4th dose Covid vaccine: France, indications, for whom?

VACCINE REMINDER. The second booster vaccine or fourth dose of vaccine against Covid-19 limits the serious forms of the disease. The HAS recommends a 4th dose for the most vulnerable people in the fall of 2022. 31% of 60-79 year olds have already received it. Is it mandatory? Who should do it? The immunocompromised?

[Mise à jour le 10 juin 2022 à 11h50] The vaccination more fragile facing Covid-19 must continue, especially as the virological indicators are on the rise in France with the arrival of fine weather. The fourth dose of vaccine (corresponding to a second booster dose) is opened French people aged 60 and more 6 months after their last reminder and at all immunocompromised patients and the over 80s 3 months after their last recall. “As of June 6, 31% of 60-79 year olds and 28.4% of people aged 80 and over eligible for the second booster dose had actually received it.” emphasizes Santé Publique France in its epidemiological update of June 9, 2022.has High Authority of Health (HAS) recommends”to anticipate the organization of a campaign of vaccination booster for fall 2022 populations most at risk severe forms of the disease” and “consider vaccination of health professionals“. 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 who received their booster dose more than 3 months ago and to all patients immunocompromised (no longer just the “severely immunocompromised” as before). 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 May 16, among the 60-79 years, 5.3% received a second booster dose. From 80 years and overthe vaccination coverage of this second dose was 18.1%“informs Santé Publique France in its epidemiological update of May 19.

What does the HAS recommend for the 4th dose?

On May 25, 2022, the Haute Autorité de Santé (HAS) unveiled its vaccine strategy recommendations for fall 2022. She recommends “to anticipate the organization of a campaign of booster vaccination for the fall of 2022 for the populations most at risk severe forms of the disease (in particular, people immunocompromised and their entourage, the people of 65 years and over and/or with comorbidities at risk of severe form)” and “to consider vaccination of health professionals“.

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:

  • the people immunocompromised
  • the people of 65 years and over and/or with comorbidities at risk of severe form

A 4th dose for everyone in September 2022?

The 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 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 Pr Arnaud Fontanet on France 5 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%“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 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 last booster 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 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.

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 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

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