Booster vaccinations for COVID-19

One of the tools we have in the fight against COVID-19 is vaccination. We have achieved very good results in vaccination, but the vaccines we have now are not specially designed against the delta variant that is now prevalent, and they are therefore not as strong a protection against that variant as they were against the original pandemic virus. Vaccines are a preventative measure, not a treatment when things are in dire straits. It takes about 2 weeks before the vaccination takes full effect, and it is uncertain what the real gains in reducing the spread will be. We will not achieve herd resistance with the vaccines we currently have, but they may be useful in addition to other measures to stop the spread and boost the protection of those most at risk of developing a serious COVID-19 infection as much as possible. Due to the length of time it takes to reap the benefits we hope the following booster vaccinations will achieve, they should not be considered as a substitute for other measures to curb spreading.

Please note that the term booster vaccination is used here for simplification, though the vaccinations are performed in different contexts:

  • Primary vaccination following COVID-19 disease (stimulation of the immune response to the virus itself)
  • An additional dose if there is a risk that primary vaccination will not elicit a satisfactory response
  • Booster when vaccination of a healthy individual is completed, but the risk of protection is considered to decrease if no extra dose is given (actual booster vaccination)

The aim in all cases is to strengthen the protection of individuals against COVID-19 infection and serious illness as much as possible. In some cases, it is difficult to define which of the above categories the booster vaccination falls under according to the following. Therefore, it is simplest to use one term for these vaccinations and publish a plan of action in one place.

The groups most in need of a booster vaccination are:

1. Individuals 12 years and older with a history of COVID-19. Vaccinations of this group (16 years and older) began in June and are continuing (12 years and older).

    • 1 dose of Janssen vaccine (18 years and older) or 2 doses of Pfizer/BioNTech vaccine (12–17 years old, pregnant women, immunocompromised individuals, etc.) after at least 3 months from infection.

Argument:

    • The risk of re-infection is much smaller for those vaccinated than those unvaccinated with a history of COVID-19.
    • One dose of COVID-19 vaccine provides good stimulation of antibodies after COVID-19 infection (review here), but for simplification and consistency, including the electronic issuance of vaccination certificates, the same scheme is used here for those with a history of COVID-19 and all others. Therefore, Janssen is recommended except for those who are not recommended to receive that vaccine in Iceland or according to the patient information leaflet.

Arrangement: According to announcement from the healthcare centre.

Timing: Already started, will continue while needed.

Numbers: Around 6,000 people nationwide at the start of the current wave.

 

2. Individuals without history of COVID-19 antibodies who were vaccinated with the Janssen vaccine.

    • 1 dose of Pfizer/BioNTech or Moderna vaccine at least 4 weeks after Janssen vaccination.

Argument:

    • One dose of Janssen vaccine provides comparable protection to one dose of other vaccines commonly given as a two-dose vaccine. See also here.
    • One dose of COVID-19 vaccine developed against the original SARS-CoV-2 virus is an inferior protection against the delta variant compared to the alpha variant. If two doses are given, the protection against delta and alpha is comparable.

Arrangement: According to announcement from the healthcare centre.

Timing: Already started, will continue while needed.

Numbers: Around 53,000 people nationwide.

 

3. Nursing home residents and other very vulnerable welfare service recipients (formerly Group 3) – 60 years and older only

    • 1 dose of Pfizer/BioNTech or Moderna vaccine at least 13 weeks after the last dose of primary vaccination with COVID-19 vaccine.
      • A 26-week interval is recommended if the individual experienced significant side effects after the last dose.
    • Further information on booster vaccinations for this group can be expected from abroad, which will affect guidelines in Iceland.

Argument:

    • The risk of serious COVID-19 infection and death due to COVID-19 increases with increased age and is highest in the frail elderly, i.e. those living in nursing homes.
    • The immune response is more uncertain with increasing age after the age of 60. Examples include an increased risk of pneumonia, severe influenza and an increased incidence of shingles in this age group.
    • Two doses of mRNA vaccine protect the elderly in nursing homes less than healthy healthcare professionals in middle age and younger according to a Danish study.
    • COVID-19 infections have already occurred in nursing homes during this wave and disrupted their operations.

Arrangement: Going to the nursing homes and offering a booster vaccination to those who want it. Relatives should be consulted, and consideration should be given to infirmity, since side effects such as fever and flu-like symptoms can be very difficult for those who are the most frail. Outside nursing homes, arrangements will essentially be the same as for primary vaccinations, based on lists and dates of primary vaccinations.

Timing: Started and will continue in September.

Numbers: Around 14,000 people nationwide.

 

4. Highly immunosuppressed individuals with continuing immunosuppression

  • Organ recipients on immunosuppressive drugs
  • Patients with bone marrow failure due to disease or chemotherapy
  • As more groups are added, this text will be updated
    • 1 dose of Pfizer/BioNTech or Moderna vaccine at least 12 weeks after the last dose of primary vaccination with COVID-19 vaccine.
    • Further information on booster vaccinations for this group can be expected from abroad, which will affect guidelines in Iceland.

Argument:

    • Antibody formation in e.g organ recipients after 3 doses of mRNA vaccine is comparable to 1 dose of vaccine in healthy subjects according to repeated very small studies.
    • These groups require extensive services from the healthcare system and are at risk of serious illness if infected.
    • See:

Arrangement: Announced centrally based on the timing of the primary vaccination and the diagnostic registration in the Directorate of Health’s data which formed the basis for the definition of at-risk groups in the primary vaccination. Specialists can request that a patient group/diagnoses is added through communication with the Chief Epidemiologist or that individuals are added by a doctor’s letter to the individual’s healthcare centre.

Timing: Systematic as soon as possible.

Numbers: Around 2,000 people nationwide.

 

 

5. Age 70 and older outside nursing homes

    • 1 dose of Pfizer/BioNTech or Moderna vaccine at least 13 weeks after the last dose of primary vaccination with COVID-19 vaccine.
      • A 26-week interval is recommended if the individual experienced significant side effects after the last dose.
    • Further information on booster vaccinations for this group can be expected from abroad, which will affect guidelines in Iceland.

Argument:

    • The risk of serious COVID-19 infection and death increases with increasing age.
    • The immune response is more uncertain with increasing age after the age of 60. Examples include an increased risk of pneumonia, severe influenza and an increased incidence of shingles in this age group.

Arrangement: Announced centrally based on the timing of the primary vaccination.

Timing: As soon as possible.

Numbers: Around 35,000 people nationwide.

 

6. Age 60 and older outside nursing homes

    • 1 dose of Pfizer/BioNTech or Moderna vaccine at least 26 weeks after the last dose of primary vaccination with COVID-19 vaccine.
    • Further information on booster vaccinations for this group can be expected from abroad, which will affect guidelines in Iceland.

Argument:

    • The risk of serious COVID-19 infection and death increases with increasing age, despite vaccination. This age group has a higher incidence rate of underlying risk factors than those who are younger, although health conditions vary widely in these age groups.
    • The immune response is more uncertain with increasing age after the age of 60. Examples include an increased risk of pneumonia, severe influenza and an increased incidence of shingles in this age group.

Arrangement: Announced centrally based on the timing of the primary vaccination.

Timing: September–October 2021.

Numbers: Around 40,000 people nationwide.

 

7. Frontline healthcare workers (formerly groups 1 and 2 according to Regulation 1198/2021)

    • 1 dose of Pfizer/BioNTech or Moderna vaccine at least 26 weeks after the last dose of primary vaccination with COVID-19 vaccine.
    • Further information on booster vaccinations for this group can be expected from abroad, which will affect guidelines in Iceland.

Argument:

    • There is the greatest risk of exposure for this group.
    • There is a risk of transmission to vulnerable individuals if members of this group are infected with COVID-19.
    • Sensitive operations are significantly disrupted by any infection that occurs within the institutions where these employees work.
    • The incidence rate of infection in those fully vaccinated has increased in recent months; it is still not known for sure how large a factor thedegradation of the immune response the more time passes from the vaccination is in that increase, but the spread of the delta variant and the decline in the immune response are both thought to be factors in this development.

Arrangement: Announced centrally based on the timing of the primary vaccination.

Timing: September–October 2021.

Numbers: Around 11,000 people nationwide.

 

Other groups, such as younger individuals with risk factors for severe COVID-19 infection other than severe immunosuppression, need to be addressed with the involvement of specialists, which is in preparation.


Fyrst birt 13.09.2021

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