Boosters for Immunocompromised and Patients at High Risk
Continuing Education Credits
In support of improving patient care, Community
Health Center, Inc. / Weitzman Institute is jointly
accredited by the Accreditation Council for
Continuing Medical Education (ACCME), the
Accreditation Council for Pharmacy Education
(ACPE), and the American Nurses Credentialing
Center (ANCC), to provide continuing education for
the healthcare team.
A comprehensive certificate will be sent after the
end of the series, December 2021.
Disclosures & Disclaimers
With respect to the following presentation, there has been no relevant (direct or indirect)
financial relationship between the faculty listed above or other activity planners (or spouse/partner)
and any for-profit company in the past 12 months which would be considered a conflict of interest.
The views expressed in this presentation are those of the faculty and may not reflect official
policy of Community Health Center, Inc. and its Weitzman Institute.
We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or
under investigation (not FDA approved) and any limitations on the information that are presented,
such as data that are preliminary or that represent ongoing research, interim analyses, and/or
This project is supported by the Health Resources and Services Administration (HRSA) of the
U.S. Department of Health and Human Services (HHS) as part of an award totaling $137,500 with 0%
financed with non-governmental sources. The contents are those of the author(s) and do not
necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S.
Government. For more information, please visit HRSA.gov.
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Delta Variant – “like COVID on steroids”
• It is a variant of concern! (VOC)
• One of the most transmissible viruses known
– (Up there with chickenpox, varicella)
• Contains at least 13 mutations from the original strain
– 4 of these are of particular concern affecting the Spike protein
• Higher transmissibility, more amounts of virus (1200x)
• Stronger attachment to ACE-2 receptor
• Decreased recognition by the immune system
• Increased cell to cell infectivity (?)
• Delta itself is mutating further: DELTA VARIANTS
– AY.1 to AY.38
– ‘Delta plus’ AY.1 and AY.2
Groups at Higher Risk for Infection
Asthma Serious Heart Disease
Chronic Lung Disease Hemoglobin Disorders
Diabetes Nursing home residents/LTC
Chronic Kidney Disease - Dialysis Aged 65 and older
Liver Disease Immunocompromised
The Amazing Immune System
Working ‘Behind the Scenes’
• Receive the vaccine, immunity starts to go up
• Get a second shot – and immunity increases nicely
Do we need boosters?
What might happen
immunologically after a booster?
• Receive the primary series, immunity very good after 2nd shot
Get a booster shot ….
Get a booster shot expect immunity to explode upwards!
“It's very, very clear that
there's waning immunity,
and we need to boost
individuals who have
received any of the three
products that we've been
dealing with right now”
– Dr. Anthony Fauci
• Pfizer vaccine approved 3rd shot 6 months out
• Moderna, J&J - could get approval as booster
shots this week - by Wednesday evening?
– Up to the full FDA and CDC to give the green light
– 15 million Americans got Johnson & Johnson
• “Mix and match” study showed increased
– J&J vaccines given another J&J booster = 4x
– J&J vaccines given Moderna = 76x increase
“Mixing and Matching”
• The immune system will respond to what it
– NIH study: Atma RL et al. Heterologous SARS-CoV-
2 Booster Vaccinations – Preliminary Report
• COVID-19 vaccines are robust!
– Pfizer vaccine: Left hook
– Moderna vaccine: Right jab
– J&J: Big punch
Moderna or Pfizer Boosters for Johnson &
• Providers should be given a measure of
discretion as the campaign ramps up
– Dr. Paul A. Offit, FDA and Children’s Hospital of
Philadelphia, noted “we should move quickly on
this, because it’s already happening.”
• Operationally: try to make it easy…
COVID-19 Vaccinations Across the Nation
COVID-19 Boosters Across the Nation
Percent Fully Vaccinated by State for the
10/18: Welcome everyone – today’s topic concerns immunocompromised and high risk patients: with a focus on boosting immunization.
10/4/21: Here you can see from the map the ‘hot spots’ occurring around the country. The Darker colors mean more active infections: Alaska, the “Mountain West”, some parts of the midwest – Coal mining areas (W Virginia).
10/19: . ~86,000 new cases/day (down from 160,000 daily beginning of September) -most states are rebounding… TROUBLE spots: Colorado, Vermont, Michigan ALASKA – still having trouble - may have peaked? ANCHORAGE approved a MASK MANDATE – who would believe?? -FLORIDA is much better – one of the lowest average daily cases in the U.S.
10/18/21: Here you can see with the red arrow where we are with ‘new’ reported cases… the Summer Surge is thankfully declining nicely… For 10/17 – 7 day average was 83,576 cases/day. Monday 22,152 (always low on a Monday)
10/18/21: New Cases are trending downwards…
B.1.617.2 (India) – DELTA variant -"like Covid on steroids," Andy Slavitt, former White House senior adviser for Covid-19 response -thee dominant strain: 99% of all new infections (in the middle of June – just 20%) CDC -Researchers: 1260x more virus in nasopharynx than wild type -shorter onset: 4 days rather than 6
Of course those who were never immunized: Now at higher risk of contracting it The vaccines work – up to a point, in the face of this new threat.
Who are those most at risk?
The most important diseases as risk factors: Cancer Cerebrovascular disease Chronic kidney disease* COPD (chronic obstructive pulmonary disease) Diabetes mellitus, type 1 and type 2* Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies) Obesity (BMI ≥30 kg/m2)* Pregnancy and recent pregnancy Smoking, current and former
Enormously complex ‘work of art’ As you can see – there are different parts to it… B cell arm – creating antibodies…. T cell arm- army of cellular defenses – cells that go on the attack! Myriad other supports – FEVER being an example of that… the FEVER response. It turns on and starts to ‘hurt’ the invaders.
Should be getting 3rd shots – booster shots as of now…
Should be getting 3rd shots – booster shots as of now…
*antibody increases were seen after 15 days from the booster… J&J vaccinee given a PFIZER booster – also increased the titers. (They were only measuring antibodies –NOT the cellular immune response) COULD NOT COMPARE mRNA vaccines based on this study – not designed to… Johnson & Johnson is headed for a booster shot of its vaccine at least two months after the first dose.
This is interim data from an ongoing study study has limitations. It was not designed to directly compare responses between different booster regimens. Still a lot that’s unknown: The immunogenicity data are limited to immune responses through Study Day 29, and only serologic responses are reported. The different homologous and heterologous vaccination regimens may vary in terms of cellular and humoral immune responses as well as longevity of the response.
unclear what dosage of Moderna’s vaccine might be authorized for use as a booster for recipients of other vaccines
10/19: Connecticut 69.9% Vermont: 70.6% Puerto Rico – doing very well: 72% immunized Alaska – 51.7%