Do I have to wait 60 days for the third injection after vaccination? It's been more than 50 days since we separated.

Up to September 19, China reported a total of 265,438+700 million doses of COVID-19 vaccine. According to Mi Feng, spokesperson of the National Health and Family Planning Commission, as of September 15, the number of people who had completed the whole vaccination in China exceeded 10 1 billion.

The topic of "more than 654.38 billion people in China have completed the whole course of COVID-19 vaccine vaccination" quickly climbed into the hot search, but this did not alleviate the public's nervousness. On September 10, the first locally confirmed case was reported in Putian City, Fujian Province. Subsequently, the communication chain quickly extended to neighboring Xiamen, Quanzhou and Zhangzhou, forming a number of communication centers. The epidemic situation in Fujian Province has suddenly warmed up.

Data Map of Fujian Epidemic Situation since September 10 | Cartography: Health Department

The sudden epidemic tore the "sense of security" brought by the high vaccination rate, and some live reports from the front were really worrying-the first epidemic was found in Putou Primary School, Fengting Town, Xianyou County, Putian City. Principal Zhu Meimei said: "These children are very young, some are only 9 years old, and they have to take blood tests five times a day. Some children are too thin to bleed. 」

A video circulating on the Internet shows that a child is wearing protective clothing, dragging his luggage to the car alone, and quietly following the instructions of the hospital to undergo CT examination. The children's clever and sensible back is distressing. According to Zhu, a nurse from the Affiliated Hospital of Putian University who filmed this video, the youngest of these children is only 4 years old.

Less than a month after the end of the last epidemic, Xiamen's tourism industry was hit hard again: a travel agency closed down just a few days after it resumed business; The number of people on Gulangyu Island is also less than usual 10%, and the homestays on the island have been checked out in large areas.

15 At 3: 30 in the morning of September, at the entrance of the Third Experimental Primary School in Licheng District, Quanzhou City, a large number of parents looked around anxiously, because they could not take their children home until all the students' nucleic acid test results came out.

More than 10 million people were vaccinated with COVID-19 vaccine. What can China do to avoid the recurrence of the epidemic? In view of the new problems exposed by the Fujian epidemic, the health department contacted a number of medical experts for analysis and interpretation.

Loss of primary school students: children's immunization is feasible but must be more cautious.

"The outbreak of this epidemic shows that children should also be vaccinated. Hu Shanlian, a professor at Fudan University School of Public Health, told the health department.

Zhang, an associate professor at the University of Pennsylvania School of Medicine, told the health sector that there were three hot spots in this epidemic: the primary school in Xianyou County, Putian, the handicraft factory in Tongan District, Xiamen, and the shoe factory in Quangang District, Quanzhou. On the one hand, we should see the shortcomings of immunization coverage of unvaccinated primary school students; On the other hand, among adults who have completed vaccination, there is still an infection chain of 1 to 37, which is also the reason for the expansion of the epidemic.

More and more experts have noticed that children are the weak link of group immunity. Wang Huaqing, chief expert of immunization program of China CDC, pointed out that people who meet the vaccination conditions should be vaccinated as soon as possible, and people below 12 should also consider vaccination.

Many interviewed experts said that schools are dense places. Without the protection of vaccine, once an epidemic occurs, it is likely to become the hardest hit area. Zhang further pointed out that the significance of vaccinating children is that the vaccine can minimize the probability of contracting the virus and spreading it to others, which helps to block the risk of "children spreading the virus home".

According to the news of the Ministry of Education on September 15, at present, the COVID-19 vaccination rate of students aged 12- 17 in the education system has reached 9 1%.

Incomplete statistics of health departments show that Beijing, Shanghai, Hubei, Anhui, Zhejiang, Sichuan, Jiangsu, Guangdong, Heilongjiang and other provinces and cities have started the vaccination work for 12- 17-year-old adolescents. Fujian, where the epidemic broke out, plans to complete the whole vaccination of people aged 12- 17 by the end of September.

Then, in the process of popularizing vaccination to young children, what other matters are worthy of attention?

"It is feasible to vaccinate children with COVID-19 vaccine, but we must be more careful. Zhuang Shihe, a master of neuroscience at Hokkaido University, told the health department that before deciding to vaccinate children with COVID-19 vaccine, details such as dosage and frequency should be made clear, "because people's tolerance for adverse reactions of children after vaccination may be much lower than that of adults".

Zhuang He Shili said that many adverse reactions have nothing to do with the vaccine itself. "But they appear in their own children. If they are not properly guided, they will be very unfavorable to the epidemic prevention work."

Zhang also agreed with this view. According to him, after the large-scale vaccination in the United States, it was found that children vaccinated with mRNA vaccine may have severe myocarditis, but the incidence rate is not high. Compared with the possible consequences of viral infection, the vaccine is still worth vaccinating. He pointed out that China has a strong control over the epidemic, which is why China can wait patiently for more clinical trial results. Only according to these data can we judge the safety of the vaccine.

Strengthen the vaccine: it really needs another shot.

As we all know, no vaccine has the protective effect of 100%. Many confirmed cases in this epidemic were vaccinated with two doses of vaccine, which triggered a heated public debate: Since the threat from COVID-19 will not subside in a short time, will it be safer to get another shot of vaccine?

In this regard, a number of interviewed experts said that starting from the actual situation in China, it is really necessary to have another shot.

"The third injection must have a strengthening effect. I have taken two doses of vaccine, and I am willing to take the third shot by the end of this year or at the right time. Hu Shanlian said frankly to the health sector.

Some provinces have been in the forefront, and the completion rate of the second dose of Henan Province1population over 8 years old reached 84.8%. On September 16, it was revealed at the national video conference on prevention and control of COVID-19, influenza and other key infectious diseases in autumn and winter that the COVID-19 vaccine booster immunization will be launched nationwide. For the key population aged 18-59 who have been vaccinated with two doses of inactivated vaccine for six months, according to the time requirement of six months, they will be vaccinated on September 202 1, June 1, June 1, March 1, and March/.

According to the Beijing News reported on September 20th, according to the information of the disease control department, Beijing has not started the vaccination program.

Throughout the world, China is not the first country to promote vaccine booster. The United States, France, Germany, United Arab Emirates, Israel and other 13 countries have started or announced to strengthen immunization, mainly targeting medical personnel, high-risk groups, the elderly and people with low immunity:

Looking around the world, Israel is the first country to provide its citizens with the third dose of vaccine made in the west on a large scale. In July, 20021,the Israeli government took the lead in providing the third dose of vaccine for people with weak immunity. Israeli President Herzog, 6 1 year-old, became the first booster vaccinator on July 30th. So far, about 3 million people have been vaccinated urgently. On July 29th, Israeli Prime Minister Bennett said in a televised speech to the whole nation that his first call was to call his mother and persuade her to take the booster.

Bennett said that an Israeli expert group overwhelmingly believed that it was meaningful to carry out intensive vaccination. However, at that time, the World Health Organization only said that there was not enough evidence to show the necessity of strengthening injection, and neither the United States nor the European Union approved it.

The data show that the probability of serious illness among people over 60 years old in Israel after the third dose of vaccine is110 for those who have been vaccinated with two doses and140 for those who have not been vaccinated.

On September 17, a scientific advisory committee of the US Food and Drug Administration (FDA) unanimously voted to approve the emergency use authorization for the third booster of Pfizer vaccine for people aged 65 and over and severely high-risk groups in COVID-19 after six months of full vaccination;

Singapore, which calls itself "living with COVID-19", stipulates that people over the age of 60 and people living in old-age care institutions need to be vaccinated with the third dose. In order to make a demonstration, Singapore Prime Minister Lee Hsien Loong was inoculated with fortifier on the morning of September 17. He called on people to get vaccinated if they were informed of the booster.

In this regard, Zhang pointed out that the announcement of additions by Israel and the United States is related to the increase in new cases in the country. The data show that due to the spread of Delta strain and lax epidemic prevention measures, the protective power of these two countries has obviously decreased after vaccination with two doses of vaccine, and even there is a trend of serious diseases reappearing in Israel.

As far as the epidemic prevention situation in China is concerned, he thinks it is not necessary for everyone to take the third shot, but for those who took the vaccine at the earliest, the antibody level in the body may already be very low. Therefore, it is really necessary for high-risk groups such as medical staff, entry-exit personnel and the elderly to get a third shot. Therefore, according to the order of inoculation date, it is feasible to adopt rolling scheme for intensified inoculation.

He also called on relevant departments to make public the research reports of previously confirmed cases in Guangzhou, Nanjing and other places as soon as possible, so as to analyze the ability to prevent severe diseases after complete vaccination. If the protective effect is high, it will also provide a clearer reference signal for the inoculation of domestic enhancers.

Post-epidemic period: COVID-19 vaccine needs repeated vaccination.

According to reports, as of September 4, the vaccination rate of Xiamen1population over 8 years old has reached 90%. In this regard, Zhuang pointed out that in the case of high vaccine coverage, the proportion of people who have been vaccinated among newly infected people will also increase significantly. The focus of epidemic prevention in the future is to prevent and control the epidemic situation more scientifically, accurately and humanely under such a high vaccine coverage rate.

"In the future, the world without repeated vaccination against COVID-19 will no longer exist." Zhang is outspoken. In his view, COVID-19 has taken root on the earth and spread to animals such as mice. Even if human society can eliminate viruses, it is impossible to completely eliminate these viruses existing in rodents. Every three or five times, they will still be invaded by viruses.

According to his prediction, there may be two situations in the future: one is that human beings have developed a highly protective vaccine, and it is possible that the interval between vaccination can be extended to one to two years; The other is that the protective effect of the developed vaccine is limited, so it has to be vaccinated more frequently through timely monitoring and early judgment.

The latter situation seems to be unfolding in Israel. Shaman Zalka, Israel's national epidemic prevention adviser, said in early September that Israel was preparing the fourth dose of COVID-19 vaccine to ensure adequate supply when necessary.

However, the authoritative medical journal The Lancet published an opinion article on the Internet on September 13, suggesting that rashly boosting the vaccine will increase the probability of side effects of the vaccine, and repeated vaccination will also reduce people's acceptance of the vaccine, but it is not worth the candle.

Coincidentally, William Moss, a public health expert at Johns Hopkins University, also pointed out in an interview with The The Hill that opening up and strengthening vaccines will distract the inattentive population from vaccination and aggravate the unfairness of global vaccine distribution.

For these concerns, Hu Shanlian believes that this is actually the choice of different epidemic prevention strategies. He said that from the perspective of encouraging popularization, priority should be given to using limited vaccines to expand immunization coverage, and on this basis, pilot immunization should be strengthened. However, considering that COVID-19 is a respiratory infectious disease and will exist in human society for a long time, it can follow the example of regular influenza vaccination.

As for whether the booster will continue to use the current domestic vaccine in the future, Hu Shanlian suggested that from the perspective of safety, the previously vaccinated vaccine types should continue to be used. However, Zhang believes that the option of mixed vaccination should not be closed, and it can be studied in depth to work out the most suitable vaccination plan.

In fact, the trial of the third dose of mixed inoculation has also made progress in stages. On September 7th, Kangxinuo released its booster protection rate: according to the clinical study of sequential vaccination initiated by Zhu, deputy director of Jiangsu CDC, volunteers were vaccinated with inactivated vaccine twice and then with Kangxinuo biological adenovirus vector vaccine once. After 14 days, the level of neutralizing antibody increased by about 78 times. This study not only shows good safety, but also proves that the immune effect of the mixed vaccine is obviously better than that of the inactivated vaccine.

From this, we may have a wider range of options when we guard against COVID-19 in the future. "Relatively speaking, (another shot) is to strengthen the immune response of the body, not to say that you have been vaccinated before." Zhang concluded.

References:

1. Johns Hoops University: What's behind Biden's booster vaccine program?

2. The Hill: coronavirus pneumonia-19: We all need a shot in the arm-but some people will be earlier than others.

3. WHO: WHO Consultation on Coronavirus Pneumonia-19 Vaccine Research-Considerations for Promoting pneumonia vaccine Immune Response of Coronavirus (13 August 202 1)

4. The Lancet: Consideration of promoting pneumonia vaccine immune response of coronavirus.

Source | Health Department

Author | Huang Zijiang

Edit | Zhang Beihai