indication, for all in the fall?

[Mis à jour le 5 mai 2022 à 12h38] The vaccination more fragile facing Covid-19 must continue even if the epidemic is decreasing in France. The fourth dose of vaccine (corresponding to a second booster dose) is opened French people aged 60 and more and to all patients immunocompromised. « 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. « 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’s true that with the drop in the BA.2 wave, 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 over 60 years of age. Will it go beyond, that is to say for the youngestwe do not know yet. It really depends on the epidemic situation. at this moment“defended Professor Arnaud Fontanet. « 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« , declared Professor Bruno Mégarbane, head of the intensive care unit at the Lariboisière hospital in Paris, on April 24 on Franceinfo. « As of April 25, among the 60-79 years, 3.3% received a second booster dose. From 80 years and overthe vaccination coverage of the second booster dose was 13.2%“informs Santé Publique France in its epidemiological update of April 28. 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 mandatory ? What are the indications and recommendations? How long after the third injection ? With which vaccine? Pfizer or Moderna?

4th dose of Covid vaccine: for whom?

Since April 7, the injection of a fourth dose of coronavirus vaccine is open 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 people aged 80 and over who received their booster dose more than 3 months ago and all patients immunocompromised (no longer just the « severely immunocompromised »). In accordance with the COSV opinion of November 2021, severely immunocompromised people 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 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

“As of April 18, 2022, among those aged 80 and over, the vaccination coverage of the second booster dose was 11.2% and 17.4% of those who were eligible by that date had received it. From 60-79 years, 2.7% had received a second booster dose (28.8% among eligible 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 « people aged 65 and over, at very high risk of a severe form of the disease and/or polypathological and who so wish, 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 an infection by Omicron, there is no no need to consider a second booster dose in people with recent SARS-CoV-2 infection with this variant, regardless of their age ».

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.

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 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 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 Franceinfo.

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 on 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« 

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 » indicates Professor Arnaud Fontanet on May 5. « It is known that a second booster vaccination [ou quatrième dose] reduces the risk of hospitalization, resuscitation, and death by 80% » Olivier Véran announced 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 opinion of March 17, 2022.

How long does it take 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.

For people who have already had the Covid after their first reminder:

• If the infection occurred more than 3 months after the first booster, a second reminder is not necessary.
• If the infection occurred less than 3 months after the first booster, a second booster is necessary. You should then wait at least 6 months after the infection before receiving your second booster.

► From the age of 80 and for the immunocompromised: the fourth dose of vaccine is for those who have received their booster dose since more than 3 months.

► 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.

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) previously used according to the COSV. The Pfizer vaccine is the only one recommended for people under the age of 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.

What results from 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 immunocompromised people concerned since December 31 according to the country’s Ministry of Health. « 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:

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