1/ Today, Pfizer released a PRE-PRINT with 6 months of follow-up data for its phase 2/3 COVID vaccine trial:
medrxiv.org/content/10.110…

THE TAKEAWAY: 2 doses of the Pfizer vaccine are highly effective in preventing severe disease, hospitalization, & death out to 6 months.
2/ Pfizer saw no new safety issues between its 2-month and 6-month analyses.

This is consistent with what we've seen with every other vaccine. If people are going to have a side-effect from a vaccine, they'll have it within 2 months of getting vaccinated.
3/ The Pfizer vaccine was over highly effective in preventing ANY SYMPTOMATIC INFECTION out to 6 months:
2 months 96%
2-4 months 90%
4-6 months 84%
4/ Vaccine efficacy against severe disease and death were in the mid-high 90% out to at least 6 months.

Vaccine efficacy for severe COVID disease in South Africa was 100%. The Beta variant, which is the MOST immune-evading of the variants, is prevalent in South Africa.

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Keep Current with Céline Gounder, MD, ScM, FIDSA

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More from @celinegounder

30 Jul
1/ Here’s the CDC MMWR’s report on the cluster of vaccine breakthrough infections in Provincetown.

I started hearing about these infections from friends in mid-July.

THIS is the report that led the @CDCgov @CDCDirector to issue new guidance on masking.

cdc.gov/mmwr/volumes/7…
2/
469 SARS-CoV-2 infections

346 (74%) were among fully vaccinated

Of these:
16% J&J, 46% Pfizer, 38% Moderna
3/
Among virus samples that were genetically sequenced, 90% Delta variant.

80% of vaccinated persons with breakthrough infection had symptoms like cough, headache, sore throat, muscle aches, and fever.
Read 6 tweets
29 Jul
1/ This latest paper by @KizzyPhD, who helped develop @moderna_tx's mRNA COVID vaccine, helps us understand why vaccines can protect against severe disease in the lungs but not mild infection in the nose and throat.
science.sciencemag.org/content/early/…
2/ Lower antibody levels are needed for reduction of viral replication in the lower airway than in the upper airway.

RNA in BAL = amount of virus in the lungs drops more quickly than
RNA nasal swabs (NS) = amount of virus in the upper airway Image
3/ Antibodies taken from unvaccinated & vaccinated non-human primates (NHPs) were infused into hamsters.

Hamsters that were given antibodies from NHP who received the higher dose vaccine had little/no weight loss (i.e. little/no disease). Image
Read 5 tweets
28 Jul
1/ Pfizer says that a 3rd dose of its vaccine can boost protection against the Beta & Delta variants
BUT
does everyone need that boost?
2/ Do severely immunosuppressed people need extra doses of COVID vaccine? Certainly.
3/ Do older people (esp over 80) need extra doses of COVID vaccine? Probably.
Read 4 tweets
27 Jul
1/ How is it possible that vaccines could prevent severe disease, hospitalizations, & deaths from COVID

BUT not prevent mild infections & onward transmission?

advances.sciencemag.org/content/7/12/e…
2/ If the vaccines induce systemic immunity protecting the lungs

but not mucosal immunity in the upper airway (nose, throat),

you could still get upper airway SARS-CoV-2 infection, causing no or mild symptoms

without severe illness (e.g. hypoxia or low oxygen levels).
3/ We're already seeing the benefit of mixing-matching different types of vaccines (what we call heterologous prime-boost).

Perhaps we should be doing the same with injectable COVID vaccines and intranasal COVID vaccines.
Read 4 tweets
27 Jul
1/ Clearing up confusion about what it means that Delta viral loads are ~1000x higher than the viral loads seen with the original SARS-CoV-2.
medpagetoday.com/special-report…
2/ We need to be precise in speaking about infectiousness.
Exposure = Dose x Time
If viral loads in infected people are ~1000x higher with Delta than original SARS-CoV-2, the dose of virus to which the uninfected person is exposed has gone up ~1000x.
3/ Exposure = Dose x Time
If Dose increases 1000x
the Exposure you would have gotten from an infected person early in the pandemic over 15 minutes
you now get in 0.9 seconds (~1 second).
15 minutes = 900 seconds
But in NEITHER scenario are you 100% sure to be infected.
Read 7 tweets
22 Jul
2/ COVID VACCINES WORK. They protect you from severe disease, hospitalization, and death.

IF YOU HAVEN'T YET GOTTEN VACCINATED, THIS IS THE TIME. Image
3/ The Delta variant has turned suburban streets into a @NASCAR track.

Seatbelts might be enough to keep you safe when you're driving in your suburban neighborhood, but if you're a NASCAR driver, you also want a helmet, airbags, and more. Image
Read 7 tweets

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