Mantovani: British estimates speak of a 10 percent of people presenting symptoms more than a year later of the disease with fatigue, neurocognitive and cardiorespiratory problems
Who should do the fourth dose of Covid-19 vaccine? “I think it is appropriate, as well as for frail and vulnerable individuals of any age, for anyone over 80 years old. And it would be desirable for Europe to make a single and shared choice in this regard, avoiding that each country establishes different ages “replies Professor Alberto Mantovani, scientific director of the Humanitas Institute of Milan and president of the Humanitas Foundation for research. “The fourth dose for other vaccines is nothing new: for example, that against hepatitis B is routinely given to immunocompromised subjects, such as those with severe renal insufficiency”.
But what are the data available for the fourth dose of the Covid vaccine?
«The studies on which we can rely so far are essentially two, both conducted in Israel
. The first, in a small number of people, indicates that the immune response is being restored to the level it was in the first few weeks after the third dose. The second, in over a million people, suggests that the fourth dose in those over 60 is safe and reduces the risk of hospitalization and serious illness. There is concern that the effects of the fourth dose may be short-lived, however the efficiency of the immune system in defending us from infections over the years must be considered. To make a comparison: there are those who, at 75 or 80, still walk challenging paths in the mountains without major problems, and those who, at the same age, have to walk with a cane at home. In the same way our “defense system” can be more or less in shape, so I think that the administration over 80 years in general is reasonable because several over 80 years old can be similar to the immunocompromised that we follow and study in the Vax4frail consortium, while I would not propose it for overall healthy people already at the age of 60 “.
Wouldn’t it be better to wait until autumn, hoping for updated vaccines against the new variants?
«I would say no for fragile subjects, although I am optimistic about the arrival of new preparations. Rather in the autumn it will be appropriate to reiterate that, in addition to the Covid vaccine, the flu vaccine will also be done. There is very convincing data from the UK showing that the coexistence of the two infections greatly increases the risk of serious or very serious disease. In any case, the most urgent problem, even more than the fourth dose, is that relating to millions of people in Italy who have not yet undergone the third. And this also worries in key Long-Covid».
What do you worry about the most about Long Covid?
«The possible impact on our society. So much so that soon as the Accademia dei Lincei we will probably publish a document on the subject. British estimates speak of the 10% of people who have symptoms more than a year after the disease. Then there is the Epilogue study, a large survey of non-hospitalized people in Southern Germany between 18 and 65 who have had Covid, in which the persistence of fatigue, neurocognitive and cardiorespiratory problemsnot counting the others, starting with pains. Among other things, it is striking that these people, even young or middle-aged, after 6-12 months have not fully recovered their ability to work, without there being an association between age and symptoms. It is something that alarms and it should encourage young people to get vaccinated».
Is it possible to understand who is most at risk of Long Covid?
«Some recent studies are helping us in this sense. For example, they seem to be important high levels of viral RNA in the bloodthe reactivation of another virus, that of Epstein-Barrthe type 2 diabetes
the appearance of autoantibodies broad spectrum (in acute disease around 10% of people develop autoantibodies that block the first line of defense of the immune system). In general, inappropriate activation of the immune system appears to play a role, as also indicated by their usefulness as disease markers. interferon lambda and of PTX3, a protein that we have identified and which constitutes a powerful prognostic indicator in acute disease, whose value has now been extended to Long-Covid. With Elena Azzolini and Maria Rescigno we are carrying out an investigation on Long Covid in the Humanitas community: by acquiring more and more information, we hope to learn to predict its progress and block it ».
As far as prevention is concerned, there is always the open front of the lack of vaccinations in low-income countries.
“It’s a big problem for us too if we let the virus replicate freely. To understand the situation, I quote two data. The first refers to the rate of vaccination of healthcare workers in Africa: 1 in 4, and not always with the best vaccines. This also affects the safety of those who go to hospital and means, for example, that women are afraid to go there to give birth in protected conditions, with imaginable consequences. The second data comes from autopsies conducted in Lusaka, in Zambiawhich they unveiled as the 90% of the deceased had contracted Covid in the peak phase of the pandemic, and most of them had not been to the hospital. The narrative about the lower impact of the pandemic in Africa is based on data that does not take into account many aspects. Now in low-income countries the challenge is not only to get vaccines to arrive but to transform vaccines into vaccination: to make them go “the last mile” ».
April 4, 2022 (change April 4, 2022 | 09:24)
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