A team of scientists led by Matthias Preusser of MedUni Vienna’s Division of Oncology had already shown that cancer patients benefited from a third vaccination to protect them from COVID. A recent study now also supports the fourth vaccination for this vulnerable group of cancer patients. However, passive immunization by administering a combination of antibodies to cancer patients does not appear to provide adequate protection.
The results of the study have been published in the scientific journal JAMA Oncology.
Fourth vaccination: that’s who it’s essential for
The study was based on close observation of 72 patients: fifty-four of them received a fourth vaccination with one of the currently approved vaccines (active immunization) and 18 underwent passive immunization with the thixagevimab / cilgavimab antibody combination. To assess immunity, the researchers compared antibody levels and their inhibitory effect against the SARS-CoV-2 omicron BA.1 and BA.4 subvariants after three and four vaccinations and after administration of the antibody combination thixagevimab / cilgavimab.
Patients with solid tumors and those with haematological tumors not on B-cell therapy showed a significant increase in antibody levels after a fourth vaccination of one of the currently approved drugs. Based on the data obtained, study leader Matthias Preusser of the Division of Oncology of the Department of Medicine I at MedUni Vienna concluded that the administration of a fourth vaccination in cancer patients should be approved in cancer patients themselves, even in the absence of specific vaccines. for the variant.
However, this is not the case with passive immunization of patients: “Our results suggest that immunization with thixagevimab / cilgavimab does not effectively block the more recently dominant BA.4 variant,” said study first author Maximilian Mair. of the MedUni Vienna Division of Oncology. Further studies are now needed to confirm the findings in support of the fourth vaccination recommendations. Furthermore, there is still a lack of reliable information to define a valid threshold for sufficient antibody levels to provide adequate protection against SARS-CoV-2 infection.
Cancer patients are often on immunosuppressive therapy. As a result, cancer patients are particularly at risk of developing severe clinical courses of COVID-19, underscoring the importance of SARS-CoV-2 vaccination.
“We recommend a prompt fourth vaccination for the particularly vulnerable group of cancer patients. Furthermore, our patients continue to rely on the protection provided by a responsible company and control measures such as isolation of infected people and the use of face masks indoors.In addition, even mild cases of COVID-19 can lead to to the postponement of urgent cancer treatments, which can adversely affect cancer prognosis, ”said study leader Matthias Preusser, as COVID restrictions are increasingly lifted.
Walter Ricciardi, Full Professor of Hygiene at the Catholic University of Rome and consultant to the Minister of Health, Roberto Speranza, expressed himself on the possibility of a fourth vaccination already planned for the most fragile subjects, taking stock of the situation on the pandemic: ” likely that in the fall it will be useful to everyone. Antibody immunity drops, but cellular immunity may last longer. We will see”.
Ricciardi also explained that the vaccination that affects children is not taking off “due to a series of problems: many parents are not clear about the danger to children of Omicron, erroneously more afraid of vaccines”.
Massimo Andreoni, scientific director of the Italian Society of Infectious Diseases and ordinary in Tor Vergata in Rome, with respect to the fourth vaccination declared: “First of all, it must be said that it is not easy to convince those who do not want to vaccinate. Having said that, it must be explained that we now have a very large number of cases. Some of these have complications, even important ones, that lead to ordinary hospitalization or intensive care. We are in a moment of great epidemic explosion and this variant is circulating which responds a little less to vaccines ”.
“To keep the antibody titer high, which at least protects against serious illness. For this reason, even for the healthy 60-year-old it may be worth getting vaccinated. It is possible and desirable, it would mean that we have entered a situation of endemic, with the virus circulating but has stabilized enough. It would practically become like the flu ”.
The Minister of Health, Roberto Speranza, he added: “We have always followed the indications of the scientific authorities in particular of Ema and Ecdc. There is confrontation right now and we will evaluate how to adapt the use of vaccines ”.
Guido Rasi, former executive director of the EMA and scientific director of Consulcesi, takes stock of the current situation: “Italy’s line was the most reasonable. A line that wanted to wait for the presence of solid data before taking a public decision that would have involved some complexities since the third dose was already not adequately accepted, so I imagine that a fourth dose extended to the general population would have recorded a further hesitation”.
“Ema and Ecdc expressed themselves very clearly by evaluating the data and drawing conclusions on the basis of which the advantage of a fourth dose of vaccine against Covid in subjects already vaccinated with three doses is marginal or completely absent. This is also quite logical for how we understand the immune response to this virus to be. Encountering the virus again after vaccination or doing an additional dose of vaccine means creating an antibody spike that lasts 4-8 weeks at most ”.
“The big problem is that if a person becomes infected with omicron, they will develop specific antibodies against omicron; if, on the other hand, he undergoes a first generation vaccine, ie those currently available, here the specific neutralizing antibodies of the omicron variant are only a part. Therefore, not only is the advantage limited in time but it is also absolutely limited in effect “.
“The third dose, on the other hand, is essential because it confers cellular and solid memory immunity that protects us from severe disease. In other words, with a virus that multiplies at such speed and such multiplicity it is useless to chase it with antibodies but it is essential to have a strong immunological base barrier to combat severe disease “.
“It is always better to avoid contracting the disease and therefore get vaccinated, use masks indoors and take any other form of precaution. And this is because the individual response to the virus is always very variable. We know that this virus can last for a long time, and we don’t yet know if it will remain permanent in any organ. For most people it could all be resolved with a cold or the flu but for others it could represent something more. And above all, we do not yet know what the effects of this disease may be in the medium-long term ”.
“We are in the same situation we were in at the beginning of December with Omicron. If the Xe variant were to assert itself over the current one, it will prove to be even more infectious. And we already know today that the current variant, in terms of transmissibility, is at the level of measles. But that doesn’t mean it must necessarily be dangerous. We do not have any elements to answer precisely on this variant at the moment. We must therefore insist on surveillance, sequencing and await new data ”.
“We begin to say that a highly vaccinated population is a more protected population since a certain amount of immunity is maintained. We will first have to understand if we will have to deal with this or with a new variant. If by hypothesis a variant that escapes the immune response were to appear, it would be a big problem and we would have to start all that work carried out over the last year and a half from the beginning. As for vaccines, two types of products are being worked on: a vaccine designed to respond to the omicron variant should be ready as early as September-October; we are then working on a universal vaccine for coronaviruses, this would certainly be the solution to the problem “.
“In a country with a high seismic activity, slowly all buildings are built to meet anti-seismic standards. In a situation with a pandemic tail that we do not know when it will end, a very likely recovery in October and other pandemics that could appear, we need to start thinking about how to structurally respond to this situation by overcoming the logic of the emergency “.
“And therefore, for example, public buildings, hospitals and schools should be equipped with that controlled mechanical ventilation that has already given great results in some experiences. We must think about local transport to avoid peaks of gatherings and plan smart working. More specifically, to healthcare, this should be rethought in three streams: treatment of the epidemic disease of the moment with dedicated paths if not real pandemic hospitals; treatment of normal pathologies in infected patients; planning for all other pathologies “.
“Attention, today we are dealing with Covid, tomorrow we do not know if anything else could appear. Even before the pandemic, many hospital infections occurred because there was a patient suffering from a certain disease “x” who was infected in the hospital by the virus “y” “.
“This means that the hospital layout at this time is not designed to hinder and manage infections well without having to resort to the antibiotic. This implies large investments which could, however, save us a lot of money in assistance as well as in terms of diseases avoided and lives saved. We also need to rethink the amount of staff that we know is currently insufficient. Instead, we must begin to understand which and how many experts to train “.
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