A third dose too much for seniors who have had COVID-19

Notice to those 70 and over: If you have suffered from COVID-19, a third dose of the vaccine is no longer recommended. The Quebec Immunization Committee (CIQ) changed its mind after seniors in CHSLDs who had already contracted the disease suffered significant side effects during the booster dose.

This is the D^D Sophie Zhang, deputy co-head of accommodation at the CIUSSS du Center-Sud-de-l’Île-de-Montréal, who alerted the CIQ and the Ministry of Health and Social Services about this.

The D^D Zhang and the doctors practicing in the CHSLDs she manages observed “a lot, a lot of side effects” in the elderly who had had COVID-19 and had already received two doses, unlike those who had not contracted the sickness.

The vaccine operation began on October 18. Residents were given a third injection of Moderna vaccine. Soon after, many seniors suffered from high fever and saw their general condition deteriorate (loss of appetite, weakness, fatigue and lethargy), says Dr.^D Zhang. “In some more severe cases, the person had difficulty breathing and the oxygen level dropped,” she adds. Seniors have also found themselves in delirium, according to the doctor.

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

Have any residents died? “It’s really delicate as a question, answers the D.^D Zhang. When a senior in a CHSLD dies, 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 every week in these living environments.

The D^D Zhang specifies, however, that his team has submitted to Public Health “several reports of unusual clinical manifestations”, the procedure to be followed “when there is a serious side effect or death, if it is believed that there is a possible link. to be with the vaccine, especially because it happened soon after ”.

Change of position of the CIQ

The CIQ analyzed the preliminary data collected by the D^D Zhang and his colleagues. “We did not receive signals of the same order from other regions”, specifies D^r Gaston De Serres, physician-epidemiologist member of the CIQ.

The committee nonetheless modified its recommendations in an opinion released on November 9. Since then, the administration of a third dose of the vaccine “is no longer recommended” for seniors who have contracted COVID. This is a change of position since in a notice made public 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 based on this advice to quickly launch its vaccination campaign in CHSLDs on October 18. At the time, the booster dose of Moderna had not yet been approved by the Food and Drug Administration, the US equivalent of Health Canada. It was not until two days later that the product was approved in the United States with a half dosage, 50 micrograms rather than 100.

“We gave 100 micrograms,” says the D^D Zhang. Probably we shouldn’t have given the Moderna at that time. “

According to the D^r De Serres, “the combination of this higher dosage and the administration of the Moderna vaccine to people who had already had the infection and who had had two doses” “possibly contributed” to the side effects observed in these seniors. “But what would have happened if we had given 50 micrograms instead of 100?” It’s not clear, ”he said.

The D^D Caroline Quach-Thanh, who also sits on the CIQ, underlines that at the end of September, when the notice was published on the relevance of a third dose in seniors living in CHSLDs and in private residences, “nobody knew “that Moderna would submit a booster dose with a” different “dosage. “Pfizer had applied for approval of its third dose with the same dose, 30 micrograms [d’ARN messager] She says.

The recommendations of the CIQ 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 that immunity would drop and they would end up with outbreaks,” she says. There were starting to be infections in retirement homes. “

According to the D^D Quach-Thanh, this event is nevertheless proof that the CIQ can change its recommendations “when there is a signal on the ground, however small”.

The D^D Zhang, she wants to reassure the elders about the third dose. “If this was my mom, she hadn’t had COVID and had received two doses, I would be very comfortable having her take her third dose. I am not worried about side effects. But if her mother had had COVID, I would tell her “don’t take your 3^e dose, you are correct with two ”. “

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

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