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michaelzlin's profile
Michael Lin, MD PhD 🧬
Michael Lin, MD PhD 🧬
Michael Lin, MD PhD  🧬
@michaelzlin

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Michael Lin, MD PhD  🧬

@michaelzlin

Associate Professor of Neurobiology & Bioengineering @Stanford ☘️🧪🦠🧠🌈🔬📖🇺🇲🌏 Molecular engineering for voltage, viruses, and SARSCoV2. Fan of facts.

Harvard/UCLA/HMS/UCSD/Stanford
linlab.stanford.edu
Joined July 2015

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    1. Michael Lin, MD PhD  🧬‏ @michaelzlin 14 Dec 2021

      Basically you need a RNA vaccine at some time to prime a wide B cell population for antibodies against variants. J&J does not substitute. If you don't do it earlier, you'll just have to do it later. I hope for the health of JnJers that @CDCgov and @CDCDirector will consider it.

      8 replies 25 retweets 129 likes
      Show this thread
    2. Michael Lin, MD PhD  🧬‏ @michaelzlin 14 Dec 2021

      A couple of clarifications: As 2x RNA didn't produce nAbs vs variants (that's the recently vaxxed but unboosted case) but a 3rd shot of any sort did, it means 2x RNA may be needed to activate that broad memory B cell population. So for omicron JnJers may need 2x RNA in sequence.

      10 replies 12 retweets 75 likes
      Show this thread
    3. Michael Lin, MD PhD  🧬‏ @michaelzlin 14 Dec 2021

      Second, J&Jers boosted with Moderna should do fine against Delta. J&J + Moderna gives even more nAbs against Delta than 2x Pfizer unboosted (below), and that correlates with 80% VE against Delta disease. This is consistent with the previous prediction at https://twitter.com/michaelzlin/status/1466488989003616257 …pic.twitter.com/7vW45HFPBi

      4 replies 7 retweets 71 likes
      Show this thread
    4. Michael Lin, MD PhD  🧬‏ @michaelzlin 14 Dec 2021

      So in a sense JJ+RNA booster gets to where 2xRNA was to begin with (pic1 below). But it is worse than 3xRNA for variants, esp Omicron (pic2 below). And with decay we expect some loss of protection to Delta in the upcoming months (if we go by 2xPfizer decay, maybe 50% VE at 6mo).pic.twitter.com/5T7c0F1sDI

      8 replies 9 retweets 74 likes
      Show this thread
    5. Michael Lin, MD PhD  🧬‏ @michaelzlin 14 Dec 2021

      Michael Lin, MD PhD  🧬 Retweeted Michael Lin, MD PhD  🧬

      Made a mistake above regarding J&J as a booster. I misread a case of Moderna+Pfizer (blue dot) as Moderna+JJ (green dot). So this study doesn't say how well J&J works as a boost for RNA vax. The earlier study says J&J is inferior to RNA in boosting nAbshttps://twitter.com/michaelzlin/status/1466488989003616257 …

      Michael Lin, MD PhD  🧬 added,

      Michael Lin, MD PhD  🧬 @michaelzlin
      That's for original strain; for Delta you need ~400. (Not clear for omicron, but expected to be higher than that.) So I circled all the numbers that are ≥400 or are statistically indistinguishable from 400 (close enough). Also translated vaccine names into American English pic.twitter.com/DBIa9LGm8U
      Show this thread
      5 replies 6 retweets 47 likes
      Show this thread
    6. Michael Lin, MD PhD  🧬‏ @michaelzlin 15 Dec 2021

      Another way to explain the data is that 3 immunizations are needed for broad nAbs. Note the infection+2xRNA nAb levels are after 6mo decay; if the sera had been obtained soon after the last shot, those levels might be similar to recent 3xRNA.pic.twitter.com/TK6lNCcQtX

      3 replies 7 retweets 32 likes
      Show this thread
    7. Michael Lin, MD PhD  🧬‏ @michaelzlin 15 Dec 2021

      Since 1xJJ is similar to infection by WT strain (ref below), then we expect that after a second RNA boost (i.e. JJ+RNA+RNA) then nAb levels may be like 3xRNA. So this is even more reason to advocate for a 2nd boost.https://www.nature.com/articles/s41591-021-01377-8 …

      4 replies 15 retweets 66 likes
      Show this thread
    8. Michael Lin, MD PhD  🧬‏ @michaelzlin 15 Dec 2021

      And if we now space the two RNA shots 2-6mo apart then one gets 2-4x higher nAbs than the original 3-4wk interval (https://sciencedirect.com/science/article/pii/S0092867421012216 …). Note the most evasive Beta variant sees the biggest benefit, suggesting activation of a broader set of B cells with the longer interval.pic.twitter.com/caKiW3KBWV

      2 replies 8 retweets 38 likes
      Show this thread
    9. Michael Lin, MD PhD  🧬‏ @michaelzlin 15 Dec 2021

      Above I wrote 3mo as ideal interval in one tweet and 6-mo two tweets later. 3 or 6 mos between RNA shots 2 and 3 elicit similar peak nAbs, based on my skimming of the studies. So anything from 3 to 6 mos would work and timing could be based on when omicron protection needed.

      9 replies 9 retweets 64 likes
      Show this thread
    10. Michael Lin, MD PhD  🧬‏ @michaelzlin 15 Dec 2021

      In sum, 1x J&J is at most like 1 dose of RNA (seen as far back as phase1 antibody measurements). That's been reinforced by its use as a booster where it's worse than 1 dose of RNA. But 1xJ&J and 2xRNA (but not 1xRNA) were designated as vaccinated. This has led to confusion since

      5 replies 9 retweets 59 likes
      Show this thread
      Michael Lin, MD PhD  🧬‏ @michaelzlin 15 Dec 2021

      CDC could clarify and rationalize guidance, significantly improving understanding and health, by shifting to a simple counting system. "Make sure you get 3 shots, at most 1 J&J, and space them 2-6 months apart" is all they need to say

      3:35 PM - 15 Dec 2021
      • 58 Retweets
      • 222 Likes
      • harvey MILF claude, a gay chilly cowboy 🤠❄ Æmber Pradyun Gedam Juju Bee DCoderLT hoydenne jennielf nora dot jewelry
      16 replies 58 retweets 222 likes
        1. New conversation
        2. Michael Lin, MD PhD  🧬‏ @michaelzlin 16 Dec 2021

          And vulnerable 2xRNA-vaccinated can schedule that 3rd dose before 6mo by declaring themselves immunocompromised. This policy was from back when Pfizer+Moderna's studies found a need, while J&J didn't do studies although JJ was even less protective.https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html …

          4 replies 9 retweets 23 likes
          Show this thread
        3. Michael Lin, MD PhD  🧬‏ @michaelzlin 20 Dec 2021

          Michael Lin, MD PhD  🧬 Retweeted Michael Lin, MD PhD  🧬

          I get asked whether to get 100mcg Moderna (original dose), 50mcg Moderna (booster), or 30mcg Pfizer (original and booster). As mentioned below, you'd expect 100>50>30 in potency since RNA is RNA. But some people asked if diffs in the lipid carriers matter.https://twitter.com/michaelzlin/status/1466492316542111749 …

          Michael Lin, MD PhD  🧬 added,

          Michael Lin, MD PhD  🧬 @michaelzlin
          If you compare the green numbers here to 2x Moderna's peak # of 247, you see #JnJers will have higher nAbs after boosting with 1 dose of Pfizer (30mcg) or Moderna 100mcg. The official Moderna booster dose is 50mcg, so likely will be in between the Pfizer and Moderna numbers here. pic.twitter.com/1RiwJaOIWs
          Show this thread
          4 replies 5 retweets 20 likes
          Show this thread
        4. Michael Lin, MD PhD  🧬‏ @michaelzlin 20 Dec 2021

          Moderna found 100mcg and 50mcg Moderna 3rd doses raise nAb levels against Omicron by 87x and 37x respectively. Pfizer found its 30mcg booster raises nAbs by 25x. The Mod and Pfizer results are in different studies but so far it seems 100>50>30 indeed.https://www.telegraph.co.uk/global-health/science-and-disease/reassuring-moderna-booster-jab-triggers-strong-response-against/ …

          9 replies 16 retweets 49 likes
          Show this thread
        5. Michael Lin, MD PhD  🧬‏ @michaelzlin 27 Dec 2021

          Many are wondering if they can boost earlier than 6mo. The NIH heterologous boost study used 3mo after initial series (1xJJ or 2xRNA). Pfizer tested 8mo after 2xRNA. Results were similar, suggesting 3-8mo all ok. CDC guided 6mo because immunity waned to <50% VE against Delta then

          2 replies 6 retweets 32 likes
          Show this thread
        6. Michael Lin, MD PhD  🧬‏ @michaelzlin 27 Dec 2021

          And now Israel is allowing boosters 3mo after the previous shot. This will allow those 3mo out from last shot to get boosted ahead of winter, whereas earlier you had to wait for 6mos.https://www.usnews.com/news/health-news/articles/2021-12-27/live-updates-israel-trials-4th-dose-of-covid-19-vaccine …

          7 replies 8 retweets 33 likes
          Show this thread
        7. End of conversation
        1. New conversation
        2. screen name currently taken‏ @scnamecurtaken 15 Dec 2021
          Replying to @michaelzlin

          And yet CDC is maintaining initial J&J + 1 addl dose is fine. Which doesn’t make sense to me, but just a lay person here…

          2 replies 0 retweets 9 likes
        3. Infection Prevention RN‏ @RnInfection 15 Dec 2021
          Replying to @scnamecurtaken @michaelzlin

          You are a highly informed, well read, smart "lay person" and spot on about not making sense.

          0 replies 0 retweets 2 likes
        4. End of conversation
        1. New conversation
        2. WendyJ17‏ @SeipWendy 15 Dec 2021
          Replying to @michaelzlin

          So I got J&J in March.Took it upon myself to get full dose Moderna in late June.If I understand this correctly, I should get a booster, Moderna (half dose),in late December.(But finding a pharmacy will be difficult b/c of cdc not recommending it.) Thank you!

          1 reply 1 retweet 8 likes
        3. Sarah Rogers‏ @sarharogres 15 Dec 2021
          Replying to @SeipWendy @michaelzlin

          I got a J&J in April, a Pfizer in July (in another state), then a full-dose Moderna end of November back in my home state. This was obviously not planned in advance but looks like a solid regimen in retrospect

          1 reply 0 retweets 8 likes
        4. Show replies
        1. New conversation
        2. Aviva Gabriel‏ @avivajazz 15 Dec 2021
          Replying to @michaelzlin

          @threadreaderapp unroll

          1 reply 0 retweets 0 likes
        3. Thread Reader App‏ @threadreaderapp 15 Dec 2021
          Replying to @avivajazz

          Halo! you can read it here: An important study just posted from @BalazsLab Findings are good for… https://threadreaderapp.com/thread/1470798236919025665.html … Have a good day. 🤖

          0 replies 1 retweet 1 like
        4. End of conversation

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