Third dose vaccines, here’s how to move. Report
How, when and for whom will there be the third dose of the Covid vaccine? Here is what emerges from the updated report by the Gimbe Foundation on the vaccination campaign in Italy
How, when and for whom will there be the third dose of the Covid vaccine?
The European Medicines Agency (Ema), in accordance with the report of the European Center for Disease Prevention and Control (Ecdc), pointed out that, given the high (and prolonged) efficacy of vaccines against severe forms of disease and deaths from Covid -19, at the moment there is no urgency to administer a booster dose in the general population vaccinated with a full course, not even for the professional categories most at risk (eg health professionals).
At the same time, the EMA has started the evaluation of the data on the efficacy of the third dose to be administered 6 months after the conclusion of the vaccination cycle in order to enhance the immune response.
"The approach is different for immunosuppressed subjects and frail elderly people, in particular guests of RSA – explains Renata Gili, Head of Research on Health Services of the Gimbe Foundation – who may not have reached an adequate level of protection with the first complete cycle".
In this case, the third dose would not be configured as a booster, but as an integral part of a vaccination cycle of three doses: for this reason both the EMA and the ECDC suggest for these subjects the administration of an additional dose of mRNA vaccine. .
"In our country – explains the president of the Gimbe Foundation, Nino Cartabellotta – after the Technical Scientific Committee has already expressed itself positively, we only await the green light from Aifa to start administering the third dose in immunocompromised people and in the elderly. high fragility ".
Here is the full report of the Gimbe Foundation with the update on the pandemic and the vaccination campaign in Italy
The independent monitoring of the Gimbe Foundation detects in the week 1-7 September 2021, compared to the previous one, a decrease in new cases (39,511 vs 45,134) (figure 1) compared to an increase in deaths (417 vs 366), however influenced by recalculations (figure 2). Currently positive cases (133,787 vs 137,925) and people in home isolation (128,917 vs 133,129) also drop, while there is a slight increase in hospitalizations with symptoms (4,307 vs 4,252) and intensive care (563 vs 544) (figure 3) . In detail, compared to the previous week, the following changes were recorded:
- Deaths: 417 (+ 13.9%), of which 82 referred to previous periods
- Intensive care: +19 (+ 3.5%)
- Hospitalized with symptoms: +55 (+ 1.3%)
- Home isolation: -4,212 (-3.2%)
- New cases: 39,511 (-12.5%)
- Currently positive cases: -4.138 (-3%)
"For the first time since the end of June, new weekly cases are decreasing – declares Nino Cartabellotta, President of the Gimbe Foundation – both as absolute numbers and as a moving average of daily cases which stands at 5,644" (figure 4). In the week 1-7 September 2021, compared to the previous one, only 3 Regions recorded a percentage increase in new cases, while in 9 Regions the currently positive cases grew (table 1). 63 Provinces have an incidence equal to or greater than 50 cases per 100,000 inhabitants: in Emilia-Romagna, Sardinia, Sicily, Tuscany and Umbria all the Provinces reach or exceed this threshold. In 7 Provinces there are over 150 cases per 100,000 inhabitants: Syracuse (231), Messina (189), Ragusa (170), Trapani (170), Catania (165), Prato (164) and Caltanissetta (159) (table 2) . Deaths increased: 417 of which 82 related to previous periods.
"On the hospital front – says Renata Gili, Head of Research on Health Services of the Gimbe Foundation – it further slows the increase in beds for Covid patients: compared to the previous week, they grew by only 1.3% in the medical area and by 3, 5% in intensive care ». At the national level, the employment rate remains low (7% in the medical area and 6% in the critical area), albeit with significant regional differences (figure 5): for the medical area they are above the 15% threshold Sicily (23% ) and Calabria (19%); for the critical area above the 10% threshold Sicily (13%) and Sardinia (15%). "Daily admissions to intensive care are stable – explains Marco Mosti, Operations Director of the Gimbe Foundation – with a 7-day moving average of 42 admissions / day compared to 43 in the previous week" (figure 6).
Vaccines: supplies.
On 8 September (update 6.12) 89,721,203 doses were delivered. In terms of deliveries, after the sharp change of pace recorded in August (almost 15 million doses in the period 2-29 August for a weekly average of 3.75 million), only 2 million were received in the week 30 August-5 September. of doses from Pfizer (figure 7). "Despite the drop in supplies in the last week – explains Marco Mosti – the stocks of mRNA vaccines continue to increase, now exceeding 9.6 million doses".
Vaccines: administrations.
As of 8 September (update 6.12), 73.2% of the population (43,371,929) received at least one dose of vaccine (+762,552 compared to the previous week) and 65.9% (39,072,107 ) completed the vaccination cycle (+1.189.855) (figure 8). The number of administrations increased in the last week (1,934,230) (figure 9), but the 7-day moving average, after the peak of almost 280 thousand doses / day on September 3, dropped to around 256 thousand on September 7. (figure 10). "Despite the acceleration of supplies – comments Cartabellotta – for three weeks the number of first doses has in fact been stable at around 720-750 thousand, a sign of the difficulty of convincing the undecided".
Vaccines: coverage of over 50s.
88.4% of the population over 50 received at least the first dose of vaccine, with a negligible national weekly increase (+ 0.6%) and clear regional differences: from 92.9% in Puglia to 82.3% in the Sicily. In detail:
- Over 80: of the over 4.4 million, 4,194,928 (93.6%) completed the vaccination course and 104,950 (2.3%) received the first dose only.
- Age range 70-79: of the over 5.9 million, 5,326,891 (89.3%) completed the vaccination course and 139,811 (2.3%) received the first dose only.
- Age range 60-69: of the over 7.3 million, 6,321,767 (85%) completed the vaccination course and 237,700 (3.2%) received the first dose only.
- Age range 50-59: of the over 9.4 million, 7,361,245 (77.8%) completed the vaccination course and 501,638 (5.3%) received the first dose only.
Overall 4.1 million over 50s (15.2%) have not yet completed the vaccination cycle (figure 11) with significant regional differences (from 17.7% in Sicily to 7.1% in Puglia, figure 12): these, 3.16 million have not yet received even a dose. Faced with a substantial flattening of vaccination trends in this age group, the under-50 curves continue to rise, despite a decline in those of 40-49 years and an initial slowdown in those of 20-29 and 30-39 years ( figure 13). On the other hand, the rise in the 12-19 age bracket remains constant, an encouraging sign given the imminent reopening of schools. Figure 14 illustrates vaccination coverage by age group: in particular, in the 12-19 age group, 40.1% completed the cycle, 23.1% received the first dose and 36.8% did not. has not yet received a single dose of the vaccine, with significant regional differences (Figure 15).
Vaccine efficacy.
The efficacy of the vaccine from April to today remains stable and very high in reducing deaths (96.6%) and severe forms of the disease requiring hospitalization (93.9%) and hospitalization in intensive care (96%). With regard to the diagnosis of SARS-CoV-2, on the other hand, the effectiveness is reduced from 88.5% (period 4 April-11 July) to 78.1% (period 4 April-29 August), especially in the younger than the population, albeit with stabilization in recent weeks (Figures 16 and 17): there is therefore a progressive reduction in the effectiveness of vaccination coverage against asymptomatic infections and mild forms of disease that do not require hospitalization. "Given that the reduction in effectiveness is more evident in the under 50s – explains Cartabellotta – it is likely that, during the summer, the increase in social contacts and less attention to individual behaviors, essential for preventing contagion even in vaccinated people ". Compared to unvaccinated subjects, there is a sharp decline in the incidence of diagnosis and especially of severe disease requiring hospitalization, hospitalization in intensive care or leading to death in subjects vaccinated with a complete cycle. In fact, in the various age groups, the diagnoses of SARS-CoV-2 are reduced by 76.6-79.9%, hospitalizations by 88.8-95.6%, admissions to intensive care by 93.4 -96.5% and deaths of 93.4-100% (figure 18).
Third dose.
The European Medicines Agency (Ema), in accordance with the report of the European Center for Disease Prevention and Control (Ecdc), pointed out that, given the high (and prolonged) efficacy of vaccines against severe forms of disease and deaths from Covid -19, at the moment there is no urgency to administer a booster dose in the general population vaccinated with a full course, not even for the professional categories most at risk (eg health professionals). At the same time, the EMA has started the evaluation of the data on the efficacy of the third dose to be administered 6 months after the conclusion of the vaccination cycle in order to enhance the immune response. "The approach is different for immunosuppressed subjects and frail elderly people, in particular guests of RSA – explains Gili – who may not have reached an adequate level of protection with the first complete cycle". In this case, the third dose would not be configured as a booster, but as an integral part of a vaccination cycle of three doses: for this reason both the EMA and the ECDC suggest for these subjects the administration of an additional dose of mRNA vaccine. . "In our country – explains Cartabellotta – after the Technical Scientific Committee has already expressed itself positively, we only await the green light from AIFA to start the administration of the third dose in immunocompromised people and in the elderly with high frailty".
Herd immunity and vaccination obligation.
"In the face of a political debate and public communication that chase target percentages of vaccination coverage – states Cartabellotta – it is good to remember that today there are no epidemiological conditions to achieve the so-called herd immunity, able to protect the unvaccinated thanks to a high percentage of people no longer susceptible to contagion, because they have been vaccinated or cured ». Indeed:
- At the moment no vaccine is approved for individuals under 12 years of age: over 5.8 million people (9.9% of the population) including the virus continues to circulate freely.
- Approved COVID-19 vaccines are non-sterilizing, meaning they do not confer total immunity against the virus, and even those who are vaccinated have a much lower chance of becoming infected and transmitting the virus. At the moment in Italy the effectiveness of the vaccine against the infection is around 78%.
- The efficacy of vaccines against infection begins to decline approximately 6 months after the conclusion of the vaccination cycle, particularly in the younger age groups.
- In low-income countries less than 2% of the population has received at least one dose of the vaccine: this inhomogeneity in access to vaccines contributes to the high circulation of the virus and the emergence of new variants.
"Given the high efficacy and safety profile demonstrated by the administration of over 5 and a half billion doses of vaccine all over the world – concludes Cartabellotta – it is useless to pursue the chimera of a percentage of the vaccinated population capable of" extinguishing "the switch of viral circulation. The public health goal is to vaccinate all those who do not have specific contraindications, in order both to provide individual protection from serious illness or death, especially for those over 50, and to minimize viral circulation. Since this objective is now based on robust evidence, it is up to politics to choose the strategy with which to achieve it: from a scientific point of view, all the papers are in order to establish the vaccination obligation ».
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/terza-dose-vaccini-ecco-come-muoversi-report/ on Thu, 09 Sep 2021 07:55:07 +0000.