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WHO changes guidelines on vaccines against Covid-19; check the scheme

The World Health Organization (WHO) announced, on Tuesday (28), new recommendations on vaccination against Covid-19. A simplified risk classification now includes three risk groups (high, medium, and low) and proposes a differentiated approach to delivering the primary series and additional booster doses for each risk group.

According to the WHO, healthy adults can be immunized with a two-dose primary schedule and a first booster. The elderly population, people with comorbidities and immunocompromised people, pregnant women and health professionals should receive additional boosters (in addition to the 1st) 6 or 12 months after the last dose (see the scheme below )

The guidelines are the result of a meeting held by the WHO Strategic Advisory Group of Experts on Immunization (Sage). At the meeting, which took place between March 20 and 23, experts discussed guidelines to prioritize the use of vaccines according to the impact of the Omicron variant and the high immunity of the population as a result of vaccination and natural infection.

priority groups

According to the WHO, all recommendations for vaccines against the coronavirus are limited in time and apply only to the current epidemiological scenario. In this context, the additional booster guidance should not be seen as ongoing annual boosters of Covid-19 vaccines. The objective is to guide countries in short and medium term planning.

The WHO advisory group describes three priority groups for vaccination against Covid-19: high, medium and low. The definition is based primarily on the risk of serious illness and death and considers factors such as vaccine performance, cost-effectiveness and community acceptance.

the group of high risk includes elderly; younger adults with significant comorbidities (eg, diabetes and heart disease); people with immunocompromised conditions (eg, people living with HIV and transplant patients), including children aged 6 months and older; pregnant people, and frontline health workers .

For the high-risk group, WHO recommends a additional booster 6 or 12 months after the last dose with the term depending on factors such as age and immunocompromised conditions .

the group of medium risk includes healthy adults under age 60 without comorbidities and children and adolescents with comorbidities . For this population, it is recommended to primary series and the first booster doses . For this group, there are no risks to receiving additional doses, but the strategy is not routinely recommended because of the comparatively low public health returns.

the group of low risk includes healthy children and adolescents aged 6 months to 17 years for which Primer and booster doses are safe and effective . However, given the low burden of disease, Sage indicates that countries considering vaccinating this age group should base their decisions on factors such as burden of disease, cost-effectiveness, and other programmatic or health priorities.

However, children who are immunocompromised and with comorbidities face a higher risk of severe Covid-19 and were included in the high and medium priority groups, respectively.

Although low overall, the burden of severe Covid-19 in infants younger than 6 months is still higher than in children aged 6 months to 5 years. According to the WHO, vaccinating pregnant women – even with an additional dose if more than 6 months have passed since the last dose – protects both them and the fetus, while helping to reduce the likelihood of hospitalization of babies for Covid -19.

WHO recommends that countries that already have a policy for additional boosters should assess the evolving need based on the national burden of disease, cost-effectiveness and opportunity costs.

In addition to the vaccination schedule guidelines, Sage has also updated its recommendations on bivalent COVID-19 vaccines, now recommending that countries consider using Pfizer’s bivalent vaccine (BA.5) for the primary series.

Changes

The guidelines also prioritize the protection of populations at greater risk of death and serious illness from SARS-CoV-2 infection, in addition to focusing on maintaining the functioning of health systems.

The new guidance considers recent data on the cost-effectiveness of vaccinating against the disease for those at lower risk – that is, healthy children and adolescents – compared to other health interventions.

The document also includes revised recommendations on additional booster doses and the spacing of boosters. Reducing post-Covid conditions from current vaccines has also been considered, but evidence on the extent of their impact is inconsistent, according to the WHO.

“Updated to reflect that much of the population is vaccinated or previously infected with Covid-19, or both, the revised roadmap re-emphasizes the importance of vaccinating those who are still at risk of serious illness, particularly older adults and those with underlying conditions, including with additional reinforcements,” said Sage President Hanna Nohynek.

“Countries must consider their specific context when deciding whether to continue vaccinating low-risk groups, such as healthy children and adolescents, without compromising routine vaccinations that are so crucial to the health and well-being of this age group.”

Source: CNN Brasil

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