Risks of COVID-19 Booster Shots


An explanation of the risks associated with COVID-19 booster shots.

Peter Salgo, MD: Is there any evidence to suggest that there’s a safety and efficacy difference amongst the booster shots across various manufacturers, Donald?

Donald Alcendor, PhD: I would think not. Not in any serious way. Meaning, in terms of protection, if we think what a vaccine should do, I talked about this before: prevent severe disease, prevent hospitalizations, and prevent death in people that receive it. Between those 3 vaccines there’s no difference.

Peter Salgo, MD: Check box number 2. What are the risks associated with the booster compared to the second shot or first shot initial vaccination? Is there a difference? Do we have to worry with our third or second, depending on how you did the first immunization, more than we worried with the first 1, Jeff?

Jeff Goad, PharmD, MPH: For example, if you look at the Pfizer data, what they saw in the third dose or booster versus second dose, they’re very similar. The adverse event profile looks similar from dose number 2 to booster, which was more than dose number 1. I think that’s what we’ll see throughout the other vaccines that people anecdotally reporting and that we’ve seen in studies. There is no difference from the second dose.

Peter Salgo, MD: Check box number 3. This comes up all the time. What are your recommendations regarding the booster shot in pregnant and breastfeeding populations? Is that a reasonable question, Jason?

Jason Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS: That’s a wonderful question. I’m so glad it came up. I feel like it’s worth more than just the check box because this is a highly under-vaccinated population that’s at enormous risk of complications from COVID-19. Every time it comes up, I think of a specific patient. However, some of the worst outcomes I’ve seen personally have been in pregnant women and they’re heartbreaking, truthfully.

Peter Salgo, MD: Let me be very clear. You’re saying some of the worst outcomes are COVID in pregnant patients, not from vaccines in pregnant patients?

Jason Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS: Yes, wholly not my intention of course. I was specifically talking about COVID outcomes in unvaccinated pregnant women. Almost everyone that’s in our hospital with COVID is unvaccinated, truthfully. That is the population that just breaks my heart the most because they’re young, they’re healthy, and they’re 2 people. Their outcomes are poor. So it’s essential that they are vaccinated and boosted if they’re time-wise eligible.

Peter Salgo, MD: So it’s safe and efficacious both in breastfeeding populations and in pregnant populations?

Jason Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS: Yes. And this has been tracked. At first there was no reason to be worried, though obviously individual people were. There actually is data now saying that this is safe.

Donald Alcendor, PhD: I just want to remind folks that in the Moderna trial, some of the women became pregnant during the time they received the vaccination. Simply meaning that they got the vaccination and became pregnant. The idea is, they followed those women. I think it was about 36 of them. Eighteen of them were in the vaccine arm and again they followed them. There were no ill effects seen. Moderna also looked at 1000 rats looking for changes in fertility, changes in the amount of pups they had, and changes in pregnancy in these animals. They saw no ill effects. That was a bell ringer for the women that were pregnant to get this. Of course, ACOG [American College of Obstetricians and Gynecologists] and all the governmental bodies for health and wellness of women have approved that.

Peter Salgo, MD: Thank you.

Angela Rasmussen, PhD: I just want to add too that this is something that ASIP [American Society for Investigative Pathology] periodically revisits. They look at the rates of miscarriage and stillbirth over backgrounds, and there’s absolutely no increase whatsoever in vaccinated pregnant people compared to unvaccinated.

Peter Salgo, MD: I want to thank you at home for watching this Peer Exchange discussion. If you enjoyed the content, subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your inbox.

Transcript edited for clarity.

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