Transmission electron micrograph of SARS-CoV-2 virus particles (gold) within endosomes of a heavily infected nasal epithelial cell.
Credit: NIAID
My first two anti-COVID vaccines were the Astra-Zeneca vaccines but, for reasons of availability, my booster was the Pfizer vaccine. None of the vaccines caused anything more than the slightest discomfort at the injection site which lasted about 2 days. However, a friend of mine declined an offered booster because it wasn’t the same as the initial vaccine and thought there might be a smaller boost as well as doubling the risk of an adverse reaction.
So, which of us was right?
The preliminary results of a clinical trial by the US National Institute of Health, show that there is certainly no disadvantage in a mix and match approach and there may even be a benefit. The trial results are reported in The New England Journal of Medicine.
As the NIH News release explains:
The new report describes findings from 458 adults who had been fully vaccinated with any of three EUA COVID-19 vaccines at least 12 weeks prior to enrollment and who had no reported history of SARS-CoV-2 infection. At enrollment, a single booster dose was administered to each participant: 150 received Janssen/Johnson & Johnson’s Ad26.COV2.S vaccine; 154 received Moderna’s mRNA-1273 vaccine; and 154 received Pfizer-BioNTech’s BNT162b2 vaccine. Depending on which primary vaccine regimen a participant had received, the booster vaccine was either different (mixed, or heterologous) than or the same (matched, or homologous) as the original vaccine.What this means is that firstly, there were no serious vaccine-related adverse reactions; and secondly, heterologous (mixed) boosters gave the same or better levels of antibodies and increased T-cell response, compared to the homologous (matched) booster.
The trial participants kept diaries of any side effects. More than half of participants reported headache, pain at the injection site, muscle aches and malaise. No serious vaccine-related adverse events were reported.
All combinations of primary and booster vaccine resulted in increased neutralizing antibody levels (ranging from 4.2- to 76-fold higher levels than those detected prior to boost.) Likewise, all primary-boost combinations increased binding antibody levels 4.6- to 56-fold. For each primary EUA COVID-19 vaccine, heterologous boosts elicited similar or higher antibody responses as compared to responses to a homologous booster. Cellular responses (CD4 and CD8 T cell) also increased in all but the homologous Ad26.CoV2.S-boosted group, though CD8+ T cells were highest at baseline in those participants who had received the Ad26.CoV2.S EUA vaccine.
Taken together, the investigators concluded, “these data strongly suggest that homologous and heterologous booster vaccine will increase protective efficacy against symptomatic SARS-CoV-2 infection.”
These interim results cover available immunogenicity data through the initial 29 days following booster vaccination. Investigators will continue to follow participants for one year to assess what impact booster vaccination has on longer-term immune responses. Additional arms of the trial may test other investigational, EUA or FDA-approved COVID-19 vaccines and/or vaccines based on SARS-CoV-2 variants as the boosting vaccine.So, the message is clear:
Get boosted with whatever is available.
You don't need the same booster as your original vaccine(s).
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You don't need the same booster as your original vaccine(s).
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