The most vulnerable patients will receive a third dose of the anti-covid vaccine.

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FRANCOIS GREUEZ / SIPA

  • In an urgent note addressed to health professionals who are vaccinated, the Directorate General of Health recommends the administration of a third dose of anti-Covid vaccine for immunocompromised people.

  • Patients on dialysis, who have had an organ transplant or who have cancer have a weaker immune system.

  • To protect them effectively from the coronavirus, two doses of the vaccine are not enough.

Insufficient immune response after two doses.

On Sunday, the Directorate General of Health (DGS) sent an urgent note to all health professionals who vaccinate, informing them that a third dose of anti-Covid vaccine is now recommended for immunocompromised patients.

Several recently published studies show that in these vulnerable patients, the classic two-injection protocol is not enough to develop sufficiently protective immunity against the coronavirus.

"In accordance with the opinion of April 6, 2021 of the Vaccine Strategy Orientation Council (COSV), the injection of a third dose of messenger RNA vaccine is necessary for severely immunocompromised people", indicates the DGS.

A news greeted with relief by patient associations, mobilized on the issue for several weeks.

A third dose of messenger RNA vaccine

In practice, this third dose will be eligible for patients "transplanted solid organs, recent bone marrow transplants, patients on dialysis, or even suffering from autoimmune diseases under strong immunosuppressive treatment", specifies the DGS.

It further provides that "recommendations will subsequently be issued regarding the need for a third dose for chronic renal failure not on dialysis, patients with cancer and patients with autoimmune diseases on other immunosuppressive treatments."

The application of this new recommendation provides that "this third injection must take place at least four weeks after the second dose, or as soon as possible for people who have already exceeded this time", adds the DGS, which reserves specifically for this population of doses of messenger RNA vaccine.

Patients with a weaker immune response

This announcement was expected by patient associations, who demanded a scheme adapted to the most vulnerable.

"We very quickly observed that the immune response was reduced in people with transplants and dialysis, after the first injection, but also after the second," recalls Magali Léo, head of the advocacy department of Renaloo, an association of patients with kidney diseases leading to transplants. and dialysis.

This is not surprising, since vaccination is often less effective in this immunocompromised population.

But it is a real disappointment for these people at high risk of severe form of Covid-19, who know they are vulnerable and who see in the vaccination the hope of returning to a more normal life.

The announcement of this reduced vaccine efficacy worries them, many of whom have been in a form of self-containment and confinement for months ”.

This new vaccination schedule “requires support for immunocompromised patients, because all those who are transplanted or dialysed do not necessarily know that they are not protected with two doses, that they now have a third injection to receive, and that the High Authority for Health (HAS) should soon open vaccination to their relatives, continues Magali Léo.

We are working with Health Insurance so that complete information is relayed to patients, but also to all vaccine structures ”.

Observational studies in progress

On the research side, "there is a request for clarification on the level of antibodies to be reached by immunocompromised patients," observes André Le Tutour, co-president of Transhépate, the National Federation of hepatic patients and transplant recipients.

Because "the clinical trials conducted by the laboratories do not include severely immunocompromised patients, transplant recipients or dialysis patients, who have been excluded", regrets Magali Léo.

Result: "today, we have no indication on the level of antibodies which, in immunocompromised patients, neutralize the risk of severe form of coronavirus, nor on the role of cellular immunity for their protection, she says.

If things had turned out differently, perhaps we could have planned an

ad hoc

vaccine

for severely immunocompromised people, perhaps more dosed or with adjuvants.

But this is not the case.

And we can only have data in real life.

So we are awaiting the work of the Vaccine Strategy Orientation Council (COSV), which provides for serology after the second and third dose to assess the induced immune response.

Thus, we will soon be able to measure the effectiveness of this third dose ”.

Especially since "patients also join the COV-POPART cohort of the ANRS, which will allow the collection of valuable data", hopes André Le Tutour.

An even more reinforced pattern?

Too early to say

If the results of these studies required it, “we could move towards an even more reinforced scheme for a part of this population, with additional injections of vaccine, advances Magali Léo.

But for now, it is far too early to say.

What is certain is that France is currently the only country offering this third dose ”.

A liver transplant recipient several years ago, André Le Tutour remains confident: “We should not be alarmed.

I received my first two injections, and now I will make an appointment for the third.

Not only do I feel protected, but in addition, I participate in collective immunity ”.

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