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  • 1.  Vaccine booster

    Posted 09-06-2021 13:50

    Wondering what everyone's or anyone's thoughts are regarding the SARS COV-2 booster. I am all about offering them to my patients who are sex workers, or IVDU. In my opinion they are at a heightened risk of exposure to the delta variant despite whether or not there is an underlying co-morbidity.  Just to put things in a better perspective, I am in central Florida, where a lot is going on right now. What are your thoughts, if any? The FDA now recommends that one can receive the 3rd booster of Pfizer or Moderna 28 days after their 2nd dose if …
    Thanks,

    Amber



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    Amber Siegel DNP AGNP-C AAHIVS
    Crew Healthcare
    Orlando, Florida
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  • 2.  RE: Vaccine booster

    Posted 09-06-2021 16:54
    Given that the data are based on initial vaccine response, I have been offering third doses to my patients with cd4 count <200 regardless of occupation. I wouldn't expect sex workers to have more contact with other humans than a massage therapist (anecdotally, they have the same number of clients refuse to wear a mask), and I'm not vaccinating massage therapists. Instead for patients who have high-risk work situations, I've been verifying immunity by antibody levels. Yet to need to give a booster and it reassures folks of their immunity.

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    Zil Goldstein
    Callen-Lorde CHC
    New York, NY
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    Original Message


  • 3.  RE: Vaccine booster

    Posted 09-06-2021 16:57
    Hi, good questions.  Re: checking for immunity, I'd caution that we don't know yet what level of Ab is protective against Covid so I'd be wary of reassuring anyone or relying on Ab levels.  I think right now they are just indicated for research purposes rather than clinical guidance. Please feel free to highlight info to the contrary that I may not be aware of.
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    Aliza Norwood
    Vivent Health
    Austin Texas

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    Aliza Norwood
    Austin TX
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    Original Message


  • 4.  RE: Vaccine booster

    Posted 09-06-2021 17:43
      |   view attached
    The data on booster is still evolving, most however believe that a booster may not be required in everyone. The immunology underlying this is the fact that vaccinated individuals have both a B-cell antibody response which most of the studies focus on and a T-cell cellular immune response which is less talked about. In addition there are memory B-cells that remain long after vaccine administration. In SARS-CoV-2 infection in vaccinated individuals the memory cells may not be effective in protecting individuals who have baseline immunodeficiencies and those older than 65 years who may progress faster into cytokine storm  before they can mount an immune response against the virus.

    Vaccinated individuals with good immune systems may be able to mount broader cross strain immune responses and may not really need booster. Most of this information is mostly theoretical and partly based on research on individuals who received mRNA vaccines. The information is still evolving. At this time for most fully vaccinated healthy individuals younger than 60 years individuals even with high likelihood of exposure may be fine without boosters. Goel, Rishi R., et al. "mRNA Vaccination Induces Durable Immune Memory to SARS-CoV-2 with Continued Evolution to Variants of Concern." bioRxiv (2021). research not peer reviewed.

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    Leonard Sowah
    Baltimore MD
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    Original Message


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