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A fourth dose of the Pfizer BioNTech vaccine is effective in reducing the short-term risk of COVID-19 infection, hospitalization, and death in people who received the third dose at least four months ago on Wednesday. A large study published in shows.
But the author of Paul Offit, MD. editorial With research Medscape Medical News“I argue, without fear of contradiction, this will not affect this pandemic.”
“We are still in the midst of a zero-tolerance policy against this virus. We do not accept mild illnesses, and if we are not willing to accept mild illnesses, we will boost it. I think we have to. Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia (CHOP), said:
Booster confusion
Research results from Israel published on Wednesday New England Journal of Medicine Make a fourth booster case for people over 60 years old.
Researchers led by Ori Magen, MD, Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, and Israel have recorded 182,122 records by Israel’s largest medical institution from January 3 to February 18, 2022. We analyzed the data comparing matching pairs. With more than 4.7 million members, Clarit Health Services covers more than half of Israel’s population.
The researchers compared the results of people over the age of 60 (mean age 72 years) who received the fourth dose with those of those who received only the third dose. They collated the two groups of people individually, taking into account factors such as age, health, and ethnicity.
The relative vaccine efficacy 7-30 days after the 4th dose was estimated to be 45% (95% confidence interval). [CI]44-47) 55% (95% CI, 53-58) for confirmed SARS-CoV-2 infection, 68% (95% CI, 59-74) hospitalization for symptomatic COVID-19 In contrast, 62% (95% CI, 50-74) were for severe COVID and 74% (95% CI, 50-90) were for COVID-related death.
Several countries, including the United States, have begun offering a fourth vaccination to high-risk populations in the light of evidence of weakened immunity after the third vaccination. Wave of infection, Driven by Omicron and its variants in some parts of the world. However, the recommended age groups are quite different.
For example, in the United States, the US Food and Drug Administration in late March Approved A fourth dose of Pfizer or Moderna vaccine for people over the age of 50 and 18 who have undergone a solid organ transplant or have similar levels of immune risk.
Offit points out that Israel provides a fourth vaccine for people over the age of 60 and the European Medical Association provides it for those people. 80 and more. He said it was not surprising that the fourth dose was widespread.
Booster advice
Offit provides this perspective:
someone Immunodeficiency He said they could reasonably receive a fourth dose, depending on how they were at risk.
“People who have a solid organ transplant are not the same as those who have a monoclonal antibody. Rheumatoid arthritis“Ofit said.
He said that if you are 65 years of age or older and have multiple comorbidities, you can also reasonably discuss a fourth dose.
“I’m over 65,” Ofitt said. “I’m generally healthy. I don’t take the fourth dose.”
He said that people over the age of 12 with multiple comorbidities could reasonably receive a third dose.
“For everyone else, healthy people under the age of 65, I argue that this is a two-dose vaccine,” Ofitt said.
As an example, CHOP mandates a vaccine, but does not mandate three doses, he says, which is not uncommon in hospital systems.
“How many lives are really saved by that fourth dose? If you really want to affect this pandemic, vaccinate those who haven’t been vaccinated,” Ofitt said. rice field.
Focus on memory cells
In an editorial, Offit said, “Undoubtedly, the most disappointing mistake surrounding the use of the Covid-19 vaccine was to classify mild illnesses or asymptomatic infections after vaccination as” breakthroughs. ” As with all mucosal vaccines, the goal is to protect people from serious illnesses — keep people away from hospitals, intensive care units, and morgues.The term “breakthrough”, meaning failure, created unrealistic expectations and led to adoption of this virus’s zero-tolerance strategy.
Ofitt said the focus should be on memory cells, not neutralizing antibodies.
Regarding the mRNA vaccine, Offit said, “The surprise of this vaccine-which surprised me and other vaccine researchers-is that these two doses of mRNA are actually a long-lived memory response when given at intervals of 3-4 weeks. It looks like there is.
“It’s not the history of vaccines. Looking at inactivated polio vaccines or inactivated vaccines hepatitis For vaccines, frequent doses of memory cells require a dosing interval of 4-6 months. It doesn’t seem to be the case here. Two doses given nearby seem to do just that. Memory cells, if not, can last for decades in some cases. “
Neutralizing antibodies, on the other hand, protect against mild illness and become less effective after a few months.
“At some point we will need to get used to the mild illness,” Ofitt said.
The Centers for Disease Control and Prevention needs to determine who will benefit most from booster administration and educate the general public about the limitations of mucosal vaccines, Offit wrote in an editorial.
“Otherwise, a zero-tolerance strategy for mild or asymptomatic infections can only be implemented with frequent booster doses and will continue to mislead the general public about what the Covid-19 vaccine can and cannot do. “
The work was funded by the Ivan and Francesca Berkowitz families Living Lab collaboration between Harvard Medical School and Clarit Institute.
Marcia Frellick is a freelance journalist based in Chicago.She previously Chicago Tribune, Science news, And Nurse.com Chicago Sun Times, Cincinnati EnquirerAnd that St. Cloud (Minnesota) Times.. Follow her on her Twitter @mfrellick.
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