2nd COVID Booster Advised For Highest Risk
The SAGE group has recommended a second COVID-19 booster for those most at risk.

An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier.

WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization.

To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country.

It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers.

“There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses.

“Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.”

Targeted Guidance for ‘Certain Populations’

SAGE chairperson Dr Alex Cravioto

The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions.

“We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing.

“The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.”

On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors.

Selective Approach with Children Fits Panel’s ‘Roadmap’

In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses.

Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used.

Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said.

The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants.

“In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.”

SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022.

Image Credits: Marco Verch/Flickr.

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