Coming up on Mayo Clinic Q&A,

there's a lot changing

the fact that recommendations

are changing. I want to urge you is

not evidence

that people don't know what they're

doing.

It's evidence that they do

know what they're doing and they're

paying close attention

to new data that's coming

along and then adjusting

recommendations.

Based on that,

recommendations on COVID 19

booster shots and vaccinations

for children are expected to happen

this month based on data presented

to the FDA advisory panel last

week.

How will you know what's recommended

for you and your loved ones?

Think that there's there's going to

be a lot of information?

Social media is not always going

to get it right.

Please go to credible sources.

Welcome everyone to Mayo Clinic Q&A.

I'm Dr. Holly Gazelka.

We're recording this podcast on

Monday, October the 18th

Twenty Twenty One.

Last week, an FDA advisory

panel met to discuss and make

recommendations on booster shots

from Moderna and JNJ vaccines.

And here with us to discuss today is

Dr. Greg Poland.

Thanks for being here again today,

Greg.

Yes, of course.

Good morning and happy Monday.

Wonderful to have you here today.

We have some updates today

and then I would your mailbag

for you as well.

OK. Those are always good,

but tell us what's been happening

with all these meetings and advisory

panels. It's hard for us all to keep

up.

It was a really busy week,

a lot of hours spent

in committee meetings, so

there were two meetings all

day meetings this past week.

And basically what the committee

heard were the data supporting

the notion of a booster

dose for Moderna

and JNJ.

And then the second item was

about so-called mix and match

who should get what kind of vaccine?

Now the important part here, and I

want to go through this a bit slowly

so people don't get confused.

Previously, the

recommendation was made for

a third dose

of Pfizer vaccine

for people who were moderately

to severely immunocompromised.

So if you're moderately to

severely immunocompromised

in reality, your series

is three doses

for everybody else.

It's a series of two doses.

And, Booster,

if you fit into certain categories,

the other point is that very

likely the Maddern of Booster

will be half the

dose that you got in your primary

series.

So in other words, not 100

micrograms, but 50

micrograms, JNJ

and Pfizer will stay the same.

What happened this past week

is that the committee voted on

both questions unanimously

in favor of authorizing

a Maddern, a booster and a JNJ

booster.

Now here's what has to happen.

The FDA takes

that advisory committees

recommendation under advisement.

They will issue a recommendation

this week.

It will go now to the CDC

to what's called the ACIP

Advisory Committee on Immunization

Practices, and they will

actually implement

and approve that.

So what do I expect will

happen? I expect that we

will see that recommendation

voted favorably upon.

And it's pretty simple.

It's four things

if you are, I guess.

Five, If you are over the age of

sixty five, you should

be offered a booster.

If you are over the age of 18

and in a long term care

setting, you should be

offered a booster.

If you are greater than 18

years old and you have underlying

medical problems, that

puts you at risk

for severe COVID.

You should be offered the vaccine.

If you're over 18 and you

work in a high risk setting,

you may

be offered the booster.

And if you're over 18 and

living in a high risk

setting, for example,

a home prison, something

like that, then you also

may be offered that vaccine.

So really, at this point,

it's functionally

almost everybody over the

age of 18 who's

at elevated risk.

That includes Selena.

You and I being in

health care.

It's it's

first responders.

It's teachers.

Those are high risk settings, as

we know, as kids have gone back to

school.

Now what will happen toward the

end of this month will

be another committee meeting

about extending the Pfizer

vaccine down to age

five.

So a lot happening.

One of the big, big questions

that comes up is this mix and match.

And let me kind of summarize that

data.

I think this is my belief

we will move to the point where

Jay and Jay is the two dose series,

just like the RNA vaccines.

If you got the if you got the JNJ

vaccine and you get a JNJ

booster, your antibodies

go up about four fold.

If you got the JNJ

as your primary dose

and you get Pfizer,

your antibodies go up thirty

five fold.

If you got the JNJ as your

initial dose and got them Moderna

booster, your antibodies

go up 76

fold.

Now those are impressive numbers.

But even yeah, but even the

second JNJ

vaccine is tremendously

effective.

And one other point, just again

in transparency, none

of the studies that are being

brought forward to talk

about booster doses measured

T-cell immunity, which is a major

arm of immunity.

So we're kind of basing

all of this on antibody

level, which we believe is

likely to turn out to be a correlate

of protection.

There's one other point that

likely will not

occur to people immediately.

A very high risk group

and we've talked a bit about it in

the past are pregnant women.

So the recommendation for pregnant

women, even though

they are younger,

they don't have any perhaps

underlying medical conditions.

They're not in a high risk setting,

they're not living in a high risk

setting or in a high risk

workplace.

They do get a booster

because the risk when you're

pregnant is so high

about a 70 fold

increased risk of death

even for a healthy pregnant

woman.

So a pregnant woman who's

had two doses, let's say, of an

RNA vaccine

does get a booster

dose if it's been.

Six or more months?

A lot of information there

is, but it's a lot of information,

and I appreciate you mentioning the

pregnancy because have

multiple listener questions on

that very topic.

And speaking of listener questions,

Greg, I have a number of them for

you today.

So I think you answered

this question earlier.

But just to clarify for this

listener, this

listener wants to know about booster

shots. Are booster shots the exact

same vaccine as what

was given earlier?

So when you get a booster of Pfizer,

it's the same vaccine you received

earlier, whereas there's something

different about what is

being injected.

No, you're you're exactly

right, Helene. If you get a JNJ

booster, it is identical

to your first shot.

If you get a Pfizer booster,

it is identical to

the original Pfizer vaccine.

If you get them during a booster,

it is identical in composition,

but different in dose

instead of 100 micrograms.

You'll get half that, you'll get

50 micrograms.

And just to make it a little more

complicated when we

when we get to the point of

immunizing children five to

11, it will be

a third of the normal

Pfizer dose when we

get to six months, up to

four years.

It'll be a tenth of the normal

Pfizer dose.

So you know,

that'll have to be kept in mind and

people cognizant of that,

particularly the ones administering

vaccine. But the composition

of the vaccine is identical

across those doses, and that

really shouldn't be surprising.

We give a child a different dose

of medicine, for example,

than we do an

adult. So.

Right.

All right. Next question.

This individual states that they're

eighty four year old mother is frail

but not really immune compromised.

They've been trying to encourage her

to consider a booster.

She has heard from a friend that

the booster gave them COVID.

Is that possible?

Yeah, no, that's it.

That's impossible.

And just to correct two

misperceptions there,

even an otherwise

healthy, non frail

eighty four year old is

in essence, immunocompromised.

They have what we call immuno

senescence.

Their immune system has aged

to the point where they don't

have the same immune response

and are at increased risk.

And we use as a cutoff for that.

It saddens me to say since

I've now joined this club,

anybody over the age 65.

So, so in fact, she

absolutely should have a booster,

but it is impossible

to get COVID from

the vaccine.

All of the vaccines available

here in the US contain

one tiny

protein from the virus.

It is not a live virus.

It's sort of like taking

a pad and just taking

the little clicker ballpoint

part of it and saying that's the

vaccine.

It's not the pen you couldn't write

with it, just like you can't

get infected with

the virus or get COVID

from the vaccine.

Sometimes I wonder how these

things pop into your head ballpoint

pen in comparison

to Iraq.

It's a great analogy.

Thank you.

You know, you answered this a little

bit earlier as well, but this

individual is

thinking about receiving a booster

vaccination while pregnant.

She received the Moderna vaccine

and now is wondering if if

a booster is

recommended, should she

get the booster prior to her

delivery.

If it has been six

or more months since she

completed her primary

series, I don't think we can go over

this enough.

It's so important and

you're pregnant, even though you are

otherwise healthy.

I mean, I know pregnant women

are still running half marathons,

for example, in their prime.

They are healthy.

Because of being pregnant,

it increases their risk

for pulmonary infection

and complications such

as blood clotting.

And as we mentioned, the risk of

death that's seven times

higher.

A woman, her exact same

age and health, but who is

not pregnant.

So if it's been six or more months,

they do get a booster.

Now, if it's Moderna, they'll get

a booster. That's half the dose of

their primary series.

But really important that they get

that booster.

All right.

Our next listener says

they have kept their children home

from school so that they will not

develop COVID once they

are vaccinated.

Would it be safe to send them to

school for the rest of the school

year?

It's a good question, and

the way I want to answer it is this

way.

There's no such thing as safe.

I mean, fundamentally, I

think we have to acknowledge that

there's no such thing as safe.

What there is is safer

and being vaccinated is

safer than not

being vaccinated.

My personal opinion is the

best place for kids

is in school.

All the activities that are occur,

the learning, the group, learning

the socialization.

There's just there's just a lot

to that. That's important.

Whether they're in home, school or

public school or private school.

And so, yes, being immunized

offers them just

fantastic odds

of either not getting infected

or if they got infected, being

asymptomatic or

at worst, mild disease.

So very much so.

Worth immunization.

Now, I would have a discussion

with your health care provider

based on any medical conditions

that the child has and

any risks associated

with the vaccine.

As we have always talked about,

there are risks to the vaccines,

but they occur a handful

of times out of a million

versus the risks of disease.

And so you and your health care

provider can best make that

determination about

benefit and risk.

All right, this next question

is about vaccine dosing.

This individual has an 11 year old

daughter whose daughter

weighs an adult wait to about one

hundred and forty pounds.

She says that if the vaccine

is approved for under age 12,

she would get a smaller dose of the

vaccine as you discussed

it, if they were to wait three more

months until her birthday in

January.

She would get a larger dose

of the vaccine because she would be

12 years old.

Would you say that she should wait

and get the larger dose of the

vaccine or accept what could

be given now?

These are tough questions.

Yeah.

You know, again that balance of

risks and benefits

regardless of weight.

This recommendation is being made

by age, and so we're obligated

to follow the prophet provisions

of the EU way.

That's one point.

The second point is, and

I want to say this carefully.

More is not

necessarily better.

And what I mean by that is

if she were to get her dose,

whether her antibodies went

up 20 fold

or 40 fold,

I don't think matters.

The point is that she'll be

protected if.

And let me just make up the numbers.

If you're antibody level that you

need for protection is one hundred

and you get a booster and

it puts you up at a thousand.

Who cares if a larger booster

puts you up at twelve hundred?

You're so far above the level

of protection, assuming an

otherwise normal healthy child

that that I think to go against

the EU way and try to dose

somebody because you think

you know more would be better.

I really, I think that's

shaky scientific ground

and it's definitely shaky legal

ground.

And then I think of the months of

being inside.

If this individual is attending

school in the winter time

and those extra months of being

vaccinated are probably quite

important.

Oh yes. And you know, I think

the parent that wrote in

is thinking wisely

as as our listeners always

have here in asking

about that and asking questions

and being skeptical and looking

for answers, I think that's that's

great.

I am concerned that

as we see around the

US, numbers are dropping

now along the north.

They're not dropping, they're

rising.

When you look at North Dakota,

Montana, Idaho, Alaska,

Minnesota is up 12

percent.

And we're going to see that we've

seen this before.

We had really large high

numbers that started dropping

in late summer, only

to see the numbers pick back

up as people go indoors

and there's cooler, wetter weather

and the virus survives better.

So now, I think, is actually

a very opportune time

to get those boosters and try

to prevent that happening,

particularly with the

holidays coming.

Mm-Hmm.

That's a very good point.

Well, Greg, you gave us a lot of

information today.

I have reached the end of the

mailbag. Do you have anything else

you'd like to share with us today?

You know, I think that there's

there's going to be a lot of

information.

Social media is not always going

to get it right.

Please go to credible sources.

There's a lot changing.

The fact that recommendations

are changing, I want to urge you

is not evidence

that people don't know what they're

doing.

It's evidence that they do

know what they're doing and they're

paying close attention

to new data that's coming

along and then adjusting

recommendations based on

that. For example, we

heard just superb

presentations.

Israel is ahead of us in terms

of the use of boosters,

despite the fact that they had such

high levels of immunization.

They were seeing breakthrough cases.

We discussed before why

that is.

They embarked on their booster

program and reduced

cases by over 90

percent.

How that's the power

of these boosters over time.

Of course, when the two dose

recommendation was made,

we didn't have years of experience

with this virus to say, Oh,

well, everybody needs a booster

at six months.

We're just learning that now

as we get to this six, seven

and eight month since people

have been immunized.

So I do urge people

to take these recommendations for

boosters very seriously.

Thank you very much, Greg, for being

here again today.

My my pleasure, Helene.

Always good to work with you.

Always good to see you.

Our thanks to Dr. Greg Poland,

virologist, vaccine expert

and infectious disease expert at the

Mayo Clinic for being here today to

share our COVID updates.

I hope that you'll learn something.

I know that I did.

We wish each of you a wonderful day.

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