Tuesday, September 28, 2021

To Boost or not to Boost

  Dr. Stacey Klutts penned the following recommendation on booster shots on his public Facebook page (September 10).  Dr. Klutts is the Chief of Pathology and Laboratory Service for the Central Iowa VA Healthcare System.  He is also a Clinical Associate Professor of Pathology and Clinical Microbiology at the University of Iowa. 

Booster shots.  I might be stepping into a pit of snakes here, as this topic is a bit controversial.  However, there's a lot of interest, so here's where we are from my perspective... 

1.  Bottom-line up front:  Yes, at some point you will need a booster shot.  That really isn't the question, though.  The real questions are about the timing.  For certain groups (e.g. immunocompromised), it is clear that they need them now.  For others, we don't really know for sure.  To frame this topic best, let's back up a couple of steps and discuss some basics.

2.  You got a vaccine in this calendar year and then another shot of the vaccine a month or so later.  So, why would you need yet another one?  There are two basic reasons as to why we need vaccine boosters:  A- The pathogen changes and/or B- Your immunity wanes over time (this happens but our immune systems have remarkably good memory, so it's a relative 'waning'--we'll discuss this).  Let's take those two things one at a time. (KF: He is not talking about immunity gained throughh infection)

3.  The pathogen changes.  Anyone following me knows that I've already done a deep dive into the topic of viral variation (Earlier Facebook post ).  If a pathogen is changing fast enough, you will likely need an updated mix of antigens in a booster shot to 'update' your immune training toward that pathogen.  For some pathogens, it might be not change fast enough for this to ever be a reason for boosting after you get the initial series of shots.  For other pathogens, it might change so quickly as to require an annual booster shot (e.g. influenza).  As noted in my previous post, the variation in SARS-CoV-2 is quite a bit slower than influenza.  However, the overall variation right now is rather high because there is so much replication/transmission.  While we do not yet have a CoV-2 variant that evades vaccine immunity, we must keep overall variation in mind in the context of boosters (more on this below).  

4.  Your immunity wanes.  As noted above, this is relative and it depends very much on the health of your immune system.  The real question is this:  Has my vaccine inspired immunity waned to the point to where I am now susceptible to significant disease from the virus?  Delta variant changed this question a bit, as it comes as you in such large waves.  Think of your initial immunity to the virus like a wall trying to hold back zombies and your adaptive immunity being a resting army on the other side of that wall available to help if any of them come over that wall.  That initial wall works great for a few of the zombies, but if enough come at you (as with Delta), they can get over it.  When that happens, your adaptive immunity army is called to action and take them out.  However, that might not be before some of those zombies have caused some minor damage.  Also important to note, the initial immunity wanes faster over time than the adaptive immunity.  So, in this era of Delta zombies, when do we need to bolster our initial and adaptive immune responses with a booster shot?  Good question.  It depends on what you're trying to prevent.

5.  A booster would definitely be useful after the adaptive immune response to the pathogen had waned significantly.  At that point, there isn't that good defense to protect you against significant disease.  Are most of us to that point?  No, and we have objective evidence.  Specifically, fully vaccinated persons are not being hospitalized and dying due to this Delta variant wave in anywhere near the numbers we're seeing among unvaccinated persons.  The adaptive immune responses from the vaccine are still very effective in the vast majority of people.  However, there are some groups of people whose adaptive responses are waning to the point of failure.  This includes the immunocompromised (e.g. transplant patients or others on immunosuppressive drugs) and certain groups of the elderly.  These groups probably didn't have great immune responses to the vaccine in the first place, and they are the ones we are seeing that are more likely to get significantly ill with Delta.  If you are among these groups, booster shots are already approved and being given.  For the rest of us?  Well, we are responding just fine with respect to adaptive immunity to the only CoV-2 variant we're seeing cause infections in the US at this time.  

6.  If you already have a sufficient adaptive response, would a booster help build a taller, initial immune wall?  The idea here is this:  If it could build a better initial wall, it would not only reduce the risk of even mild disease but also reduce the likelihood that someone becomes infectious (or significantly reduces the time they are infectious).  This is important mostly to reduce transmission, though prevention of any illness (even mild disease) is a nice bonus.  This all sounds great, but data here as to whether this would actually work are preliminary and murky.  This is where camps divide and why you hear conflicting messages.  Do we act on the presumption that this would be useful (camp #1) or do we wait on data to demonstrate it is useful (camp #2)?  

7.  Why not just go with camp #1 and get third doses rolling?  Well, you could be 'wasting' vaccine if it really doesn't do what we are hoping it will do.  Indeed, because we're still protected against severe disease, even if it does work in the way we are presuming, we may still be much better off getting those vaccines into arms as first doses in other parts of the world.  Remember, Delta and Alpha (UK variant) didn't arise from the U.S., but they have sure caused us some problems.  We have to reduce transmission in other countries or we're going to be dealing with too many variants for too long. This is WHO's global point...stop giving boosters and distribute those vaccines more evenly across the inhabited globe.  Also, if we give a bunch of boosters now, we might be unable to safely provide new, specific boosters later this year against any new variants that might arise (that might not be so well covered by the current vaccines).  Finally, we really don't have data to strongly indicate that the best time to provide a 3rd dose for immune competent persons is right now (the point made by camp #2).  So...it's murky and this is why you don't see consistent messaging on boosters.

8.   Sidebar:  What if you are fully vaccinated but then had an infection, even a minor one, with the Delta variant?  Does that infection count as a 'booster'?  Most of us think that it's safe to presume, yes, it does.  Nothing really more to say about that at this point other than I don't think anyone is recommending a booster for those who have had a relatively recent infection after being fully vaccinated earlier this year.   

9.  So, where are we?  At the time of this post, the booster shots are only FDA approved for immunocompromised patients.  If you are immunocompromised, act now if you have not already. There really is no good way to determine if you still have sufficient immunity using lab tests (long story as to why), so just go get the shot.  For the rest of us, there really isn't anything to do until approval is granted.  When it is granted, just watch out for CDC guidance on this. They've played the middle on the topic and are a great source of guidance for this kind of issue.  Regardless, likely more to come... 

Stay safe, stay well, everyone!

45 comments:

Anonymous said...

Fully vaccinated
Covid positive / Delta 5 months after last shot
Pneumonia
Monoclonal antibodies
Ivermectin

Got Booster shot - why the hell not. It’s not wasting a vaccine in this state.

Anonymous said...

Even with the growing facts coming out of The Holy Land about how the vaccines were created for Covid itself and not the variants, they keep posting these really slanted articles. My natural immunity is BETTER than the jab and I suspected as much from day one. For those who are among the most vulnerable by all means get your shot as it was for you to begin with. But quit telling healthy adults and kids to get one !! This is beyond tiresome and the science isn't lying !

Anonymous said...

Nicely said 1:25

Anonymous said...

3:07 : Thanks.

Anonymous said...

@1:25 -- you do realize that vaccines are designed to enhance your immunity, right?

Anonymous said...

Even with the growing facts coming out of The Holy Land about how the vaccines were created for Covid itself and not the variants, they keep posting these really slanted articles. My natural immunity is BETTER than the jab and I suspected as much from day one.



Seriously asking if anyone but a moran should take any anonymously offered medical commentary here at JJ for anything more significant than the scribbling you used to see on the walls of the bathroom stalls?

The graveyards are filling up with the gullible vaccine doubting horse paste eaters. Thanks in no small part to people like

Kingfish said...

The problem w natural immunity is now how well it works but swamping the hospitals and morgues to let it just run its course.

Anonymous said...

1:25, "My natural immunity is BETTER than the jab..."
Natural immunity is better, but not long-lasting - MAX 7-8 months, so you will eventually need to be "jabbed". Even within that 7-8 mo period after you've had Covid, if you also get vaccinated, you have a higher level of protection against variant forms.

Anonymous said...

Pimping for natural immunity instead of vaccination is like pimping for those you influence to win Darwin Awards.

Anonymous said...

I'm not getting a booster shot under any circumstances.

I got the two-part shot and I'm done.

Whatever happens, happens and I'm not wearing a f--g mask either. If the damn government is so worried about viruses, seal the southern border and then we'll talk.

Anonymous said...

3:37 : And do you realize the human body does actually create its own immunity for MOST things it comes in contact with and has since we were created. It's why we are still here.
3:37 : I did mention that the vaccine was geared towards the vulnerable and they should get it.
3:45 : There is no problem with natural immunity other than it doesn't line the pockets of "they" and you know damn well who is filling up the ER's and morgues KF. The vulnerable ! You need to study up on these vaccines I think. Sh!t is coming out all over the world about how well they truly work.

Anonymous said...

@4:10- Did you ever wonder why most polio survivors you see are older?

Also MMR vaccines are they the thing or are having Measles, mumps and Rubella running wild what you want to go back to?

Never mind.

Cain't fix stoopid!

Anonymous said...

3:47 : Are you even paying attention to what's going on with the vaccine "protection" times ? Big Tony is already chirping about having to be jabbed twice a damn year ! G-damn man......are you even curious as to why that is ? As I said and millions of us believe, if you are vulnerable get the shot. I don't get the flu shot either ! Why ? In 1991 I had one and it made me dog sick for 2 weeks.I paid 30 bucks to get sick. Fool me once.....

Anonymous said...

So when will they quit calling them break thru cases of the fully vaxxed ? Just found out that a fully vaxxed Dad of one of my cousins just passed from Covid complications . He was a diabetic and a shut in who contracted it from his fully vaxxed wife ! You people calling folks names and getting all pissy over the unvaxxed need take a step back. The vaccines were built for the original Covid and that is documented. They are clearly flawed and not seeing it is , IMO, is as dangerous as you think the unvaxxed are. While we are distracted ...........

Anonymous said...

KF... come on man.. the only reason why hospitals were "swamped" was due to provider shortages not the virus..

Anonymous said...

On the MSDH page ( https://msdh.ms.gov/msdhsite/_static/14,23549,420,971.html ) about halfway down, the state has weekly charts showing cases of fully jabbed and non jabbed. For the past month, it appears that the fully jabbed out infect the unjabbed. Scroll down one more chart and you see the same trend for the weekly death count.

Seems someone forget what the narratives are.

Anonymous said...

This non scientist moron ponders if the vaccines are creating viral loads that created the variants. Of course this being MAN MADE the scientist are scrambling. Ever tried to get a bird nest from your fishing reel you didn't create ? The virus is real but so is the massive money grab they got going on. Funny how it's cool to use the new treatments but a year ago when Trump mentioned it he was beat down for it. Now it's all good. Imagine how many folks have died in a year just because of the media storm. Evil is among us.

Anonymous said...

2 weeks to flatten the curve

Anonymous said...

At my last checkup, my allergist mentioned the NovaVax vaccine would be coming out around 3Q of this year. He said this product was much like the flu vaccine, in that it was not a mRNA type. At the time, I think he mentioned a flu/covid shot. Any scuttlebutt on this option?

Anonymous said...

@5:29 - Nova in Spanish means “ no go”.

They should have taken their cues from Chevy.

Anonymous said...

The purge continues. Good!

Anonymous said...

4:40 - that is not at all what any of the charts come remotely close to suggesting.

Anonymous said...

While I did get the two pfizer sticks, and I never cared
"who did or who didn't".

(Same with the goofy mask debate).

This new "booster shot" nonsense makes me question everything.

Covid is real, but so is Government Bull Shit.



Anonymous said...

But wait, theres more;

"Truth Being Ignored –9.28.21 Victoria Australia Records 867 New COVID Cases, 375 in Hospital and 95% of Those Hospitalized are Vaccinated

Victoria, Australia, Health Minister Martin Foley

Health Minister Foley announced 867 new COVID cases recorded yesterday. During the statistical outline Foley identifies 375 people as hospitalized, 81 people in intensive care and 61 people on a ventilator. Then comes the statistic everyone in government and media ignore. Amid the recorded cases “78% of the hospital cases are fully vaccinated, and 17% are partially vaccinated (1 dose)”….

That means 95% of the COVID patients in Victoria hospitals are vaccinated.

356 people out of 375 patients are vaccinated, yet 81 people are still in intensive care with 61 on a ventilator."

Anonymous said...

But wait, there's more....

https://www.zerohedge.com/covid-19/damn-you-hell-you-will-not-destroy-america-here-spartacus-covid-letter-thats-gone-viral

Anonymous said...

4:40 should have stuck with just one six pack. His carburetor is flooded, and he's high on fumes. NONE of those charts say any such thing. YOU LIE!

KF posts a well written article, and Cletus breaks out in a sweat at science and discussion by someone knowledgeable. Good grief. What is in the water around here? Oh, boo boo. I know.

Anonymous said...

I’m getting the booster as soon and I can I may get two. You can’t be too careful with all of the unhealthy potential carriers in this state. Fattest and least educated and most unvaccinated, and one of the most infected states. Coincidences? Ha.

Anonymous said...

KF, you do identify probably the main problem with natural immunity.

But the second one is the absolute denial of those that do come down with COVID, and whether they live through it or not, then deny that they actually had it.

Yes, herd immunity does have some merit, should you live through it - and don't go to the hospital or doctor for treatment. Otherwise, you are part of the problem, not the solution. And lying about it afterward is just a great way of continuing to show one's ignorance.

Anonymous said...

4:10 - NO, the ones that are filling up the hospitals, the ICU, and the morgues are those that are not vaccinated.

Yes, last year before there was a vaccine, it was the vulnerable. But last year is just that. Old news.

The ones that are filling up the hospitals, and costing everyone, are those that are too much of an idiot than to take advantage of a solution. Because they are too f***King hard-headed.

Anonymous said...

4:40 - Let me call you out. What you just posted is absolute bullshit. Maybe your medical education didn't include basic reading. Or maybe you misread "INFECTION" as "INJECTION"

But the MSDH website has graphs and charts that are absolutely OPPOSITE of what you claim.

If you want to deny that - let's figure a way to meet offline of this blog and I'll put up ten to one odds against what you are claiming, and let you decide the amount to wager on your claim.

Or, I'll be glad to meet you at the front door of the MSDH offices and kiss your ass at noontime if you can show where your statement is anywhere near correct.

In the meantime, I'll take a sip of some nice 12 year old and wait for you to come back and defend your flat out lie.

BTW, the charts are there for everybody to see. Clearly show that 90% (+/-) of hospitalizations, ICU, Vents, etc are from the NON vaccinated.

Anonymous said...

I fail to understand why, from at least a scientific standpoint, that the medical establishment continues to ignore cellular (T cell) immunity, which has been shown to be effective for SARS even 17 yrs later. Antibodies will always wane over time. And yes, demanding that people who were previously infected and recovered from Covid to take a jab is completely INSANE. This discussion should be reframed by the realization that we have never had a successful vaccine against SARS viruses to date (think constant mutations) and that a vaccine which is not sterilizing (recent redefinition of vaccine by the CDC to allow them to call this a vaccine when it would not qualify under previous definitions) will not stop transmission and further mutation even w/ vaccinations. Microbiology/Immunology degree + MD
Not posting my name because there are too many trolls out there to be bothered with

Anonymous said...

Just figured I'd drop this here:

https://theintercept.com/2021/09/28/covid-telehealth-hydroxychloroquine-ivermectin-hacked/

"A network of health care providers pocketed millions of dollars selling hydroxychloroquine, ivermectin, and online consultations, according to hacked data provided to The Intercept. The data show that vast sums of money are being extracted from people concerned about or suffering from Covid-19 but resistant to vaccinations or other recommendations of public health authorities.

America’s Frontline Doctors, a right-wing group founded last year to promote pro-Trump doctors during the coronavirus pandemic, is working in tandem with a small network of health care companies to sow distrust in the Covid-19 vaccine, dupe tens of thousands of people into seeking ineffective treatments for the disease, and then sell consultations and millions of dollars’ worth of those medications. The data indicate patients spent at least $15 million — and potentially much more — on consultations and medications combined."

It appears that there a few of these fools right here in the JJ comments.

Better Than Ever said...

So is this a good time to point out that 'natural immunity' (there's an oxymoron if I ever heard one... if you were 'naturally' immune then why did you get covid? But I digress...) completely fails to create lasting antibodies in ~10% of recovered? And that this phenomenon is not correlated at all to severity of symptoms, length of infection, or post-recovery status.

But keep your head in the sand. It's the liberals... don't fall for their plan.

Mississipi... last in everything that matters: income, education, life expectancy, diabetes prevalence, obesity, covid per capita deaths, etc.

And congrats to the person who mentioned the reddit herman cain awards. PLENTY of examples (dead people) on there that were young & healthy. Now they are worm-food. If you won't believe me, go take a look at your fellow vaccine-deniers. While you are there but sure to contribute to their gofundme.

Anonymous said...

11:46 - if you are going to ridicule people, reconsider starting your post with that idiotic understanding. You are your own worst enemy.

Anonymous said...

Looks like the comment at 4:29 shut many of you up.

Col. Reb Sez said...

I see the odds of getting enough of the world's population vaccinated that mutations will stop to be virtually zero. The virus is here and is not going away for a while. It will continue to mutate whether we send free stuff overseas or not. Therefore, it is impossible to "waste" vaccines. We have them, they are here, and we should use them to save Americans instead of squandering them by giving them away to foreigners. In addition, I am not satisfied that the virus doesn't spread and mutate just as well if not better in vaccinated people.

We take flu booster shots every year. COVID is a novel virus to which our bodies initially had zero immunity. As we slowly build our individual and herd immunity we may need to get booster shots every four to six months for the next few years.

BTW, I had the J&J in early March and was able to get a Pfizer booster two months ago simply by making an appointment. The form had lots of questions but didn't ask if I had been vaccinated before. Since the J&J has proven so ineffective I went ahead and got a second Pfizer shot. In hindsight I wish I had gotten Moderna instead of Pfizer but am glad I got boostered. Everyone should make their own medical choices and not wait for government "permission" to get a booster shot.

Anonymous said...

I got the initial shots and the booster because my doctors recommended them. I hope the unvaccinated consult their doctors rather than the morons on this blog.

Anonymous said...

“Just thought I’d drop this here”

How much has St fauci earned from Moderna? Asking for a friend…

Here is another thought, have you ever seen science scared to be reviewed or have alternate views if the “follow the science”is valid?
Me either.

..dropped this for you..

“ Youtube Announces Censorship Of ALL Content That Opposes ANY Vaccine, Several Channels Already NUKED”

Anonymous said...

We are living 1984.

Anonymous said...

“You must follow the science!”
(Unless it’s different than what St Fauci says- which changes daily)


STOP THE PRESSES — Sanjay Gupta finally asks Fauci about Israeli study showing ‘Natural Immunity’ is 13X times greater than Vaccine…

Anonymous said...

"I got the initial shots and the booster because my doctors recommended them."

The truly confounding thing is that if it were just about anything - ANYTHING - else, this would be a statement of obvious common sense that damned few would even notice. Think about that for a moment with a pre-COVID mindset. Someone saying that they followed the advice of their doctor wouldn't engender a second's notice from anyone. In fact, it would be statement of plain common sense. For those who would ignore the advice of not only their doctors but 1000s of other doctors, what in the hell are you going to do, think, or say when you seek treatment from those very same doctors (and you will sooner or later) on any other symptom or injury?

Those of you spouting these asinine and ludicrous conspiracy theories will need treatment from those who you now accuse or dismiss. And it'll be your problem to resolve in whatever brain you may possess. We'll treat you because that's what we do and we take the oath to do so very seriously. But in the back of a whole lot of minds, especially with younger doctors who dealt with this whole mess from the saddle and in the trenches, it will be in a lot of minds.

Anonymous said...

I don't disagree with 10:52.
I also listened to my doctor and got the jab.

But "asinine and ludicrous" are subjective.

For example: It would asinine and ludicrous to think at least some level of distrust of media, politicians, and even medical professionals has not been rightfully earned in the last 2-3 years.

Calm Down said...

Define "fully vaccinated".

Anonymous said...

There still seems to be a lack of comprehension about " asymptomatic".

It means you could have it and not have symptoms.

You can still spread it and help it mutate ( possibly to a state that is more deadly).

If you had it without knowing, yes , you can have a temporary immunity. The odds that you have a " natural immunity" which would come from a mutant gene in your family tree is slim to none.

Your ignorance has allowed Delta to thrive and now pregnant women and young people are dying in Mississippi. Their deaths could have been prevented.

George Washington mandated his troops to take the smallpox vaccine. In 1905 there were still " deniers" on that vaccine. The Supreme Court ruled then that even a religious objection couldn't not bar a health mandate.

Indeed, it's rather hard to reconcile any claim of Christianity with a lack of concern about your neighbor so stubborn as to willing to contribute to their death or possible long term disability.

But, still you whine and look for any fantastical excuse to keep from admitting you were WRONG.

That you missed that science is like government in that gathering sufficient data is often annoyingly time consuming and can result in finding new information that necessitates a change in direction , the main problem we have today is those among us who have unrealistic expectations, are stubborn, ignorant and/or gullible. Are you sure that's how you want to be seen? Because every time you go to an unreliable source, it pegs YOU as unreliable.





Anonymous said...

11:04am wrote/asked, "For example: It would asinine and ludicrous to think at least some level of distrust of media, politicians, and even medical professionals has not been rightfully earned in the last 2-3 years."

No, it would not be but with a slight caveat: "distrust" would be better restated, at least as to doctors/"scientists" in general terms because the vast majority of them did exactly what they should have done and continue to do. That is, they have provided the best information available at the time, which was and is a combination of basic known medicine and science (very simplistically, you cannot "catch" a virus over the phone, a virus isn't a living organism, etc.) and rapidly-increasing specific knowledge of a particular pathogen, etc.

When laypeople started "interpreting" information on social media AND it was accepted by other laypeople, it became a serious mess. When a tiny number of doctors or others claiming some sort of scientific credentials started chiming in to further their own personal goals (financial most often, but also political or other reasons), it became a very large serious mess. Neither doctors nor laypeople had much experience communicating under such circumstances and on such venues. Both "innocent sides" caught in the middle could and should have done a better job, at the very least by showing more respect and understanding to and for each other. An opportunity to learn lessons for both. I hope the opportunity won't be lost.

I'm not a politician or a "media personality" so I'll let those folks provide their own thoughts. If it matters, I don't trust many politicians and I don't listen to "media personalities" unless by happenstance. It isn't a matter of "trust," it's a matter of not being interested in left- or right-wing pandering on any topic.



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Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).


Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

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In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.


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If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

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