MURCIA. After the lifting of the restrictions, the processions of Holy Week y Spring parties They have favored large gatherings, without respecting distances and with the absence of masks as the main element of protection, again associating themselves with a reactivation of COVID-OMICRON. In Spain it has increased to >700 cases per 100,000 inhabitants in 14 days, especially in people >60 years of age, with which hospitalizations have risen. in our region>300 patients are admitted to the different hospitals, with 15 in the ICU and lower mortality than previous outbreaks.
Given this, it is discussed to assess the need for a fourth dose of the vaccine, especially in immunosuppressed patients or in people over 60 years of age with chronic underlying diseases.
What does the fourth dose provide?
In a national study from Israel published in early April in the classic journal NEJM Two groups of 182,122 people who have received three or four doses of vaccine have been comparatively evaluated Pfizer. The incidence of covid in hospitalized patients was 266.7/100,000 in the three-dose group compared to 86.6/100,000 in the group that received the fourth dose. As for severe covid with four doses, it was found in 42.1 compared to 68.8 in the three-dose group. These differences were statistically significant.
On May 5, another study appeared in the same journal, assessing the protection of the fourth dose of the Pfizer vaccine against COVID-ÓMICRON in Israel. 1,252,331 people >60 years of age who had received three or four doses of the vaccine were analyzed. Covid requiring hospitalization was found in 177/100,000 among patients who had received a fourth dose, compared to 361/100,000 in the three-dose group. The severity was three times less in the group that received the fourth dose. Therefore, the efficacy of its protection in the acute phase six weeks after the administration of the supplementary or booster dose of the vaccine is demonstrated.
So what is the problem?
The problem has two parts:
1.- It has not shown protection against patients with asymptomatic or mild covid. In other words, the mild clinical cases, luckily a large part, in this current variant are going to remain the same in these people.
2.- The duration of protection is currently limited to 6-8 weeks after administration.
For this reason, American experts consider it is necessary to wait for vaccines to improve and, on the other hand, to re-establish the obligation to maintain basic protection measures (masks, hand washing, social distance, isolation).
Finally, the use of new antivirals with anti-covid efficacy is assessed in cases of high-risk patients (severely immunosuppressed and older people with advanced or severe chronic underlying diseases. These indications are outlined in the updated protocol of the Society Spanish of Infectious Diseases and Clinical Microbiology (SEIMC) However, these drugs do not exist in pharmacies, so they cannot be prescribed on an outpatient basis in selected cases and under protocol, in order to prevent hospital admissions and reduce their severity. For this, the competent authorities would have to facilitate that this possibility could be carried out, for a better support of these patients.
Joaquin To contact Gómez
Emeritus Professor of Infectious Diseases of the Department of Internal Medicine of the Faculty of Medicine of the University of Murcia
Former head of the Internal Medicine-Infectious Diseases Service of the Virgen de la Arrixaca University Clinical Hospital
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