You can mix and match your COVID-19 booster, but should you? – Community News
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You can mix and match your COVID-19 booster, but should you?

When Alex Ossola first received her Johnson & Johnson COVID-19 vaccine earlier this year, she queued for three hours at her local pharmacy. It was “misery,” she told TODAY. But at the same time, she was relieved that the convenient one-dose injection was over and done.

The following week, however, the Food and Drug Administration and the Centers for Disease Control and Prevention took the shot off the market because of an emerging link between the vaccine and rare blood clots. And in the months that followed, breakthrough infections became more common as the data began to show more clearly that the J&J vaccine is less effective in preventing COVID-19 infections and hospitalizations than the mRNA injections from Pfizer-BioNTech and Moderna.

More and more it started to feel like “everyone gets Gucci and Prada and we’re shopping here at TJ Maxx and trying to get some of that,” Ossola said. So when the time came for her booster dose in late October, Ossola knew she wanted one of the mRNA vaccines instead of another dose of J&J. She ended up at Moderna.

“As things kept coming out about the Johnson & Johnson vaccine after I got it, I was more and more disappointed that I got it,” Amanda Keller, who also originally received J&J, told TODAY. Just like Ossola, she opted for a Moderna booster a few weeks ago.

Now that both the FDA and CDC have approved booster doses for just about everyone over the age of 18, this kind of mix-and-match strategy is something that a much larger segment of the public is likely to consider. But it’s not something everyone should be concerned about, experts told TODAY.

Pretty much all adults should think about getting a booster – of any kind

As of Oct. 21, booster shots were available to people age 65 and older, as well as to people age 18 and older who have certain underlying health conditions, work or live in a high-risk environment, or live in long-term care facilities. And last week, FDA and CDC advisory panels expanded eligibility to allow anyone 18 and older to receive a booster dose. People who initially received a Pfizer or Moderna vaccine may receive a booster six months after their first dose, and those who received the J&J shot may receive their booster two months later.

“This is what it takes to get full immunity. And if you think about it that way, then everyone should get it,” Dr. Thaddeus Stappenbeck, chair of the division of inflammation and immunity at the Cleveland Clinic Lerner Research Institute, TODAY.

Recent research from clinical trials and data from Israel suggest that protection against the vaccines diminishes over time. But the data also suggests that a single booster dose could revive that protection. It is not yet entirely clear whether boosters can help prevent the transmission of COVID-19.

But at a time when coronavirus cases and hospitalizations are on the rise again (even among fully vaccinated people), COVID-19 boosters are a welcome idea for many. “If you’re considering a booster, just buy it,” Dr. Gabor Kelen, professor and chair of the department of emergency medicine at Johns Hopkins University, TODAY. “And if you’re not considering a booster, just buy it.”

Are there any potential benefits to mixing and matching?

For most people, it probably makes the most sense to just stick with the same manufacturer you originally had. That’s because the best data we have on boosters comes from the drug manufacturers’ clinical trials in which all participants received boosters from the same company as their original doses. “I would just follow the studies,” Stappenbeck said. “If you had the Moderna vaccine, I’d get the third shot of Moderna. And if you had the Johnson & Johnson, I’d get a second shot of Johnson & Johnson because of these vetted studies that’ve been done.”

But there is some limited data from smaller studies that suggests that some people might get more protection by mixing and matching their booster. One of the most compelling studies on the mix-and-match strategy — also called heterologous vaccination — comes from the National Institutes of Health. In this study, approximately 450 people who had originally received Pfizer, Moderna, and J&J injections were then given one of three booster injections. Some people received a booster from the same manufacturer as their initial dose (homologous vaccination), while others received mixed boosters.

The results showed that everyone who got a booster saw an increase in antibody levels, but for those who originally got the J&J shot, there was an additional twist: If they got a Moderna or Pfizer booster, they developed an even bigger increase. of the protective antibodies than with the J&J booster.

“So for that group of people, switching may actually have a benefit,” Dr. Bernard Camins, medical director for infection prevention at the Mount Sinai Health System, TODAY. (And recent CDC data suggests that more than three-quarters of J&J recipients do just that.) But, he continued, the dose of Moderna given as a booster in that study was not the same dose as the Moderna booster given. . which is given to the public, which is only half a dose. And that may have contributed to the positive Moderna effects in that study.

Studies like this one also have another problem. “Instead of thousands or tens of thousands of subjects (in the clinical trials), these are hundreds of subjects, so they’re really incapable of drawing adequate conclusions,” Stappenbeck explains. “I think they’re interesting, but they’re not convincing.”

For some people, the possible side effects of the injections may also play a role in their decision about a booster. For example, blood clots appear to be a very rare but serious potential risk from the J&J injection. And those most likely to be affected are women of childbearing age. So if you’re in that group, consider switching to Pfizer or Moderna, Camins said.

You may not be able to choose which vaccine to get

Depending on the availability at your local vaccination site, you may not necessarily be able to choose which vaccine to get as a booster. In some cases, the site may require you to use the same type of injection as for your first doses. In other cases, you may inadvertently mix and match.

For Lindsay Mann, who received two doses of Pfizer in the spring, the only option for a booster at her pharmacy was the Moderna injection. “I would have loved to stay in the same vaccine family,” she told TODAY, “but I also just wanted to get it.” Mann went ahead and received the Moderna booster along with a flu shot and overall felt the experience was “pretty seamless.”

A CVS spokesperson told TODAY that the company allows people in its pharmacies to mix and match their booster dose, but each CVS location usually only has one type of shot available. So if you’re looking for a specific brand, you may need to click through some locations to make your appointment. If you want to make an online appointment for a booster injection at a Walgreen pharmacy, you can only match your booster to your previous doses for now, the company told TODAY. But mix and match is allowed for walk-ins.

Either way, know that there are no additional risks associated with mixing and matching, Kelen said. Of course, there are the usual risks of temporary side effects (for example, injection site pain, fatigue, and other flu-like symptoms) and the risks of much rarer and possibly more serious side effects (such as heart inflammation with the mRNA vaccines and blood clots after the J&J injection). But again, those aren’t added risks of mixing and matching, it’s just the inherent risks of the vaccine itself.

With the number of cases rising again, boosters are a crucial tool in this phase of the pandemic

Ultimately, the most important thing is to be protected as best you can — not just for yourself, but for those around you and in your community. “The vaccinations are a public health measure,” Stappenbeck said. “They protect society, that’s the key. So that’s why everyone should get it.” And Kelen agreed: “It’s not just about you,” he said. It is to protect “all kinds of people”, including your loved ones and total strangers.

As we head into Thanksgiving and the winter holidays, it’s important to get a booster, Camins said. It’s also important to follow CDC guidelines about gatherings and try to keep events small, he said. But the real key isn’t getting boosters for the vaccinated, it’s vaccinating those who haven’t had their injections yet — about 30% of the US population. “When people are interested in boosters, it’s almost like we’re preaching in front of the choir,” he said. “Really, the message should be that the unvaccinated should get their first and second doses.”

But for those who qualify, boosters offer more protection and a taste of that normality that so many of us crave, especially at this time of year. “Life is trying to get going again,” Ossola said. “People have weddings and we’re going into the winter months here. Who knows how it will turn out?’