Booster dose for the elderly and nursing home residents
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The Government has, in accordance with the advice of the National Institute of Public Health (NIPH), decided to offer an additional dose (booster dose) to the older age groups. It is recommended to start with vaccination for the age group 85 years and older as well as nursing home residents. The additional dose can be given no earlier than 6 months after receiving their second vaccine dose. The offer to the age group 85 years and above will be followed by booster vaccination in stages of the age group 75-84 and then the age group 65-74.
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A booster dose is a vaccine for people who have had a good effect from the first two vaccine doses, but who over time have less protection against becoming seriously ill or dying if they become infected with the coronavirus. The aim of such a booster dose is to increase the protection against becoming seriously ill in the event of infection, to improve the conditions for a high degree of protection also against new virus variants, and to extend the duration of protection.
- In the assessment of the need for booster doses, several things will come into play. Knowledge about the protective effect, the epidemiological situation, the vaccination strategy and available vaccines and public support for vaccination are considered. We see that different countries therefore make different assessments. We have a good situation in Norway with control of the pandemic, very high vaccination coverage in large parts of the population, and we have time to make thorough assessments, says Deputy Director General and head of the coronavirus vaccination program at the NIPH, Geir Bukholm.
There is currently no basis for a recommendation for a vaccine booster for the rest of the population.
The NIPH will also consider offering a booster dose to health personnel in order to reduce the risk of further transmission to particularly vulnerable persons (indirect protection).
Not sure how much better the protection will be with a booster dose
Several countries in Europe have recently recommended booster vaccination for selected sections of the population.
- We have seen that there have been discussions for and against booster vaccination in international forums. There is currently limited knowledge about how much a booster dose will improve protection against infection and serious course of illness in different age groups, says Bukholm. - But it is likely that a booster dose will improve protection, he says.
The manufacturers' clinical studies, which form the basis for the application for extended approval, are small and smaller than what is usual for similar applications. The evaluation of effectiveness is based on antibody levels alone, and it is not known what level of antibodies are required to provide protection, and to what extent other parts of the immune response contribute to protection.
The European Medicines Agency has approved the Pfizer / BioNTech vaccine for a booster dose
A regulatory approval is a seal of quality, where assessments have been made based on a larger data set than what is publicly available. The European Medicines Agency (EMA) has pointed out that an assessment of the benefit - risk balance should be made in each country, based on the infection situation in the country. EMA also pointed out that knowledge of any side effects after a booster dose is currently limited.
- An assessment and approval from the EMA and national drug authorities is important when the knowledge basis is limited, says Bukholm.
Booster dose currently not recommended for the rest of the population
The National Institute of Public Health continuously assesses the need for booster vaccines. - We will emphasize the disease burden and the potential for preventing serious COVID-19 disease, the balance between effectiveness and safety, and feasibility, says Bukholm.
There is currently no basis for recommending a booster dose to the general population. An assessment of the group of 18 to 65 years with an underlying disease that may increase the risk of a serious course of coronavirus infection is relevant in the long term. In this group, a recommendation is given for a third dose in the basic vaccination for those with a significantly weakened immune system as a result of illness or medical treatment. For the rest of this group, there are no clear signs that there is a need for a booster dose now.
Booster vaccination against COVID-19 must not be administered at the expense of influenza vaccination
If the municipalities have capacity challenges in the coming weeks, when they also have to vaccinate against seasonal influenza (flu), they must prioritize in this order:
- First dose of coronavirus vaccine for the unvaccinated
- Second dose of coronavirus vaccine for those vaccinated with only one dose
- Third dose of coronavirus vaccine for immunosuppressed patients
- Seasonal influenza vaccine
- Booster dose of coronavirus vaccine for nursing home residents and anyone over 65 years of age
The elderly have an increased risk of a serious course of influenza. Booster vaccination against COVID-19 must not be administered at the expense of influenza vaccination. It is important that the elderly accept the offer of the influenza vaccine because we expect a stronger outbreak of influenza this season.
NIPH does not recommend that the influenza vaccine and coronavirus vaccine be administered at the same time. They should be administered one week apart.