A third more dose for older people who have had COVID-19

Warning for those over 70: If you have had COVID-19, a third dose of the vaccine is no longer recommended. The Quebec Committee on Immunization (CIQ) changed its mind after older people in CHSLD who had already contracted the disease suffered significant side effects during the booster dose.

It was Dr. Sophie Zhang, deputy deputy director of accommodation at CIUSSS du Center-Sud-de-l’Île-de-Montréal, who alerted CIQ and the Ministry of Health and Social Services to this issue.

Dr. Zhang and the doctors who practice in the CHSLDs she administers have seen “many, many, many side effects” in older people who have had COVID-19 and have already received two doses, as opposed to those who have not contracted COVID-19. disease.

The vaccine operation began on October 18. Residents received a third injection of the Moderna vaccine. Soon after, many older people developed a high fever and saw their general condition deteriorate (loss of appetite, weakness, fatigue and lethargy), says Dr. Zhang. “In some more severe cases, the person had difficulty breathing and the oxygen level dropped,” he adds. Older people have also found themselves delirious, according to the doctor.

Shocked by the situation, the CIUSSS du Center-Sud-de-l’Île-de-Montréal team stopped the third dose 48 hours later in older people who had already had COVID.

Have any residents died? “It’s a really tough question,” says Dr. Zhang. When an elderly person dies in a CHSLD, how to say that it is the vaccine or not the vaccine [qui a entraîné la mort] ? She recalls that the life expectancy of residents is “very short” and that deaths are recorded in these living environments every week.

Dr. Zhang specifies, however, that her team has submitted to Public Health “several reports of unusual clinical manifestations”, the procedure to follow “when there is a serious side effect or death, if it is believed that there is a link perhaps with the vaccine, especially because it happened shortly after ”.

CIQ position change

The CIQ analyzed the preliminary data collected by Dr. Zhang and her colleagues. “We have not had similar signals from other regions,” specifies Dr. Gaston De Serres, a physician epidemiologist member of the CIQ.

However, the committee modified its recommendations in an opinion published on November 9. Since then, giving a third dose of the vaccine is “no longer recommended” for older people who have contracted COVID. This is a change of position since in a statement released on September 28, the CIQ indicated that “people who had an infection and subsequently received two doses of vaccine could also receive a booster dose six months or more after the last dose received “.

The CIUSSS du Center-Sud-de-l’Île-de-Montréal relied on this advice to quickly launch its vaccination campaign in the CHSLDs on October 18. At that time, Moderna’s booster dose had not yet been approved by the Food and Drug Administration, the American equivalent of Health Canada. It was not until two days after that the product was approved in the United States with a half dose, 50 micrograms instead of 100.

“We gave 100 micrograms,” says Dr. Zhang. We probably shouldn’t have given him the Moderna at the time. “

According to Dr. De Serres, “the combination of this higher dose and the administration of the Moderna vaccine to people who had already had the infection and who had received two doses” “possibly contributed” to the side effects seen in these older people. . “But what if we had given 50 micrograms instead of 100?” It’s not clear, ”he said.

Dr. Caroline Quach-Thanh, who is also a member of CIQ, notes that in late September, when the opinion on the relevance of a third dose in older people living in CHSLD and in private residences was published, “no one knew.” that Moderna would present a booster dose with a “different” dose. “Pfizer had requested approval of his third dose with the same dose, 30 micrograms [d’ARN messager] She says.

The CIQ’s recommendations were made in the “urgency of the moment,” argues the microbiologist-infectious disease specialist. “There was still pressure from the ground because they were afraid the immunity would drop and they would end up with flare-ups,” she says. Infections were beginning to occur in nursing homes. “

According to Dr. Quach-Thanh, this event is, however, proof that the CIQ can change its recommendations “when there is a signal on the ground, no matter how small.”

Dr. Zhang, you want to reassure the elderly about the third dose. “If this were my mom, she would not have had COVID and had received two doses, I would feel very comfortable with her taking her third dose. I am not worried about side effects. But if your mother had COVID, she would tell you “don’t take your third dose, it’s okay with two.” “

An infection counts as one dose. And maybe even a little more.

Third Recommended Dose for People 50 Years of Age and Older in Canada

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