Welcome to the August newsletter. This newsletter aims to provide information and analysis of timely topics from recent articles published in the medical literature. I hope you find this information useful and helpful in your health journey. If you have comments or questions, please let us know!
Booster shots are all over the news currently and I have been getting a lot of questions about them. Are they available, who should get them, and when should people get them? I'll try to summarize what I know from reading the medical literature. The discussion began after a study out of Israel showed that some of the first people vaccinated were catching Covid (Delta variant), while those vaccinated later were not getting as infected as often. This led to concerns about waning immunity and loss of vaccine effectiveness. Leaked earnings reports phone calls from Pfizer and Moderna calling for boosters accelerated the discussion and soon after the current administration began to recommend booster shots 8 months after the initial vaccination, which has now been changed to 6 months (no data to support this). However, the data out of Israel is up for debate among scientists and there are definitely problems with the data which may make universal booster recommendations premature. The resumption of activities (especially international travel) by fully vaccinated individuals coupled with the arrival of a more easily transmissible Delta variant likely led to the findings, rather than waning immunity. We are seeing no change in the ratio of positive COVID tests among older adults and unvaccinated children. If immunity was waning one would expect to see more rise in older people (the first to get immunized) than children. Immunity may wane a bit over time, but all signs point to long-term immunity (memory B and T cells) so even if antibody levels wane, immunity is intact. A recent study out of Penn State showed B-cell responses (long-term immunity) continued to increase for at least 6 months after mRNA vaccination even as the circulating antibody levels waned. Memory B-cells were capable of rapidly generating new antibody responses providing protective responses after exposure and appeared to have an advantage at binding new variants. This rapid recall response is what limits initial viral replication and dissemination in the host, preventing severe disease. This means that regardless of antibody levels, your immune system will kick in and make more with exposure to the virus. This leads to some suggesting that small exposures over time may actually be beneficial to our immune systems as we will be "seeing" the virus multiple times, allowing our bodies to make new antibodies. Research looking at immunity following natural infection found that boosting pre-existing immunity with mRNA vaccination mainly resulted in a transient benefit to antibody titers but little to no long-term impact on cellular immune memory which likely means that similar findings would be seen from boosting people. Bottom line, it isn't all about the antibodies!
Booster shots do make sense for vulnerable people (immunocompromised and elderly with medical conditions) who may not build the responses outlined above and gives them another shot at building adequate long-term immunity. They already have a harder time fighting infections than the rest of us. Immunocompromised people comprise 3% of the vaccinated people who get infected but are accounting for over 40% of the hospitalizations in vaccinated people - remember 97-99% of hospitalizations are unvaccinated people, with most of the rest involving frail elderly. For the rest of the population, the vaccines continue to provide excellent protection against severe illness and hospitalization. Around the country 97-99% of the hospitalized are unvaccinated so without a doubt, the best protection from infection is vaccination. Of the vaccinated with a positive test, 96% are asymptomatic or mild, 3% are moderate symptoms, less than 0.05% are severe, and 0.05% result in death (J&J data). Therefore, in my mind, booster shots for the general population don't make sense at this time. Perhaps we should put more effort into vaccinating the world rather than giving 3rd vaccines to healthy teens and young adults. Science needs to drive any need for boosters, not earnings reports from vaccine manufacturers. If a person is immunocompromised or over 65 with chronic illnesses, I would recommend a booster when available. I have not received any information from the state to this point on how boosters will be distributed but the general recommendation is to get another dose of your initial vaccine. I am hearing that Walgreens will give boosters of the Pfizer vaccine (not sure on Moderna). This is a complicated topic but I will stay on top of things as more information comes out.
I am happy to announce that I have secured access to one of the newest diagnostic tests available. The Galleri test is a blood test that can detect over 50 types of cancer before they are apparent through regular screening testing (and many cancers don't have a screening test). The test detects methylation patterns of cell-free DNA which can indicate cancer and thus has the potential to detect cancer at the earliest stages. If you are interested in learning more about this test please let us know.