CDC recommends Covid Booster injections to millions of Americans

In a landslide victory for the Biden administration, the Centers for Disease Control and Prevention on Thursday approved booster shots of the Moderna and Johnson & Johnson Covid-19 vaccines for tens of millions of Americans.

The move follows the agency’s approval last month of booster injections of the Pfizer-BioNTech vaccine and opens the door for many Americans to seek a booster injection as early as Friday.

The coronavirus vaccines “are all very effective in reducing the risk of serious illness, hospitalization and death, even in the midst of the widely circulating Delta variant,” said Dr. Rochelle P. Walensky, director of the CDC, in a press release.

Its endorsement of recommendations made by a science advisory committee brings the country one step closer to President Biden’s August pledge to offer reminders to all adults. The pandemic is now receding in most parts of the country, but there are still around 75,000 new cases every day and around 1,500 deaths from Covid.

The pledge angered many experts, including some advising the Food and Drug Administration and the CDC, who said scientists had yet to have a chance to determine whether the boosters were really needed.

Studies have shown that the vaccines remain highly effective against serious illness and death, although their effectiveness may have declined against milder infections, especially as the Delta variant spread across the country this summer.

The purpose of vaccines is to prevent disease severe enough to require medical attention, not to prevent infection, Dr. Wilbur Chen, an infectious disease physician at the University of Maryland School of Medicine and a member of the CDC group, the Advisory Committee on Immunization Practices said Thursday during its deliberations.

“It may be too much to ask for a vaccine, whether it’s a primary series or the booster, to prevent all forms of infection,” Dr Chen said.

CDC advisers last month tried to reduce the number of Americans who should receive a booster dose of the Pfizer-BioNTech vaccine, saying research did not support recalls for people whose jobs exposed them to the coronavirus, such as the FDA had indicated.

But in a very unusual move, Dr Walensky overturned their decision, aligning the agency’s advice with the criteria set out by the FDA.

The Food and Drug Administration cleared booster shots for millions of people who received Moderna and Johnson & Johnson vaccines on Wednesday, just as it did for recipients of Pfizer-BioNTech injections last month. The FDA has also given the green light to those eligible for booster shots to get a dose of a different brand.

But in practice, who gets the shots and when will depend greatly on the final guidance from the CDC. While the agency’s recommendations are not binding on state and local authorities, they have great influence on the medical community.

CDC panel members on Thursday endorsed the so-called mix-and-match strategy, saying people fully immunized with a company’s vaccine should be allowed to receive a different vaccine for their booster.

Limited evidence strongly suggests that booster doses of one of two mRNA vaccines – Moderna or Pfizer-BioNTech – increase antibody levels more effectively than a booster dose of Johnson & Johnson vaccine.

The committee advised recipients of the single-dose Johnson & Johnson Covid vaccine to be boosted at least two months after their first dose.

Among Americans initially immunized with an mRNA vaccine, adults over 65, adults 50 to 65 years of age with certain medical conditions, and those residing in long-term care facilities should receive a single booster dose six months or more after their second dose, the committee decided.

For adults aged 18 to 49 with certain medical conditions and adults whose work regularly exposes them to the virus, the panel opted for milder language, saying they might choose to receive a booster after taking account their individual risk.

Experts stressed that people who have received two doses of mRNA vaccine or a single dose of Johnson & Johnson should still consider themselves fully vaccinated. Federal health officials said they would continue to investigate whether those with weakened immune systems and had already received a third dose of a vaccine should continue to receive a fourth dose.

Some advisers were concerned that young, healthy Americans who don’t need a booster might choose to get one anyway. Side effects are rare, but in young Americans they may outweigh the potential benefits of booster doses, scientists said.

“Those who are not at high risk should really think about getting this dose,” said Dr. Helen Talbot, infectious disease expert at Vanderbilt University.

The committee’s final votes contrasted sharply with discussions earlier today. The panel learned that in adults under 65, even those with chronic illnesses, the Moderna vaccine remained highly protective against serious illness and showed only a slight decline in effectiveness over time, if any.

The Johnson & Johnson vaccine was shown to be less effective than the Moderna vaccine overall, but the data were too limited to determine if there might be a decline over time.

Having already authorized the Pfizer-BioNTech recall, some advisers however said in interviews that they felt compelled to do the same for the other two vaccines, adding that it was only fair to the people who had received those vaccines. .

Just over 11 million people have so far opted for an additional injection, and up to three million are people with weakened immune systems who have been allowed a third dose to boost their immune response. So far, only 6 percent of fully vaccinated people and about 15 percent of adults over 65 have received a booster dose.

Moderna’s recall shot won’t be the same as his initial shot. The dose will be 50 micrograms, which is half the dose given in the first cycles of vaccination. Moderna scientists presented data indicating that the smallest dose is enough to wake up the immune system.

But the smaller dose may need to be delivered from the same vials currently used for the initial vaccination. Some committee members noted that this can increase the risk of contamination and incorrect dosing. (Moderna has tested vials that deliver smaller volumes of vaccine to alleviate this problem, according to a former government official.)

CDC scientists told the meeting that the Pfizer-BioNTech and Moderna vaccines are generally safe, with the exception of rare and mostly mild heart problems in young men. The risk of a disease – called myocarditis, an inflammation of the heart muscle – is highest after the second injection of an mRNA vaccine, and highest in men aged 18 to 24.

In people under 20, the disease can affect more than 100 in a million men immunized with an mRNA vaccine. Studies have shown that the risk of heart problems after a bout of Covid-19 is much higher.

The Johnson & Johnson vaccine carries a low risk of blood clots in young women. Company officials said they estimated the blood clot rate at 15.1 cases per million after the first dose and 1.9 cases per million after the second.

Some panelists said they were concerned about the risk of blood clots in young women receiving a second booster dose of the Johnson & Johnson vaccine, and the risk of myocarditis in young men after a third dose of an mRNA vaccine. .

Maybe young women should be directed to mRNA vaccines and young men to Johnson & Johnson vaccine, Dr Talbot said.

“We are in a different place from the pandemic than we were before,” she said. The opportunities to mix and match vaccines “are priceless”.

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