Booster vaccines for COVID-19 vaccine breakthrough cases?

We read with interest the Viewpoint by Philip Krause and colleagues.1

  • Krause PR
  • Fleming TR
  • Peto R
  • et al.

Considerations in boosting COVID-19 vaccine immune responses.Although considerations for boosting COVID-19 vaccine immune responses are surprisingly controversial, several existing non-COVID-19 vaccines have routine three-dose regimens to provide maximum efficacy. A recent study from Israel reinforces the value of a third vaccine dose in individuals aged 60 years or older2

  • Bar-On YM
  • Goldberg Y
  • Mandel M
  • et al.

Protection of BNT162b2 vaccine booster against Covid-19 in Israel. and the recent decision by the Food and Drug Administration to recommend an additional vaccination in those aged 65 years or older in the USA reflects the need to continue to protect the most vulnerable. Bar-On and colleagues show data supporting an additional dose,2

  • Bar-On YM
  • Goldberg Y
  • Mandel M
  • et al.

Protection of BNT162b2 vaccine booster against Covid-19 in Israel. but they do not cover efficacy of a third dose for someone who has had a breakthrough infection after full vaccination. These are individuals usually with no underlying known immunogenicity, who, nonetheless, for a variety of reasons (ie, higher exposure to viral inoculum, prolonged exposures to multiple infected people, or a previously undiagnosed mild immunodeficiency) become infected with SARS-CoV-2. Although there are many potential reasons for vaccine breakthroughs, including variants, it might be that a booster dose is most needed in those whose vaccine-induced immunity had already failed. Official data from Israel have shown that in those who receive a third dose, with or without breakthrough infection, there are potential side-effects, although similar to or better than after dose two of the primary series.3Israel Ministry of Health
Link to the lecture: The efficacy of the third dose, recovered individuals’ protection and updates on the monitoring of side effects. Careful monitoring is needed for vaccine breakthrough cases since they might be the most susceptible to additional re-infections and might be most in need of another dose of vaccine.

RES declares consulting fees from Miromatrix and Alnylam, payment or honoraria from Alnylam, and has a scientific advisory board role at Miromatrix. DFN and LCN declare no competing interests.

References

  1. 1.
    • Krause PR
    • Fleming TR
    • Peto R
    • et al.

    Considerations in boosting COVID-19 vaccine immune responses.

    Lancet. 2021; 398: 1377-1380

  2. 2.
    • Bar-On YM
    • Goldberg Y
    • Mandel M
    • et al.

    Protection of BNT162b2 vaccine booster against Covid-19 in Israel.

    N Eng J Med. 2021; 385: 1393-1400

  3. 3.
    • Israel Ministry of Health

    Link to the lecture: The efficacy of the third dose, recovered individuals’ protection and updates on the monitoring of side effects.

Article Info

Publication History

Identification

DOI: https://doi.org/10.1016/S0140-6736(22)00044-7

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© 2022 Elsevier Ltd. All rights reserved.

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Linked Articles

  • Considerations in boosting COVID-19 vaccine immune responses
    • A new wave of COVID-19 cases caused by the highly transmissible delta variant is exacerbating the worldwide public health crisis, and has led to consideration of the potential need for, and optimal timing of, booster doses for vaccinated populations.1 Although the idea of further reducing the number of COVID-19 cases by enhancing immunity in vaccinated people is appealing, any decision to do so should be evidence-based and consider the benefits and risks for individuals and society. COVID-19 vaccines continue to be effective against severe disease, including that caused by the delta variant.

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  • Booster vaccines for COVID-19 vaccine breakthrough cases? – Authors’ reply
    • Since the publication of our Viewpoint,1 results of studies in the USA have continued to indicate high effectiveness of vaccination against severe disease.2 Recent data also indicate that booster vaccination can protect against COVID-19, and several countries have developed policies in favour of booster dosing. WHO’s Strategic Advisory Group of Experts on Immunization has since updated its roadmap for COVID-19 vaccines prioritisation, emphasising the greater benefit of primary vaccination over boosting, and the relative importance of targeting boosters towards high priority groups.

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