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Should Quebecers get a fourth dose of the COVID-19 vaccine?

Quebec residents 18 or older are now eligible for a fourth dose, but officials have given few guidelines about who should consider getting the extra shot.

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Quebec’s Department of Health announced Wednesday that all adults 18 and older are now eligible to receive a fourth dose of the vaccine to protect against COVID-19.

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However, he did provide a few guidelines on who should consider getting the extra shot, also known as the second boost. The shots were already available to Quebec patients 60 or older, as well as immunocompromised people.

Healthy adults may wonder if they should bother getting a fourth dose now, because it is widely expected that another dose will be necessary in the fall. At the same time, infection and hospitalization rates are declining in the county.

In the opinion of Dr. Donald Finh, an infectious disease specialist and medical microbiologist at McGill University Health Center, having a fourth dose makes sense.

“If you want to avoid the risk of developing moderate disease, this dose is for you,” he said. In general, there is no harm or safety issue with having the fourth dose.

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“Second, if you were to take a fourth dose, it would be a transient response to (the Omicron BA.2 subvariable) and what appears to be the BA.2 subtypes that appear.”

Vinh said doctors are still seeing patients who, despite being vaccinated, are so sick that they have had to miss work, school or hospitalization, even if they don’t fall into a high-risk category.

“To avoid this problem, I will have the fourth dose.”

Those who have exceeded their last dose by three to four months are at risk because their immunity has diminished. While earlier doses protect against severe illness, mild to moderate illness is still possible, which can result in up to a week’s missed work or school with fever and other symptoms.

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Vinh said getting a fourth dose would also prevent transmission of the virus to people at risk, their colleagues or peers.

Vinh’s recommendations come amid a number of vague or conflicting messages about the necessity of a fourth dose.

An Israeli study published Thursday in the New England Journal of Medicine found that rates of infection and severe COVID-19 were significantly lower after a fourth dose of the Pfizer-BioNTech vaccine than after a third dose. Protection from infection seemed short-lived, and diminished after four weeks, but remained strong against severe disease at least six weeks after the injection.

The World Health Organization has not made an official recommendation for a fourth dose yet. WHO chief Somya Swaminathan said there was not enough research yet on how much protection a fourth dose could provide.

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“What we know from immunology is that if you give another booster, you will see a temporary increase in neutralizing antibodies,” Swaminathan told CNBC this week. “But what we also saw is that these neutralizing antibodies would disappear very quickly.”

Howard Ngo, deputy head of Public Health Canada, said asking whether healthy adults should take a fourth dose now or wait until fall is a “personal decision, and everyone should have a good discussion with a health professional.”

But he added, “For sure, with a fourth dose you’ll get an increase in antibodies for a period of time to better protect against infection.”

Although the numbers are low here, Vinh said data from other countries show BA.2 and its subtypes are still in circulation and represent a continuation or even an increase in infections in many communities.

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Scientists anticipate that there will be a new generation of vaccine rolled out in the fall, while the current booster dose is working with the first generation of vaccines developed to combat the original strains of COVID-19.

Vinh said the next generation will be effective against a different set of disease variants, and hopefully protect against whatever spreads into the fall-winter period.

He noted that it is critical that people in high-risk groups get a fourth or even a fifth dose, adding that it is not always clear who is in those categories until they get sick.

Vinh said other factors favoring second boosters include the rapid rise in flu cases in Quebec and new studies showing that people who contract a combination of flu and COVID-19 are at greater risk of severe symptoms.

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Confused Quebecers can turn to the US Centers for Disease Control and Prevention, which provides clearer guidelines for Americans who qualify for fourth doses. The agency helpfully identifies “factors to consider while considering a second supporter.” Among other things, he suggests considering whether you or someone you live with is more likely to get severely ill, whether you’re more likely to be exposed to COVID-19 because of where you work or live, or if you travel a lot or attend gatherings a lot.

Prospective recipients may want to wait before getting their fourth shot if they’ve had COVID-19 in the past 3 months or “feel that getting a second booster now will make you not want to get another booster in the future.”

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A second boost may be more important in the fall, or if a vaccine for a variant of COVID-19 is available in the future, the CDC explains.

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2022-05-06 23:05:37

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