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Monica Gandhi MD, MPH

3 Jul, 7 tweets, 2 min read

J&J VACCINE AND VARIANTS: Wanted to go over paper from yesterday. 19 million worldwide have received 1 dose J&J (including health care workers S. Africa as condition of trial who are seeing a lot of virus right now with high rates community transmission)
biorxiv.org/content/10.110…

Remember about J&J which is that - in its phase I/II clinical trial, antibody and CD4/CD8 (T cell) responses increased over time. Not that high at 2 weeks (which may account for lesser effectiveness in ENSEMBLE trial when looking at that time point)
nejm.org/doi/full/10.10…

Immune response increased over time out to 59 days when phase I/II stopped reporting. So, this study took participants from ENSEMBLE who had received 1 dose J&J (n=8, 47-91 years, 71 days after shot) and exposed their blood (test tube) to variants (alpha, beta, gamma, delta).

Neutralization Ab titers were high against all variants, same as for alpha/ancestral strain; slightly reduced (1.6) for delta but still well above titers needed to neutralize; even more reduced against beta, gamma (~3.5) but still above titers necessary to neutralize virus. AND

delta did not knock out all of those dominant T cells that form across spike protein with delta .So many T cells from vax cluster across spike protein, delta can't knock out T cell response (see end of Results section). Real world data out later this year, but conclusion is

vaccine effectiveness of a single dose of J&J should be preserved against delta because of neutralizing Ab responses seen here AND, importantly, strong T cell immune responses elicited by this vax. Tomorrow, I will go back to T cells & also summarize Novavax NEJM study

Also, in terms of lasting durability of antibodies/T cells after 1 dose of J&J, at least 8 months and counting (stopped examination then - waiting for this biorxiv paper - did anyone see it? so I can summarize more)
prnewswire.com/news-releases/…

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Monica Gandhi MD, MPH

@MonicaGandhi9

3 Jul

I & others quoted in this LA Times article about the effectiveness of the vaccines against the delta variant (and LA & masks): Dr. Fauci "“If you are vaccinated, you have a high degree of protection — so you need not wear a mask, either indoor or outdoor"
latimes.com/california/sto…

Dr. Ghaly: "The data is clear: Nearly all new COVID-19 hospitalizations and deaths are preventable. The vaccines work and they protect us,” Me: "The rise in coronavirus cases in Israel may reflect the healthcare system there still testing...

vaccinated people for coronavirus infection, even if they have no symptoms.". If no symptoms & low viral load in nose (like 5 studies have shown us now), " I don’t call that a vaccine failure. I call that a success, because that’s exactly what your vaccine is supposed to do.

Read 13 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

2 Jul

"The Delta variant, which is now responsible for most coronavirus infections in England, is not driving a surge in the rate of hospitalizations there, according to data released by Public Health England on Thursday."
nytimes.com/2021/07/01/hea…

"The data suggest that countries with high vaccination rates are unlikely to see major surges in hospitalization rates from Delta. Nearly 75% of adults in England — including 95 % of those 80 or older — have had at least one shot, according to the agency’s numbers."

Here is the direct link to the PHE report discussed by the NYT today
assets.publishing.service.gov.uk/government/upl…

Read 4 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

1 Jul

White House task force briefing from Jeff Zients, Dr. Fauci and Dr. Walensky with questions about delta variant. Great briefing with bottom line:
1) Vaccines work against delta, both adenovirus/DNA and mRNA vax, 88% against symptomatic infection, 96%

against severe disease with Pfizer (Scotland data); 92% with AZ 2 doses
2) J&J neutralizing Abs under study with delta, but no reason to suspect doesn't work (like AZ) and no need for mRNA booster after J&J without data
3) When WHO makes recs on masking for world, reflects 10.7%

of population being vax'd, not 67% 1st vax rate by July 4 which has been achieved in US
4) Country doing well with outbreaks of delta in unvaccinated counties; CDC will deploy surge teams for testing, treatment, vaccination
5) Vaccines safe & effective 3 billion doses given out

Read 6 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

1 Jul

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

Read 4 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

30 Jun

https://twitter.com/benryanwriter/status/1410279474495725570

Thanks, want you to have these slides and papers if these help, everyone

https://twitter.com/benryanwriter/status/1410279474495725570

Here is another slide with references

3rd slide- top paper on T cells is from NIAID/NIH!

Read 4 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

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

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