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Monica Gandhi MD, MPH Profile picture
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1 Jul, 4 tweets, 2 min read
NIH-sponsored study similar to SIREN in UK where HCW, workers were swabbed weekly (!) Dec 14, 2020-April 10, 2021. Even with circulating virus, 81% vaccine effectiveness with 1 dose; 91% with 2 doses, even asymptomatic infection. Only 5 breakthrough
nejm.org/doi/10.1056/NE…
infections in 3975 participants after full vaccination; only 11 breakthroughs after 1 dose. All milder infection breakthroughs than COVID infections in nonvaccinated. Importantly, CT values were higher in those breakthrough infections in vax'd (40% lower viral load).
Kind of reminds you of the other many many studies that show massive reductions in asymptomatic infections after vaccines, right? And there are also other studies that show low viral loads if do get breakthrough so hard to transmit
And here are other studies including SIREN where viral loads measured after vax if there are "breakthroughs" and much lower; so not impossible to transmit (yes, nothing is 100%) but very difficult.

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
30 Jun
Thanks, want you to have these slides and papers if these help, everyone
Here is another slide with references
3rd slide- top paper on T cells is from NIAID/NIH!
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
29 Jun
DO I NEED AN mRNA VACCINE BOOSTER AFTER A J&J SHOT? The answer to this is that no one knows, actually. Humility in COVID means we change our recommendations with changing data. And I also think there is no harm. But I don't see how the data indicates this yet.
Remember that J&J and mRNA vaccines actually not that different - J&J has DNA inside an adenovirus "vector" (that brings it in) and mRNA vaccines have mRNA inside a lipid envelope. The DNA from J&J gets "transcribed" into mRNA and that is the same mRNA in mRNA vax.
That mRNA is then "translated" into a part of the spike protein by your machinery and you see that spike protein, think it's different, and raise a vigorous immune response against it (antibodies; now we know memory B cells; memory T cells). Some vaccines need repeated boosters
Read 11 tweets
Monica Gandhi MD, MPH Profile picture
28 Jun
Had referenced pre-print of this study in article I wrote "7 reasons you won't need boosters" but it is now published in Nature. Simply, put, as there are B cells (which produce antibodies) you produce to vax or natural infection and there are T cells.
nature.com/articles/s4158…
You want your B cells to form MEMORY B cells which can then come out and fight infection for 90 years or more (see influenza study in this article). Nature paper above biopsied lymph nodes of those who received mRNA vax 3, 4, 6 and 7 weeks after 1st dose
leaps.org/booster-shot/
and found strong increasing concentrations of memory B cells forming. Now if you want evidence those memory B cells can produce antibodies that are honed towards specific variants later? See this paper by OHSU which shows just that. These memory B cells
medrxiv.org/content/10.110…
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
27 Jun
Wanted to explain concept of CONTROL vs ELIMINATION (& eradication) with an infectious diseases, why getting immunity up in a population can get us to control, & why living with a controlled infectious diseases is very manageable (and no longer problem of the public just ID MDs)
Even though we tried to control COVID with other strategies (masks, distancing, ventilation, testing, contact tracing), true control of a pathogen achieved when a significant proportion of the population becomes immune. Never this degree of testing done for a pathogen before.
In 1918 influenza pandemic, masks, distancing, closures employed but there was no vaccine developed for influenza until 1942. So, instead the pandemic came to an end through terrible loss of human life, 50 maybe up to 100 million dead, 5% of world's population.
Read 16 tweets
Monica Gandhi MD, MPH Profile picture
25 Jun
CDC weighs in that boosters don't seem to be needed or no evidence at this time. Agree and I summarize some of the T cells/B cell studies in the paper below in next tweet but want to add a few more!
nbcnews.com/health/health-… via @nbcnews
Here is the paper where I tried to put some of this together but 3 more EXCELLENT studies that came out since wrote this that add to the idea we won't need boosters (at least anytime soon!)
leaps.org/booster-shot/
One paper that didn't get into the summary above shows that memory B cells formed from even mild COVID (other papers have shown this) but then they were tested to see if they produce antibodies specific to a variant if they see a variant & they do
medrxiv.org/content/10.110…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
23 Jun
Wrote to CDC:
1) For males 18-30, J&J preferred as myocarditis not seen (clot risk mainly in females). If mRNA, #2
2) For males 12-18, give 1 dose Pfizer. Give 2nd dose (at 3 weeks or 8-12 weeks) based on community transmission. If low (<5 hosp/100K), latter to increase safety
<10K cases across country now. Does NOT increase vax hesitancy to acknowledge a side effect. It decreases vaccine hesitancy and increases trust to tell people that public health cares about both safety and protection from COVID.
Since US & Israel seeing more cases of myocarditis in young with 2nd dose & use 3 weeks spacing - whereas UK uses 8-12 weeks & not seeing the number of cases of myocarditis- increasing that spacing between doses could help. Prior tweets - 1 dose Pfizer 94% effective against delta
Read 5 tweets

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