With octogenarians it hasn't had much success, but sixty-year-olds are responding with greater conviction to the appeal issued in recent days for the fourth dose of anti-Covid 19 vaccine. This age group, young and dynamic, apparently does not want to be knocked down by the virus during the holidays, yet there are many doubts circulating about the advisability of administering it, even among experts. To better understand the risks and opportunities of the new recall, FIRSTonline interviewed Paolo Pandolfi, director of public health of the Bologna Local Health Authority, a reality made up of 45 Municipalities and approximately 900 thousand people.
The fourth dose of the vaccine according to Pandolfi: the interview
Professor Pandolfi, let's start from here: why should a XNUMX-year-old in good health be immunized with an "old" vaccine, designed for the Wuhan virus, instead of waiting for the new one scheduled for October-November?
«Unfortunately, doctors are also divided and sometimes create confusion, so I'll try to clarify things. Vaccination is strongly recommended for a sixty-year-old, because the third dose has now largely exhausted its effects and infections are increasing daily. The argument that the vaccine is old does not hold water, because even the Omicron variant that is circulating is not that of the expected new vaccine. We call it Omicron, but we should rename it differently, because we put different viruses under the same banner.
The reality is that we will never be able to keep up with this ever-changing virus. For example it is also tracking Centaurus, a variant that comes from India. In any case, we know that the vaccine we have available, the one against the Wuhan coronavirus to understand each other, does not protect much from the infection, but offers excellent coverage from the serious consequences of the disease. It is true that the prevalent infection at the moment mainly affects the upper airways and causes fewer hospitalizations, however it is not a light disease. In our area there were 300 hospitalized a few days ago and now there are already 400, this is an important progression ».
Why was it decided to immediately extend the fourth dose to sixty-year-olds, even if they are in good health?
«Why theage is a risk factor and it adds up to the other pathologies that a sixty-year-old, even in good physical shape, almost always has. Aging problems generally begin after the age of 40, when the body's ability to react is reduced. The person may appear young, the sixty-year-olds of 2022 are not those of 30 years ago, but their body already has elements within it that make it older. We, in Bologna, carry out studies on frailty and are able to predict precisely, during the year, how the risk of death increases in relation to age. The situation progresses to 75 years of age, when the person becomes really old and at that point the adverse events are more difficult to reverse, since the organism is less efficient.
It is no coincidence that before EMA and then AIFA gave the indication to vaccinate the over sixties. A person who wishes to go on vacation and lead a somewhat freer life must protect himself. I believe it should also vaccinate health workers, among which the share of infected subjects has increased. In our company, these days, we have about 200 sick people, many doctors and nurses, but also vaccination workers. It's an important number. On the other hand, the daily infections show us how much the infection is running ».
Is it true that those who get the vaccine in this period will not be able to repeat the vaccination in October, in order not to send the immune system into a tailspin? Is it worth queuing?
«The times between one vaccination and another must generally be four months, so whoever gets vaccinated can get another dose at the end of November or in December. It's a perfect time to do the too flu vaccine and the two protections could be combined».
What greater protection does the fourth dose offer than the third dose?
“An important protection. In general, the antibodies drop considerably after six months from the third administration. At that point a protection from adverse events remains around 30-40%. With the new booster, protection from serious disease can be brought back to 70-80%, the fourth dose therefore offers this 40% more protection, since it restarts the antibody response. The action of the immune system set in motion in this way prevents the spread of the virus to the body. On the other hand, protection from contagion is much lower, around 50%.
How much does the fact that many doses of vaccines expire weigh on this invitation to sixty-year-olds?
«There may also be an aspect of this kind, but it is not decisive. We, for example, have purchased 2,5 million doses of vaccines, even if 10 or XNUMX expire, the unused portion is minimal. We always try to stay wide to best respond to possible requests and unfortunately some waste is inevitable. This is certainly not the real reason for the invitation to protect oneself».
In recent months we have heard a bit of everything, those who say that we need to let the virus go, those who want to avoid restrictions on asymptomatics: do these statements make sense?
«Running the virus is a huge mistake, because there is always someone who gets really hurt in this roulette game. Surely the attention must remain high on the symptoms, for which isolation is needed. The asymptomatic, on the other hand, are the weak point of any prevention, because those who do not know they are positive cause viruses or bacteria to circulate. If, on the other hand, a person is aware of being positive for the coronavirus and leads a life without restrictions, it is irresponsible and it also violates the law. We have a moral and legal duty to those close to us, children, spouses, parents, grandparents and colleagues.
In light of the spread of infections, in your opinion, did it make sense to remove the obligation to wear masks?
«Absolutely not, in my opinion it was a big mistake. There are basic precautions to mitigate the spread of contagious diseases such as masks, distancing and the hand washing. Recently, however, we have let our guard down on all fronts and the results can be seen. Do you know how many infections there are from a coffee break? Because it's true that if we eat the virus we don't get sick, but it's also true that with our hands we may touch the conjunctiva (an important gateway for the virus) or we pick our nose and even then the trouble is over. So let's sanitize our hands as often as possible. The mask in closed places should always be used and also protects us from other diseases such as measles, meningitis, asthma. It's not a 100% covering barrier, but it's very useful. Unfortunately there are many doctors who underestimate it, probably because they do not take into account the teaching of the history of medicine, which has known the usefulness of masks and hygiene for centuries".
From your observatory you can also assess the spread of other infectious diseases such as monkeypox or dengue and Nile fever. Is the world becoming an increasingly dangerous place for humans?
“Infectious diseases have always been there. For what concern monkeypoxis not currently a major public health problem. For now we are in a surveillance phase. Unfortunately this virus has come out of its natural basin which is Africa and has also landed here, but for now it remains limited to small numbers of people. It's less of a concern though than measles, diphtheria, whooping cough or hepatitis. In Bologna we have many cases, well beyond the fingers of two hands, but these are not real outbreaks because the infections do not have a common origin.
The vaccine that was used many years ago for smallpox seems effective, but those born in the 90s never did it; in fact, the disease is prevalent above all among young men. The situation is monitored at European level and in case of growth it will be possible to exhume the smallpox vaccine to protect the unimmunized population. Other diseases on which we operate surveillance are also widespread in our area, such as leishmaniasis, which is spread by pappataci, the West Nile, carried by common mosquitoes, the Chikungunya , Dengue due to the tiger mosquito. There prevention consists in the defense against insect bites and the treatment of mosquito larvae. In the case of outbreaks, an important treatment is also carried out on live insects in the affected area, trying to keep people away. However, these insecticides cannot be abused because they are often carcinogenic and harmful to humans.
