/cloudfront-eu-central-1.images.arcpublishing.com/madsack/EIZT3Y56V5BS7EGLXUDUPBM2LQ.jpeg?fit=%2C&ssl=1 "When should you refresh with the second booster?")
In Germany, the corona infections are increasing again. Incidences are increasing in all age groups, most notably among 50 to 59 year olds and 15 to 35 year olds. Only among the five to nine-year-olds did they fall compared to the previous week – but only “slightly”, as the Robert Koch Institute noted in its weekly report. The risk of becoming infected with Corona in everyday life is therefore increasing again. At the same time, there are hardly any protective measures left.
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The timing is bad. It has been months since the last booster dose for many people. Numerous studies show that the antibodies in the blood that are relevant for protection against infection decrease again after three months. Then there is the new variant BA.5, which is spreading throughout Germany and bypasses the immune system even more than previous Omikron lines. Should we perhaps try to get a second corona booster vaccination now as a precaution? Instead of waiting until a vaccine that is better adapted to Omicron will probably be approved in the fall?
Avoid all corona infections? The vaccination target is crucial
If the Standing Vaccination Commission (Stiko) has its way, the individual decision for or against a second booster with the conventional vaccines depends primarily on one factor: age. Since February, the expert committee has been explicitly recommending a second booster dose for people over 70: with one of the already approved mRNA vaccines, i.e. Biontech or Moderna – and at the earliest three months after the last administered dose. People in nursing homes, medical staff and people with an immune deficiency should also be vaccinated a fourth time.
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Studies have shown that another booster can significantly increase the level of protection against infection, illness and death. Why isn’t this recommended to the whole population? This has to do with the vaccination goal. According to the scientific recommendation of the Stiko, this is the following: “to reduce as much as possible severe courses, hospitalizations and death as well as long-term consequences of Covid-19 in the population of Germany”.
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The vaccinations should therefore first and foremost help to avoid the worst, but not necessarily all infections. After three corona vaccinations, people over 70 and people with immunodeficiency have a lower risk of becoming seriously ill than without a vaccination. In many cases, however, it is still relatively high, especially if it has been months since the last vaccination.
The situation is usually different in immunologically healthy younger people. Your risk of infection also increases the longer it has been since the last vaccination, because relevant antibodies dwindle. But their risk of a severe course remains low in the long term if they are triple vaccinated because other areas of the immune system also protect against Covid-19. This is the knowledge of immunologists so far.
Will new omicron lines change the situation?
I currently see no reason for a fourth vaccination in immunocompetent people under the age of 60.
Carsten Watzl,
Immunologe
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Anyone who has been vaccinated three times and is not particularly old or suffers from an immune deficiency is usually very well protected against Covid-19. Fortunately, this also remains the case with the new Omikron lines BA.5 and BA.4. According to the weekly report of the Robert Koch Institute (RKI), the triple vaccination has not lost its importance due to its “high protective effect against a severe course” even in diseases caused by the omicron variant.
“In immunologically healthy people under 60, I currently see no reason for a fourth vaccination,” says immunologist Carsten Watzl, Secretary General of the German Society for Immunology. “These people still have very good protection against the serious illness, but sooner or later they will have a breakthrough infection.” This then leads to so-called hybrid immunity, which again protects very well against infection and disease. “In this way, most people will refresh their immunity every few years,” suspects the Corona expert.
Booster campaign in autumn: is it necessary for everyone?
Now mRNA vaccines that are better adapted to new omicron variants are to be approved in autumn. The Stiko will therefore adjust its recommendation again in the future. The federal and state governments are already planning a booster offensive for the general public. The hope: In the short term, as has already happened in other vaccination campaigns, infections in the population could be reduced and thus a wave of infections in the general population flattened out.
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However, as with previous vaccinations, the effect of vaccinations in stopping infections would probably decrease again within a few weeks to months. So far, vaccination has only been able to prevent the virus from entering the mucous membranes of the respiratory tract for a short time. However, it is not yet finally clear whether this will remain the case with the new vaccines. The data from the manufacturers Biontech and Moderna are still missing. A decision on approval from the European Medicines Agency (EMA) is expected in September.
In view of the lack of data, experts are still hesitant as to whether further vaccinations should be recommended for everyone in autumn – or only for people at particularly high risk of a severe course, i.e. those over 70 and those with an immune deficiency. It is “too early” to consider using a fourth dose of mRNA vaccines in the general population, it said in an EMA release from early April. The Stiko, which has announced that it will check its vaccination recommendations for corona vaccinations in the fall, sees it similarly.
It is also still unclear which variants with which properties will then circulate and how good the immune protection will then be. In the worst case, a new virus variant could circulate that is even more contagious, bypasses immune protection even more than before and is more deadly than previous Omicron lines. Then vaccinations could possibly be necessary for everyone again. But that is the worst-case scenario, as the Corona Expert Council stated last week.
In the best case, i.e. if omicron variants continue to circulate that are comparatively less pathogenic, older people and people with immunodeficiency could still have a relatively high risk of serious illness. “Therefore, they should improve their immunity in autumn with an adapted vaccine so that they can get through the winter without infection or at least without serious illness,” says immunologist Watzl.
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Corona vaccination: where can I get it?
So far, however, the offer of the fourth dose among older people has been accepted very hesitantly: only around 19 percent of people over 60 in Germany had decided on the second booster dose by mid-June. Your family doctor can be the point of contact for first, second, third and fourth vaccinations. Mobile vaccination teams, company doctors, public health service facilities, hospitals, vaccination centers and pharmacies can also vaccinate against Covid-19.
You can also get advice from the free hotline 116 117 of the National Association of Statutory Health Insurance Physicians. The Internet portals of the municipalities, districts and federal states also offer information. Another contact point is the portal operated by the Federal Ministry of Health zusammengegencorona.de. There is an interactive one there, for example germany map, where you can find links, telephone numbers and concrete vaccination offers.
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