Helen Branswell 🇨🇦 Profile picture
Nov 19, 2021 33 tweets 16 min read Read on X
1. #ACIP will begin meeting at noon ET on the expansion of the emergency use authorizations for Pfizer & Moderna #Covid19 boosters.
The agenda is here: cdc.gov/vaccines/acip/…
The meeting can be listened to here: video.ibm.com/channel/VWBXKB…
I will be live blogging in this thread.
2. #ACIP is beginning. Roll call was conducted in an unusual fashion so I'm not sure I've got this right, but I think 2 voting members of the committee are not present (meeting was called at the last minute). So 13 members will be voting.
3. #ACIP is getting a bit of data on #Covid vax uptake in kids aged 5-11. So far nearly 2M kids have been vaccinated.
Matt Daley, chair of ACIP's Covid vax work group, says he's been talking to kids about vaccination. They're excited "not about the poke, but about the promise."
4. Daley is going through something I'd missed before. @CDC's Emergency Use Instructions outline additional uses of the Pfizer booster. It can be used as a boost for non-FDA authorized vaccines, ie AZ or other vaxes not used in the US, & for people who were in vax trials.
5. Pfizer is presenting data to #ACIP now. This is a breakdown of Grade 3 or higher reactions after a booster in a clinical trial the company ran.
6. The Pfizer representative, Dr. John Perez, vp for vaccine clinical research & development, just called a 55 year old woman "elderly."
I need a minute.
#ACIP
7. Pfizer's booster efficacy data, by demographic groups. #ACIP
8. Rituparna Das from Moderna is now presenting on their #Covid booster data. A reminder: The Moderna booster is a half dose (50 mcg) of their full dose (100 mcg). But it's still bigger than the Pfizer booster (30 mcg). #ACIP
9. Side effects reported after the Moderna booster were similar to those seen after earlier doses. The only side effect that was reported more frequently was swelling or tenderness of lymph nodes in the armpit. Similar to what Pfizer reported. #ACIP.
10. Moderna only filed for an EUA extension this wk & it feels like they weren't as ready to file as Pfizer was. Pfizer's presentation was 21 slides long; Moderna's was 5. Much less detail, including they don't have efficacy data. Das explained it wasn't placebo controlled. #ACIP
11. #ACIP is running late 20 minutes late. Just broke for a 4 minute break, to be followed by a 20 minute public comment session.
This meeting is unlikely to end at 3 pm, as scheduled.
12. #ACIP's public comment session ended early & the committee is plowing ahead. @CDCgov's Tom Shimabukuro is presenting on booster dose safety & the systems for soliciting information on vaccine side effects.
13. Shimabukuro presented this table, which is a bit confusing. But focus on the blue numbers — they show that 95% of Moderna vaccinees who have been boosted got Moderna for their booster. For Pfizer recipients, it was 99%,
14. Shimabukuro says in most cases, people who were boosted with the Pfizer vaccine had fewer reactions after dose 3 than after dose 2. #ACIP
15. One interesting take away from Shimaburuko's presentation: Most people who got an mRNA vaccine (which is most vaccinated Americans) stuck with their original vaccine when they got boosted. So much for mix-n-match.
16. Another interesting observation, as noted by @RandomlyBob: J&J recipients in the main have chosen mRNA vaccines as their boosters. Not sure that's a surprise. #ACIP
17. Shimabukuro reports from Sept 22 to Nov. 5, 54 cases of myocarditis were reported among the 26M people who have received boosters. Investigations suggest 12 are probably linked to vaccine receipt. The people are older, but people who have been getting boosted are older. #ACIP
18. #ACIP member Keipp Talbot tells the committee the data so far suggests #Covid boosters are safe. The Moderna booster appears to be the most reactogenic of the boosters. Not a surprise — it contains 1.66 times as much vaccine as the Pfizer booster.
19. In a Q&A session, Shimabukuro says it's too early to draw conclusions on the risk of myocarditis after the 3rd dose of mRNA vaccines, because teens and younger adults haven't yet been being boosted in big numbers. #ACIP
20. @CDCgov's Sara Oliver is now presenting. This is going to set up the decision(s) #ACIP will face. Anyone who wants to download the slides being presented at this meeting, they are here: cdc.gov/vaccines/acip/…
21. One of the factors driving the change to the booster eligibility criteria is the complexity of the current criteria. This survey, which Oliver presented to #ACIP, shows a fair percentage of people do not know if they're eligible or not — especially among the youngest adults.
22. Here's an illustration of how complex the current booster recommendations are:
23. And here's what the expanded eligibility would mean:
24. @nirav_mainecdc, president of the Association of State & Territorial Health Officials & a non-voting representative to #ACIP, said states unanimously support changing the eligibility criteria. Though well intentioned, the current criteria are an obstacle to boosting, he said.
25. #ACIP member Sarah Long, who hasn't been a fan of broad boosting, is indicating she supports giving people the choice to boost or not.
The vote to broaden the eligibility for boosters is going to pass.
26. #ACIP chair Grace Lee asks the committee if they should consider changing the wording of the recommendation for who "should" get a booster from 65 & older to 50 & older.
27. #ACIP member Matt Daley says a lot of people 50 to 64 should get boosters because of underlying health issues (Oliver says 75%), but restricting boosters to only those people is confusing people & probably preventing some people who qualify from getting one.
28. Sarah Long isn't comfortable with moving people 50-64 into the "should" category without more discussion — "in the last 5 minutes" before the vote.
To be clear, there hasn't been a motion moved yet.
If this change is made, the recommendations would look like this.
29. #ACIP is going to take 2 votes. Starting now.
30. This motion passed 11-0.
31. This motion passed 11-0.
There were only 11 votes because 2 members missed this meeting and 2 members — Sarah Long and Keipp Talbot — could not stay for the votes.
This meeting was put together very quickly and some of these people could not clear their calendar to attend.
32. #ACIP chair Grace Lee in adjourning meeting noted that this is the 22nd meeting that ACIP has held on #Covid vaccines. What she didn't say is that's almost twice the number of meetings an ACIP member would attend in a 4-year term in normal times. Huge workload.
33. The #ACIP recommendations now go to @CDCDirector, who will sign off on them some time today.

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More from @HelenBranswell

Jun 22
1. Some thoughts on #H5N1 #birdflu in cows. A 🧵
A bunch of new herds were announced by a couple of states today — Colorado and Iowa. The former reported +5 & looks like it may have another pending; It now has 18 in total, maybe 19. Iowa reported 2 more, taking it to 10.
2. To the best of my ability to keep up — and that's being challenged — I think there have been 125 herds reported in 12 states since the end of March. This graph combines @USDA's numbers from yesterday with the newly reported herds from Colorado & Iowa. Image
3. But @USDA threw a wrench into the works today. It updated its exceedingly wonky #H5N1 #birdflu in cows landing site. Some things work better, but the cumulative number of herds was lowered by 4 (from yday) with no explanation. USDA now says 112 herds in 12 states. Image
Read 8 tweets
Apr 26
1. @USDA posted an FAQ today about the federal order restricting movement of dairy cattle infected with
#H5N1 #birdflu. Interesting information therein.
A 🧵
New to me: USDA says 8 poultry operations in 5 states have had poultry outbreaks with the virus detected in cows. Image
2. Minnesota hasn't reported #H5N1 #birdflu in cattle, but it has had at least 1 poultry outbreak with the cattle virus, @USDA reveals. More evidence, probably, that the virus is far more widely spread than has been realized. The FAQ is here: aphis.usda.gov/sites/default/…
3. The federal order on the movement of dairy cows goes into effect 4/29. @USDA is setting what looks like an ambitious timeline for processing of tests, especially "non-negative" tests that must then go for confirmatory testing at the USDA lab in Ames, Iowa. #H5N1 #birdflu Image
Read 7 tweets
Apr 25
1. Listening to an @ASTHO - @IDSAInfo - @CSTEnews webinar on #H5N1 #birdflu in cows.
Of interest so far:
— @USDA is monitoring feral swine; no detections of H5 so far.
— in the "small number" of samples tested to date, doesn't look like cows are shedding virus thru feces.
2. @USDA Rosemary Sifford said the infections are "mostly" being seen in lactating herds.
1 herd was found to be positive despite the fact there were no clinical signs among the cows.
Sifford said USDA doesn't yet know how long infected cows shed virus.
#H5N1 #birdflu
@USDA 3. Sonja Olsen from @CDC says there've been 6 infections detected in cats on dairy farms. Not sure I've seen the exact number. #H5N1 #BirdFlu
Read 16 tweets
Apr 19
1. A 🧵 on #flu, #Covid & #RSV (mostly flu). The
#influenza-like illness season is pretty much over. The percentage of people seeking care for ILIs is below 2.9%, that dotted line. You can catch flu at any time of the year, but chances of catching it now thru the summer are low. Image
2. It's not just #flu. #Covid activity now is at low levels nationally and #RSV activity has declined to the point where @CDCgov says the season is ending. Hallelujah.
cdc.gov/respiratory-vi…
Image
3. It hasn't been a particularly bad #flu season, but the estimated number of hospitalizations for flu has been pretty high — one of the highest in recent years. (red line) The 2017-18 season, which was harsh, was worse. CDC estimates there were 370K hospitalizations this year. Image
Read 5 tweets
Feb 9
1. A 🧵on #flu & #Covid activity trends based on reports today from @CDCgov. Most of the data is for the week ending Feb. 3. The #influenza-like illness (ILI) season seems to have peaked at the end of Dec, with declines in flu, Covid & #RSV since then. But the season isn't over. Image
2. There was a bit of an uptick in #flu activity in the central & south central US. It corresponds with an increase in flu B detections there. Pre-Covid, flu B often arrived in a late season wave. We may see that again this year.
Map on left is the week ending 1/27; right is 2/3.
Image
Image
3. An additional 8 pediatric #flu deaths were reported to @CDCgov in the wk ending 2/3. The season's death toll in kids now stands at 74, which is awful, obviously, but not as bad as most years pre-Covid. But if there's a lot of flu B activity, this number could climb. Image
Read 5 tweets
Jan 5
1. Traditionally I've done #flu updates on Fridays, but given our new reality — #Covid is here to stay — & the expansion of data on @CDCgov's website, I'm going to broaden the scope going forward. Top line news: Lotta illness out there right now.
cdc.gov/respiratory-vi…
2. Most parts of the country are ensconced in #influenza-like illness season right now. (Minn, what are you doing to stay so healthy?) This graphic doesn't just represent #flu activity; #Covid, #RSV & other ILIs are also captured here. @CDCgov's FluView: cdc.gov/flu/weekly/
Image
3. #Flu is the most common bug making people sick right now, but there's a lot of #Covid going around too. (I know from recent experience.) #RSV is still fairly active but declining. This breakdown of what's causing most illness is seen both in positive tests & ER visits.
Image
Image
Read 7 tweets

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