Today the Weekend Editrix got shot (for the 6th time!)Tagged:
Today the Weekend Editrix got shot, also for the sixth time this year! It was pretty good.
Choosing a booster
(Did you know that during my mis-spent childhood, “boosted” was slang for “stolen”? Language is weird.)
We’re pretty vax-positive, here at Chez Weekend. But… 6 shots each in 1 year? That’s pretty weird: 2 Pfizer for COVID-19 + 2 Shingrix for shingles + 1 Seqirus Fluad for influenza… and now a COVID-19 booster. I guess this is what happens when one reaches a certain mature age in a time of pandemic.
Given that heterologous boosters are now approved, she has a few more options for boosting than I had. So we looked over the data on booster effects presented at the FDA hearing on mix-n-match boosters  to figure out what to do. The goods are on slide 22 (page 23, if you include the header page the FDA tacked on):
Here Kirsten Lyke, Robert Atmar, and colleagues at NIH/NIAID did a small trial with all possible combinations of primer vaccines and booster vaccines, in all orders. Since there are 3 vaccines available in the US (Pfizer, Moderna, and J&J) that means the results are a 3x3 matrix of the 9 combinations as shown here. The levels are pseudovirus neutralization antibody titers for the D614G variant:
- The primer vaccine is shown on the columns. Since the Weekend Editrix, like your humble Weekend Editor, got the Pfizer vaccine, it’s the 3rd column that’s relevant.
- The booster vaccine is shown on the rows.
- The blue number shows the neutralizing antibody titer (bigger is better here).
- The red number shows the geometric mean fold ratio (basically how many times larger the antibody count is two weeks after boosting; bigger is also better here).
So her choices for a booster to follow Pfizer have these results:
So based on both antibody level and fold induction, it looks like Moderna is her best bet for getting the strongest immunity. She agreed. Since she hates fiddling with all the computer barriers thrown up around getting vax appointments, I found an appointment for her to get Moderna about a week later.
Getting the booster
“About a week later” is today!
We boarded the Weekend Zeppelin and set sail for the pharmacy, a short ride away. It was early evening, because we’d timed the booster appointment (a) to work around the Weekend Editrix’s work meetings, and (b) to time the side-effects to happen mostly while she’s asleep.
Herewith the now regrettably-canonical stick pic. While it may be regrettable that we have to get so many vaccinations, it’s more regrettable that so many others will not do so, and are thereby both prolonging the pandemic and breeding new variants.
After that, we adjourned to her favorite restaurant for dinner and then boarded the Weekend Zeppelin for the short sail homeward to Château Weekend.
Look: it’s easy to get vaccinated, so easy that even a couple of weird folks like us can do it. You can do it too.
The Weekend Conclusion
All boosted here; 2 weeks from now we will both be as immune as science can make us so far. If another booster is required next year, we’ll happily take that, too. Though, truth be told, we’d prefer it if all the vaccine resisters got vaccinated so we could wind down the pandemic (mabye replace it with endemic conditions, but wound down).
Ok, technically, we’re not all boosted here. The Weekend Publisher has been lagging behind, as shown here in his favorite “lagging behind” pose. Not because he’s a vaccine denialist, of course; he is, after all, my cat! Rather because veterinary vaccines are not yet available. 
But when feline vaccines are available… there’s gonna be a coupla quick trips to the vet, followed by some cat treats to restore diplomatic relations to a state of general amity and decorum.
(Also, I may have exaggerated that part back there about the zeppelin.)
Addendum 2021-Oct-28: Side effects
Well, that turned out to be a bit rougher than either of us thought it would be.
Both of us had relatively mild reactions to 2 doses of Pfizer, and I had a mild reaction to the 3rd Pfizer booster. We figured that Moderna at half dose in the booster should be comparable.
Wrong: today she has +3°C fever, aches all over, extreme fatigue. After digging around the CDC advisories, we figured out that Tylenol/acetaminophen was ok if taken a while after the vaccination. So at VAX + 14 hours this morning, we got a couple time-release acetaminophens in her that will work for the next 8 hours. After breakfast (and after retrieving with me the Weekend Publisher from the back yard, the little snot having escaped the tent on the back deck into the wilds of the back yard) and a light lunch, she went back to bed. Sleeping now, with a cold compress on her forehead.
So it doesn’t look serious, but it does look annoying.
I’m slightly jealous: I want my immune system to work that hard building immunity for me, too. (Yes, I know: this is the innate immune system, not the acquired immune system, which is the one that matters. Still!)
Updates later when things change.
Addendum 2021-Oct-29: Side effects abate
All better. Fever reduced, aches & pains fading. Still a bit of a headache, but overall ok.
Notes & References
1: K Lyke, et al., “DMID 21-0012 - Heterologous Platform Boost Study Mix and Match”, FDA VRBPAC 2021-Oct-15 Materials, retrieved 2021-Oct-15. ↩
2: S Ventiera, “Is a COVID-19 Vaccine for Pets on Its Way?”, AARP, 2021-Aug-26. ↩
Thanks for this info! If I’m reading the plot correctly, Moderna also gives me the strongest response if my original shots were Moderna?
I wasn’t in a hurry to get boosted because I was slammed by my second dose of Moderna at the end of April, unable to get out of bed for about 24 hours. But, my 80-yo mother was just hospitalized with Covid across the country, Omicron is coming, etc., so I now have a Moderna booster scheduled Monday morning.
I read something yesterday about the J&J booster having the highest response via T cells, though lower via antibodies. Have you heard anything about that? Would that be valuable, especially in light of Omicron?
Yes, Moderna seems to give the highest fold ratio of abs. But then, you’d expect that, given Moderna is just dosed higher than Pfizer.
I don’t know any studies on T-cell activity in response to COVID-19 vaccines. Might be some studies, but I just haven’t seen them.
When you mention adjourning to the favorite restaurant, what type of visit was it? Pick-up? Dining outdoors? Eating indoors? Curious about your risk tolerance now.
Let’s just say that: (a) it was her real favorite, where we had not gone in a year and half, (b) I owed her a favor for allowing me to talk her into the booster, and (c) her risk tolerance is way higher than mine.
So… indoor dining. But both of us highly vaccinated, large distance to nearest other customers, and staff all masked. A tolerable risk.