlier,” she said. The opportunities to mix and match vaccines “are priceless.”
On Wednesday, the F.D.A. authorized boosters for millions of people who received the Moderna and Johnson & Johnson vaccines, just as it did for recipients of Pfizer-BioNTech shots last month. The F.D.A. also gave the go-ahead for people eligible for boosters to get an extra dose of a different brand from the one they first received.
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