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

The vaccination plus fragile versus COVID-19 should continue though the epidemic is declining in France with the arrival of good weather. The fourth dose of vaccine (corresponding to a second booster dose) opens 60 year old French and more 6 months after your last reminder and not at all immunocompromised patients and patients older than 80 years 3 months after your last withdrawal. “As of May 9, between 60-79 years, 4.5% received a second booster dose. From 80 years and overthe vaccination coverage of this second dose was 16.7%“reports Santé Publique France in its epidemiological update of May 12”.nothing excludes new vaccine [4ème dose] by the end of the year if the appearance of new variants required it” indicated Olivier Véran during the Council of Ministers on May 11, 2022. For all or for the most vulnerable? “I don’t have the answer to this question because I still don’t know which variant we will be dealing with, when and what the immunity of the population will be.“added the Minister of Health. appointment are open (possibility of taking them into Doctolib) and the vaccination It can be done in a vaccination center, in a pharmacy, in a doctor’s office or at home. Who has to do 4 doses today in France? It’s her required ? Which are the instructions and recommendations ? How long after the third injection ? With what vaccine? Pfizer or Moderna?

4th dose of Covid vaccine: for whom?

From April 7, 2022, the injection of a the fourth dose of the coronavirus vaccine is open to people 60 years and older who are 6 months or more from their first booster (or last covid infection). This second retreat was already open to French people over 80 years old who received their booster dose more than 3 months ago and all patients immunocompromised (no longer just the “severely immunocompromised”). According to the COSV opinion of November 2021, severely immunosuppressed people affected by the 4th dose are:

• solid organ transplant recipients,
• recent bone marrow transplant recipients,
• dialysis patients,
• patients with autoimmune diseases receiving aggressive immunosuppressive treatment such as anti-CD20 or antimetabolites,
• patients with certain types of lymphoma treated with anti-CD20 inhibitors or BTK,
• patients with chronic lymphocytic leukemia,
• patients with rare forms of primary immunodeficiency,
• myeloma under treatment

“As of May 9, between 60-79 years, 4.5% received a second booster dose. From 80 years and overthe vaccination coverage of this second dose was 16.7%“reports Santé Publique France in its epidemiological update of May 12.

What does the HAS recommend for the 4th dose?

The High Health Authority (HAS) recommends a fourth dose of the vaccine”people aged 65 and over, with a very high risk of suffering from a severe form of the disease and/or polypathology and who so wish, within the framework of a shared medical decision with their health team, taking into account their individual medical situation“.

Due to the good efficacy of the vaccine (more than 70% in 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 states “that due to the still limited data on the protection conferred by an Omicron infection, 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 the coronavirus vaccine not required butOpened“, that is, possible for people 60 years and older who have 6 months or more since their first reminder, people at least 80 years old and for all immunocompromised patients (from 3 months after their first booster). Therefore, the fourth dose is not it’s not mandatory.

A fourth dose for everyone at the start of the school year in September?

“nothing excludes new vaccine [4ème dose] by the end of the year if the appearance of new variants required it” indicated Olivier Véran on May 11. For all or for the most vulnerable? “I don’t have the answer to this question because I still don’t know which variant we will be dealing with, when and what the immunity of the population will be.added the Minister of Health. In the opinion of several doctors, a fourth dose of vaccine (second booster) is expected to be offered to the entire French (adult) population at the start 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 most of those vaccinated. “There will be a strong proposition for an additional dose just before the start of fall since we know that there may be an epidemic outbreak, it will affect the population over 60 years of age. Whether it will go further, that is, 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 that will circulate“, Professor Bruno Mégarbane had also advanced on April 24 on Franceinfo.

Than vaccine production laboratories ? Stephane Bancel, CEO of modernShe had 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 reinforcements fall 2022 and beyond.“Albert Bourla, CEO of Pfizerhe said on BFM-TV on Monday January 17: “At this time it is important to have three doses for a complete vaccination, maybe a fourth dose a little later for the general population“

How effective is the fourth dose?

“The 4th dose divides by 4 our risk of hospitalization, then there is a real effect in severe forms and there it 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 about 85% after 5 to 9 weeks and then to 75% after 10 to 14 weeks. After a booster with the Moderna vaccine, the efficacy of the booster 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 fourth 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 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 must then wait at least 6 months after infection before receiving your second booster.

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

► In severely immunocompromised persons, the fourth dose of the vaccine is part of your complete primary vaccination schedule. They can then make a withdrawal 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 individuals is done only with an mRNA vaccine, either Pfizer (30 µg dose) or Moderna (50 µg dose), regardless of previously used vaccine(s) based on COSV. Pfizer’s vaccine is the only one recommended for people under 30 years of age. “A full dose of the Pfizer-BioNTech vaccine or a half dose of the Moderna vaccine are used for this second booster injectionrecommends 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 establishments“, in addition to immunocompromised people affected 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, then there is a real effect in severe forms and there it 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 in France 5 on May 4.

Sources:

Recommendations of the Strategic Orientation Council on Vaccines for the protection of severely immunocompromised persons 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 Opinion of the Vaccine Strategy of August 19, 2021 – Minimum time between primary vaccination and booster vaccination