*Updated November 19, 2021: The FDA has authorized the Pfizer and Moderna boosters for all adults.

As we move into the holiday season, a new definition of “full vaccination” is emerging. With the increased awareness and occurrence of breakthrough infections in those who have received two doses of the Pfizer or Moderna vaccines or the J&J vaccine, the value and role of boosters has become a key topic. 

Booster vaccinations clearly enhance antibody levels, and the FDA will most likely approve boosters for all adults over 18 this week and potentially approve Moderna boosters on Friday as well. It is likely this will become the new standard to achieve maximum vaccine protection, especially with a new COVID-19 surge underway and the likelihood that the delta plus variant (or an alternate new variant) is becoming a dominant strain.

For myeloma patients with compromised immunity, the booster is a must. In addition, the vaccination of children, and the booster for all adults can protect myeloma patients in all types of social gatherings. 

Preparing for the holidays 

In a recent New York Times article, three experts were asked for advice about handling social gatherings at Thanksgiving and Christmas. Dr. Linsey Marr (an engineering professor at Virginia Tech, where she studies airborne transmission of viruses), Dr. Juliet Morrison (a virologist at the University of California, Riverside) and Dr. Jennifer Nuzzo (an epidemiologist at the Johns Hopkins Bloomberg School of Public Health) offered a few clear recommendations:

• Try to socialize in groups whose members are fully vaccinated, including having the booster vaccine, if possible.
• For those who are unvaccinated, a rapid COVID test can be considered (with a negative test required for an invitation). 
• Use masks indoors when not eating or drinking if there is any concern about some individuals, and especially if unvaccinated children are part of the group. 
• Excellent cross ventilation is strongly recommended, and any activities outside are preferred, with fire or heaters as needed. 
• When the level of COVID infection in the community is low, the risk of infection is also much lower. If you are in an area with very low vaccination rates (less than 50%), greater cautions are necessary. 

Continued good news about treatments 

• MONOCLONAL ANTIBODIES: A follow-up study of 1,395 patients by Mayo Clinic shows a 77% reduction in the risk of hospitalization in individuals with breakthrough infections treated with monoclonal antibodies. So, excellent news! 
• ORAL ANTI-VIRAL MEDICINES: 
  • The Merck anti-viral molnupiravir was recently approved in the U.K. based on data indicating a 50% reduction need for hospitalizations. 
  • Pfizer has announced that its new COVID-19 antiviral, Paxlovid, which reduced need for hospitalizations by 89%, will be submitted to the FDA for approval in the U.S. The company anticipates receiving approval by year’s end. 

These are wonderful developments that can be game-changers for myeloma patients (and other immune-compromised groups). Much more needs to be learned, but it is particularly encouraging that agreements have already been reached to provide generic versions to low- and middle-income countries, where there can be a major impact. There is definitely more to come. And in the meantime, we should not forget about dexamethasone—a drug familiar to so many myeloma patients. A new study confirms the reduced need for hospitalizations after the use of dexamethasone. 

Looking toward 2022 

As we head into the holidays and look forward to 2022 as time when things can finally become more normal, there are many new tools at our disposal. Both the broad use of boosters and the availability of anti-viral treatments will have a big impact. Wider availability of rapid COVID tests will also be helpful in reducing exposures from asymptomatic individuals. 

So, plan ahead and enjoy the upcoming holidays with family and friends!