4TH VACCINE REMINDER. In France, immunocompromised patients must take a 4th dose of vaccine against Covid. For the rest of the population, the Council of orientation of the vaccine strategy rejected the idea of a generalization of the fourth dose. Olivier Véran considers this option “possible”. Details.
[Mis à jour le 4 février 2022 à 15h49] The booster vaccination (2nd, 3rd or 4th dose) allows boost the immune system and to limit severe forms of coronavirus infection. In Franceonly the severely immunocompromised patientsmust perform four doses vaccine against Covid-19 in accordance with the opinion of the Vaccine Strategy Guidance Council (COSV) of November 2021. The Minister of Health deemed it “possible” that a booster dose would be necessary next fall, on the set of BFM TV on February 2 even though the COSV estimated that “the available data do not currently call for the implementation of a second booster vaccine [quatrième dose], a second booster dose would not bring any significant individual benefit” had he cut into a opinion published in January. Israel, Hungary and Chile started administering a fourth dose of Covid vaccine to their populations. A study from Sheba Hospital in Israel, which is expected to last 6 months, found that the fourth dose multiplied by five the antibodies participants but was only partially effective against Omicron variant. “Many people infected with Omicron received the fourth dose, the main thing is that the vaccine is excellent against Alpha and Delta but for Omicron, it is not not good enough“said Professor Gili Regev-Yochay, an expert in infectious diseases who is leading this study. Who should do 4 doses in France ? How long after the third injection ? With which vaccine? Pfizer or Moderna? What is the situation in Israel?
Who should take a 4th dose of vaccine in France?
Today, in France, severely immunocompromised patients must take a 4th dose of vaccine against Covid-19. In accordance with the November COSV opinion, severely immunocompromised people affected by the 4th dose are:
- solid organ transplant recipients,
- recent bone marrow transplant recipients,
- dialysis patients,
- patients with autoimmune diseases undergoing aggressive immunosuppressive treatment such as anti-CD20 or antimetabolites,
- 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
Tomorrow, a 4th dose for everyone?
Olivier Véran judged “possible“that a booster dose is necessary next fall on BFM TV February 2. However, “Le Council [d’orientation de la stratégie vaccinale) considère que les données disponibles n’appellent pas actuellement à la mise en place d’un second rappel vaccinal [quatrième dose], a second booster dose would not bring any significant individual benefit” decided the COSV in a opinion published on Wednesday January 26. “The COSV notes that careful monitoring of the evolution of the curve of hospitalizations of 80 year olds or more who received their first booster shot. If the slight increase in the number of hospitalizations, which began in December, were to continue over the next few weeks, the COSV could recommendsystematic administration of a second booster vaccine for these people. AT
At present, however, this signal does not seem sufficient to issue such a recommendation”. The COSV said that its position could evolve depending on the publication of new scientific data. “If a 4th injection protects the most fragile against the risk of serious forms, we will do it“, had defended Olivier Véran on LCI January 25. “If on the other hand it is not necessary, we will not do it“, he added.
What do the vaccine production laboratories ? Stéphane Bancel, CEO of Modernahad 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 fall 2022 and beyond.“Albert Bourla, CEO of Pfizersaid on BFM TV Monday January 17: “At the moment it is important to have three doses for a complete vaccination, maybe a fourth dose a bit later for the general population with some exceptions for immunocompromised people. We are in the process of testing the fourth dose but we do not have any data yet. At month of March, we will have the data on the efficacy of a fourth dose.”
How effective is the 4th dose?
“Epidemiologically, the proper conduct of the primary vaccination and booster vaccination campaigns would bring positive effects
higher than the introduction of a second booster dose (4th dose, editor’s note)“ defended the COSV in its opinion. “Real-life studies have demonstrated a relative efficiency of [premier} rappel vaccinal face au variant Omicron en ce qui concerne l’infection, bien que cette protection soit inférieure à celle conférée contre le variant Delta. Une étude britannique suggère également que le rappel permet de maintenir une bonne protection contre les formes sévères: trois doses de vaccination réduit le risque d’hospitalisation de 68% en comparaison aux non-vaccinés, et offre une protection de 88% [78%-93%] against hospitalization due to Omicron. In France, hospitalization, critical care admission and death data from the DREES also suggest that the recall would effectively protect against severe forms.although protection is lower against the Omicron variant than against the delta variant” specified the COSV. “The ‘hybrid’ immunities (vaccine and infection) also confer better neutralization capacities. However, faced with the current very strong viral circulation, it is very likely that the proportion of the population with hybrid immunity is increasing.” indicates the COSV again. According to the first results of a study conducted at Sheba Hospital in Tel Aviv initiated at the end of December 2021, the administration of a fourth dose of vaccine against Covid-19 would make it possible to multiply by 5 the antibodies one week after the injection but was only partially effective against Omicron variant. “Many people infected with Omicron received the fourth dose, the main thing is that the vaccine is excellent against Alpha and Delta but for Omicron, it is not not good enough“said Professor Gili Regev-Yochay, an expert in infectious diseases who is leading this study.
How long does it take to take your 4th dose?
In immunocompromised people, the fourth dose of coronavirus vaccine is part of their comprehensive primary vaccination schedule. They can then make a recall on medical advice. As the COSV reminded us in November 2021, the third dose (D3) and the fourth dose (D4) differ from a recall in that they are carried out one month after the last dose, contrary to recall made to him at least nearly 3 months.
Moderna or Pfizer: which vaccine for the 4th dose?
The booster dose for immunocompromised people is done only with an mRNA vaccine, either Pfizer (30 µg dosage) or Moderna (50 µg dosage) regardless of the vaccine(s) previously used according to the COSV. The Pfizer vaccine is the only one recommended for people under the age of 30.
What results in Israel?
Israel began on January 3, 2022 at inject a fourth dose”for people aged 60 and more, medical personnel and employees of health and social protection establishments“in addition to the immunocompromised persons concerned since December 31 according to the Ministry of Health from the country. According to Zvika Granot, an Israeli immunologist at the Hebrew University of Jerusalem quoted in the January 26 COSV advisory, “the initiative to start a fourth dose campaign [en israël] is not based on any clinical trial. There is no guarantee that it is safe“.”It is open to the most fragile, but it is not necessarily recommended (…). There are insufficient data regarding the efficacy and safety of this fourth dose.“, admitted Cyrille Cohen, immunologist at Bar-Ilan University in Tel Aviv (Israel), to franceinfo, January 3, 2022. The Sheba Hospital team initiated a planned 6-month clinical trial, vaccinating 154 caregivers with a fourth Pfizer dose and 120 other volunteers with a fourth Moderna dose. They had all received a third dose more than four months ago and the amount of their antibody seemed to have waned. The hospital said thatone week after the start of the clinical trialthe participants’ antibodies had increased fivefold. “However, we find that many people infected with Omicron have received the fourth dose. Admittedly, a little less but still a lot of infections“clarified Professor Gili Regev-Yochay, an expert in infectious diseases who is leading this study. According to the professor, “the bottom line is that the vaccine is great against Alpha and Delta but for Omicron it’s not good enough.”
Sources:
Vaccine Strategy Guidance Council Recommendations for the protection of severely immunocompromised people against Covid-19 (Vaccination and primary prophylaxis) – November 19, 2021
Launch of the vaccine booster campaign against Covid-19 for priority populations – DGS – August 27, 2021
Advisory Council for the Vaccine Strategy Opinion of August 19, 2021 – Minimum time between primary vaccination and booster vaccination