Sue writes:
Hello Dr. Griffin,
First, a big THANK YOU to you and everyone at TWiV for the ongoing and wonderful discussions of the science of virology and especially COVID-19 each week.
The FDA has approved updated mRNA COVID-19 boosters for fall 2024 from Moderna and Pfizer. My understanding is these boosters are based on the KP.2 strain, one of the FLiRT variants currently circulating. The FDA has not yet approved an updated Novavax booster for 2024-2025, but I expect it will before long. Novavax’s website indicates it is working with the FDA on an EUA (Emergency Use Authorization) for its updated booster and that its booster is based on “JN.1, the ‘parent strain’ of currently circulating variants” and that the Novavax’s updated booster “has demonstrated cross-reactivity against JN.1 lineage viruses, including KP.2.3, KP.3, KP.3.1.1 and LB.1.”
I’ve been following the TWiV discussions about durability of the mRNA vaccines/boosters compared to protein-based vaccines/boosters. I’d like to have the most durable and effective booster (I’ve had all the recommended vaccines/booster and one COVID-19 infection) this fall.
My questions:
1) Will a protein-based vaccine based on the parent strain (JN.1) provide better protection against severe COVID-19 than an mRNA vaccine based on one of the currently circulating variants evolved from that parent strain ? I understand, from TWiV, that these vaccines are not intended to prevent infection.
2) How much more effective/durable is one compared to the other, i.e. is there a measurable difference between a protein-based vaccine that targets the parent strain or an mRNA vaccine targeting variants evolved from the parent strain?
3) What data is there about these distinctions, durability and efficacy, from earlier vaccines that target parent strains compared to evolved and circulating variants from the parent?
Again, thanks for all that you do to keep listeners informed!
Sue
Portland, Oregon
Yeida writes:
Hi,
I recently visited my PCP for my yearly physical exam. I asked the physician if they could prescribe Paxlovid, as I expect to travel out of the country and would like to have the medicine with me should I test positive for Covid-19 abroad.
I am an asthma patient, and have always use the antiviral drugs when I’ve gotten sick with Covid-19. However, the physician mentioned that the healthcare system she works for requires filling and submitting a form, after testing positive, which can only be completed and submitted while the person is in state (Florida).
Otherwise they will not prescribe Paxlovid. She also mentioned that they are not prescribing the drug much and mostly treating Covid-19 infections like the flu due to decreased Paxlovid effectiveness. I feel somewhat skeptical about their claims for not prescribing Paxlovid and I am concerned about the difficulty to obtain a prescription.
Could you please clarify about prescription guidelines as they refer to prescribing for people with asthma and potentially leaving the country who prefer to have the drug at hand? Also, are there any guidelines for Healthcare systems regarding their policies that affect clinician prescription practices? I am concerned the procedure she explained makes getting Paxlovid more difficult and can cause delays in starting treatment.
All the best,
Yeida
Amy writes:
Hi TWIV & Dr. Griffin,
This might be above your pay grade, but if anyone had an opinion, I figured you would. I’m 50, and in the ELEVATE clinical trial (https://clinicaltrials.gov/study/NCT05563220), in the ribociclib (Kisqali) arm, taking 400mg daily for three weeks and then a week off. I’m also taking 300mg Elacestrant daily without a break. So far my WBC count has been low but stable at ~3.2 K/uL.
I’ve asked my oncologist if she has a recommendation for timing vaccines this fall for best immune response, and she has had no opinion aside from *after* scheduled scans, and in my left arm (I’m de novo oligometastatic with one metastasis in my right lung, primary tumor is on my right). Should I time my vaccines during the one week break? Am I overthinking this? I’m looking to get the shingles vaccine, and Covid and flu when they become available.
Thanks for all you do,
-Amy
Richard writes:
Hi Daniel
I am someone who got long Covid early on in Dec 2020 and there was little information then beside patient groups on social media.
My primary care physician was fantastic and he acted as quarterback as I got all manner of testing and treatments as that first 12-18 months I felt I would not survive as it seemed all organs and systems were malfunctioning. So with extreme PTSD I was very fearful of reinfection which did happen 2 years exactly later. Still suffering long Covid symptoms although improved I asked my Doc for Paxlovid which he called in immediately. My goal was to cut viral load asap to limit more damage. I am happy to report pretty severe flu symptoms dissipated within 24-36 hours. Fast forward post infection my doctor wrote me another prescription for Paxlovid to keep on hand. I have not had covid since but is it true that Paxlovid can expire out? Another doctor client of mine told me that it’s not true just keep it on hand.
Thank you