General COVID-19 Vaccine Discussion

[mviy]

Interestingly "The researchers report that the number of severe COVID-19 cases among the younger fully vaccinated groups were too small to draw any conclusions [about waning immunity to severe illness]"

This would seem to support not as much urgency to get boosted if healthy and in a younger age group. I think I'll be getting my booster probably somewhere around the 6 month mark after my second give or take a bit.

 

[drron]

Interestingly "The researchers report that the number of severe COVID-19 cases among the younger fully vaccinated groups were too small to draw any conclusions [about waning immunity to severe illness]"

This would seem to support not as much urgency to get boosted if healthy and in a younger age group. I think I'll be getting my booster probably somewhere around the 6 month mark after my second give or take a bit.

Though very few young people had been vaccinated for 6 months at the time.

 

[Lynda2475]

Breakthrough infections basically started to rise 2-3 months after the second jab and steeply rise after 6 months.

13k breakthrough infections from 4.7 million people is a break-through rate of 2.7%. Approximately 400 of which went on the develop severe illness requiring hospitalisation (so only 3% of the 2.7% of breakthrough cases).

Those percentages don't look alarming to me and the numbers dropped when boosters rolled out. They actually look pretty good as no vaccine is 100% effective.

Curious what percentage of people who get a flu vaccination still contract the flu in any given year?

Though very few young people had been vaccinated for 6 months at the time.

Those in military service (which is mandatory in Israel for those of university student age) were vaccinated quiet early, some would have been at 6 months by July for sure. The report talks about patterns for 40-59 and 16-39 so definitely did include younger people.

20% (~1.76M) of the Israeli population is 55 and over, so at least of the 2.94M of those in the study were under 55, so younger.

 

[Lynda2475]

So Dr Norman Swan was just giving an update on ABC news and talking about boosters.

Stay up to date with all the COVID-19 news in our live blog — as it happened

Catch all the latest COVID-19 updates from across Australia, all in the one place.

www.abc.net.au

He mentioned (but did not give source) that latest information is that AZ protection weakens quicker than Pfizer 4 months vs 6 months and that those over 60 should definitely be seeking out a booster.

 

[drron]

So Dr Norman Swan was just giving an update on ABC news and talking about boosters.

He mentioned (but did not give source) that latest information is that AZ protection weakens quicker than Pfizer 4 months vs 6 months and that those over 60 should definitely be seeking out a booster.

Norman Swan has been wrong about a lot of things so I don't regard him as a good source.I have published the real world data from the UK that suggests Pfizer starts loosing significant effectiveness from the end of 2 months after the second jab whilt the AZ loss of effectiveness is much slower so the by 6 months AZ is slightly more effective than Pfizer against the delta variant.
So before I believe you please cite a proper study.

 

[NM]

Norman Swan has been wrong about a lot of things so I don't regard him as a good source.I have published the real world data from the UK that suggests Pfizer starts loosing significant effectiveness from the end of 2 months after the second jab whilt the AZ loss of effectiveness is much slower so the by 6 months AZ is slightly more effective than Pfizer against the delta variant.
So before I believe you please cite a proper study.

Do you think one reason for variations in length of effectiveness may be the age of the vaccine recipient? In Australia, the majority of AZ recipients will be in the older population brackets, and the majority of mRNA recipients are likely to in the younger cohort. So is it possible/likely that age may have as much of an impact of effective duration as does the vaccine type/brand?

 

[Lynda2475]

Do you think one reason for variations in length of effectiveness may be the age of the vaccine recipient?

Look at the data in the NSW Surveillance reports, the majority of breakthrough cases resulting in hospitalization, ICU and deaths have been in over 60s (the cohort who by the way mostly got AZ). Age is a huge factor.

We know most also had underlying conditions, but we also know only some were in aged care, and the only elderly people who were given Pfizer were in Aged care, those in the community got AZ.

its a good read: https://www.health.nsw.gov.au/Infec...nts/covid-19-surveillance-report-20211111.pdf

 

[Quickstatus]

The data that is missing from Covid19 vaccine studies is the relative lack of negative studies. It is not sexy and loses funding

reality of scientific research.

Be skeptical of all published data. The reality of scientific research is that not all research is published- especially the studies which had a negative result. And then there are the studies that were not even done

 

[Quickstatus]

The Singaporean government will no longer cover the medical costs of people

Opening a Pandora's box
I can think of a whole list of personal behaviours/activities that could be a Medicare exclusion.

Smoking?, obesity?, risky activities?
Drunk driving and crashed car?
Illegal activities?
Recreational drugs?

 

[drron]

Pfizer is recommending a third the adult dose for under 12s.

Evaluation of BNT162b2 COVID-19 vaccine in children 5 to 11 years of age

A coronavirus disease 2019 (COVID-19) vaccination regimen consisting of two 10-μg doses of BNT162b2 (Pfizer-BioNTech) administered 21 days apart was found to be safe, immunogenic, and efficacious in children 5 to 11 years of age, according to a Phase I study and Phase II-III randomised trial...

dgalerts.docguide.com

The CDC has recommended Immunocompromised people should have a 4th shot 6 months after their 3rd jab.

CDC says some immunocompromised people can get fourth COVID shot

Some immunocompromised people will be able to receive fourth doses six months after their third.

www.axios.com

Another Indian vaccine has published a successful Phase 3 trial result.

Efficacy, safety, and lot-to-lot immunogenicity of an inactivated SARS-CoV-2 vaccine (BBV152): interim results of a randomised, double-blind, controlled, phase 3 trial

BBV152 was highly efficacious against laboratory-confirmed symptomatic COVID-19 disease in adults. Vaccination was well tolerated with no safety concerns raised in this interim analysis.

www.thelancet.com

 

[Lynda2475]

So before I believe you please cite a proper study.

Not a study but real world UK statistics from SAGE (Scientific Advisory Group for Emergencies)

This paper from September: https://assets.publishing.service.g...OVID-19_vaccines_against_clinical_disease.pdf

concludes

"the results indicate that there is waning of VE against symptomatic disease with both the Pfizer and AstraZeneca vaccines from approximately 10 weeks after the second dose. This is most evident in older adults.

There is some indication of waning against hospitalisation from 15 weeks after the second dose, in particular among recipients of the AstraZeneca vaccine, though this waning appears to be predominantly in clinical risk groups. This is a broad group of clinical conditions including those who are immunosuppressed, where faster waning may be predicted. Nevertheless, protection against hospitalisation remains high throughout the follow-up period and even within clinical risk groups, VE against hospitalisation at 15-20 weeks is 75-90% with the AstraZeneca vaccine and over 90% with the Pfizer vaccine.

Finally, those aged 80 years and older who received the Pfizer vaccine within a 3-week interval between doses showed a greater degree of waning compared to the broader 65+ age group who had a 20+ week interval between doses though further analysis is needed to understand this difference."

And then this table also from SAGE based on UK data also does not support your assertion that Pfizer wanes faster than AZ, and is consistent about what Norma Swan stated (im no fan of his either) https://assets.publishing.service.g...4/S1411_VEEP_Vaccine_Effectiveness_Table_.pdf



I will be keeping an eye on this table as its updated monthly.

 

[drron]

The actual study though is not as clear cut as the conclusion.So for death the article you link shows this-

Stratifying by age group gives similar results to the overall analysis, though there is some suggestion of greater waning with AstraZeneca in the oldest age groups from 20+ weeks, however confidence intervals are wide (Figure 4). Further stratifying the 40-64 years age group according to whether they are in a risk group indicates that the waning seen with AstraZeneca is restricted to those in clinical risk groups (Figure 5). In those aged over 65 years, the broader clinical risk group variable is not available, however, Figure 6 shows the stratification according to whether they are in the narrower clinically extremely vulnerable group. Waning appears to be greater with both AstraZeneca and Pfizer among those in the clinically extremely vulnerable group, though data beyond 20 weeks is limited.

The confidence intervals being wide means there is not a definitive answer. And words such as "some suggestion of greater waning with AstraZeneca in the older age group" again don't seem to fit with the conclusion.

And those figures are for the time up to the 20th August 2021.Remember the UK was using 8-10 weeks between Pfizer jabs for most except the early patients and 12 weeks for AZ.This means numbers at 6 months post second jab are not high. the paper does gives the times vaccination was started at the various age groups.
• 80+: first dose from Dec 8th, 2021 (includes those who received doses 3 weeks apart)
• 65+: First dose and cases from Jan 4th, 2021
• 40-64: First dose and cases from Feb 1st, 2021
• 16-39: First dose and cases from May 10th, 2021 (not shown due to limited follow-up)

So in the 80+ patients mainly had Pfizer and at 3 weeks interval and there is this-

Figure 7 shows VE against hospitalisation in the 80+ age group, many of whom received the Pfizer vaccine with a 3-week interval between doses. There is some indication of a greater degree of waning in this group compared to the broader 65+ age group, though the time since the second dose in the 20+ week period is also likely to be longer in this group.

So probably a greater drop with pfizer if 3 weeks between doses rather than the longer interval.here in australia Pfizer has mainly been given with the 3 week interval.

Here is a later study from Israel where the evidence for Pfizer at 6 months post second jab was not as good.

Covid-19: Antibody levels fall after second Pfizer dose, but protection against severe disease remains, studies indicate

Six months after the second dose of the Pfizer-BioNTech covid-19 vaccine, antibody concentrations in healthcare workers had decreased substantially, especially among older men and immunosuppressed people, a study has found.1 The Israeli researchers carried out a six month longitudinal...

www.bmj.com

There is a second study quoted in that article from Qatar where Pfizer drops in efficacy were lower but only 9% of patients were over 50.

 

[Lynda2475]

Cases in Germany have double in recent days

Germany recommends only Biontech/Pfizer vaccine for under-30s

People aged under 30 in Germany should only receive the Biontech/Pfizer COVID-19 vaccine as it causes fewer heart inflammations in younger people than the Moderna shot, an advisory committee said on Wednesday.

www.reuters.com

STIKO made a new recommendation yesterday that people aged under 30 in Germany and all Pregant women regardless of age should only receive the Biontech/Pfizer (PFE.N) COVID-19 vaccine as it causes fewer heart inflammations in younger people than the Moderna (MRNA.O) shot.

The recommendations are based on new safety data from the Paul Ehrlich Institute (PEI), Germany's authority in charge of vaccines, and new international data.

The German PEI data showed a "report rate" for heart inflammations of 11.71 per 100,000 shots with the Moderna vaccine for men in the 18-29 age group, compared with 4.68 for the Biontech/Pfizer shot. For women, the rate was 2.95 with Moderna and 0.97 with Biontech/Pfizer.

In the 12-17 age group, the rate was 11.41 for males with the Moderna shot compared with 4.81 for Biontech/Pfizer.


This article lists countries which recommend Pfizer over Moderna for certain age cohorts and also the adjusted doses of Pfizer and Moderna being recommended for under 16s.

Countries respond to heart inflammation risk from mRNA shots

Some countries are limiting the use of COVID-19 shots based on so-called mRNA technology to younger people following reports of possible rare cardiovascular side-effects.

www.reuters.com

 

[Lynda2475]

So USA is now making booster available to everyone 18+, not that it was difficult to get one before the official ruling changed last week.

All US based friends under 50 had already had one in Sept and Oct anyway.

There is talk of no longer recognising people as fully vaxed if haven't had a booster, reckon we will see that change here too before next winter.

 

[ethernet]

Herd Immunity Observations. ACT is 97.7% plus vaccinated and covid is still being nasty and seeking out younger age groups. I suggest herd immunity is >97%. So it makes sense when Austria and Israel conclude 3rd and 4th boosters will be necessary, having rejected the Pfizer two shots and you are done mantra. Given Victoria's numbers, QLD's 80% target, is going to challenge resources and beds. While I agree with Drron concerning natural infection, I remain concerned that a natural mild infection may do one more damage than the risk of boosters. I think a good question to ask is are the booster doses optimal? Not optimal for the bottom line. I recall accidental low dose shots invoked a stronger response. Given the disparity between Israel and the US reporting, I would like to see some original ATAGI thinking here. I speculate for older age groups visiting Qld, a very mild booster would be cost effective in the scheme of things.

 

[andye]

Herd Immunity Observations. ACT is 97.7% plus vaccinated and covid is still being nasty and seeking out younger age groups. I suggest herd immunity is >97%. So it makes sense when Austria and Israel conclude 3rd and 4th boosters will be necessary, having rejected the Pfizer two shots and you are done mantra. Given Victoria's numbers, QLD's 80% target, is going to challenge resources and beds. While I agree with Drron concerning natural infection, I remain concerned that a natural mild infection may do one more damage than the risk of boosters. I think a good question to ask is are the booster doses optimal? Not optimal for the bottom line. I recall accidental low dose shots invoked a stronger response. Given the disparity between Israel and the US reporting, I would like to see some original ATAGI thinking here. I speculate for older age groups visiting Qld, a very mild booster would be cost effective in the scheme of things.

My understanding is herd immunity is based on whole population so ACT is not at that level

 

[drron]

The problem really isn't herd immunity.It has been shown in a few places case numbers start to drop once 75% double vaxed levels are reached.
The problem is that the current vaccines and regimes do not produce long lasting effects unless you had had covid and then vaccinated.

The studies in Israel showed that the increase in infections occurred some 6 months after the second jab and does show decreasing antibody levels. this graph is informative.
.

Israel started vaccinating in December 2020.They had given 205 of first shots in the first 3 weeks. The wave that began in Late November was controlled by late March.
However the next wave began in July 6 months after people began getting their second jab. Instead of locking down they decided on getting booster doses. So by October - again about 3 months after rolling out boosters the wave was controlled. So the Israelis have been encouraging booster at 5 months so as not to let covid escape.

https://www.nejm.org/doi/full/10.1056/NEJMoa2114583

The US has now recommended everyone should have a booster at 6 months as is Norway. IMHO Australia should do the same.

A question does remain that if the US etc had followed the real world advice about a longer spacing between Pfizer jabs.

An interval of at least six weeks between the two doses of the Pfizer-BioNTech covid-19 vaccine increased concentrations of neutralising antibodies, research funded by the Department of Health and Social Care for England has found.1

The preprint, released on 23 July, looked at immune responses in 503 healthcare workers who had received the Pfizer vaccine. It found that, after the second vaccine dose, neutralising antibody concentrations were higher after an interval of 6-14 weeks than after the 3-4 week regimen that was initially recommended.

Covid-19: Longer interval between Pfizer doses results in higher antibody levels, research finds

An interval of at least six weeks between the two doses of the Pfizer-BioNTech covid-19 vaccine increased concentrations of neutralising antibodies, research funded by the Department of Health and Social Care for England has found.1 The preprint, released on 23 July, looked at immune responses...

www.bmj.com

 

[jrfsp]

EU kicks off debate on need for booster shots to travel | eKathimerini.com

European Union governments kicked off a debate on Tuesday about how long vaccines are effective against Covid-19 and whether evidence of a booster dose will be required to maintain free travel across the bloc as cases spike.

www.ekathimerini.com

Its looking likely that for travel to the EU you will need to have had a jab within the last 6 months.

 

[jrfsp]

The problem really isn't herd immunity.It has been shown in a few places case numbers start to drop once 75% double vaxed levels are reached.
The problem is that the current vaccines and regimes do not produce long lasting effects unless you had had covid and then vaccinated.

The studies in Israel showed that the increase in infections occurred some 6 months after the second jab and does show decreasing antibody levels. this graph is informative.
View attachment 265700.

Israel started vaccinating in December 2020.They had given 205 of first shots in the first 3 weeks. The wave that began in Late November was controlled by late March.
However the next wave began in July 6 months after people began getting their second jab. Instead of locking down they decided on getting booster doses. So by October - again about 3 months after rolling out boosters the wave was controlled. So the Israelis have been encouraging booster at 5 months so as not to let covid escape.

https://www.nejm.org/doi/full/10.1056/NEJMoa2114583

The US has now recommended everyone should have a booster at 6 months as is Norway. IMHO Australia should do the same.

A question does remain that if the US etc had followed the real world advice about a longer spacing between Pfizer jabs.

Covid-19: Longer interval between Pfizer doses results in higher antibody levels, research finds

An interval of at least six weeks between the two doses of the Pfizer-BioNTech covid-19 vaccine increased concentrations of neutralising antibodies, research funded by the Department of Health and Social Care for England has found.1 The preprint, released on 23 July, looked at immune responses...

www.bmj.com

Are there are stats as to the interval that has been given in Australia? How many people had 3, 4, 5 weeks etc.

I specifically waited for 6 weeks on the basis of the results out of the UK

 

[drron]

the official recommendation in Australia has been 3 weeks for Pfizer and 12 weeks for AZ.There was a short time I believe when in some places they put Pfizer out to 6-8 weeks. So I am certainly saying to anyone I meet who had their second jab May or before to have a booster.

There is still a lot to know about covid,it's treatment and prevention. I came across this article based on discussions with a few immunologists.They rightly point out that the initial drop noted after the second jab is the fall off in IgM antibodies then the fall off slows as it is replaced By IgG antibodies. As well cellular antibodies kick in. That is why you are not considered fully vaccinated until 2 weeks after the second jab.

The Good Part About ‘Waning’ Immunity

You might have fewer antibodies now. But they’re better than the ones you started with.

www.theatlantic.com

However it goes on to say falling antibody levels are of no concern as the antibodies then are more potent. Unfortunately that flies in the face of real world results particularly the Israeli experience. They noted a rapid fall in antibody levels approximately 6 months after the second Pfizer jab and that was associated with a large increase in Breakthrough infections. The outbreak was controlled not by lockdowns but by a booster dose campaign.

Also AZ put out an information guide last week going through many covid topics. Some might find it of interest.

Explaining waning immunity after vaccination

Explaining how vaccines produce immunity, how immunity is measured, the short and long-term effect of vaccination on immunity and booster vaccinations.

www.astrazeneca.com