4th dose Covid vaccine: indication, for all in the fall? – The Women’s Journal

The booster vaccine limits severe forms of Covid-19 disease by boosting the immune system. “There will be a proposal for an additional dose before the fall” estimated Professor Arnaud Fontanet on May 4. For whom today? And for whom in autumn? Compulsory at 60? Summary

[Mis à jour le 5 mai 2022 à 12h38] The vaccination of the most vulnerable to Covid-19 must continue even if the epidemic decreases in France. The fourth dose of vaccine (corresponding to a second booster dose) is open to French people aged 60 and over and to all immunocompromised patients. “The Israeli data show us that for the over 60s the 4th dose divides our risk of hospitalization by 4, so there is a real effect on the severe forms and there are no more adverse effects than after the 3rd dose or exhaustion of the immune response when you repeat the injections” indicates Professor Arnaud Fontanet on France 5 on May 4. “There is therefore no reason to refuse a fourth dose. Now there is a real weariness. We can clearly see that this fourth dose does not take. It is true that with the drop in the BA wave .2 people say to themselves that in the end it may not be worth getting vaccinated now” adds the epidemiologist from the Institut Pasteur. “What is almost certain is that there will be a strong proposal for an additional dose just before the start of autumn since we know that there may be an epidemic resumption, it will concern the population of the most 60 years old. Will it go beyond that, that is to say for the youngest, we don’t know yet. It will really depend on the epidemic situation at that time” defended Professor Arnaud Fontanet. “We do not rule out that at the start of the school year”, in September, “we will have to redo a 4th dose for the entire population, but we will see at that time depending on the variants which will circulate”, had declared the Pr Bruno Mégarbane, head of the intensive care unit at the Lariboisière hospital in Paris, April 24 on Franceinfo. “As of April 25, among 60-79 year olds, 3.3% had received a second booster dose. Among those aged 80 and over, vaccination coverage for the second booster dose was 13.2%” informs Public Health France in its epidemiological update of April 28. Appointments are open (possibility to make them on Doctolib) and vaccination can be carried out in a vaccination center, in a pharmacy, a practice or at home. Who has to do 4 doses today in France? Is it mandatory? What are the indications and recommendations? How long after the third injection? With which vaccine? Pfizer or Moderna? Our goal is to maintain optimal protection against the virus, for the most vulnerable people. Thus, people aged 60 to 80 can, if they wish, receive a new reminder, 6 months after the previous one. pic.twitter.com/R4S5i63hZR — Olivier Véran (@olivierveran) April 7, 2022 4th dose of Covid vaccine: for whom? Since April 7, the injection of a fourth dose of coronavirus vaccine has been open to people aged 60 and over who are 6 months or more from their first booster (or last covid infection). This second booster was already open to French people aged 80 and over who had received their booster dose for more than 3 months and all immunocompromised patients (no longer just “severely immunocompromised”). In accordance with the COSV opinion of November 2021, the severely immunocompromised persons concerned by the 4th dose are: solid organ transplant recipients, recent bone marrow transplant recipients, dialysis patients, patients with autoimmune diseases undergoing aggressive immunosuppressive treatment anti-CD20 or antimetabolite type, patients with certain types of lymphoma treated with anti-CD20 or BTK inhibitors, patients with chronic lymphocytic leukemia, patients with rare forms of primary immunodeficiency, myeloma under treatment “Au 18 April 2022, among those aged 80 and over, vaccination coverage for the second booster dose was 11.2% and 17.4% of those who were eligible by this date had received it. 2.7% had received a second booster dose (28.8% among eligible people in this age group)” reveals Public Health France on April 21. What does the HAS recommend for the 4th dose? The High Authority for Health (HAS) recommends a fourth dose of vaccine “to people aged 65 and over, at very high risk of a severe form of the disease and/or polypathological and who wish it, within the framework of a medical decision. shared with their healthcare team, taking into account their individual medical situation”. Due to the still good vaccine efficacy (over 70% on hospitalizations) 3 months after the first booster, the HAS recommends in the event of a second booster to preferably respect an interval of at least 6 months with the first booster. The authority notes “that due to the still limited data on the protection conferred by infection with Omicron, there is no reason to consider a second booster dose in persons who have recently acquired an infection with SARS-CoV -2 with this variant, regardless of their age”. Is the 4th dose mandatory? The fourth dose of the coronavirus vaccine is not compulsory but “open”, i.e. possible for people aged 60 and over who are 6 months or more from their first booster, the elderly at least 80 years old and for all immunocompromised patients (from 3 months after their first booster). The 4th dose is therefore not compulsory. A 4th dose for everyone at the start of the school year in September? In the opinion of several doctors, it is to be expected that a fourth dose of vaccine (second booster) will be offered to the entire French population (adult) at the start of the school year. This, in view of a possible resumption of the epidemic in the fall and because the date of the last dose will have exceeded 6 months for the majority of those vaccinated. “There will be a strong proposal for an additional dose just before the start of the fall since we know that there may be an epidemic resumption, it will concern the population over 60. Will it be ok? beyond, that is to say for the youngest, we don’t know yet. It will really depend on the epidemic situation at that time” defended Professor Arnaud Fontanet on May 5. “We do not rule out that at the start of the school year”, in September, “we must redo a 4th dose for the entire population, but we will see at that time depending on the variants which will circulate”, had also advanced Professor Bruno Mégarbane on April 24 on Franceinfo. What do the vaccine production laboratories say? Stéphane Bancel, CEO of Moderna, had assured, during a press conference on January 6 that a 4th dose of anti-Covid vaccine will most likely be necessary: ​​”I still believe that we will need boosters in the fall of 2022 and beyond.” Albert Bourla, CEO of Pfizer, said on BFM-TV on Monday January 17: “At the moment it is important to have three doses for a complete vaccination, perhaps a fourth dose a little later for the general population” How effective is the 4th dose? “The 4th dose divides our risk of hospitalization by 4, so there is a real effect on the severe forms and there are no more adverse effects than after the 3rd dose nor exhaustion of the immune response. when you repeat the injections” indicates Professor Arnaud Fontanet on May 5. “We know that a second booster vaccination [ou quatrième dose] reduced the risk of hospitalization, resuscitation and death by 80%,” Olivier Véran announced on April 7 on RTL. about 85% after 5 to 9 weeks then 75% after 10 to 14 weeks. After a booster with the Moderna vaccine, the effectiveness of the booster against hospitalization was 90 to 95% up to 9 weeks after vaccination” indicated the HAS in its opinion of March 17, 2022. What is the deadline for making your 4th dose? ► from 60 to 79 years old: from 6 months or more from the first booster or from 6 months after the last infection For people who have already had Covid after their first booster: If the infection occurred more 3 months after the first booster, a second booster is not necessary. If the infection occurred less than 3 months after the first booster, a second booster is necessary. It is then advisable to wait at least 6 months after the infection before receiving their second booster ► From the age of 80 and for immunocompromised persons: the fourth dose of vaccine concerns those who have received their booster dose for more than 3 months ► In severely immunocompromised persons, the fourth dose of vaccine is part of their complete prim regimen o-vaccination. They can then make a recall on medical advice. It is carried out one month after the 3rd dose. Moderna or Pfizer: which vaccine for the 4th dose? The booster dose for eligible people is done only with an mRNA vaccine, either Pfizer (30 µg dosage) or Moderna (50 µg dosage) regardless of the vaccine(s) used previously according to the COSV. The Pfizer vaccine is the only one recommended for people under the age of 30. “A full dose of the Pfizer-BioNTech vaccine or a half-dose of Moderna vaccine are used for this second vaccine booster” recommends the DGS. What results from the fourth dose in Israel? Israel began on January 3, 2022, to inject a fourth dose “to people aged 60 and over, medical personnel and employees of health and social care institutions”, in addition to immunocompromised people affected since December 31, according to the report. country’s health ministry. “The Israeli data show us that for the over 60s the 4th dose divides our risk of hospitalization by 4, so there is a real effect on the severe forms and there are no more adverse effects than after the 3rd dose or exhaustion of the immune response when you repeat the injections” indicates Professor Arnaud Fontanet on France 5 on May 4. Sources: Orientation Council for the Vaccine Strategy Recommendations for the protection of severely immunocompromised people against Covid-19 (Vaccination and primary prophylaxis) – November 19, 2021 Launch of the booster vaccination campaign against Covid-19 for priority populations- DGS- August 27, 2021 Vaccine Strategy Advisory Council Opinion of August 19, 2021 – Minimum time between primary vaccination and booster vaccination