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Monica Gandhi MD, MPH Profile picture
@MonicaGandhi9
Apr 4, 2021 • 10 tweets • 5 min read • Read on X
Wanted to address question of "should I get vaccinated if I have had #covid19"?. Fair question given that immunity likely long-lived from natural infection per this study from Drs. Weiskopf, Sette, & Shane Crotty from the La Jolla Institute for Immunology
nih.gov/news-events/ni…
And other evidence laid out in this thread. However, I would take the vaccine (1 dose) if I had COVID-19 in the past personally. Why? Because I hate COVID and vax can serve as major immune response booster when a virus is still circulating at high rates
threadreaderapp.com/thread/1368679…
See difference between now & any other time in history is that we are giving out vaccine AS CASES are still circulating high rates. So unprecedented! In fact those who had chickenpox as child (like me, I am old enough!) were not offered VZV vax because I have natural immunity
Re-infection so rare after natural infection but can occur (same with after vax though). You can take one dose because the data is so compelling from great journals that one dose for those who had #covid gives you 10x the antibody response than those not having had #covid19.
Here are 3 papers here - Lancet, JAMA, great journals that 1 dose of mRNA vaccine fine after natural infection in past for high immune responses. papers.ssrn.com/sol3/papers.cf…
jamanetwork.com/journals/jama/…
Another paper from Lancet on this that one dose will give you same immune response as someone who didn't have natural infection & got 2 doses. And evidence that vax helps long covid. So I would take 1 dose if had #covid in past
thelancet.com/journals/lance…
One more paper from NEJM providing evidence that after the administration of a single dose of vaccine, the antibodies against SARS-CoV-2 in people who've had COVID is > response in those without COVID-19 who got 2 doses: nejm.org/doi/full/10.10…
I had tweeted this some time ago regarding if you need vaccine after #covid19 infection. Had suggested 1 dose given studies above & fact that virus still circulating. Now virus circulating much less. This study from Israel shows rate of re-infection
medrxiv.org/content/10.110…
after natural infection vs getting vaccines when cases were (of course) at same level because in same environment. This quite stunning paper from this am in @Nature shows that even with mild infection, develop memory B cells (shown by bone marrow biopsy)
nature.com/articles/s4158…
So, what is my answer? I don't know. If I had COVID in past, I would likely get 1 dose but I will admit this is from emotion more than facts I provided above & in this thread. antibodies don't tell whole story if you are immune (from either prior or vax)

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
Aug 30, 2023
HOW LONG DOES IMMUNITY LAST? To COVID vaccines or infection? We do not really know but there have been some really nice papers lately that give us more information. Please remember immunity divided into antibodies (which can come down & not work as well against variants)
IgA is one in the nose & mouth ("mucosa") that is raised by shots (vaccines) to certain extent but rise higher after natural infection; IgG is the one that is "humoral" or in the bloodstream. Many threads on here about cellular-mediated immunity: B & T cells cover all variants
This recent preprint is really important and summarized by @florian_krammer below in depth. Main take-aways: Breakthrough infections induce IgA (we knew) but protection from vaccine long-lasting even against former variants to severe disease/mortality
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
May 3, 2023
RSV VACCINE FOR OLDER ADULTS: Respiratory syncytial virus (RSV) respiratory virus (most common after flu pre-COVID). 2 subtypes, A&B (1 dominates/season). Droplet; Recurrent infections. Most severe in neonates & adults >65; FDA approves 1st RSV vax today
msn.com/en-us/news/us/…
RSV vaccine 3 trials of new RSV vaccine, all published in the @NEJM recently so just to keep them straight- here is the vaccine which just got approved May 3 by the FDA for older adults. Remember our T/B cells so protection against severe disease higher!
nejm.org/doi/full/10.10…
A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related severe respiratory illness by 94% in adults>=60 years (71% against RSV infection, likely to fall with time as antibodies fall but severe disease protection will remain)
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Mar 21, 2023
NASAL VACCINES: To explain nasal vaccines, we have to explain the immune system first.
IgA is an antibody that helps attack the pathogen and exists in mucosal surfaces (like nose/mouth)
IgG is an antibody that is in the bloodstream
bbc.com/news/world-asi…
Cellular immunity is fantastic, redundant (so even if one cell line down in immunocompromised, have other), generated by either vaccine or infection; Comprised of
T cells- so in breadth from vax - works even across spike protein with its mutations
And the 2nd type of cell produced by vaccines or infection -B cell- amazing thing about B cells is that - if see omicron or one of its subvariants in future- they make antibodies adapted to that variant or subvariant (aided by T cells); adaptive immunity
Read 15 tweets
Monica Gandhi MD, MPH Profile picture
Mar 15, 2023
PUBLIC HEALTH POLICY: Seem to be at reckoning phase of COVID response- what worked, what didn't. Which interventions will be used in future pandemic responses? Interventions asked of public need good medical evidence for them (e.g. RCTs preferably, systematic reviews) to impose
In our field, Cochrane reviews represent best way to sum up the medical evidence to date by performing meta-analyses or systemic reviews of currently-available data; here is Cochrane on masks & other interventions for respiratory viruses including COVID
cochranelibrary.com/cdsr/doi/10.10…
Many asked past 3 years how CDC developed policies on masks (& age to mask), distancing (feet), ventilation, schools-> all non-pharmaceutical interventions. Originally theory-based. Now 3 years in, have data (RCTs highest level) to form policies from both US and other countries
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Mar 6, 2023
VACCINE DISCRIMINATION: We need to stop vaccine requirements for US entry like almost every other country. Am finishing COVID chapter for our ID "bible" & vaccines prevented transmission early on with alpha, but not enough now with current variants to justify such discrimination
Moreover, shame, stigma, blame (remember COVIDiots?), coercion, discrimination not good public health tools. When used for HIV, public health & ID physicians decried them but tactics used a lot in COVID. This book tries to explore & correct that for future
barnesandnoble.com/w/endemic-moni…
Concept of #harmreduction in pandemic responses means watching carefully if vulnerable people (like students, older people, low-income populations, migrants, sex workers, prisoners, those with disabilities, refugees, minorities) harmed more by response
nature.com/articles/s4146…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Feb 8, 2023
FEAR: Some media & public health officials concerned Americans aren't fearful of COVID now. But the vaccines & therapeutics DO WORK. If we can't celebrate biomedical advances & imbibe their effectiveness (we have better tools for COVID than flu), what is point of developing?
In HIV medicine, when therapies came out, we didn't say to people- stay fearful; make this the controlling principle of your life. The book #Endemic I wrote (coming out July 11, 2023) hails these biomedical advances & the age we are in to fight pandemics to reassure the world
This is a rather brilliant summary of the issue from @benryanwriter
Read 4 tweets

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