In some hospitals, they represent up to 30% of intensive care stays while they are less than 300,000 in France ... At the start of the year, six associations representing immunocompromised patients launched an appeal for help. to the President of the Republic in the Journal du dimanche (JDD), Sunday, January 2, for better care of these particularly fragile people.

With the epidemic resumption of Covid-19 in France, these patients with weakened immune systems, due to a transplant, a chronic disease, the taking of certain drugs, age or sometimes hereditarily, abound in emergency services dedicated to the coronavirus.    

“The vast majority of cases that arrive in intensive care are unvaccinated: around 7 out of 10.

We also have people vaccinated but immunocompromised, therefore fragile, as well as people far from their second dose and who have not yet recalled ”, explains Professor Gilles Pialoux, head of the infectious and tropical diseases department at the Tenon hospital (AP-HP), interviewed by France 24.  

An observation shared by Pierre Tattevin, head of the infectious diseases department at Rennes University Hospital: “After the unvaccinated, the immunocompromised are the second most important category of patients in intensive care.

The difficulty is that the vaccination works less well, even very badly in some of them.

With the arrival of new variants more resistant to the vaccine, the risk could become even greater for this category of patients. "   

Random vaccine efficacy  

If the effectiveness of vaccines is now well known in the general population, the same is not true for the immunocompromised.

The latter, like pregnant women and children, were excluded from phase 3 of the vaccine tests on large samples of the population, because they were deemed to be more vulnerable.   

Since then, several studies have been carried out on this category of patients, such as at the Sainte Catherine d'Avignon Cancer Institute.

“As early as last February, we launched a clinical trial on 90 immunocompromised patients and we observed large disparities in the results”, explains the director, Roland Sicard, contacted by France 24.  

“Some patients with five doses have not developed antibodies while others have as early as the second.

Several studies are now in line with our conclusions: the vaccine has random efficacy on this category of patients without knowing why at this stage, which makes it a population particularly at risk of Covid-19 and makes their medical monitoring very complicated." 

Roland Sicard makes no secret of this: the arrival of the Omicron variant represents an additional source of stress for immunocompromised patients.

Because if, faced with this variant, the vaccine retains high efficacy against severe forms in the general population (70%, against 90% for Delta), the level of vaccine ineffectiveness could further increase in people with immune systems. weakened.  

>> To read also: Covid-19, at the origin of the variants, the track of the immunocompromised patients

Ineffective treatments  

In addition to its greater resistance to the vaccine, the Omicron variant poses another threat to immunocompromised patients.

Several recent studies indicate that it renders most monoclonal antibody treatments ineffective. 

“These treatments are used to bring antibodies to fragile people.

They can be used in curative mode for fragile people with Covid-19 but also preventively in immunocompromised people who have already been vaccinated four times but have not developed antibodies.

In this case, the treatment makes it possible to overcome the ineffectiveness of the vaccine, ”explains Éric Bulleux, doctor and president of Transhépate, the national federation of liver transplant patients.   

Among the nine types of monoclonal antibodies currently used, a recent study by the Institut Pasteur concludes that six “completely lose their antiviral activity, and the other three are 3 to 80 times less effective against Omicron compared to Delta”. 

“Up to now, the doses were available but we had difficulty accessing these treatments because of organizational problems and the lack of personnel linked to Covid-19”, emphasizes Éric Bulleux.

“The arrival of Omicron further complicates our situation because the Ronaprève treatment, the most accessible today in France, is now ineffective.”   

Calls for individualized care  

In their joint forum published by the JDD, the six associations representing immunocompromised people - including Transhepate - call on the Head of State to develop appropriate responses to “protect the most vulnerable” and to accelerate research and the supply of new treatments.   

“Twenty-five to thirty percent of liver transplant recipients have no antibodies at all despite their four doses of the vaccine.

Without the possibility of treatment, they have no protection against Covid-19 and are condemned to live prostrate at home, ”emphasizes Éric Bulleux.

He himself explains that he has largely given up on all social life and today communicates almost exclusively through an interposed screen.    

“As president of the federation and doctor, I receive many calls from people in psychological distress, lost, because the general messages of the government do not correspond to our situations.

It is high time that the public authorities develop specific awareness campaigns with regard to vulnerable people ”, he asserts.    

Roland Sicard, director of the Sainte Catherine d'Avignon Cancer Institute, is also worried about the risk of marginalization of immunocompromised patients. “These fragile people cannot go to the services where Covid-19 patients are located and it is becoming more and more difficult with the progression of the pandemic. Added to this is the deprogramming of certain operations due to a lack of personnel and follow-up delays which sometimes cause, for the most vulnerable, loss of luck, ”he laments.   

“With the progression of the pandemic, we are now relying on collective immunity.

But it should be understood that this situation is impossible for the immunocompromised, who need long-term, personalized follow-up, with regular tests to assess their level of protection.

Admittedly, this approach does not correspond to the national logic which aims to set rules for everyone, but it is the only solution.

This personalized approach is being developed at the hospital level, it is now necessary for the State to institutionalize it ”, pleads Roland Sicard. 

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