4th dose of Covid vaccine: France, indication, for whom?

The second booster or fourth dose of Covid-19 vaccine limits the severe forms of the disease by boosting the immune system.16.7% of people aged 80 and over received the fourth dose. Is the date mandatory? who should do it The immunocompromised? We take stock.

That vaccination more fragile opposite to Covid-19 must continue, even if the epidemic is declining in France with the arrival of fine weather. That fourth vaccine dose (corresponding to a second booster vaccination) is opened French at the age of 60 and more 6 months after the last reminder and in general immunocompromised patients and those over 80 years of age 3 months after the last call. “From May 9th among the 60-79 years, 4.5% received a second booster dose. Out of 80 years and olderthe protection of this second dose was 16.7%“informs Santé Publique France in its epidemiological update of May 12.”Nothing excludes a new vaccination [4ème dose] until the end of the year when the emergence of new variants required it” stated Olivier Véran during the Council of Ministers of May 11, 2022. For everyone or for the weakest? I don’t have an answer to this question because I don’t yet know which variant we will face, when and how high the population immunity will be‘ the health minister added. meeting are open (possibility to take over Doctolib) and the vaccination can be carried out in a vaccination center, in a pharmacy, in a doctor’s office or at home. Who has to do 4 cans in France today? Is she causing obligation ? What are the instructions and recommendations ? How long after the third injection ? With what vaccine? Pfizer or Moderna?

4th dose of Covid vaccine: for whom?

Since April 7, 2022, the injection of a The fourth dose of the coronavirus vaccine is open to people aged 60 and over who are 6 months or more away from their first booster shot (or last Covid infection). This second recall was already open French over 80 years who received their booster dose more than 3 months ago and all patients immunocompromised (no longer just the “severely immunocompromised”). In accordance with the November 2021 COSV Opinion, severely immunocompromised individuals affected by the 4th dose are:

  • recipients of solid organ transplants,
  • recent recipients of bone marrow transplants,
  • dialysis patients,
  • Patients with autoimmune diseases undergoing aggressive immunosuppressive therapy 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

From May 9th among the 60-79 years, 4.5% received a second booster dose. Out of 80 years and olderthe protection of this second dose was 16.7%“informs Santé Publique France in its epidemiological update of May 12.

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 developing a severe form of the disease and/or polypathology and who so wish, as part of a medical decision shared with their medical team, taking into account their individual medical situation“.

Due to the still good vaccine efficacy (over 70% in hospital stays) 3 months after the first booster dose, The HAS recommends keeping a gap of at least 6 months between the first refresher and a second refresher if possible. The authority states “that there is none due to the limited data on protection from infection by Omicron there is no need to consider a second booster dose in individuals with recent SARS-CoV-2 infection with this variant regardless of age”.

Is the 4th dose mandatory?

The fourth dose of the coronavirus vaccine is not mandatory, but”opened‘ So it’s possible for the Persons aged 60 and over whose first reminder was sent 6 months or more ago, People over 80 years of age and for all immunocompromised patients (from 3 months after the first booster vaccination). The 4th dose is therefore not not mandatory.

A 4th dose for everyone at the start of the September school year?

Nothing excludes a new vaccination [4ème dose] until the end of the year when the emergence of new variants required it” instructed Olivier Véran on May 11. For everyone or for the weakest? “I don’t have an answer to this question because I don’t yet know which variant we will face, when and how high the population immunity will be” added the Minister of Health. According to several doctors It is expected that the entire French population (adult) will be offered a fourth dose of vaccination (second booster) at the beginning of the school year in September 2022. This is in view of a possible resurgence of the epidemic in the autumn and because the date of the last vaccination will be more than 6 months for the majority of those vaccinated. “There will be a strong suggestion for an extra dose just before the start of autumn As we know that the epidemic could resume again, this will affect the population over 60 years of age. Whether it goes beyond that, i.e. for the youngest, we don’t know yet. It really depends epidemic situation at that time defended Pr Arnaud Fontanet on May 5 on France 5. “We are not ruling out until the start of the school year“, in September, It is necessary to repeat a 4th dose for the entire population, but we will see at this point for the variants that will circulate“, was also presented by Professor Bruno Mégarbane on Franceinfo on April 24th.

What are they doing Laboratories for the production of vaccines ? Stephane Bancel, CEO of modernHe had assured during a press conference on January 6 that a 4th dose of the anti-Covid vaccine will most likely be necessary: ​​”I still think so We need boosters in autumn 2022 and beyond.“Albert Bourla, CEO of Pfizersaid Monday on BFM-TV January 17: “At the moment it is important to have three doses for a full vaccination, maybe a fourth dose later for the general population

How effective is the 4th dose?

That 4. dose divided by 4 our hospital risk, so there is one real effect on heavy forms and there is no more side effects than after the 3rd dose nor depletion of the immune response if you repeat the injections” announces Professor Arnaud Fontanet on May 5th. “A second booster vaccination is known [ou quatrième dose] reduces the risk of hospitalization, resuscitation and death by 80%“, announced Olivier Véran on April 7th on RTL.After a booster vaccination with the Pfizer vaccine, The effectiveness of the vaccine in hospital admissions was 90%, falling to about 85% after 5 to 9 weeks and then to 75% after 10 to 14 weeks. After a booster dose of Moderna vaccine, the efficacy of the booster versus hospital admission was higher 90-95% up to 9 weeks after vaccination stated the HAS in its statement of March 17, 2022.

How long does it take to take your 4th dose?

► from 60 to 79 years: out of 6 months or more from the first booster vaccination or from 6 months after the last infection.

For people who already had the Covid after their first memory:

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

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

► For severely immunocompromised people the fourth vaccine dose is part of their full primary immunization schedule. You can then arrange for a recall on medical advice. she is performed one month after the 3rd dose.

Moderna or Pfizer: which vaccine for the 4th dose?

The booster dose for eligible persons has taken place only with an mRNA vaccine, either Pfizer (30 mcg dose) or Moderna (50 mcg dose), regardless of previously used vaccines according to 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 refresher 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 over 60 and more, medical staff and employees of health and social protection institutions, in addition to immunocompromised individuals who have been affected since December 31, according to the country’s health ministry. “That Israeli data Show us that for those over 60 the 4. dose divided by 4 our hospital risk, so there is one real effect on heavy forms and there is no more side effects than after the 3rd dose nor depletion of the immune response if you repeat the injections” announces Professor Arnaud Fontanet on France 5 on May 4th.

Sources:

Vaccine Strategy Guidance Council Recommendations on Protecting Severely Immunocompromised Individuals from Covid-19 (Vaccination and Primary Prevention) – 19 November 2021

Launch of Covid-19 booster vaccination campaign for priority populations – DGS – August 27, 2021

Advisory Council for the Vaccine Strategy Opinion of 19 August 2021 – Minimum time between primary vaccination and booster vaccination

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