Another paper from the PICOBOO randomized trial, evaluating second boosters after mRNA priming.
1) novavax is more durable
2) mRNA vaccines have higher antibody responses
3) novavax has fewer side effects
More nuances in this thread
journalofinfection.com/article/S0163-… 1) Durability: Pfizer antibody levels drop around 40% between 1 month to 3 months post vax.
Moderna is less, w/ a 14% drop in younger adults, 26% decline in older adults.
Novavax had only a 3% decline in younger adults and 17% in older adults.

A trio of Novavax preprints, showing 1) remarkable durability >6 months, 2) cross protection against newer variants, and 3) low reactogenicity (side effects), supporting NVX as an excellent booster platform.
medrxiv.org/content/10.110…
medrxiv.org/content/10.110…
medrxiv.org/content/10.110… 1) Antibody levels remained high over 6 months after the first booster, with pre-boost levels before Dose 4 being similar to post-primary antibody levels. This is quite remarkable durability.

Comparison of NVX (Novavax) and BNT (Pfizer) after primary or booster from South Korea through 180 days. NVX primary series offered slight "added protection" against infection (~10%) and severe disease (~35%), while homologous boost findings were mixed.
sciencedirect.com/science/articl… Again, this is one of the few populations that have the adequate sample size to explore this comparison. The 180 day window is helpful at assessing longer term patterns.

Preprint: Pfizer preprint supporting that JN.1 and KP.2 vaccines are similarly effective against currently circulating strains, including KP.3.1.1 and XEC.
And some very interesting info supporting earlier suggestions about conformation of JN.1, KP.2, and KP.3.1.1 The current dominant strains are KP.3.1.1 and XEC (which is gaining steam quickly)
covid.cdc.gov/covid-data-tra…

I closed my Public Health lecture today with this quick thought.

We can't control everything around us, but we can control our actions, we can impact those around us, and we can save and help millions around the world with our work, which is now more important than ever. There are reports a certain vaccine conspiracy theorist may have a role in the next administration. Vaccines have saved 154 million lives over the last 50 years - six lives every minute. Many more live full healthy lives thanks to prevention of chronic/debilitating illness

Large study provides support for many long COVID (LC) findings:
1 Fatigue & neurological symptoms most common
2 Women more likely to have LC
3 Reinfection has milder acute symptoms but more severe LC
4 Vaccination reduces LC risk
5 ⬆️post-COVID infections
thelancet.com/journals/lanwp… For #1, memory loss was a leading LC symptom along with fatigue, and brain fog was in ~15% of respondents.
Brain damage and neurological symptoms following even mild cases of COVID are becoming better understood and characterized

https://x.com/Daniel_E_Park/status/1847257999305273465

I do quick cognitive tests as part of my daily work routines to adjust my tasks based on my current state. My very "mild" case of COVID resulted in a ~20% slowdown and 10% reduction in overall cognition, which only gradually resolved over a year.

https://twitter.com/Yash25571056/status/1847139677775732972

Just a reminder that COVID damages the brain, along with other organ systems.
nejm.org/doi/full/10.10…
thelancet.com/journals/eclin…

I've recently discussed sudden behavioral issues in school aged children w/ parents and teachers. In most cases, this followed the kids being sick.
Reminder: COVID can cause increased anxiety, aggression, and defiance in children.
mecp.springeropen.com/articles/10.11…
ncbi.nlm.nih.gov/pmc/articles/P… These symptoms can last months after the initial infection.
Long COVID in children also manifests differently by specific age group
jamanetwork.com/journals/jama/…

Just out: mRNA COVID-19 vax do not establish in long-lived plasma cells; could account for faster waning vs. infection. Other mechanisms still protect durably vs. severe illness, but improving durability is important. Adjuvants (like in Novavax) may help.
nature.com/articles/s4159… My previous thoughts on the preprint here.

h/t @atranscendedman

https://x.com/Daniel_E_Park/status/1766079718854455681

Vaccines likely lower transmission, in addition to reducing infection and severe illness. New study shows Novavax and Moderna significantly reduce viral load (amount of virus) in the upper respiratory tract.

academic.oup.com/jid/advance-ar…
Novavax reduces viral load by 2.78 log10, while the Moderna vaccine was 2.12. The log10 scale is 10x for each step, indicating Moderna reduces viral load by just over 100x, and Novavax reduces viral load by over 600x. No significant reductions seen for others.

There is a common and dangerous misconception that the JN.1 vaccines are inferior to KP.2 vaccines. In reality, JN.1 and KP.2 vaccines will both provide excellent protection, with each being slightly better in different aspects. But the experts were right to pick JN.1. First, a bit of background. The FDA vaccine expert committee, consisting of 14 highly experienced and accomplished vaccine experts, supported selecting JN.1, with many suggesting it would be a safer and potentially better strain to select compared w/ KP.2.
fda.gov/advisory-commi…

Preprint: Interesting study from Korea comparing homologous NVX (Novavax) and BNT (Pfizer) COVID vax. One of the few places where there are enough NVX doses to do this analysis. Slightly better effectiveness (16% better) with NVX after primary series

medrxiv.org/content/10.110…
More interestingly (to me at least), NVX effectiveness is 35% higher than BNT comparing after the 1st homologous booster. There have been suggestions that homologous NVX boosts can uniquely improve antibody avidity, affinity maturation, & epitope spreading
nejm.org/doi/full/10.10…

Excellent broad cross neutralization to variants with the upcoming JN.1 Novavax COVID vaccine, including some of the best responses to variants that are likely to be dominant this late fall and early winter
novavax.widen.net/s/zg79lxwknx/2…
The latest CDC nowcast shows a rapid rise in KP3.1.1, which is the variant with best response to the NVX JN.1 vaccine. Others variants to keep an eye on include LB.1 (a direct JN.1 descendant) and LP.1 (KP1.1 descendant)
covid.cdc.gov/covid-data-tra…

How our family stayed COVID-negative when my 2-year old was infected. An epidemiologists’ perspective. In late February, our toddler woke up with a runny nose. Anyone with a toddler will know runny noses are very typical. However, thanks to ongoing local surveillance (which I monitor ~weekly), I knew case rates were slightly elevated in our area, and that led me to test.

Small but helpful study of Novavax from Germany highlighting some of the key benefits of this vaccine option. Very low incidence of side effects among this high-risk population. And excellent long-term protection (95% at 10 months). Paper: mdpi.com/2076-393X/12/4…

Further evidence that COVID-19 vaccination protects you from poor cardiovascular outcomes, this time from a cohort of over 20 million people. Vaccinated individuals had at least half the risk of adverse outcomes w/in 30 days post-infection.

heart.bmj.com/content/early/…
h/t @EricTopol

https://x.com/EricTopol/status/1767692589506167131?s=20

Preprint: Immunity from mRNA vaccines wanes more rapidly due to inability to induce long lived plasma cells in bone marrow. This seems unique to current mRNA, and less for the adenovirus vector (J&J, AZ) and protein-based (Novavax) options

medrxiv.org/content/10.110…
H/t to @ENirenberg who has an excellent thread on this

https://twitter.com/ENirenberg/status/1765957382176223526?t=mQnHR4sNI4cG03qZr1fGZw&s=19

Yikes! Microplastics and nano plastics frequently found in carotid artery plaques (58%), and were associated with much higher risk of heart attack, stroke, and death (4.5x higher risk)
nejm.org/doi/full/10.10… The researchers saw jagged edged microplastics embedded in the plaque (possibly serving as an anchoring point for plaque growth)

Interesting: different immune responses to Novavax & mRNA COVID vaccines. TLDR: NVX has higher proportion of the "best" IgGs (IgG3), while mRNA have higher of the "not always good" IgG4. IMO more importantly, NVX has stronger Fc-effector functions
journalofinfection.com/article/S0163-… Fc-effector functions have been hypothesized to be behind much of the efficacy w/ NVX. Ppl with essentially undetectable IgG still had >60% efficacy vs infection in the original trials.
nature.com/articles/s4146…

Just released: Pretty remarkable 1-year durability data for Novavax 2-dose primary series. Though there is some expected waning, there was >65% efficacy at 1y (mRNA options typically wane to this level by ~4-5 months). Also fewer waning differences by age.
sciencedirect.com/science/articl…
Refs:
NVX:
BNT:
Waning:
sciencedirect.com/science/articl…
sciencedirect.com/science/articl…
thelancet.com/journals/lanre…

Preprint: saponin adjuvants (like the one in Novavax) shown to enhance durability (length) of protection compared with mRNA options. Potentially relevant as we shift to annual doses for COVID-19.
biorxiv.org/content/10.110…
Per the authors, "in a murine vaccine study, the adjuvants greatly improved the potency, durability, breadth, and neutralization of both COVID-19 and HIV vaccine candidates, suggesting the potential broad application of these adjuvant constructs to a range of different antigens."