While the regions begin to organize themselves for the administration of the so-called third dose, the circular of the Ministry of Health arrives which establishes the criteria, however inserting a distinction between the additional dose and the “booster” dose. The additional dose of Covid vaccine should be administered at least 28 days after the last. By additional dose “we mean an additional dose to complete the primary vaccination course, to achieve an adequate level of immune response”. In this case we start from the transplanted patients.
The novelty of the booster
The “booster” dose, unlike the additional one, will be administered after 6 months, defining the strategy in favor of further groups including fragile and higher risk groups due to occupational exposure. By “booster” “we mean a booster dose after the completion of the primary vaccination cycle, after a certain time interval, administered in order to maintain or restore an adequate level of immune response over time, particularly in populations characterized by a high risk, due to frail conditions associated with the development of serious or even fatal disease, or due to occupational exposure “.
M-RNA vaccine will be used
At the moment, according to the indications of the CTS, the circular specifies, “the administration of the additional dose is considered a priority in transplanted and immunocompromised subjects”. Without prejudice to the priority of achieving high vaccination coverage with the completion of currently authorized courses, “the strategy of administering a” booster “dose of m-RNA vaccine (Comirnaty by BioNTech / Pfizer and Spikevax by Moderna) will be defined. in favor of further target groups, starting with those mentioned above, taking into account the scientific evidence and the evolution of the epidemiological scenario “.
Third additional dose to 10 categories of patients
According to the circular of the Ministry of Health, 10 categories of patients will be able to receive a third additional dose: solid organ transplant recipients in immunosuppressive therapy; hematopoietic stem cell transplantation; waiting for organ transplant; T cell based therapies; oncological pathology; primary immunodeficiencies; secondary immunodeficiencies; dialysis and severe chronic renal failure; previous splenectomy; AIDS. Any of the 2 authorized mRNA vaccines can be used as an additional dose: Pfizer in subjects over 12 years of age and Moderna in over 18 years of age.
In particular, for the additional dose the following conditions are included which, the circular specifies, may be updated on the basis of available evidence: solid organ transplant in immunosuppressive therapy; haematopoietic stem cell transplantation (within 2 years of transplantation or in immunosuppressive therapy for chronic graft-versus-host disease); waiting for organ transplant; therapies based on T cells expressing an antigenic chemical receptor (CART cells); oncological or onco-haematological pathology in treatment with immunosuppressive drugs, myelosuppressive drugs or less than 6 months after the suspension of treatment; primary immunodeficiencies (eg DiGeorge syndrome, Wiskott-Aldrich syndrome, common variable immunodeficiency etc.); immunodeficiencies secondary to pharmacological treatment (eg: high-dose corticosteroid therapy over time, immunosuppressive drugs, biological drugs with significant impact on the functionality of the immune system, etc.); dialysis and severe chronic renal failure; previous splenectomy; acquired immunodeficiency syndrome (AIDS) with CD4 + T cell counts 200 cells / μl or based on clinical judgment. Based on the information provided above, such individuals should have already received two doses of the mRNA vaccine; however, regardless of the vaccine used for the primary cycle (Comirnaty, Spikevax, Vaxzevria, Janssen), considering the indications provided by the technical-scientific commission of AIFA, it is emphasized in the circular, “it will be possible to use any of the two vaccines as an additional dose. -RNA authorized in Italy: Comirnaty by BioNTech / Pfizer in subjects over 12 years of age and Spikevax by Moderna in subjects over 18 years of age. The additional dose should be administered at least 28 days after the last dose “.