Is second booster recommeded after Evusheld?

[Ibru]

Have had four Pfizer vaccines and the last one was six months ago. Then had Evusheld three weeks ago. I am on Ibrutinib.

Is another vaccine booster recommeded? I have heard the effect of the vaccine would be "neutralized by the Evusheld.

[Palmetto]

Can you get the spike protein igg q test to check on antibody response? Husband got Evusheld in late January and just showed 150.00 Way high. May not need the booster. He had Obinutuzumab last infusion August 2021. His was the lower dose not the one recommended now.

[Bikram21]

I can’t imagine that Evusheld cancels the vaccine. Evusheld doesn’t take the place of the vaccine. 🤞

[AussieNeil Administrator in reply to Bikram21]

The Evusheld monoclonal antibodies can neutralise the spike proteins, so our immune system has nothing left to stimulate antibodies.

[Bikram21 in reply to AussieNeil]

I was thinking that Evusheld gave me extra protection.

[AussieNeil Administrator in reply to Bikram21]

Yes, Evusheld provides (monoclonal) antibodies that we may not be able to make. If you want protection from both vaccination and Evusheld, you should have the vaccination at least two weeks before the Evusheld administration, for the reason I explained above.

Neil

[Bikram21 in reply to AussieNeil]

Do you suppose the antibodies produced from the 4 vaccines are still helpful?

[AussieNeil Administrator in reply to Bikram21]

Yes, vaccinations can provide better protection in that:-

1) Evusheld doesn't work as well against later variants, whereas vaccinations are proving to provide wider immunity

2) Vaccinations can also provide T cell imunity

3) Vaccinations also hopefully leave us with memory B and T cells. These can respond to the challenge of an infection by rapidly multiplying to produce more antibodies and T cells.

Neil

[ragged]

This is my concern also. My CLL specialist team in Boston has recommended a 2nd booster but AssieNeil’s comments suggest that it may diminish the efficacy of Evusheld and also that Evusheld may diminish the potential for a robust immune response to the 2nd booster. As I am just now one year out from my last Obinutuzumab infusion (which depletes B lymphocytes needed for a making antibodies in response to vaccines), I am feeling more inclined to wait on obtaining the 2nd booster. My rationale is that my lymphocytes are still very low, which may suggest a decreased readiness to form antibodies. I may actually have greater protection from the Evusheld alone. Would very much appreciate the thoughts of others on this topic which would seem relevant to all of us.

[AussieNeil Administrator in reply to ragged]

I can't see how COVID-19 vaccination can diminish the effectiveness of Evusheld. In fact, it's recommended to have boosters at least 2 weeks prior to having Evusheld to give you the best of both approaches to minimising your risk from COVID-19.

In your situation, I too would defer your booster until your Evusheld top up protection wanes and you have more healthy B cells to respond to a vaccination and produce some of your own antibodies. A booster now would probably boost your T cell response to coronavirus exposure, but we currently don't have much information about how our T cells respond to vaccinations.

Neil

[Ibru in reply to AussieNeil]

Thanks Neil.

[ragged in reply to AussieNeil]

Thank you Neil. I very much appreciate hearing your perspective on this.

[ElMaga in reply to AussieNeil]

would you clarify? I had my Evusheld March 10; I was thinking of getting my booster 70-90 days out. Are you saying it would likely be better to wait longer, closer to the next Evusheld injection? thanks!

[AussieNeil Administrator in reply to ElMaga]

We really don't know the optimum timing, which in my opinion cannot be a fixed recommendation. I would suggest the best timing needs to take into account how well an individual responds to vaccinations, what variants are likely to be around in the future and the relative degree of protection from both.

Neil

[HopeME in reply to AussieNeil]

Hi Neil

How much time/research do you think is needed before the medical community has a firm understanding of best Covid vaccine timing protocol, a better understanding of the disease, etc.? Is this like the novel agents where it may be many, many years until the science is settled or could it be sooner? It seems that since the virus has weakened, government funding in the US (and other countries as well) is depleted and there are post infection treatments the urgency has diminished.

I must admit, my fear of this virus is significantly lower than it has been. I’d feel different if I were on active treatment but right now I’m less concerned than anytime since the pandemic began. It is hard to maintain a state of heightened fear for years and years.

Best

Mark

[AussieNeil Administrator in reply to HopeME]

Hi Mark,

While we have learned an incredible amount about SARS-CoV-2 in the last 30 months, the continuing appearance of new variants which are more contagious and vary in how they infect us, is proving challenging to keep up with. We are also only just beginning to investigate how long covid arises and how best to treat it. There is no guarantee that future variants of the virus will less serious. In fact, a fair amount of the reduction in symptom seriousness with Omicron is considered by some to be due to previous infection or vaccination protection. That protective benefit is reducing due to many not bothering to have the recommended booster.

I agree many governments consider that the urgency has diminished as people just want to get on with their lives, accepting living with what's around the third or fourth leading cause of death.

I consider that we need the development of vaccines and monoclonal antibodies which are less susceptible to RNA changes along with better antivirals before we can really get back to the pre-pandemic normal. However I wonder if there is the will to do this.

Neil

[AussieNeil Administrator in reply to AussieNeil]

This The Conversation article summarises the situation in Australia

theconversation.com/reducin...