Emily Oster

9 min Read Emily Oster

Emily Oster

Should You Get the Bivalent Booster?

Emily Oster

9 min Read

My inbox, and my Wednesday Instagram stories, are usually a good barometer of where people are in their concerns about COVID. In the past several weeks, nearly all of the questions I get are about vaccines, and specifically how to navigate what sometimes feels like confusing messaging. The White House and CDC have offered a particular set of guidance about vaccination, but in many cases this is at odds with the information people are getting from their own doctors, let alone internet comments. As usual, without a better understanding of why these recommendations differ, it’s hard to sort through them.

Today I want to try to help by talking through three somewhat specific questions that I think reflect where many of the readers of this newsletter are.

First: bivalent boosters. Assuming you’re fully vaccinated already, what is the value of getting the bivalent booster?

Second: vaccines in pregnancy. Is there a best time to get boosted?

Third: vaccines for the under-5 set. We’re now a few months out. Have we learned anything more?

Bivalent boosters

TL;DR: The most important point here is that it is an extremely good idea for anyone who is older or immunocompromised to get the booster. If you’re over 50 or (especially) over 65 — booster!

To refresh your memory… The mRNA COVID vaccines (Pfizer and Moderna) work by inducing your body to produce antibodies to the spike protein of the SARS-CoV-2 virus. The vaccines were developed to target the original viral sequence (sometimes called the “wild type” variant). The initial vaccination protocol for adults was two doses, separated by three or four weeks.

Vaccination provides protection in at least two ways. First, your body produces antibodies to the spike protein, which are then circulating in your blood to target the actual virus. These antibodies fade out over time; the exact timing is unclear, but in general antibodies last perhaps six months. Second, in response to vaccination, your body produces T-cell memory to be able to quickly produce antibodies if necessary. This protection is much longer-lived.

Over the past couple of years of vaccination and viral evolution, we have learned three things. First, the vaccine protection against serious illness is quite robust and long-lived even with the evolution of the virus. Second, the vaccine protection against symptomatic infection is incomplete and relatively short-term. This has been especially true during Omicron. Third, the immune response of older individuals is less robust.

The combination of the last two here — the reduction in protection over time, and the vulnerability of older people — has led to the development of booster doses. A booster dose of the vaccine ramps up the immune response and generates more immediate antibodies (and more T-cell memory). It therefore provides better protection in the long term and, especially, the short term.

We have some good data on the value of booster doses overall. In these data, it has become very clear that for older or immunocompromised individuals, booster doses are crucial for lowering the risk of hospitalization and death. A new analysis out of Scotland last week showed that a booster dose reduces the risk of hospitalization by four times for people over 80; for people with underlying conditions, this could be as much as 10-fold. This data doesn’t show the same added protection for people under 60. This is likely because their baseline risk of hospitalization with initial vaccine doses is already very low.

It also appears that booster doses reduce the risk of symptomatic infection for several months; this reduction (based on a number of papers — see here, here, and here) seems to be about 50%.

The new bivalent booster is a booster dose that is reformulated to better match the circulating form of the virus. The original vaccine was developed to match the wild-type SARS-CoV-2 virus. This updated booster includes some of that original vaccine, but also includes code to induce your body to make antibodies to two forms of the Omicron variant. The hope is that this would provide better protection, against either serious illness or symptomatic infection.

We do not yet have concrete data about whether this booster provides better protection. Last week, Pfizer issued a press release saying that they saw a better antibody response to BA.4 and BA.5 with the bivalent booster. That’s encouraging, but we do not have direct evidence that this booster is better than earlier boosters in terms of performance.

So… should I get it?

If you’ve recently had COVID or had a booster shot in the past couple of months, no. Recommendations are to wait three months between doses, or between an infection and booster dose.

If you haven’t had COVID recently… For older (say, over 50 and certainly over 65) or immunocompromised individuals, absolutely yes to the booster. We are still losing 300 to 400 people a day to COVID, and nearly all of the deaths in the past several months are in individuals over 50. The vast majority are in people over 75. We know from earlier booster doses that they protect this group. If you’re in this group, please get a booster shot. If you have a parent or older relative in the group, please get them a booster shot.

For people younger than this, the value of the booster shot is a period of some protection against symptomatic COVID over the next several months. It’s difficult to know exactly how much protection; without more detail about the performance of the bivalent booster, I think it’s safe to assume it’s similar to the older version — about 50%. The booster will also ramp up protection against serious infection, but in this group, that risk is already very small after initial vaccination. Note that a lower risk of infection will also lower your risk of passing the virus on to others. These are good reasons to do it! The value is lower than in older people, but still there.

We are not seeing serious adverse reactions to the vaccine; the side effects are similar to earlier doses — sore arm, often a day or two of fatigue and fever, maybe some nausea.

Pregnancy

During the Delta wave of the virus, unvaccinated pregnant women appeared to be at much higher risk for serious illness and death than others. However, in the more recent waves, and with vaccines, these risks are much lower. I’ve written more extensively about this here. So the first thing to say is that if you are completely unvaccinated and pregnant, it is a very good idea to get vaccinated.

Assuming you’ve had some vaccines already, there are two reasons to get boosted during pregnancy. One is that pregnancy is something of an immune-system compromise, so the value is higher than if you were not pregnant. The second is that a booster dose in the latter half of pregnancy (say, end of the second or beginning of the third trimester) can give an antibody boost to your baby for the first six months of life, before they can get vaccinated. We have seen lower hospitalization rates for infants of mothers who were vaccinated during pregnancy.

Under-5 adverse-effect data

Finally, this is a good time to review what we know so far about under-5 vaccines. The take-up of vaccines for the under-5 set has been tepid. Approximately 10% of this group, about 1.5 million children, have been vaccinated. However, that is still a lot of vaccines, and enough to start looking at realized safety data. For many parents, these early safety data are part of what they are waiting for.

To look at what has gone on with the vaccines, I pulled down data from the Vaccine Adverse Event Reporting System (VAERS) for COVID-19 vaccines for the under-5 age group. I’ve written extensively about this system when doing a similar analysis for the 5-to-11 age group, which you can read here. The short version is that this is a CDC system in which anyone can report adverse events from vaccination. It’s intended to capture a picture of safety in the real world, with millions rather than thousands of vaccines.

To begin: as mentioned, about 1.5 million children have been vaccinated. For 1,931 of that group, there are adverse events reported in the system. This is about 1 for every 800 vaccinated children. However: 831 of these events actually did not have any adverse health events (they may be incorrect timing of dose, for example). If we ignore those, 1,092 children have a reported adverse event. That’s 1 in about 1,370 children vaccinated.

Most of these cases are the adverse events we would have expected from the trials: fever, rash, injection-site pain or swelling, nausea, and diarrhea. It is important to note that the VAERS is not an ideal data set in which to evaluate these minor adverse events. Based on the trials, we know that a lot of children have fever post-vaccination and most of them will not be reported as an adverse event. On the flip side, without a comparison group, it’s hard to know whether (for example) diarrhea is more likely than it would be otherwise.

What the VAERS data is very useful for is looking at serious adverse events, like those that result in hospitalizations.

There are 28 hospitalizations reported in the data, or about 1 for every 53,000 vaccine doses. Nine of these hospitalizations are linked explicitly in the narrative to other viruses. Of the others, most are non-specific. There are four instances of seizure, which could plausibly be linked to the vaccine, and two instances of Guillain-Barré syndrome. These cases all resolved, and, again, as a share of 1.5 million children vaccinated, these events are extremely rare.

Combining these VAERS data with the fact that we haven’t seen attention or reporting on any vaccine risks for children should increase confidence in vaccine safety.

Efficacy data is less available. Serious illness is very rare in this age group, so while we would expect the vaccine to decrease the risk, that is not something we have yet seen in the data (in contrast to the 5-to-11 group, where we have enough data during Omicron to show reductions in hospitalization risk). Based on what we know, though, we would expect the vaccines to provide some protection against symptomatic illness; the trials showed 50% to 75% protection.

What if your child had COVID? In that case, it may be best to think about these vaccines as (effectively) a booster dose. They can provide additional protection against symptomatic illness and lower their risk of getting COVID this winter. And given the number of illnesses we all seem to be picking up these days, lowering the risk of this particular one seems like a good idea.

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Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic. 

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents. 

Share this post with a friend who could use a little more data, and a little less parenting overwhelm. 

📷 Me and my oldest, collaborating on “Expecting Better”

Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic.

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents.

Share this post with a friend who could use a little more data, and a little less parenting overwhelm.

📷 Me and my oldest, collaborating on “Expecting Better”
...

I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles

I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles
...

Here’s why I think you don’t have to throw away your baby bottles.

Here’s why I think you don’t have to throw away your baby bottles. ...

Drop your toddlers favorite thing right now in the comments—then grab some popcorn.

Original thread source: Reddit @croc_docs

Drop your toddlers favorite thing right now in the comments—then grab some popcorn.

Original thread source: Reddit @croc_docs
...

Just keep wiping.

Just keep wiping. ...

Dr. Gillian Goddard sums up what she learned from the Hot Flash  S e x  Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships

Dr. Gillian Goddard sums up what she learned from the Hot Flash S e x Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships
...

Should your kid be in a car seat on the plane? The AAP recommends that you put kids under 40 pounds into a car seat on airplanes. However, airlines don’t require car seats.

Here’s what we know from a data standpoint:
✈️ The risk of injury to a child on a plane without a carseat is very small (about 1 in 250,000)
✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats 
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy. 

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety

Should your kid be in a car seat on the plane? The AAP recommends that you put kids under 40 pounds into a car seat on airplanes. However, airlines don’t require car seats.

Here’s what we know from a data standpoint:
✈️ The risk of injury to a child on a plane without a carseat is very small (about 1 in 250,000)
✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy.

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety
...

SLEEP DATA 💤 PART 2: Let’s talk about naps. Comment “Link” for an article on what we learned about daytime sleep!

The first three months of life are a chaotic combination of irregular napping, many naps, and a few brave or lucky souls who appear to have already arrived at a two-to-three nap schedule. Over the next few months, the naps consolidate to three and then to two. By the 10-to-12-month period, a very large share of kids are napping a consistent two naps per day. Over the period between 12 and 18 months, this shifts toward one nap. And then sometime in the range of 3 to 5 years, naps are dropped. What I think is perhaps most useful about this graph is it gives a lot of color to the average napping ages that we often hear. 

Note: Survey data came from the ParentData audience and users of the Nanit sleep monitor system. Both audiences skew higher-education and higher-income than the average, and mostly have younger children. The final sample is 14,919 children. For more insights on our respondents, read the full article.

SLEEP DATA 💤 PART 2: Let’s talk about naps. Comment “Link” for an article on what we learned about daytime sleep!

The first three months of life are a chaotic combination of irregular napping, many naps, and a few brave or lucky souls who appear to have already arrived at a two-to-three nap schedule. Over the next few months, the naps consolidate to three and then to two. By the 10-to-12-month period, a very large share of kids are napping a consistent two naps per day. Over the period between 12 and 18 months, this shifts toward one nap. And then sometime in the range of 3 to 5 years, naps are dropped. What I think is perhaps most useful about this graph is it gives a lot of color to the average napping ages that we often hear.

Note: Survey data came from the ParentData audience and users of the Nanit sleep monitor system. Both audiences skew higher-education and higher-income than the average, and mostly have younger children. The final sample is 14,919 children. For more insights on our respondents, read the full article.
...

Happy Father’s Day to the Fathers and Father figures in our ParentData community! 

Tag a Dad who this holiday may be tricky for. We’re sending you love. 💛

Happy Father’s Day to the Fathers and Father figures in our ParentData community!

Tag a Dad who this holiday may be tricky for. We’re sending you love. 💛
...

“Whilst googling things like ‘new dad sad’ and ‘why am I crying new dad,’ I came across an article written by a doctor who had trouble connecting with his second child. I read the symptoms and felt an odd sense of relief.” Today we’re bringing back an essay by Kevin Maguire of @newfatherhood about his experience with paternal postpartum depression. We need to demystify these issues in order to change things for the better. Comment “Link” for a DM to read his full essay.

#parentdata #postpartum #postpartumdepression #paternalmentalhealth #newparents #emilyoster

“Whilst googling things like ‘new dad sad’ and ‘why am I crying new dad,’ I came across an article written by a doctor who had trouble connecting with his second child. I read the symptoms and felt an odd sense of relief.” Today we’re bringing back an essay by Kevin Maguire of @newfatherhood about his experience with paternal postpartum depression. We need to demystify these issues in order to change things for the better. Comment “Link” for a DM to read his full essay.

#parentdata #postpartum #postpartumdepression #paternalmentalhealth #newparents #emilyoster
...

What does the data say about children who look more like one parent? Do they also inherit more character traits and mannerisms from that parent? Let’s talk about it 🔎

#emilyoster #parentdata #parentingcommunity #lookslikedaddy #lookslikemommy

What does the data say about children who look more like one parent? Do they also inherit more character traits and mannerisms from that parent? Let’s talk about it 🔎

#emilyoster #parentdata #parentingcommunity #lookslikedaddy #lookslikemommy
...

SLEEP DATA 💤 We asked you all about your kids’ sleep—and got nearly 15,000 survey responses to better understand kids’ sleep patterns. Comment “Link” for an article that breaks down our findings!

This graph shows sleeping location by age. You’ll notice that for the first three months, most kids are in their own sleeping location in a parent’s room. Then, over the first year, this switches toward their own room. As kids age, sharing a room with a sibling becomes more common. 

Head to the newsletter for more and stay tuned for part two next week on naps! 🌙

#parentdata #emilyoster #childsleep #babysleep #parentingcommunity

SLEEP DATA 💤 We asked you all about your kids’ sleep—and got nearly 15,000 survey responses to better understand kids’ sleep patterns. Comment “Link” for an article that breaks down our findings!

This graph shows sleeping location by age. You’ll notice that for the first three months, most kids are in their own sleeping location in a parent’s room. Then, over the first year, this switches toward their own room. As kids age, sharing a room with a sibling becomes more common.

Head to the newsletter for more and stay tuned for part two next week on naps! 🌙

#parentdata #emilyoster #childsleep #babysleep #parentingcommunity
...

Weekends are good for extra cups of ☕️ and listening to podcasts. I asked our team how they pod—most people said on walks or during chores. What about you?

Comment “Link” to subscribe to ParentData with Emily Oster, joined by some excellent guests.

#parentdata #parentdatapodcast #parentingpodcast #parentingtips #emilyoster

Weekends are good for extra cups of ☕️ and listening to podcasts. I asked our team how they pod—most people said on walks or during chores. What about you?

Comment “Link” to subscribe to ParentData with Emily Oster, joined by some excellent guests.

#parentdata #parentdatapodcast #parentingpodcast #parentingtips #emilyoster
...

Humility. That’s why. That’s the whole reason.

#emilyoster #secondbaby #parentingjokes #parentinghumor

Humility. That’s why. That’s the whole reason.

#emilyoster #secondbaby #parentingjokes #parentinghumor
...

Bug season is upon us. Besides annoyance, this can bring up safety concerns, particularly with ticks. They are carriers of diseases, most notably Lyme disease. So what’s the best course of action?

Prevention is key! I suggest:
⭐ Regular tick checks
⭐ Using bug sprays with DEET 
⭐ Wearing long sleeves and pants in the woods

Some parents worry about DEET, but repellants with up to 30% DEET are recommended by both the CDC and AAP. The data says you’re in the clear, so go for it. Enjoy your summer!

#parentdata #emilyoster #tickseason #bugbites #bugspray

Bug season is upon us. Besides annoyance, this can bring up safety concerns, particularly with ticks. They are carriers of diseases, most notably Lyme disease. So what’s the best course of action?

Prevention is key! I suggest:
⭐ Regular tick checks
⭐ Using bug sprays with DEET
⭐ Wearing long sleeves and pants in the woods

Some parents worry about DEET, but repellants with up to 30% DEET are recommended by both the CDC and AAP. The data says you’re in the clear, so go for it. Enjoy your summer!

#parentdata #emilyoster #tickseason #bugbites #bugspray
...