CDC advisers recommend Moderna and Johnson & Johnson boosters; say shot can differ from original - The Washington Post

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Advisers to the Centers for Disease Control and Prevention on Thursday unanimously recommended the Moderna and Johnson & Johnson boosters for tens of millions of Americans deemed vulnerable because of their age, health or occupation to bolster their protection against the coronavirus.

The panel also said that consumers should be allowed to choose from any of the three boosters now authorized in the United States, no matter which vaccine they first received. Members directed the CDC to provide further guidance about which groups might benefit from choosing one booster over another, noting the risks and benefits vary based on age and sex, among other factors.

The ability to mix and match vaccines “gives us the flexibility we need for an effective and efficient vaccine implementation,” said Sandra Fryhofer, an internist representing the American Medical Association.

CDC Director Rochelle Walensky is expected to sign off on the recommendations later Thursday, allowing clinicians and pharmacies to begin giving booster doses of the Moderna and Johnson & Johnson boosters, in addition to the already authorized Pfizer-BioNTech shots, to nearly 100 million eligible Americans.

Action by Walensky — following a green light Wednesday from federal regulators — would largely fulfill the administration’s promise to make boosters of all three vaccines available to Americans, albeit a month later than promised and for a smaller group. The administration’s focus on boosters came as the highly contagious delta variant sickened millions and killed tens of thousands, and also reflected concern about waning vaccine immunity, especially in older and immunocompromised people.

A CDC sign-off would give greater flexibility not just to consumers, but to clinicians and pharmacies offering vaccines to vulnerable populations by allowing them to mix and match shots. Immunization and health officials have repeatedly sought ways to make it easier for people to get another dose, especially those who have had side effects from one brand, or who worry about risks associated with a particular shot.

The availability of boosters would be particularly welcome to the 15 million recipients of the Johnson & Johnson vaccine, many of whom have been particularly fearful of breakthrough infections given that shot’s lower level of protection compared to the messenger RNA vaccines.

“I agree that those who received a [Johnson & Johnson] vaccine should receive a second dose — I would prefer that those individuals get an mRNA vaccine,” rather than a second Johnson & Johnson shot, said panel member Pablo J. Sanchez, a pediatrician at Ohio State University.

Interchangeability of shots is also likely to speed booster vaccination in nursing homes and other institutional settings where residents received different shots during the early rollout. The Pfizer-BioNTech booster is already in use since it was authorized and recommended earlier this month.

“I think the opportunity for these [mix and match] boosts are priceless,” said Helen Keipp Talbot, an infectious-disease doctor at Vanderbilt University, who heads the advisory panel’s vaccine safety group. “It gives those who receive a [Johnson & Johnson vaccine] if you’re a young woman [a chance] to receive a messenger RNA. And if you’re a young man who’s received the messenger RNA, maybe we switch over to the [Johnson & Johnson].”

The advisory panel’s recommendation was similar to Wednesday’s action by the Food and Drug Administration

The FDA did not take a position on whether people should stay with the original vaccine or switch to a different one. Top FDA officials said they did not have the data to make those specific judgments.

Regulators authorized a third shot of Moderna or Pfizer-BioNTech for anyone 65 and older, or any adult at high risk of severe illness because of underlying conditions or job exposure, who has gone at least six months since their second dose. They broadened eligibility for those who received the single-shot Johnson & Johnson vaccine: Anyone 18 and over who has gone at least two months since getting that shot can get a booster — criteria reflecting the lower protection afforded by that vaccine compared with the others.

Mixing and matching booster shots may appeal to consumers concerned about possible risks associated with their first vaccine, panel members said.

“A lot of what our efforts are centered around is trying to mitigate risk as much as possible, both from disease as well as vaccination,” said Grace Lee, a professor of pediatrics at Stanford University School of Medicine and chair of the panel.

More data on the safety of booster shots for different groups may help determine “whether or not a different boost would be appropriate, for example, for young women” who first received Johnson & Johnson, Lee added.

Some questioned administering a second Johnson & Johnson shot to women of childbearing age, for instance, because of the rare but serious risk of blood clots. Analyses of vaccine data for those who have received that shot suggest an increased risk of a rare type of blood clot, especially for women 18 to 49 years old.

Both Moderna and Pfizer vaccines are also associated with the extremely rare risk of inflammatory heart problems, such as myocarditis, especially in young men. Some safety data from the United States, Canada and Scandinavian countries show greater risk with a Moderna than Pfizer, but others show no difference between brands, according to a presentation by Talbot.

Follow-up study of the heart problems suggests the cases are generally mild and symptoms resolve promptly, Talbot said. The Moderna shots tied to that risk were full doses, not the half-dose booster cleared by the FDA and recommended by the CDC panel. Safety data of the half-dose Moderna booster is limited, but Talbot said the risks might be lower at the lower dose.

Approximately 105 million, or about 66 percent of fully vaccinated people, have received the two-shot Pfizer series, according to the CDC. About 70 million, or about 37 percent of fully vaccinated people, have received the Moderna series. Only 15 million Americans, or about 8 percent, were vaccinated with Johnson & Johnson shots, which arrived later and were delayed by an investigation of a rare adverse event, as well as a manufacturing problem.

This is a developing story. It will be updated.

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