New randomized trial of COVID vaccines: bivalent Moderna mRNA and ancestral Novavax protein over a full year of follow-up. High level findings:
- IgG higher in mRNA
- Both had similar interferon gamma responses (proxy for T cell immunity)
- Both similarly protective vs infection The randomized design is valuable. In observational studies, groups receiving mRNA v protein vaccines are quite different in terms of demographics & behavior, which impacts both immunogenicity and effectiveness. The full year of follow-up is also valuable.
journalofinfection.com/article/S0163-…

New paper showing Novavax JN.1 booster elicits broad cross neutralization across circulating omicron strains, including LP.8.1, XEC, LF.7, and NB.1.8.1. Link to paper:

Reactogenicity remained similar to prior NVX boosters (e.g. similar to flu and many other conventional vaccines) sciencedirect.com/science/articl…

Quick personal note. A close friend recently died from a heart attack a week after COVID.
COVID increases risk of cardiac events.
It may have faded from the news cycle, but COVID continues to take people from their families. Please take it seriously. COVID increases risk of heart attack and heart disease for years following infection.
nature.com/articles/s4416…
nature.com/articles/s4146…
ahajournals.org/doi/10.1161/AT…

I’ve gotten questions about whether JN.1- or LP.8.1-based COVID vaccines are better.
Short answer: both should be similarly effective against currently circulating strains. The important thing is to get vaccinated.
Longer answer: see thread We are fortunate in that nearly all currently circulating strains stem from JN.1 (i.e. JN.1 lineage). JN.1 first emerged in late 2023 and became dominant during the winter 2023-2024 surge. Since then, we have gone through waves of KP.2, KP.3, XEC, and in spring 2025, LP.8.1.

New study evaluating vascular and inflammatory diseases after COVID-19 infection and vaccination in nearly 14 million children.
Large persistent increase in major cardiovascular risks following infection. A small transient myocarditis risk following vaccination Paper:

"COVID-19 infection in children & young people was associated w/ elevated risks... including venous thromboembolism, thrombocytopenia, myocarditis, & pericarditis particularly in the first month... w/ some risks remaining elevated up to 12 months"thelancet.com/journals/lanch…

Excellent study on correlates of protection for nuvaxovid / novavax. Higher IgG and nAb levels are excellent predictors for risk of any and severe infection. Helpful data on durability as well. 🧵 Paper: academic.oup.com/cid/advance-ar…

This study group received the original wuhan vaccine and assessed IgG and nAb levels vs Delta. This phase 2 follows the initial CoP analysis, which had no severe cases. That is great, but precluded analysis for severe COVID: nature.com/articles/s4146…

Excellent systematic review of COVID, flu, and RSV vaccines. Hundreds of studies, and millions of individuals represented, all demonstrating that these important vaccines help reduce the risk of severe illness and hospitalization. Link to study:

Remember that the COVID vaccine effectiveness of ~50% is comparing up to date vaccination vs a background of infection acquired and prior vaccine immunity.nejm.org/doi/full/10.10…

Lost in the recent ACIP meeting: A lack of distinction between non-mRNA Novavax & mRNA. They voted on restrictions largely based on mRNA-specific concerns (many false assertions) when these issues flat-out don't apply to Novavax. A brief overview The ACIP voted to add language about six additional risks with COVID vaccines. Let's see how those apply to Novavax

As anticipated, COVID levels are rising nationally with a late summer wave.
Wastewater detection rising quickly.
Early increases in hospitalization rates (those lag infections and viral detection).
I would expect rates to continue accelerating as kids go back to school. Rates are variable by region. For example Texas is matching the highest levels in the last two years. Some areas remain at low levels. Check your state
cdc.gov/nwss/rv/COVID1…

Great overview of one aspect of how COVID damages our bodies.

Summary:
1) blood vessel inflammation,
2) atherosclerosis (clogged arteries),
3) vascular aging (less flexible and functional blood vessels).

Couple additional thoughts 🧵

https://twitter.com/EricTopol/status/1957565029538308472

The cardiovascular impacts of SARS-CoV-2 infection have been well described since the beginning of the pandemic.
Risk of outcomes like heart attack are higher for months or years after infection.
nih.gov/news-events/ne…
nature.com/articles/s4159…

Excellent durability up to one year following Novavax booster doses shown in a new study from Japan.

Correlates of protection estimate 66% throughout the first year following first booster, and 88% throughout second year after 2nd booster. Link to study:

Slight limitation that antibody patterns suggest some people likely had asymptomatic infections that were not captured. However, I'll note that the asymptomatic infection scenario (avoiding moderate/severe disease) is also a good outcome.sciencedirect.com/science/articl…

Long COVID doesn't just pose threat to personal wellbeing, it impacts families, communities, and the national economy.

Recent estimates show it’s sidelined millions of workers, cost trillions in lost productivity, and is quietly reshaping the U.S. labor market and economy. A recent nationwide study found:
- 35 million U.S. adults (1 in 7) have had long COVID symptoms
- 30 million are working-age
- 24 million face mental health or financial strain

This number is bigger than the entire population of Texas.
Link to study: nature.com/articles/s4385…

Interesting new study comparing individuals with ME/CFS, Long COVID, and healthy controls using MRI spectroscopy, cognitive tests, and metabolites. ME/CFS patients had higher lactate in pgACC & dACC, hinting at mitochondrial dysfunction & anaerobic metabolism. Long COVID patients showed lower total choline in dACC, possibly tied to clotting & brain fog.
nature.com/articles/s4138…

The Novavax COVID-19 platform results in lower relative levels of IgG4 compared with mRNA.
IgG4 is additionally linked with lower neutralizing antibody & Fc effector functions.
Lower levels of immune imprinting also seen with NVX, highlighting further benefits of the platform. Link to study:
"Overall, IgG4 levels were notably higher (>150x) in participants primed by mRNA vaccines (8567.1 ng/mL) compared with those primed by the rS protein–based vaccine (48.7 ng/mL)."journalofinfection.com/article/S0163-…

Additional findings from the PREVENT novavax randomized trial on the 4th sequential dose:
- Robust and durable immune responses (8+ months)
- Original strain vaccine had cross protection vs. strains circulating 3 years later (BA.5, BQ.1.1)
- Low reactogenicity (side effects) Link to paper:
sciencedirect.com/science/articl…

Folks have asked me about how I feel about this. Honestly, just sad.

Sad that health has become a political football.
Sad for all the infants who will suffer from preventable illness.
Sad that more children will not have the option of preventing long COVID.

https://twitter.com/SecKennedy/status/1927368440811008138

It's common sense and good science that infants do not have the natural immunity that protects the vast majority of the rest of the population.

Studies agree infants and the elderly are at highest risk of severe disease.
cdc.gov/mmwr/volumes/7…

Marty Markary and Vinay Prasad (FDA Chief and CBER Director) released their perspective on COVID-19 vaccination in a NEJM piece today, with an accompanying webcast.

My quick thoughtsnejm.org/doi/full/10.10… First, I think they raise some reasonable points. I support their goal of increasing trust in vaccines. They do point out young children as having higher risk with COVID infections. They see significant antigenic shifts requiring broad booster uptake.

Large study in children and adolescents shows that SARS-CoV-2 infection is linked with long term cardiovascular complications Study is part of the RECOVER consortium with over 1 million kids.
Link to the paper: nature.com/articles/s4146…

Excited to see our paper out on determinants of SARS-COV-2 infection risk.
Nasal ACE2 and TMPRSS2 levels can predict higher risk of COVID-19.
The nasal microbiome can alter ACE2/TMPRSS2 levels, thus potentially modifying infection risk. Elevated ACE2 and TMPRSS2 levels were higher in individuals who went on to be infected. Higher levels were associated with a four times higher odds of future infection. Cases also had more unstable ACE2 and TMPRSS2 levels over time (i.e. potentially longer windows of risk)

Preprint: Higher IgG4 is linked with lower neutralizing Ab & Fc receptor responses. Paper also suggests the Novavax platform may produce higher IgG1/3 and lower IgG4 compared with mRNA COVID vaccines. To illustrate the magnitude:
NVX priming vs. mRNA priming = 49 vs 8,567 ng/mL in IgG4 (the bad one).
Conversely, IgG1 - 3 (the good ones) were similar or higher in the NVX group.

Link: medrxiv.org/content/10.110…

New RCT comparing Moderna bivalent and Novavax (original strain) as a fourth dose. Novavax has:
- lower side effects
- similar cell mediated immunity, lower IgG response
- potentially broader protection vs variants Link to study:

Side effects are a leading cause of vaccine hesitancy. The Novavax reactogenicity shows roughly half the frequency of each symptom, and lower severity. journalofinfection.com/article/S0163-…