Fourth dose of vaccine, Mantovani: “True autumn challenge with updated reminders”

“I believe that the real challenge, the real campaign, will be in the autumn, we hope with a new generation anti-Covid vaccine that sees the variants better. I hope there is and I am optimistic. If there is not, then it will be done with the vaccine that we have. We know that by vaccinating, the breath of the immune response widens. This will be the game. ” This was highlighted at Adnkronos Salute by Alberto Mantovani, president of the Humanitas Foundation for Research and scientific director of Humanitas. “It is reasonable to think that our challenge will be autumn – explains the immunologist, in this phase in which the debate on the fourth dose is now in full swing – We know that it will be so because all the respiratory viruses, and this makes no exceptions. , they cause us problems during the autumn-winter “. But there is also the ‘influence factor’, on which Mantovani turns the spotlight on. “There is very recent data that tells us that having two enemies is worse than having one at home. It has been seen in the UK that very seriously ill patients often have flu and SARS-CoV-2 co-infection, so much so that some have said that we should screen them all for the flu. This is why I say that the challenge will be in the autumn – he reiterates – on the Covid front, with a recall hopefully based on a vaccine more targeted to the new strains. But we hope to convince people to get vaccinated also against the flu, that they understand that there is no problem doing it “. “I believe that that will be the real match – Mantovani is convinced – I am very confident that with the messenger RNA technology and with what we know we will reach the” new challenge “with an updated vaccine compared to the Wuhan variant. new generation. Obviously we must always be humble about the data. But I am optimistic. “At the moment the position of the European Medicines Agency (Ema) and the European Center for Disease Prevention and Control (Ecdc) on the fourth dose of anti-Covid vaccine “is wise. It is a decision that cares about the most fragile people who are the ones we need to worry about now,” he says, commenting on the opinion expressed by European agencies, according to which the second recall can be taken into consideration for the over 80s, but it’s too early to give it to everyone, to the general population. The expert starts from some premises. “The first is that we are doing something that is unprecedented. Not only because we are dealing with a new, mutating virus that an Australian colleague, an evolutionary virologist, has called a ‘generalist’ virus. But also because we are doing a vaccination campaign during a pandemic, with the virus circulating, and continuing to mutate. And no one has ever done anything like that. It’s something new. ” Mantovani recalls, for example, that during his commitment to Gavi, the vaccine alliance, “an epidemic of meningitis was faced in Sub-Saharan Africa. In that situation, the epidemic arrived, then passed, the vaccine was given and the person was dabbed. Here instead the situation is different, in fact. And therefore we must act wisely on the basis of the data we have “. The other element that Mantovani highlights concerns precisely the elderly, on which the European recommendation focuses. “Looking at the data collected in Humanitas, evaluation data of the immune response not only with standard laboratory tests (ie the measurement of antibodies), but also with tests that we try to develop to measure the response of T cells, I see that in very old people there is a great variability: there are those who respond very well, such as young people or middle-aged people, and there are others who resemble immunocompromised people in their response much more “. These are the premises for Mantovani, who also answers the question: what do we know about the fourth dose at the moment? “We know little, and we have to say it,” he points out. “Basically what we know comes from Israel.” “There is an Israeli study – summarizes the immunologist – in which the order of magnitude is a few hundred people vaccinated with a fourth dose to which the immune response, both antibodies and T cells, was measured. it has been found that in this small number of people the fourth dose brings the response back to the level reached after the third dose. Then there is a larger study – released in two versions, one ‘open access’ and one published in the’ New England Journal of Medicine ‘, in which the population over 60 was looked at. It is a study on over a million people vaccinated and it was found that the fourth dose gives protection “. As for the safety of the recall, the Israeli data, adds Mantovani, “they are reassuring about the fourth dose”. And the same indication in terms of safety also comes from the data “of the Vax4Frail consortium which brings together 13 Irccs from all over Italy and is evaluating the immune response of fragile patients”. In this context, concludes the expert, it is therefore necessary to move “wisely”, having “data” as a lighthouse.