CDC panel to discuss boosters and the “Mix-and-Match” strategy

As the latest wave of the virus ebbs into most parts of the United States, advisers from the Centers for Disease Control and Prevention ...


As the latest wave of the virus ebbs into most parts of the United States, advisers from the Centers for Disease Control and Prevention will meet on Thursday to assess which Americans need extra doses of the coronavirus vaccines made by Moderna and Johnson & Johnson.

They will also discuss what is called mix-and-match strategy – whether people fully immunized with one company’s vaccine should be allowed to switch to another for their booster injection.

Wednesday, the Food and Drug Administration booster injections allowed for the millions of people who received Moderna and Johnson & Johnson vaccines, as well as Pfizer-BioNTech vaccine recipients last month. The FDA has also given the go-ahead for those eligible for boosters to get an extra dose of a different brand than they originally received.

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.

Whatever the content of the discussion, the final recommendations of the CDC panel – the Advisory Committee on Immunization Practices – should come as no surprise. The committee is expected to approve additional doses of vaccines for many Americans and move the country closer to President Biden’s pledge to provide boosters for all adults.

However, this will not happen without some misgivings.

Some CDC advisers last month expressed strong reservations about a Pfizer-BioNTech vaccine booster, saying science did not support additional injections for anyone other than adults over 65. A majority voted to recommend booster shots for people with certain medical conditions that increase the risk of Covid-19.

The committee did not support recalls for people whose jobs expose them to the virus – but in a very unusual move, CDC director Dr. Rochelle P. Walensky, overturned his decision.

“This will be a difficult meeting because I suspect the science won’t have changed much,” said Dr. Sarah S. Long, pediatrician and infectious disease expert at Drexel University in Philadelphia. “I can see it’s clear that we still don’t think this is the right approach, and Dr Walensky should ignore it.”

A similar dynamic unfolded on the panel of experts advising the FDA at a meeting last week. Several FDA advisers have criticized the lack of evidence to support a Johnson & Johnson recall and have expressed unease at having to vote on the recall before the FDA has thoroughly vetted the data.

Yet they voted unanimously in favor of a second injection of Johnson & Johnson for adults who received this vaccine because it was clear that two doses would be more protective than one, according to panel member Dr Paul A. Offit, director of the Vaccine Education Center from the Children’s Hospital of Philadelphia.

What to know about Covid-19 booster injections

The FDA has cleared booster shots for millions of drug recipients Pfizer-BioNTech, Moderna and Johnson & johnson vaccines. Pfizer and Moderna beneficiaries who are eligible for a recall include people 65 years of age and older and young adults at high risk of severe Covid-19 due to medical conditions or their workplace. Eligible Pfizer and Moderna beneficiaries may receive a booster at least six months after their second dose. All Johnson & Johnson recipients will be eligible for a second injection at least two months after the first.

Yes. The FDA has updated its clearances to allow medical providers to boost people with a different vaccine than the one they originally received, a strategy known as “mix and match.” Whether you have received Moderna, Johnson & Johnson, or Pfizer-BioNTech, you may receive a booster of any other vaccine. Regulators have not recommended any vaccine over another as a booster. They have also remained silent on whether it is best to stick to the same vaccine when possible.

The CDC said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and some disabilities. Pregnant women and current and former smokers are also eligible.

The FDA has cleared the boosters for workers whose work puts them at high risk of exposure to potentially infectious people. The CDC says this group includes: emergency medical workers; education workers; food and agricultural workers; manufacturing workers; correctional workers; workers in the US postal service; public transport workers; employees of grocery stores.

Yes. The CDC says the Covid vaccine can be given regardless of the timing of other vaccines, and many pharmacy sites allow people to schedule a flu shot along with a booster dose.

“There was value in having this as a single dose vaccine when it first came out,” Dr Offit said. “But I think it was still on its way to being a two-dose vaccine.”

He and others have suggested that people who have received the Johnson & Johnson vaccine might be better served by receiving a second dose of the Pfizer-BioNTech or Moderna vaccines. FDA Wednesday updated its authorization for all three vaccines, which will allow the CDC’s advisory committee to recommend this mix-and-match strategy at its meeting on Thursday.

At last week’s meeting, FDA advisers received evidence indicating that switching between two types of vaccines could produce a richer immune response than the booster with the same vaccine.

San Francisco has offered Pfizer-BioNTech or Moderna injections to Johnson & Johnson beneficiaries since August, and many Americans who initially received the Johnson & Johnson vaccine have sought booster doses of these vaccines themselves before federal agencies approved them.

But FDA advisers couldn’t vote to recommend that people who initially received the Johnson & Johnson vaccine follow it up with one of the mRNA vaccines because the FDA didn’t give them that option.

“The formal vote was on the J .- & – J. booster according to J .- & – J. vaccine, ”said Dr. Stanley Perlman, immunologist and coronavirus expert at the University of Iowa. But “everyone knew the data would show the heterologous boost would be better.” (Heterologous refers to an injection of a different vaccine.)

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Newsrust - US Top News: CDC panel to discuss boosters and the “Mix-and-Match” strategy
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