COVID REMINDER DOSE – As vaccine efficacy gradually decreases from the 6th month after complete vaccination against Covid, a booster dose (3rd dose) is recommended for certain people in France, such as caregivers, the immunocompromised and their relatives.

[Mise à jour le mardi 12 octobre à 17h04] Starting from the observation that l’vaccine efficacy gradually decreases over time from the 6th month after the complete primary vaccination, a booster dose of the Covid vaccine is recommended for certain populations in France. The World Health Organization (WHO) recommended on October 11 the administration of a booster dose to people “moderately or severely immunocompromised and not to the general population. The European Medicines Agency (EMA) approved on October 4, 2021 the administration of a third dose of Pfizer vaccine for those over 18 years of age,at least 6 months after the second dose, she said in a press release. The HAS has completed its opinion on the populations likely to benefit from a booster dose at 6 months, and on the fact ofbroaden the booster dose. Following the decision of the High Authority of Health, Gabriel Attal and Olivier Véran announced the opening of the third dose booster vaccination campaign for health professionals and relatives of immunocompromised people, but this is not, however, obligatory. Who should take 3 doses? How long after the second injection ? With which vaccine? A messenger RNA vaccine? Pfizer or Moderna? When does the recall campaign start? What are the potential side effects? Eligibility, deadline, schedule …

On August 12, 2021, the Ministry of Health confirmed the implementation of a vaccination booster campaign from mid-September for:

  • residents of nursing homes and long-term care units (USLD),
  • people over 80 living at home,
  • those who present a very high risk of severe form of Covid 19
  • and people who are immunocompromised. Sometimes two doses are not enough to produce enough antibodies in people who are immunocompromised

The ministry then approached the HAS for its opinion on the extent of the measure to other populations and on the probability that a booster vaccination in the general population will eventually be necessary. On August 24, the HAS issued its opinion and recommended a booster dose with an mRNA vaccine for :

  • people aged 65 and over,
  • as well as for people with co-morbidities that increase the risk of severe forms of Covid-19 (trisomy 21, transplanted solid organ or hematopoietic stem cells, renal insufficiency (dialysis), people with rare and serious pre-existing conditions or severe disabilities, diabetes (type 1 and type 2), obesity (BMI> 30 kg / m2), cancer, COPD or respiratory failure, heart failure, complicated high blood pressure, chronic liver disease, psychiatric disorders, dementia, history of stroke. .)

October 6, 2021, HAS recommends extending this recall to all professionals who take care of or support these vulnerable people (caregivers, medical transport and professionals in the medico-social sector). It also recommends offering it to the entourage of immunocompromised people.

Booster dose: for whom? © Ministry of Health

Currently, ” patients who contracted Covid-19 after their first vaccination schedule should not be offered a booster dose “, estimates the Directorate General of Health.

Since the 1st September 2021: people over 80 living at home, those at very high risk of a severe form of Covid-19 and people with compromised immunity may receive their booster dose.

September 13, 2021: start of the recall campaign for residents of nursing homes and long-term care units (USLD)

October 7, 2021: Following the decision of the High Authority for Health, Olivier Véran announced the upcoming opening of the third dose booster vaccination campaign for health professionals and relatives of immunocompromised people, but this is not mandatory.

End of October 2021, starting the start of the flu vaccination campaign (for organizational reasons): people 65 years of age and over and those at risk of severe forms of Covid-19 (comorbidities) may receive their booster dose. They can make an appointment “from the beginning of September“said Jean Castex on August 26 on RTL. The HAS proposes, to avoid any delay in influenza vaccination and simplify the vaccination course, to carry out the concomitant administration of vaccines against Covid-19 and against seasonal flu. And this, as soon as a person will be eligible for both vaccinations, most of the priority populations for influenza vaccination also presenting risks of serious forms of Covid-19. The HAS recalls that the concomitant realization of vaccines against influenza and Covid-19 is possible in order to avoid any delay in the administration of one or the other of these injections. Concretely, the two injections can be performed on the same day, but at two separate vaccination sites – a vaccine in each arm.

If you meet the criteria (be over 65, have comorbidities or have a risky condition and have received your second dose more than six months ago, people who are immunocompromised or vaccinated with Janssen), you can make an appointment as soon as possible. now for a booster dose on the platforms Doctolib, Keldoc or Maiia. You will be offered time slots depending on the vaccination location. You will have to click on the “You only want to book a third injection or booster dose“. Then, you will have to choose your vaccine: Pfizer, Moderna or” without preference “. It is also possible to make an appointment directly with your doctor or in a pharmacy. From September 13, a recall campaign specifically targets nursing homes and nursing homes. USLDs Residents do not need to make an appointment.

Inscription 3e dose Doctolib
3rd dose registration © Doctolib

After analyzing the available data, the HAS indicates that the booster dose should be given by an mRNA vaccine, regardless of the vaccine used initially. In France, the two mRNA vaccines available are the vaccines of Pfizer-BioNTech (Comirnaty®) and Modern (Spikevax®). The vaccine Comirnaty® already has an extension of Marketing Authorization for this purpose and that of the Spikevax vaccine is being examined at the EMA (full dose and / or half-dose) and should be returned in the coming weeks. Regardless of the vaccine used for the primary vaccination with an mRNA vaccine, the HAS believes “that there is no sufficient argument, to date, to preferentially recommend one vaccine over the other for the booster dose, the two available mRNA vaccines (Comirnaty® and Spikevax®) being both very effective against severe forms of Covid-19, including those related to the Delta variant“.

► The booster dose should be given after a delay ofat least 6 months after complete primary vaccination.

► For people who first received the Janssen vaccine, the booster dose should be administered from 4 weeks after the first injection.

The booster dose should be given at least 6 months after the last injection of the vaccine. From now on, and if this 6-month period is respected, the people concerned can make the vaccination appointment:

  • with their attending physician (or physician of their choice);
  • in a drug store ;
  • with a nurse;
  • in a vaccination center

► The Health Insurance launched a mailing campaign in September to all people aged 80 and over telling them how to get a booster dose or a first injection. The skip-the-line number is also communicated in the mail to easily get an appointment at a vaccination center. This message will then be declined for 65-79 year olds and sent to their Ameli account.

According to the French National Authority for Health, the booster dose makes it possible to to note the vaccine effectiveness on the cases of infection and the severe forms. “Real-life efficacy data from a booster dose of Comirnaty® vaccine first administered to people 60 years of age or older vaccinated with two doses at least five months previously show a diminution the risk of infection by Covid-19 (…), 11.3 times lower cases of infections and cases of severe forms 19.5 times lower among people who had a booster dose than among those who did not “. Administration of a booster dose would also decrease the viral load and in fact, probably the contagion people who develop SARS-CoV-2 infection.

In terms of safety, Israeli data observed in real life, although still limited in terms of follow-up, seem to show an overall safety profile of the booster dose generally comparable to that observed after administration of the second dose of vaccine. The preliminary Israeli study published on Reuters on August 8, 2021, conducted on 4,500 people who received a booster dose from July 30 to August 1, showed precisely that:

  • 88% of people who received a third dose of Pfizer’s vaccine had “felt similar or lesser side effects until after receiving the second injection“.
  • 31% of them reported side effects, the most common being pain at the injection site.
  • 0.4% reported suffering from breathing difficulties
  • 1% said they sought medical treatment because of one or more side effects.

To date, there is no data in favor of the systematic administration of a booster dose beyond the targeted persons

The European Medicines Agency (EMA) announced on October 4 that it was in favor of a third dose of the Pfizer / BioNTech vaccine for the population over 18 years of age. For his part, Professor Jean-François Delfraissy, president of the Scientific Council of Covid-19, believes that a third dose of vaccine will soon be necessary “for a large part of the population”, he said on France 2, Wednesday August 25. This booster dose will serve, according to him, to “re-stimulate the immune response to the vaccine“. The HAS considers that there is, to date, no data in favor of the systematic administration of a booster dose beyond the targeted people by government announcements and by its advice. The World Health Organization does not recommend a booster dose. “We clearly believe that current data does not indicate that recalls are necessary“WHO Chief Scientist Soumya Swaminathan told a press conference.”It is necessary wait for science to tell us when boosters are needed, what groups of people and which vaccines need boosters. ” However, the administration of a booster dose will probably become necessary in the coming months, without it being yet possible at this stage to make a precise statement, neither on the target population nor on the timetable. The health authority will therefore have to review its recommendations as soon as new data justifies it. “In this situation, the priority should now be to immunize all eligible people who have not yet completed their recommended immunization schedule.“, insists the European Medicines Agency in a press release dated September 2.

Source: Press release from the Haute Autorité de Santé, August 24, 2021.

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