Should you mix and match COVID boosters for your fourth dose?

Should you mix and match COVID boosters for your fourth dose?
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Now that people over 50 or those who are immunocompromised are eligible for a second covid reminder, you may be wondering if you should change the type of vaccine you receive for your fourth dose.

Evidence suggests that doing so for the third dose produces a stronger and more robust immune response, likely because vaccines stimulate our immune systems in different ways. Although there isn’t much data on the fourth dose, infectious disease experts suspect that mixing up your second booster will be just as beneficial.

While there may be a slight benefit to mixing vaccines, you’ll still be well-protected against serious consequences if you decide to stick with the same type of vaccine for your second booster, according to infectious disease experts.

The only caveat is that anyone who initially received the Johnson & Johnson vaccine will want to follow up with one of the messenger RNA (mRNA) vaccines like Pfizer or Moderna, as evidence consistently shows they provide stronger protection. . But mRNAs reinforce each other and can be exchanged safely.

“When it comes to the numbers that matter most, i.e. preventing hospitalizations, serious illnesses and deaths, there is literally no difference,” Onyema Ogbuaguan infectious disease specialist from Yale Medicine, told HuffPost.

What to know about mixing and matching booster shots

Data are limited on how mixing vaccines for your fourth dose specifically affects protection, but previous research shows that the mix-and-match strategy with the first three doses provided a broader immune response.

A National Institutes of Health study found that booster with a different type of vaccine than previously given was associated with higher antibody levels than people who received the same type of vaccine.

“If you switched, you actually had more of an immunological response than if you continued with the same vaccine,” said Robert MurphyNorthwestern Medicine infectious disease physician.

This is likely because the body reacts differently to vaccines, which ultimately helps produce a broader immune response.

“I think there is some evidence that mixing and matching between mRNA vaccines may have some benefit because they slightly stimulate the immune system in different ways,” said Amesh Adalja, infectious disease expert and principal investigator at the Johns Hopkins University Center for Health Security. Adalja thinks this same biological principle would also apply to the fourth dose.

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Experts believe there are some benefits to changing your COVID shot when you get a fourth booster.

The benefits of changing the dose appear to be most pronounced in people who initially received the single-dose Johnson & Johnson vaccine.

“Achieving an mRNA boost above a J&J primary results in higher antibody levels and higher clinical protection than J&J above J&J,” Ogbuagu said. For those who initially received the J&J vaccine, it is recommended to boost them with a Pfizer or Moderna vaccine.

The mRNA hits are quite comparable, according to Ogbuagu. “The mRNAs are building up nicely, but Moderna probably has a little edge,” he said.

This is likely because Moderna has a higher antigen dose and longer dosing interval than Pfizer. A study Evaluation of the effectiveness of the Pfizer and Moderna vaccines recently revealed that people who received the Moderna vaccine had more antibodies in the nasal mucosa, which helps prevent infection.

At this point, however, experts say it’s fine to opt for the other type of mRNA or stick with what you had. Both do an excellent job of stimulating robust immune responses against variants.

“There is no formal recommendation,” Murphy said. “People can just continue with the one they had or they can move on to the other.”

Don’t wait for an updated vaccine

Some people have waited for a fourth dose for an updated vaccine. Although we may eventually have variant-specific or pan-coronavirus vaccines, it is unclear when they will be available.

Murphy advised against waiting for an updated shot because the risk is now. The omicron BA.2 and BA.2.12.1 are already sweeping the population. Ogbuagu thinks the number of cases we are seeing now – close to 100,000 cases per day – are grossly underestimated as many rely on rapid home tests which go unreported and therefore not included in the official case tally.

We know that staying current with current vaccines and being boosted when eligible restores protection against severe consequences, even with new variants.

“We are in the midst of another wave of infections so now is the time to get it,” Ogbuagu said.

Experts are still learning about COVID-19. The information in this story is what was known or available at the time of publication, but advice may change as scientists discover more about the virus. Please check out the Centers for Disease Control and Prevention for the most recent recommendations.

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