Vaccination Panel: Fourth Corona vaccination “especially from the age of 60”

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The National Vaccination Panel has now published an update to its recommendations for using the Covid 19 vaccines. This update became necessary with the European approval of three so-called bivalent vaccines, directed not only against the original virus (wild type) but also against an omicron variant. At the same time, the panel is addressing two points of discussion and criticism that several experts have voiced in recent weeks.

The National Immunization Panel writes that booster shots (4th vaccination) can be given to people 12 years and older. They are “recommended for any person who wants to protect themselves.” At the same time, however, the panel now emphasizes, “In particular, persons 60 years of age and older, persons at risk for severe disease progression (including pregnant women), and persons at increased risk of exposure (health care workers, persons in long-term care or assisted living facilities, etc.) are advised to receive the 4th vaccination.”

Infectiologist Herwig Kollaritsch, a member of the vaccination committee, told KURIER: “We have had ongoing inquiries and complaints where people of different ages – one over 60, one under 60 – have gone for the fourth vaccination, and the one under 60 has been sent home again. Or a family is caring for an 80-year-old grandma, but the caregivers are all under 60. I also recommend the fourth vaccination to them because it lowers the risk of bringing infection into the family.” In such cases, to prevent those under 60 from not receiving the vaccination, the National Immunization Panel said the fourth vaccination “is open from age 12. Still, at the same time, we emphasize that it is critical for those over 60.”

The interval between the third vaccination is at least six months in the 12- to 59-year age group and at least four months for people 60 and older and those at risk 12 and older.

For the fourth vaccination, the same or a different vaccine can be used as for the basic immunization (three vaccinations). The NIG emphasizes, “Preferably, bivalent mRNA vaccines are recommended because they have been approved as the 4th vaccination from the European authorities.” However, the old (monovalent) vaccines can also be used – but they do not have specific approval for the 4th vaccination.

Meanwhile, three bivalent vaccines are approved for people 12 years and older:

  • Comirnaty Original / Omicron BA.1 from Biontech / Pfizer. Of the latter, 757,000 vaccine doses have already arrived in Austria.
  • Spikevak Bivalent Original / Omicron BA.1 from Moderna
  • Comirnaty Original / Omicron BA. 4-5 from Biontech / Pfizer

Only the existing (monovalent) vaccines are approved for the first two vaccinations, which do not yet contain an Omicron component.

For the 3rd vaccination, approval exists for monovalent and bivalent mRNA vaccines. “Data published to date show a positive impact of a vaccine switch rather than a negative impact,” the updated vaccination recommendations state.

A fifth vaccination is recommended only for at-risk individuals – especially immunosuppressed individuals – 12 years of age and older and individuals 60 years of age and older before the cold season “to provide the best possible protection during the cold season with expected waves of infection.” The interval between the fourth vaccination should be at least four months and at least six months for children and adolescents 12 to 17 years of age unless an individual examination suggests a shorter interval.

Infection does count in certain cases
In the updated recommendations, the vaccination panel also addresses the issue of vaccinations after a confirmed corona infection. Here, it most recently stated that omicron infections should not affect vaccination intervals and that the scheduled intervals between two vaccinations should not be extended, even in the presence of disease. The previous rationale: Infection with one omicron subvariant (such as BA.2) leaves only very uncertain immunity against another omicron subvariant (such as BA.5). Several experts have criticized this recommendation.

Now the new recommendations for people who already have two or more vaccinations state: In the case of symptomatic infection, vaccination may be deferred for up to 6 months for persons younger than 60. However, for persons 60 years of age and older and those at risk (regardless of age), vaccination can be given after the infection has passed (negative PCR test) or after recovery “even before reaching six months in the scheduled schedule.”

Infectiologist Kollaritsch on the change in this recommendation: “Shortly after our initial publication, several new study results on immunity after omicron infection came out, which we have now taken into account.”

The NIG summarized these new findings, such as from a study in Portugal, in its recommendations as follows: “Thrice-vaccinated individuals who have also undergone a proven omicron infection (BA.1, BA.2, or BA.4, BA.5) show a good booster response and (cross-)immunity to BA.4 /BA.5. Especially in persons under 60 years of age, in such cases athe4th vaccination within a period of up to 6 months does not further improve immune protection, and thus the 4th vaccination can be postponed accordingly.”

Procedure in case of suspected infection
The case of asymptomatic or unnoticed infection is now also addressed in detail. “The problem in daily practice is that people are not sure whether they might not have had an unnoticed infection and are therefore unsure whether they can get vaccinated,” says Kollaritsch. “TYes, vaccination is possible according to the intended vaccination schedule.”

Kollaritsch is convinced “that we now have a good version that is not too complicated but still refers to everything that matters. And I hope that we now have a version that will last longer.”

The new additions to the application recommendations have now been published in the ministry of Social Affairs. homepage.

  • sources: kurier.at/ APA/picture: pixabay.com
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