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The Vaccine Thread


JennyD

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24 minutes ago, KSera said:

I've been wondering that as well. Would they have been waiting to see if Pfizer had a better profile for kids? I don't know if approval works that way, where they would hold off on one approval while waiting for data from a similar product.

Yes, I think that's the case.  Originally, it was thought that myocarditis risk increased with decreasing age, but the large 12-15 rollout of pfizer shows there is a peak at 16-17 with rates decreasing on either side.  I believe that's why they are moving forward with the low dose Pfizer for 5-11.  I can't imagine they would consider the Moderna dose until they have a few hundred thousand Pfizer sample points to verify (with some good statistical power) that the myocarditis rate is reduced in lower ages.

I can't grasp why they aren't considering boys and girls separately.  It seems like a no brainer to vax an 11 year old girl with 1/3 the adult dose.  Think how many households this would help.

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27 minutes ago, whitestavern said:

My intent was not to come off as flip or obnoxious. I genuinely wonder if maybe that is the reason. Why are so many countries not recommending Moderna specifically? 

I think pretty clearly because Pfizer has a high efficacy with a lower risk of myocarditis in young men. 
 

 

15 minutes ago, Syllieann said:

Originally, it was thought that myocarditis risk increased with decreasing age, but the large 12-15 rollout of pfizer shows there is a peak at 16-17 with rates decreasing on either side. 

I had been wondering if they would find pre pubescent boys no longer have the increased risk. Sounds like that’s the case.

16 minutes ago, Syllieann said:

I can't grasp why they aren't considering boys and girls separately.  It seems like a no brainer to vax an 11 year old girl with 1/3 the adult dose. 

I agree with considering boys and girls separately (due to myocarditis risk), though I’m not actually following your second sentence. Are you saying that girls should be getting a lower dose than boys at 11, maybe due to size differences, or…?

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6 minutes ago, KSera said:

Snip

I agree with considering boys and girls separately (due to myocarditis risk), though I’m not actually following your second sentence. Are you saying that girls should be getting a lower dose than boys at 11, maybe due to size differences, or…?

I'm saying that an 11 year old girl getting 1/3 the dose of a 12 year old girl after we have data in the millions is just such an easy call.  The 12-15 year old female data is substantial and shows its extremely safe at 30 micrograms.  Giving 10 micrograms to the 11 year old girls seems obvious.  I'm not saying boys and girls should get different doses, although I wouldn't necessarily be opposed to it if it had a better risk/benefit for some groups.

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8 hours ago, whitestavern said:

Finland's health authorities announced that men under 30 will not get the Moderna shot. Sweden banned Moderna for everyone under the age of 30; Denmark did the same for people under 18. Norway is urging people under 30 to choose Pfizer rather than Moderna. Iceland halted all distribution of Moderna. England, Norway, and Hong Kong limiting teens to only one dose of any vaccine I believe. A Canadian boardie posted not too long ago about her province limiting or not recommending one or more vaccines for teens/young adults. Lots of countries not recommending Moderna. Maybe that is why? 

ETA: My intent was not to come off as flip or obnoxious. I genuinely wonder if maybe that is the reason. Why are so many countries not recommending Moderna specifically? 

Ontario: 

 

"Based on advice from Ontario’s Vaccine Clinical Advisory Group, the Ministry of Health is issuing a preferential recommendation for the use of Pfizer-BioNTech COVID-19 vaccine for individuals 18-24 years of age",   buried on page 7.

(ETA 12-17 and 18-24 still get a two dose regimen of Pfizer)

Moderna appears to have a higher myocarditis risk than Pfizer for this age-group.  We have a tonne of Pfizer, so based on this we aren't using Moderna under the age of 25. Moderna is still a very good vaccine, and if Moderna were all we had, I am certain that we would be using it on under 25's.  But we have an even safer choice, in abundant supply.  So we make the best possible choice given our resources.

I don't know if that is influencing the approval process for Moderna or not.  I think their trial was too small/underpowered to assess myocarditis risk (as was Pfizer's).

We aren't using AZ anymore either - but only because we have an abundant supply of mRNA vaccines.  if AZ was all we had, I'm certain that we'd be using it.

Edited by wathe
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7 hours ago, Syllieann said:

I'm saying that an 11 year old girl getting 1/3 the dose of a 12 year old girl after we have data in the millions is just such an easy call.  The 12-15 year old female data is substantial and shows its extremely safe at 30 micrograms.  Giving 10 micrograms to the 11 year old girls seems obvious.  I'm not saying boys and girls should get different doses, although I wouldn't necessarily be opposed to it if it had a better risk/benefit for some groups.

Just for interest, there is data on 11 year olds in Ontario (or to be more precise, 11.5+ year olds)  In July, vaccination eligibility opened up to all children born 2009 or earlier*, even if they hadn't turned 12 yet.  I haven't seen anything publicly accessible that breaks it down that finely by age, but the data exists, and the numbers vaccinated are big - roughly 140 000 kids born in the province in 2009, and the proportion vaccinated is about 80%.

Edited to correct:  Earlier, not later.

Edited by wathe
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New CDC guidelines say that severely immunocompromised people who received a third full-strength dose may also get a booster dose at least 6 months after the 3rd dose:

"Moderately and severely immunocompromised people aged ≥18 years who completed an mRNA COVID-19 vaccine primary series and received an additional mRNA vaccine dose may receive a single COVID-19 booster dose (Pfizer-BioNTech, Moderna or Janssen) at least 6 months after completing their third mRNA vaccine dose. In such situations, people who are moderately and severely immunocompromised may receive a total of four COVID-19 vaccine doses. A person who is moderately or severely immunocompromised and has received two doses of an mRNA vaccine and ≥28 days has elapsed since the second dose, should receive an additional mRNA dose immediately (if Moderna COVID-19 vaccine is used, administer 100µg in 0.5ml), followed ≥6 months later by a single COVID-19 vaccine booster dose (if Moderna vaccine booster is used, administer 50µg in 0.25ml)."

https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-booster

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17 hours ago, whitestavern said:

Finland's health authorities announced that men under 30 will not get the Moderna shot. Sweden banned Moderna for everyone under the age of 30; Denmark did the same for people under 18. Norway is urging people under 30 to choose Pfizer rather than Moderna. Iceland halted all distribution of Moderna. England, Norway, and Hong Kong limiting teens to only one dose of any vaccine I believe. A Canadian boardie posted not too long ago about her province limiting or not recommending one or more vaccines for teens/young adults. Lots of countries not recommending Moderna. Maybe that is why? 

ETA: My intent was not to come off as flip or obnoxious. I genuinely wonder if maybe that is the reason. Why are so many countries not recommending Moderna specifically? 

Oh I forgot about that.   Good point.

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49 minutes ago, mommyoffive said:

I had heard some peds offices were scheduling apts already.  Just called ours and they don't have dates up yet for that and are are thinking the 12.  So I will be looking for Walgreens or CVS I guess.  

Hmm. I just looked and Walgreens and CVS are not vaccinating the under 12 yet (tried making an appointment and it wouldn't let me).

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35 minutes ago, Soror said:

Hmm. I just looked and Walgreens and CVS are not vaccinating the under 12 yet (tried making an appointment and it wouldn't let me).

Yeah I haven't heard that you can make apts there yet.  Some people where able to make them at their peds offices for the future.   I am thinking I might need to go the Walgreens/Cvs route to get one right as them come out.  We are in a time crunch for getting them for our littles for something.

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I just saw the CDC has added mood disorders to the list of high risk conditions that qualify someone for a booster.

Vaccine eligibility for mood disorders underscores elevated covid risk

Quote

Two comprehensive meta-analyses published in the Journal of the American Medical Association confirmed that people with serious mental illness are more at risk for severe illness from covid-19.

 

One study that analyzed data from seven countries found that individuals with schizophrenia were the second-likeliest group to die of covid-19, after the elderly.

Roger S. McIntyre, scientific advisory board chair at the Chicago-based Depression and Bipolar Support Alliance, is one of the researchers behind the other paper, which reviewed 21 studies that included more than 91 million people.

 

The study found a strong link between preexisting mood disorders and hospitalization and death, even when adjusting for smoking, comorbidities such as heart disease, and insecurity in health care, housing and employment, he said.

“Taken together, we’ve got reasons to be hypervigilant for people who have depression. They’ve got to get in front of the queue to get their vaccines,” said McIntyre, a professor of psychiatry at the University of Toronto.

 

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7 hours ago, Soror said:

Hmm. I just looked and Walgreens and CVS are not vaccinating the under 12 yet (tried making an appointment and it wouldn't let me).

Walgreens and CVS didn't start offering boosters until several days after the approval for high risk/over 65 adults, so I wouldn't expect them to be set up for kids yet. FWIW, Walmart was the only place locally where I could get an appointment that first weekend after approval. 

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CDC hasn't voted yet, they are meeting on Tues & Wed next week, so the absolute soonest that pharmacies can be giving shots would be November 4th — and that's only if the pharmacy received a preshipment of pediatric doses, which are packaged and labeled separately from adult doses. It's a different situation than boosters, which people could get immediately since providers were just pulling doses from the same vials they already had in stock.

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2 hours ago, Corraleno said:

CDC hasn't voted yet, they are meeting on Tues & Wed next week, so the absolute soonest that pharmacies can be giving shots would be November 4th — and that's only if the pharmacy received a preshipment of pediatric doses, which are packaged and labeled separately from adult doses. It's a different situation than boosters, which people could get immediately since providers were just pulling doses from the same vials they already had in stock.

I kind of would like to know if our CVS or Walgreens got shipments.  I asked our Ped last Friday and they hadn't gotten any yet.  Anyone heard of a place getting the kiddie vaccine yet? 

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17 minutes ago, mommyoffive said:

YES!! 

How did this happen ahead of the Nov 4th date? 

 

What I don't care.    Everyone report in if you can find the shot anywhere.

The CDC still has to meet, then pharmacies can start dosing.  It does mean that ordering can begin so that's a positive according to my provider information.

Edited by melmichigan
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5 minutes ago, mommyoffive said:

YES!! 

How did this happen ahead of the Nov 4th date? 

 

What I don't care.    Everyone report in if you can find the shot anywhere.

It's the formal fda approval that goes along with the fda panel recommendation.  Cdc still needs to sign off, and I'm not sure they will give approval for all subgroups.

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Moderna says FDA needs more time to complete review of its COVID-19 shot for adolescents

"The FDA informed Moderna that the review may not be completed before January 2022, the company said in a statement, dealing a potential setback to the timing of an emergency use authorization (EUA) for that age group."  The concern appears to be the myocarditis risk.

Edited by melmichigan
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12 minutes ago, melmichigan said:

Moderna says FDA needs more time to complete review of its COVID-19 shot for adolescents

"The FDA informed Moderna that the review may not be completed before January 2022, the company said in a statement, dealing a potential setback to the timing of an emergency use authorization (EUA) for that age group."  The concern appears to be the myocarditis risk.

I think that's wise. I wouldn't be surprised if they eventually turn down the EUA for a 100 µg dose in 12-17 yr olds — that's a really high dose for kids as young as 12, and the myocarditis rate for Moderna is much higher than Pfizer. If I had a child in that age range, I would not be getting Moderna, and I suspect that most parents who want to vax kids in that age range have already done it with Pfizer, since that's been available for almost 6 months now.

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I wonder if they'll pull the plug on the under 12s who are getting 50 micrograms.  It seems really excessive now that we know Pfizer 10 micrograms is 90% effective.  Pfizer says they got essentially the same antibody response with 10, 20, and 30 so they went with the lowest.  I'd love to know how Moderna arrived at the 50 number.  I don't think it could be longevity since they didn't have long enough, but maybe some sort of bridging with the older cohort.

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20 hours ago, Corraleno said:

I think that's wise. I wouldn't be surprised if they eventually turn down the EUA for a 100 µg dose in 12-17 yr olds — that's a really high dose for kids as young as 12, and the myocarditis rate for Moderna is much higher than Pfizer. If I had a child in that age range, I would not be getting Moderna, and I suspect that most parents who want to vax kids in that age range have already done it with Pfizer, since that's been available for almost 6 months now.

Yes, I have children in that age range.  They received Pfizer.  

I think we will find Moderna is overdoing the dosing across all fronts which has led to such high rates of side effects, more of them being severe.  The number of people having inflammatory and autoimmune reactions following Moderna is concerning and is just starting to be acknowledged (and they are starting to add diagnosis codes for it). I'm glad to be responding to therapy, but that therapy has a multitude of risks involved.

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https://emilysmith.substack.com/p/natural-immunity-is-not-enough?token=eyJ1c2VyX2lkIjoxMTQ1MDQxOSwicG9zdF9pZCI6NDMzMjQ4MzgsIl8iOiJta2xNbyIsImlhdCI6MTYzNTgxMzUzNSwiZXhwIjoxNjM1ODE3MTM1LCJpc3MiOiJwdWItMzY2NTM1Iiwic3ViIjoicG9zdC1yZWFjdGlvbiJ9.cdqakiIVUq6JlTksUwhvhwj_2CBQ82qPntRXIsSNDkg

Quote

The odds of hospitalization associated with re-infection for the “Unvaccinated, Prior COVID” was:

  • 5.49 times higher than fully vaccinated individuals with no previous infections

  • 7.55 times higher than fully vaccinated individuals with no previous infections during the Delta phase (WHOA!)

 

When we look by age group, the results are even more striking. The odds of hospitalization associated with re-infection for the “Unvaccinated, Prior COVID” was:

  • 2.57 times higher than fully vaccinated 18-64 year olds with no previous infections

  • 19.57 times higher than fully vaccinated >65 year olds with no previous infections

Differences with other studies:

Quote

“What about the study from Israel that did not find this?”

A study from Israel concluded that vaccinated adults were not protected better than previous infections during the Delta phase. I see many people using this study to not get a vaccine (this one is the main study circulating in anti-vax groups too). However, that study and the CDC one differed in several important ways and likely account for the discrepancy. Here’s the discussion from the CDC study which I thought summarized the reasons well:

“These findings are consistent with evidence that neutralizing antibody titers after receipt of 2 doses of mRNA COVID-19 vaccine are high; however, these findings differ from those of a retrospective records-based cohort study in Israel,†† which did not find higher protection for vaccinated adults compared with those with previous infection during a period of Delta variant circulation. This variation is possibly related to differences in the outcome of interest and restrictions on the timing of vaccination. The Israeli cohort study assessed any positive SARS-CoV-2 test result, whereas this study examined laboratory-confirmed COVID-19 among hospitalized patients. The Israeli cohort study also only examined vaccinations that had occurred 6 months earlier, so the benefit of more recent vaccination was not examined. This report focused on the early protection from infection-induced and vaccine-induced immunity, though it is possible that estimates could be affected by time. Understanding infection-induced and vaccine-induced immunity over time is important, particularly for future studies to consider.”

I don't understand the bolded.

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Our tiny pharmacy in our local village started accepting appointments for kids (5-11) as early as this coming Friday. You betcha I got appts for my two boys (ages 9 and 10) within minutes. Fri at 3:25! We even put a star on our calendar for the holiday status that day deserves.

Edited by ericathemom
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  • 2 weeks later...

The good news....my 5 private students today all came in excited because they  got their COVID vaccine (schools were closed Thurs/Fri, and there were some special extended hours for 5-11 vaccines). 

 

The bad news-they ALL came in without masks. They put them on when prompted (masking is still required in schools, due to court order, and I haven't changed my policies-after this week, we have a one week break for Thanksgiving, and two more weeks, and then we're done for the semester), but it was clear that they really believed they didn't need them anymore. I really hope there isn't a rash of partially vaccinated kid cases in the next month!!

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49 minutes ago, wathe said:

Paediatric Pfizer covid vaccine finally approved for 5-11 year olds in Canada.  Looks like we'll be spacing doses 8 weeks apart.

I an SOOOOOOOO glad this is finally being officially acknowledged and used in implementation:

"The National Advisory Committee on Immunization (NACI), however, is recommending that the spacing between doses be increased to at least eight weeks, as evidence has been growing that a longer interval generates a more robust immune response. The longer spacing might also help to decrease even further the risk of the rare side effect of myocarditis (inflammation of the heart muscle), NACI said."

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4 minutes ago, Syllieann said:

I an SOOOOOOOO glad this is finally being officially acknowledged and used in implementation:

"The National Advisory Committee on Immunization (NACI), however, is recommending that the spacing between doses be increased to at least eight weeks, as evidence has been growing that a longer interval generates a more robust immune response. The longer spacing might also help to decrease even further the risk of the rare side effect of myocarditis (inflammation of the heart muscle), NACI said."

NACI has been both very pragmatic and right on top of best evidence since the very beginning.

For adults we had 4 month spacing while vaccine was in short supply (rationale, based on modelling, twice as many partially vaxed people would result in fewer deaths in the population than half as many fully vaxed), then moved to 21-28 day spacing when delta hit and supply became plentiful, and now increasing spacing as per evolving best evidence.

the increase to 8 week spacing for adults starts tomorrow (at least in my province).  It makes good immunological and epidemiological sense.  But a subset of people are pissed - mostly those who put off vaccination until the last possible moment and need to be vaccinated for a particular social purpose (eg travel and have a particular trip booked and paid for, or other Christmas social events, or a particular hockey game) won't be able to complete their series in time.  Vax clinic staff have already been subject to much abuse over the change.

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1 hour ago, wathe said:

Paediatric Pfizer covid vaccine finally approved for 5-11 year olds in Canada.  Looks like we'll be spacing doses 8 weeks apart.

I’ve been so tempted to space ours out that long as well. I think I would do so, except for us running up against Christmas and the anticipated Holiday spike. It’s a hard decision. It does seem likely that we will see the eight week was a smart way to go.

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8 minutes ago, KSera said:

I’ve been so tempted to space ours out that long as well. I think I would do so, except for us running up against Christmas and the anticipated Holiday spike. It’s a hard decision. It does seem likely that we will see the eight week was a smart way to go.

It is a hard choice:  Great protection sooner vs better long term protection.  I considered the same back in June wrt to my 12 and 13 yo.  I elected for great protection sooner in light of the delta wave. They'll be eligible for boosters in a few months.  Time will tell.  Some of my colleagues stretched their kids spacing to 8 weeks instead.  

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1 hour ago, wathe said:

It is a hard choice:  Great protection sooner vs better long term protection.  I considered the same back in June wrt to my 12 and 13 yo.  I elected for great protection sooner in light of the delta wave. They'll be eligible for boosters in a few months.  Time will tell.  Some of my colleagues stretched their kids spacing to 8 weeks instead.  

Is they talking about boosting teens up there currently?  I of course wish that I would have spaced out my teens, but that wasn't anything that was in the news at that moment.  Sigh.  Now with my 3 littles I think it probably is the best long term thing to do, however we are in a huge surge and I am not going to do that.  

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Boosters for 18+? ACIP meeting today - by Katelyn Jetelina - Your Local Epidemiologist (substack.com)

 

What about 12-17 year olds?

Many parents are asking if their adolescent should get a booster because the 6 month mark is coming up soon. This ACIP meeting didn’t discuss 12-17 year olds. The FDA and CDC hasn’t provided an official explanation either. But I have an idea why...

During clinical trials, 12-17 year olds had an even higher neutralizing antibody response than adults even though they were given the same dose. So, while adult antibodies are waning, the waning isn’t as urgent for adolescents. In October, we saw this phenomenon in a peer-reviewed study from the Lancet. The scientists measured VE over time for different age groups and plotted it on a graph (see below). Adolescent vaccines were not declining at the same rate as adults. Are they today? Maybe. Again, we don’t have the data.

Also, the peak for vaccine-induced myocarditis risk is at 16 years old. Regulatory agencies (FDA, CDC) are being very careful to assess whether the benefits outweigh the risks for this age group. Adolescents will likely need a booster one point. It’s just not right now.

https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F86008e65-0fee-499f-ad3b-a6cf3e3874d7_1284x2006.jpeg

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1 minute ago, Syllieann said:

@mommyoffive that's reassuring.  I wonder if it will be the same for 5-11 or if the smaller dosage will cancel.  I know I'm going  to do dd's shot at 3 weeks but I keep going back and forth on ds.  The case rate and positivity has me leaning toward 3 weeks, but I wish I could hold out for 8.

I know.  I wish I had more of a choice.  My youngers need to be fully vaxxed in early December to take part in something that requires people to be fully vaxxed to be in the theater.  If we were living our life of lockdown I would really be tempted to wait.  But with the cases in my state now, I just can't risk it even if we were not in this one thing.  Sigh.  It is such a hard choice to make.  

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2 hours ago, Corraleno said:

FDA authorizes boosters for ALL adults — it's what they should have done to begin with, but better late than never.

https://www.washingtonpost.com/health/2021/11/19/fda-clears-pfizer-biontech-moderna-booster-shots-all-adults/

The UK is going to work down the age groups as before, I think, as each reaches six months.  Most people were on a 12-week schedule for first jabs, so we are pretty spread out. Currently the over forties are starting to book. Boosters aren't going badly.

Screenshot_20211119-215749_Chrome.jpg

Edited by Laura Corin
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So now that boosters are open for all, what does everyone think about boosters for a healthy 20-year-old male at uni? Or a 24-year-old high school teacher? 

I feel as though the infection numbers are concerning, so booster away. (I got the booster as soon as I could.) Yet I also worry. 

Genuinely curious to hear thoughts on this. Thank you.

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3 minutes ago, Harriet Vane said:

So now that boosters are open for all, what does everyone think about boosters for a healthy 20-year-old male at uni? Or a 24-year-old high school teacher? 

I feel as though the infection numbers are concerning, so booster away. (I got the booster as soon as I could.) Yet I also worry. 

Genuinely curious to hear thoughts on this. Thank you.

Boosters were open to both of them from the beginning.  One because he's living in a congregate setting, the other because she/he is working in a high exposure setting.

I wouldn't hesitate for either.

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