Covid, influenza, RSV: Who should be vaccinated when and with what?

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For COVID-19, 38 people were hospitalized in Austria in the middle of July; however, the data are incomplete. In the week ending September 10, 183 people were hospitalized. A new wave of COVID is therefore building up, as also shown by the data from wastewater monitoring. The virus load measured in wastewater from sewage treatment plants corresponds to April. Since Monday, the new COVID-19 vaccine has also been available at the first vaccination sites. In the next few days or at the beginning of next week, all doctors who will be vaccinated should be supplied. At the same time, the annual influenza vaccination campaign will start in October. And for the first time, there will also be two vaccines against the respiratory pathogen RSV.

The vaccine has been adapted to the Omikron subline XBB.1.5. viruses from the XBB are currently present. Sublines circulate almost exclusively.

“A booster with the XBB.1.5-adapted vaccine broadens the antibody response once again, and antibodies are also produced that are better able to neutralize this variant again,” Leif-Erik Sander, head of the Department of Infectious Diseases at Charité – Universitätsmedizin Berlin, told the German Science Media Center. This generally applies to all circulating variants, he added.

The highly mutated Pirola (BA.2.86) subvariant has caused quite a stir in recent weeks. The XBB vaccine can now be shown to slow or prevent the infection of additional cells in this subvariant, according to preliminary laboratory data. Protection against severe disease progression is thus increased. A Swiss study recently showed that COVID-19 vaccines can reduce the number of infections, at least for a certain period, but cannot completely prevent them.

Who should get vaccinated against COVID-19 now?

“Preferably recommended” vaccination is given to people at increased risk for severe disease progression, which includes:

Individuals 60 and older (even without additional risk factors)
Pregnant women
Persons with trisomy 21
Persons with chronic underlying diseases (e.g. respiratory, cardiovascular, renal, metabolic, neurological, psychiatric, chronic inflammatory diseases)
Persons with cancer
Persons with immunodeficiencies
Severely overweight persons (BMI 30 or more)
People who are physically or mentally disabled, elderly and nursing home residents are typically looked after.
Additionally, vaccination is advised for all adults over 12 and healthcare professionals.

In Germany, a booster is not recommended until age 60, but in Austria, it is suggested from 12. Why?

The German Standing Commission on Vaccination (Stiko) currently sees no need for booster vaccination for healthy younger people. Their reasoning: “The majority of the population has already been vaccinated several times and has acquired good basic immunity due to additional SARS-CoV-2 infection(s) they have undergone.”

Vaccination expert Herwig Kollaritsch, a member of the National Vaccination Panel, emphasizes that the age limit was also intensively discussed in Austria. Still, the age limit for the recommendation was set at 12 years: “However, with the current XBB variants such as EG.5, we do not know how long there is protection against severe diseases with the previous immunity. After all, regular boosters are also useful against other viral infections.” This also reduces symptomatic infections – in the first few months afterward – and thus reduces the long-term risk because fewer infections exist.

What should the interval be from the last previous vaccination or infection?

A minimum interval of at least 6 months, ideally 12 months, is recommended for healthy people.
Specific high-risk individuals (60 years and older with weakened immune systems) may be vaccinated after four months. “However, a minimum interval of 4 months from previous exposure should be maintained even for these individuals,” the vaccination schedule states.

Where to get vaccinated now?

Primarily at physicians in private practice, although there are also some other regional vaccination centers, such as the health centers of the ÖGK or Vienna at the vaccination service Town Town. The websites of the regional medical associations sometimes contain lists of special COVID-19 and influenza vaccinators, for example, in Vienna or Lower Austria. But beware: If your family doctor is not on this list, it does not mean that they do not also vaccinate.

“The doctors on our list also vaccinate outside patients,” says the Lower Austrian Medical Association.

Sascha Bunda of the Austrian Medical Chamber comments, “For the influenza vaccination and for the Covid vaccination, reference is first made to the attending family doctor. For Covid vaccination, some provinces offer a list of physicians who offer Covid vaccinations (Vienna, Stmk) or a list of physicians who also vaccinate ‘outside patients’ (Lower Austria, Upper Austria). Vorarlberg is currently revising its list, and Burgenland is editing its list.”

When does vaccination start?

In the health centers of ÖGK, for example, already since Monday. “Doctors who have already ordered vaccines from us in the past week will receive it in the course of this week,” says Kathrin McEwen of the Vienna Medical Association. “Those who place orders this week through Thursday will receive the full amount the following week, typically by Tuesday.”

“Covid-19 vaccines are also being procured for this vaccination season by the Ministry of Health and made available to the provinces. The delivery of the vaccines adapted to the XBB variants has already started last week,” the Ministry of Health said.

In Germany, organizational problems are feared because, at least for now, the vaccine cannot be delivered in single doses. What is the situation in Austria?

The Biontech vaccine is available only in vials containing six single doses each, which must be administered within twelve hours. If not enough people are willing to be vaccinated within this period, the remaining vaccine must be discarded. “We are not satisfied with this; organizationally, single doses would be much better,” says Kathrin McEwen of the Vienna Chamber.

What’s the deal with influenza vaccination this year?

For the first time, the public sector will run an Austria-wide influenza vaccination program. This year, influenza vaccination will be available throughout Austria at a deductible of 7 euros. This was made possible by an agreement between the federal government, the provinces and the social security system. The vaccination is free of charge for persons under 18 years of age and for persons exempt from the prescription fee. The deductible is also waived for those willing to be vaccinated during vaccination campaigns in companies, older adults, and nursing homes.

However, this Austria-wide standardization of the influenza vaccination program also means the end of free vaccination campaigns in Vienna. Since 2020, Vienna offered free vaccinations at vaccination centers every year at the beginning of the flu season in the fall.

By the way, the seven euros are part of the fee for the doctor; it says on the website of the ÖGK: “You (meaning the doctor) receive 15.00 euros per vaccination sting. The deductible of 7 euros is part of the fee and remains with the doctor. Private billing of the vaccination sting or co-payment is not allowed.”

To whom is influenza vaccination recommended?

Vaccination is generally recommended at the age of 6 months. It is primarily recommended for persons over 60, persons with certain chronic diseases (e.g. chronic lung, heart, circulatory, kidney or neurological disorders, and metabolic diseases), health care workers, and senior care workers.

At what point should one get vaccinated against influenza?

“Ideally, influenza vaccination is administered at the end of October or November,” says the Austrian Vaccination Schedule. This usually allows enough time to build up good vaccination protection before the first wave of influenza, but at the same time, you still have a good defence at the end of the winter. The vaccination campaign against the real viral flu starts at the beginning of October in the vaccination centers of the ÖGK, around 2.10. The Austrian Health Insurance Fund is responsible for coordinating the vaccination campaign.

Is it possible to be vaccinated against COVID-19 and influenza simultaneously?

Yes, in principle, there is nothing to be said against it. Studies have shown that this does not affect the formation of antibodies that are relevant for protection. However, if a vaccination reaction occurs, it is unknown which vaccination caused it.

What about the new vaccinations against RSV?

This year, two vaccines against the respiratory pathogen RSV (respiratory syncytial virus) were approved. They are intended for people 60 years of age and older and for pregnant women to pass on immune protection to the baby. The National Vaccination Panel recommends vaccination from the age of 60. The importance of RSV infection is underestimated in older people. After all, no virus is routinely detected. According to a new study, the rate of acute RSV lower respiratory tract disease in persons 60 and older is 1.6 percent per season.

There is no direct recommendation for pregnant women. On request and in accordance with the vaccination schedule, pregnant women may receive one vaccination.

The background to experts in Austria and Germany’s reluctance to vaccinate pregnant women is that one of the studies showed slightly more preterm births among vaccinated women. These could also be coincidental observations, especially since the difference from the unvaccinated was not statistically significant. However, this uncertainty makes a general vaccination recommendation for all pregnant women difficult for the time being.

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