Fragile populations (immunocompromised, etc.) are eligible for a third booster which corresponds to a fifth dose of vaccine against Covid-19. Who should receive this additional dose? With which vaccine? For what protection? Information with Prof. Elisabeth Bouvet, President of the HAS Vaccination Technical Commission.
[Mis à jour le 28 octobre 2022 à 12h10] 1, 2, 3, 4 and now 5 doses of Covid vaccines. The populations at risk of severe form as immunocompromised patients are now eligible for a third reminder against Covid-19 which corresponds to a fifth dose of vaccine. “But we want to get out of this terminology of doses and do not name this new injection the 5th dose. But rather an additional dose according to the situation” indicates the Professor Elisabeth BouvetPresident of the Technical Vaccination Commission at the HAS, contacted on October 10. This additional dose is administered during the vaccination campaign this fall with bivalent vaccines. “It is now established that the covid virus is endemic, that is to say that there will be regular epidemic outbreaks. A significant part of the population is at risk of contamination and fragile people may develop serious forms, with the consequences of hospitalization and/or admission to intensive care. Gold vaccination has a definite impact on the risk of developing severe forms. It is for this reason that the current strategy targets the vulnerable population“ develops Professor Bouvet. Who should do 5 doses? What are the indications and HAS recommendations? How long after the fourth injection? With which vaccine?
Who is recommended the 5th dose of Covid vaccine?
“These are especially the people at risk of a severe form of covid who are targeted by this vaccination campaign”, replies Professor Bouvet. Vaccination against covid is complete with 2 doses and a booster. “We then recommended a second booster (=4th dose) to the most vulnerable people because when you move away from the first reminder, you again increase the risk of serious forms” notes Professor Bouvet. The injection of a fifth dose of coronavirus vaccine (or a new booster) is recommended:
- all the people over 60
- people aged 18 to 60 at risk of severe form
- patients immunocompromised
- pregnant women
- people in those around vulnerable people or immunocompromised
- health professionals
In accordance with the advice of SVOCthe severely immunocompromised persons concerned by the additional booster doses 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
What does the HAS recommend for the 5th dose?
The Haute Autorité de Santé recommends a new dose of covid vaccine for people at risk this fall-winter 2022. “It is recommended to combine vaccination against Covid with that against influenza because they concern the same population at risk. These are two different injections but can be administered on the same day without any risk. We expect a more virulent flu epidemic this year than the previous year” underlines the professor of infectious diseases. This new vaccination campaign would concern between 15 and 20 million French people.
Deadline: when to do the 5th dose of Covid vaccine?
The new booster dose recommended for populations at risk should be administered:
► For people of over 80 and immunocompromised people: 3 months from the last injection. “For these people, we observed that it is from this moment that the immunity drops“notes Professor Bouvet.
► For other populations at risk (see above): 6 months after the last injection and at least 3 months after a Covid-19 infection.
Where to get the 5th dose of Covid vaccine?
Vaccination against Covid is carried out in general practitioners, pharmacies and vaccination centres. “The vaccine comes in the form of multidoses, that is to say that when the doctor opens a vial of vaccine there is at least the equivalent of 6 doses so he must consume them within hours of opening. Logistics is easier for pharmacists“ recalls our interlocutor.
Is the 5th dose mandatory?
This additional dose is not mandatory for anyone. She is nevertheless strongly recommended for those most at risk of developing a severe form of covid-19 disease.
With the new bivalent vaccines, we can hope for a better impact on infection and transmission
Which Covid vaccine is used for the 5th dose?
The vaccines used for this new vaccination campaign are the so-called bivalent RNA vaccines from Pfizer and Moderna which protect against the initial strain of the virus and against the Omicron variant. Comirnaty Original/Omicron BA.1, Comirnaty Original/Omicron BA.4-5, Bivalent Spikevax Original/ Omicron BA.1 have been on the market since October 3. “These new vaccines are more effective since they target the circulating virus strain, the BA.5 subline of the Omicron variant. With the new bivalent vaccines, we can hope for a better impact on infection and transmission (and not only on the risk of severe form)“defends our expert.
Are pregnant women affected by the 5th dose?
Pregnant women are part of the population at risk of developing a severe form. “All the data demonstrates the risk of severe form and premature delivery. It is therefore recommended to make this new reminder to women during pregnancy.“ confirms Professor Bouvet.
Are we heading for a 5th dose for the entire population?
“For the moment, we are not heading towards a new vaccination campaign for the general population. We have no arguments to recommend it to everyone” notes Dr. Bouvet on October 10. “Our current strategy aims to protect people at risk of developing a serious form of the disease. Those who are hospitalized and in intensive care. Nevertheless, if people in contact with fragile people wish to receive a new dose for prevention, this is possible“says our interlocutor.
Thank you to Pr Elisabeth Bouvet, President of the Technical Commission for Vaccinations of the High Authority for Health (HAS).