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Monica Gandhi MD, MPH Profile picture
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Jul 20 • 6 tweets • 3 min read
Breakthrough infection by SARS-CoV-2 Delta and Omicron variants elicited immune response comparable to mRNA booster vaccination academic.oup.com/jid/advance-ar…
Adds to other studies showing an infection after vaccination serves as a booster of the immune response (of antibodies, T and B cells) like this one from Yale and others in the thread below:
mdlinx.com/news/booster-a…
Other studies here:
T CELLS: In fact, this important paper shows that any exposure (breakthrough infection) or any booster after vaccination actually broadens and diversifies the T cell memory repertoire (e.g. expands your immune response).
nature.com/articles/s4159…
B CELLS: And this paper shows that a booster shot after two mRNA vaccines expands the potency and breadth of B cells (which make new antibodies). So either natural infection or a booster shot after vaccination expands the immune response to COVID-19
nature.com/articles/s4158…
Finally, there is prevention by vaccines and the immune response and there are also treatments which are greatly needed for those at risk of a severe re-infection. We need both & need better treatments which are coming not just COVID but all RNA viruses
If we could get a whole virus vaccine that would be best since virus is evolving in spike protein (& we only have spike protein vaccines in US unlike India). Instead of "reinventing wheel", we should approve #Covaxin in US- given to millions in India, safe

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
Jul 11
EU putting out good information on monkeypox ecdc.europa.eu/en/publication…
as are @benryanwriter and @LizHighleyman. Aligns with US HHS plan to start with vaccinating men-who-have-sex-with-men & close contacts. Agree- wrote this in @TheAtlantic June 24, 2022
theatlantic.com/ideas/archive/…
UK also has good data #monkeypox. With limited US vax supply, would 1) hold for now in those who had smallpox vax (<1970 born); 3) target those w/ multiple sex partners; 4) Give 1 dose for now (like urged with limited COVID vax at start); 4) Boost supply
US apparently rejected Jynneos doses from Denmark since FDA didn't inspect but EU did & says high quality- would trust EU CDC-very good!
Beyond strategies above, here is a background on monkeypox:
Or article written for @medscape
medscape.com/viewarticle/97…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Jul 7
BA4/BA5 SUBVARIANTS: 2-dose Pfizer vaccine 87% protective against hospitalizations with these 2 subvariants in large S. Africa study. High protection against severe disease across variants/subvariants is due to cellular immunity (B/T cells) discussed often
bloomberg.com/news/articles/…
Natural infection pre-Omicron also provides strong protection against severe disease & death (97.3%) from circulating Omicron subvariants like BA4/BA5. Despite multiple mutations across spike protein in subvariants, T cells still cover multiple epitopes
medrxiv.org/content/10.110…
T cells (prevent severe disease) line up across spike protein on multiple parts or "epitopes"; even with >32 mutations across spike protein with Omicron, still have >60 T cells from vaccine on spike. BA4/BA5 booster ready by Oct to prevent mild infections
investors.biontech.de/news-releases/…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
Jun 13
RAMSEY HUNT SYNDROME: What is this? Caused by varicella zoster virus, which is a herpes DNA virus (SARS-CoV-2 is an RNA virus). DNA viruses can stay in your body (hiding out in what are called "dorsal root ganglion"; nerves) after initial infection & come back. RNA viruses don't
generally stay in your body. Viruses like HIV are "retroviruses" which means their genetic material is RNA but it converts to DNA in the human host and will then stay in the body by intercalating that DNA into the human host chromosome. So, varicella zoster virus (VZA) is agent
of chickenpox in children although we now vaccinate (although many of us who are older had chickenpox as children and considered immune for long time). Even if had chickenpox as child, that virus can hide out in body & come back as "shingles" or zoster. Ramsey Hunt syndrome is
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
Jun 7
Lowest COVID death rate below in spring 2022 predicted by multiple modelers due to vaccines and high rates of Omicron-infused immunity in the world by this date. COVID is never over. As a non-eradicable virus, will need constant management by medical system. WHO plan here:
How do we manage COVID if noneradicable? in US, therapeutics, Evusheld, vaccines. Need global equity. HARM REDUCTION means reducing effects of pathogen but considering needs of society & individuals in context of pathogen- applies to HIV, COVID, monkeypox
Pandemic preparedness from a vaccinology standpoint needs ongoing commitment. Wonderful paper by Drs. Sullivan and @BarneyGrahamMD in Nature Immunology in 2018
nature.com/articles/s4159…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Jun 6
Latest blog for @Medscape on Novavax and Covaxin vaccines (and even more vaccines for COVID needed in future including nasal vaccines); timely to discuss given that the FDA advisory meeting for Novavax EUA is tomorrow June 7, 2022
medscape.com/viewarticle/97…
@Medscape 2 major reasons listed in @Medscape blog for Novavax: 1) may increase uptake; 2) booster shot after mRNA vaccines: seems that mixing vaccines boosts broader response since - although all vaccines have spike- seem to generate different in vivo responses:
nature.com/articles/s4154…
This UK study in the Lancet did study Novavax as a booster after mRNA vaccines (specifically Pfizer) - Novavax given as a half-dose & full dose (and also following AztraZeneca). NVX boosted T cells more if prior vaccine was AztraZeneca (than Pfizer)
thelancet.com/journals/lance…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Jun 6
3 comments:
-Common cold coronaviruses HCoV-OC43, 229E, NL63, and HKU1 cause 15-30% of colds in normal years
-Antigenic drift affect antibodies so far, T/B cells protect against severe disease
-T cells expand/ diversify with repeat infection or booster: nature.com/articles/s4159…
Really helpful common sense thread from @pbleic on reinfections with human coronavirus infections (HCo-V) - typical rates, how induce B/T cell immunity, how not unexpected, and how mild post-immune infections don't lead to problems (like severe disease)
Related to this question is this intriguing hypothesis-generating paper whether "Russian influenza" outbreak of 1889-1890 was actually a coronavirus, specifically the one that became OC43 that now causes the common cold (along with 3 other HCoV strains)
sciencedirect.com/science/articl…
Read 4 tweets

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