COVID VACCINE REMINDER. The HAS recommends on July 13 to open the 4th dose to people under 60 at risk of a severe form of Covid, to pregnant women and to relatives of immunocompromised or vulnerable people.
[Mise à jour le 15 juillet 2022 à 16h59] The vaccination more fragile facing Covid-19 still has to accelerate in France, insist the health authorities while the hospitalizations and admissions in critical care due to Covid increases mid-July, especially among older. The fourth dose of vaccine (corresponding to a second booster dose) is opened to French people from 60 years old and to all immunocompromised patients and the over 80s. On July 13, the High Authority of Health recommends expanding it: to adults under 60 identified as being at risk of a severe form of Covid-19, to pregnant women and to people living in the entourage or in regular contact with immunocompromised people or vulnerable. It also specifies the time limits to be observed after the previous dose, in particular in the event of a Covid infection occurring after the last injection. “The fourth vaccination is active within 5-7 days therefore it is immediately effective” has recalled Jean-Francois Delfraissy on France Inter on July 11 before confirming that “she protected still a little more infection and transmission and above all very clearly against the occurrence of serious forms“. About the fear of receiving a more deleterious dose for the bodyJean-Françaois Delfraissy reassured: “In terms of distribution and repertoire of the immune response, this 4th dose does not modify our immune response capacity so we can do it and it’s time to do it for the oldest and most fragile now” without waiting for next fall. The appointment are open (possibility to take them on Doctolib) and the vaccination can be carried out in a vaccination centre, in a pharmacy, a practice or at home. Who has to do 4 doses today in France? Is she obligatory ? What are the instructions and recommendations ? How long after the third injection ? With which vaccine? Pfizer or Moderna?
Who should do a 4th dose of Covid vaccine?
Since April 7, 2022, the injection of a fourth dose of coronavirus vaccine is open in France to people aged 60 and over who are 6 months or more away from their first booster (or last covid infection). This second recall was already open to French over 80 since March 2022 as well as to residents of accommodation establishments for dependent elderly people (Ehpad) and long-term care units (USLD) and to all immunocompromised patients since January 2022. In accordance with the opinion of the SVOCseverely 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
► On July 13, the HAS recommended opening the 4th dose to people under 60 at risk of severe forms of Covid, to pregnant women from the 1st trimester of pregnancy and to relatives of immunocompromised people.
Delay: when to take 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.
► From the age of 80 and for the immunocompromised: from three months after the first booster injection.
► In severely immunocompromised people, the fourth dose of vaccine is part of their complete primary vaccination schedule. They can then make a recall on medical advice. She is carried out one month after the 3rd dose.
► If SARS-CoV-2 infection occurred after the last dosean additional booster dose is still recommended, respecting a minimum period of 3 months after infection.
Where to get your 4th dose of vaccine?
This second vaccination booster can be carried out either:
- in a vaccination center;
- with a city health professional authorized to prescribe and administer the vaccine;
- in a dispensary, a cabinet;
- home.
What does the HAS recommend for the 4th dose?
On July 13, 2022, the High Authority for Health (HAS) recommended toto broaden administration of an additional booster dose (2nd booster or 4th dose most often) adults under 60 identified as being at risk of a severe form of Covid-19, to pregnant women and to people living in the entourage or in regular contact with immunocompromised people or vulnerable. It also specifies the time limits to be observed after the previous dose, in particular in the event of an infection occurring after the last injection. The HAS also specifies the time limits to be observed between two booster doses:
- 3 months for people aged 80 and over, residents of nursing homes and USLDs and immunocompromised people;
- 6 months for others.
- For everyone, if an infection with SARS-CoV-2 has occurred after the last dose, an additional booster dose is still recommended, respecting a minimum period of 3 months after infection.
Is the 4th dose mandatory?
The fourth dose of coronavirus vaccine is not mandatory but “opened“, i.e. possible for the people aged 60 and over who are 6 months or more from their first reminder, people aged at least 80 and for all immunocompromised patients (from 3 months after their first booster). The 4th dose is therefore not not mandatory.
People at risk of severe forms of Covid are:
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A 4th dose for everyone in September 2022?
“We will probably go towards a fourth dose for the entire population in the fall“said Jean-François Delfraissy, President of the Scientific Council on June 18. HAS does not recommend a booster vaccination for everyone at the start of the 2022 school year but for most vulnerable people (immunocompromisedpeople from 65 and overand those with comorbidities) and for healthcare professionals. According to many doctors, it is nevertheless to be expected that a fourth dose of vaccine (second booster) will be offered to the entire French population (adult) at the beginning of the school year in September 2022. 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 vaccinated people. “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 over 60 years of age. Whether it will go beyond, that is to say for the youngest, we do not know yet. It really depends on the epidemic situation at that time“ defended Professor Arnaud Fontanet on France 5 May 5. “We don’t rule out until the start of the school year“, in September, “it is necessary to redo a 4th dose for the entire population, but we will see at that time according to the variants which will circulate“, had also advanced Professor Bruno Mégarbane on April 24 on France info.
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“.
“There are no more adverse effects than 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 Comirnaty® from Pfizer (dosage at 30 µg) or Moderna’s Spikevax® (dosage at 50 µg) regardless of the vaccine(s) previously used according to the COSV. The Pfizer vaccine is the only one given to people under 30. “A full dose of Pfizer-BioNTech vaccine or a half dose of Moderna vaccine are used for this second booster shot” recommends the DGS.
How effective is the 4th dose?
“The 4th dose divides by 4 our risk of hospitalization, so there is a real effect on severe forms and there is no more side effects than after the 3rd dose nor depletion of the immune response when you repeat the injections” said Professor Arnaud Fontanet of the Covid Scientific Council on May 5. “It is known that a second booster vaccination [ou quatrième dose] reduces the risk of hospitalization, resuscitation, and death by 80%“announced Olivier Véran, still Minister of Health, on April 7 on RTL.After a booster shot with the Pfizer vaccine, vaccine efficacy against hospitalizations was 90% and decreased to approximately 85% after 5 to 9 weeks and then 75% after 10 to 14 weeks. After a booster with the Moderna vaccine, the booster efficacy against hospitalization was 90-95% up to 9 weeks after vaccination“ indicated the HAS in its notice of March 17, 2022.
What are the results of the fourth dose 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. “The israeli data show us that for those over 60 the 4th dose divides by 4 our risk of hospitalization, so there is a real effect on severe forms and there is no more side effects than after the 3rd dose nor depletion of the immune response when you repeat the injections” indicates Professor Arnaud Fontanet on France 5 on May 4.
Sources:
People eligible for the second booster against Covid-19. 06/22/2022. Gouvernement.fr
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