Third vaccine to boost antibodies against COVID infection?

Posted by lizzy102 @lizzy102, Apr 25, 2021

Has anyone heard of or has information about transplanted folks receiving a third or another set of vaccines? I’m 20+ years out on my renal transplant and am thinking this might be a good thing to try.

Interested in more discussions like this? Go to the Transplants Support Group.

@colleenyoung

Dr. Poland, Mayo Clinic infectious diseases expert addresses the question of a booster shot and organ transplant recipients in the latest Q&A podcast here:
- Summer travel and people not in your bubble during COVID-19 pandemic https://connect.mayoclinic.org/blog/podcasts/newsfeed-post/poland-2/

Start at 16:00 minutes.
From the transcript:
“So, let's take the case of solid organ transplant patients. They're among the most immunosuppressed. So, how do we protect them? Well, the studies have shown and I'm going to simplify because there are a number of studies. But after one dose, you maybe get protection in the low teens. After two doses about 30 to 40% of transplant patients can be protected. After three doses, and I'm talking about mRNA vaccines now, they've been able to demonstrate protection up to about the 70% level. So, I was on a phone call last week with senior decision makers in the US about this. And you know, we talked very freely about the fact that we need more data. We are keeping an eye on these variants. It is likely to be the variants over anything else that might push us toward a booster. So, again, we're seeing an effect we need never have worried about had we been able to get people to wear masks and get vaccines. So, I think we'll first see recommendations in people who are highly immunosuppressed. I think it's very much an open question at this point as to whether otherwise healthy people will need vaccines, possibly we'll see a recommendation in the elderly. But again, we don't have a full measure of what's called a correlative protection. And even those correlates of protection, for the most part, ignore cellular immunity, which is an arm equally as important as antibody. So, a lot of work and research to be done. I think where we'll make that decision is if we start seeing breakthrough infections occur at greater rates over time in certain subpopulations, like organ transplants or immunosuppressed, or the elderly. But at this point, I think we're doing the right thing and preparing for the idea, but I think any recommendation at this point would be premature.“

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Thanks I like seeing that they are really watching the data rather than just go for it and see what happens. That's been a bit of my concern is it seemed everyone was following the crowd and not looking at all data. For me it seemed that everything needed the stamp of a few agencies like Who and CDC Or NIH but there are thousands of good scientist looking at all aspects so I would hope that Mayo Is also looking at all the data.
Dana

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Article in NY Times this morning about third vaccine shot trials being planned by Moderna and Pfizer.
https://www.nytimes.com/2021/07/04/health/coronavirus-immunity-vaccines.html

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Good article on today’s news on approval of a booster vaccine shot for organ transplant recipients.

FDA authorizes extra vaccine doses for immunocompromised patients to bolster protection against the coronavirus
The Food and Drug Administration action means additional shots might be available as soon as this weekend

https://www.washingtonpost.com/health/2021/08/12/booster-shot-coronavirus/
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I made some phone calls yesterday, and found that my local CVS pharmacy has the Pfizer vaccine that I had for my 1st and 2nd doses. They are waiting for further directions and guidelines before proceeding with shots. I don't know if I will need a prescription or proof of transplant, or if I can just walk in. I hope to learn more soon as the info trickles through the system.

From mayo News network Aug 13, 2021
COVID-19 booster for immunocompromised people: What does the term mean?
https://newsnetwork.mayoclinic.org/discussion/covid-19-booster-for-immunocompromised-people-what-does-the-term-mean/#

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Called my PCP Thursday to set up an appt for a 3rd/booster Moderna and they said they can't do anything until the FDA approval on Friday (8/13/21). Which is what I expected. Have any of you had better experiences with PCPs or vaccinations for the 3rd shot?

There is this article posted on the New England Journal of Medicine that's from Canada on their results from a booster or 3rd shot. I'm a 35 year out kidney transplant and have kept on top of new developments. Probably more information than anyone wants but the details are rather informative (and new) in terms of the results. (You may be able to read gratis without a subscription.)

https://www.nejm.org/doi/full/10.1056/NEJMc2111462

Randomized Trial of a Third Dose
of mRNA-1273 Vaccine in Transplant Recipients

To the Editor: In organ-transplant recipients, the standard two-dose vaccination strategy for coronavirus disease 2019 (Covid-19) has suboptimal immunogenicity.1

Both patients and health care providers have questioned whether a third-dose booster in transplant recipients would be safe and enhance immune response.2

We performed a double-blind, randomized, controlled trial of a third dose of mRNA-1273 vaccine (Moderna) as compared with placebo (the protocol is available with the full text of this letter at NEJM.org;

ClinicalTrials.gov number, NCT04885907).

Transplant recipients who had received two doses of mRNA-1273 were randomly assigned in a 1:1 ratio to receive either a third dose of
mRNA-1273 vaccine or saline placebo 2 months after the second dose of mRNA-1273 (dosing schedule: 0, 1, and 3 months). The primary outcome was a serologic response characterized by an anti–receptor-binding domain (RBD) antibody level of at least 100 U per milliliter at month 4 (measured with an Elecsys Anti-SARS-CoV-2 immunoassay [Roche]). This outcome was prespecified and was based on the protective anti-RBD titer in a challenge study involving nonhuman primates3; it was further corroborated in a large clinical cohort as the upper boundary of the estimated level required to confer 50% protective neutralization.4

Secondary outcomes included the percent neutralization, as measured with a validated surrogate virus neutralization assay
(Genscript), and the polyfunctional T-cell response (see the Supplementary Appendix, available at NEJM.org).

We enrolled 120 organ-transplant recipients (Fig. S1 in the Supplementary Appendix). No patient had a previous diagnosis of Covid-19.
The baseline characteristics were similar in the two groups (Table S1), as were the preintervention anti-RBD antibody levels and neutralizing antibody levels (Fig. 1B, 1C, and 1D). The median age of the patients was 66.6 years (interquartile range, 63.3 to 71.4), and the median time from transplantation to the third dose was 3.16 years (interquartile range, 1.71 to 6.12).

At month 4, an anti-RBD antibody level of at least 100 U per milliliter was present in 33 of 60 patients (55%) in the mRNA-1273 group and in 10 of 57 patients (18%) in the placebo group (relative risk, 3.1; 95% confidence interval [CI], 1.7 to 5.8; P<0.001) (Fig. 1A and Table S2). The changes in anti-RBD antibody level from before to after the third dose are shown in Figure 1B.

After the third dose, the median percent virus neutralization was 71% in the mRNA-1273 group
and 13% in the placebo group (95% CI for the between-group difference, 11 to 76 percentage
points), and the percentage of patients above the 30% threshold for neutralizing antibody positivity was 60% and 25%, respectively (relative risk, 2.4; 95% CI, 1.5 to 4.0) (Fig. 1C and Table S2).

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@rosemarya

I made some phone calls yesterday, and found that my local CVS pharmacy has the Pfizer vaccine that I had for my 1st and 2nd doses. They are waiting for further directions and guidelines before proceeding with shots. I don't know if I will need a prescription or proof of transplant, or if I can just walk in. I hope to learn more soon as the info trickles through the system.

From mayo News network Aug 13, 2021
COVID-19 booster for immunocompromised people: What does the term mean?
https://newsnetwork.mayoclinic.org/discussion/covid-19-booster-for-immunocompromised-people-what-does-the-term-mean/#

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@rosemarya I put a question in to my oncologist yesterday, but they did not respond, yet. It presents a dilemma, as my chemo starts on Fri 8/20, and it is my impression they vaccine needs to have a certain time befroe you can start up on the chemo again. Like there isn't enough on my plate, right?...

My husband will speak to his nephrologist on Thurs, at his quarterly appt, about getting a third vaccine.
Ginger

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@gingerw

@rosemarya I put a question in to my oncologist yesterday, but they did not respond, yet. It presents a dilemma, as my chemo starts on Fri 8/20, and it is my impression they vaccine needs to have a certain time befroe you can start up on the chemo again. Like there isn't enough on my plate, right?...

My husband will speak to his nephrologist on Thurs, at his quarterly appt, about getting a third vaccine.
Ginger

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I went to my CVS a couple of months ago ( after JH spoke about a 3rd shot being approved in France for immunocompromised people) and received my 3rd Moderna shot. Prior to that I was checked and had zero antibodies. Now, after a tither test, I do have high antibodies. I was asked Zero questions, and I did not offer any information. I'm a Liver and Kidney transplant patient. I hope the third shot is as successful for everyone else. I do still mask and avoid crowds. At that time no doctor would suggest the third shot per FDA regulation, however I see that over one million people have already done so outside of guidelines.

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Walked into my local Walgreens yesterday, asked for the third shot, and got it after some paperwork. I was prepared with my existing freedom card (CDC Covid-19 Vaccination Record Card) in hand, my open Mayo app referencing the report on my heart transplant, the Walgreens records of all the immunosuppressant drugs I take, and the worn transplant advisory bracelet. I did not have to resort to showing my chest scar (healed very well). Other than a rare afternoon nap and slight shoulder stiffness this morning I have no other side effects yet. The pharmacy technician and lead pharmacist seemed to be quite excited as I was their first third-shot-solid-organ-transplant customer.
Best always,
s!

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@scottij

Walked into my local Walgreens yesterday, asked for the third shot, and got it after some paperwork. I was prepared with my existing freedom card (CDC Covid-19 Vaccination Record Card) in hand, my open Mayo app referencing the report on my heart transplant, the Walgreens records of all the immunosuppressant drugs I take, and the worn transplant advisory bracelet. I did not have to resort to showing my chest scar (healed very well). Other than a rare afternoon nap and slight shoulder stiffness this morning I have no other side effects yet. The pharmacy technician and lead pharmacist seemed to be quite excited as I was their first third-shot-solid-organ-transplant customer.
Best always,
s!

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Scott, did you speak with the docs first? Just curious.

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