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By Mayan Lubell
JERUSALEM (Reuters) – In Israel’s COVID-19 services, doctors learn which vaccinated patients are most vulnerable to serious illness, as concerns grow about cases where injections offer less protection against the worst forms of the disease.
About half of the country’s 600 patients currently hospitalized with serious illness have received two doses of the Pfizer Inc vaccine, a rare event in 5.4 million fully vaccinated people.
The majority of these patients received two doses of the vaccine at least five months ago, are over 60, and also have chronic conditions known to exacerbate coronavirus infection. They range from diabetes to heart and lung disease, as well as cancers and inflammatory diseases that are treated with drugs that suppress the immune system, according to Reuters interviews with 11 doctors, health specialists and officials.
Such “groundbreaking” cases have become at the heart of a global debate over whether and to what people highly vaccinated countries should give booster doses of COVID-19 vaccines.
Israel began offering booster doses to people aged 60 and over in July, and has since expanded that eligibility.
The United States, citing data from Israel and other findings, said on Wednesday it would make booster doses available to all Americans from September.
Other countries, including France and Germany, have so far limited their recall plans to the elderly and people with weakened immune systems.
“Vaccinated patients are older, in poor health, they were often bedridden before infection, immobile and already in need of nursing care,” said Noa Eliakim-Raz, head of the coronavirus department at Rabin Medical Center in Petach Tikva.
In contrast, “the unvaccinated COVID patients we see are young, healthy, working people and their condition is deteriorating rapidly,” she said. “Suddenly they are put on oxygen or on a ventilator.”
Israel’s health ministry sounded new alarms this week with a report showing that the efficacy against serious illnesses of Pfizer’s vaccine, developed with Germany’s BioNTech, appears to have increased from over 90% to 55% in people. 65 years and over who received their second vaccine. in January. Disease experts say the representativeness of the numbers is unclear, but agree that it is of concern given the evidence that overall vaccine protection against infection is declining.
They cannot say whether this is due to the time that has elapsed since inoculation, the ability of the highly contagious Delta variant to evade protection, age and underlying health condition. people vaccinated, or a combination of all of these factors.
Health officials in the UK and US, two other countries with high vaccination rates and a spike in Delta infections, have reported similar trends. In the UK, around 35% of people hospitalized with a Delta case in recent weeks had received two doses of a COVID-19 vaccine. According to federal data, nearly three-quarters of breakthrough infections in the United States that resulted in hospitalization or death were in people aged 65 or older.
U.S. officials have said their recall plan is based on fears that over time vaccines will offer less protection against serious illnesses, including in young adults.
“We are watching other countries carefully and (are) worried that we too will see what Israel is seeing, which worsens infections over time” among those vaccinated, the director of the state Centers for Disease Control and Prevention said on Wednesday. -Unis, Rochelle Walensky, at a press conference. . The World Health Organization has repeatedly urged wealthy countries to refrain from providing boosters when much of the world does not yet have access to their first doses of the COVID vaccine.
IMMUNE RESPONSE
The Delta variant, first identified in India, has become the dominant version of the SARS-CoV-2 virus around the world, accelerating a pandemic that has killed more than 4.4 million people.
In Israel, daily new cases have risen from single digits in June to around 8,000 since Delta’s arrival. About half of the cases – the majority of them mild to moderate – involve people who have been vaccinated.
People vaccinated for the first time in Israel were at high risk, including those aged 60 and over. The immune response of some may have weakened by the time Delta struck Israel. But for others with underlying health issues, the vaccine may not have been activated at all.
“For some of them, the vaccine did not trigger an immune response, they did not have antibodies, either because of the disease itself or because they are being treated with drugs that suppress the system. immune, ”said Dror Mevorach, who heads the coronavirus department at Hadassah Hospital. in Jerusalem. He cited examples such as chronic lymphocytic leukemia and lymphoma.
Of the 3 million vaccinated Israelis covered by Clalit, the country’s largest healthcare provider, 600 have suffered severe breakthrough cases since June. About 75% of them were over 70 and were at least 5 months after their second dose, according to Ran Balicer, Clalit’s chief innovation officer. Almost all of them suffer from chronic illnesses.
“We hardly see any young people vaccinated in serious condition,” Balicer said.
In the UK, doctors have described similar characteristics in vaccinated patients who become seriously ill.
“In people who arrive, because of their age, because of their co-morbidities, they may be people whose vaccine would not be expected to be as effective as other groups. of age, ”said Tom Wingfield, clinical lecturer at the Liverpool School of Tropical Medicine.
A new wave of coronavirus cases and deaths in the United States has been fueled by Delta, particularly in states where vaccination rates remain low. Among the vaccinated patients who are infected, there is some evidence that the elderly are more severely affected.
In Texas, 92% of vaccine breakthrough cases that resulted in death were in people over the age of 60 and 75% had a known underlying illness that put them at high risk for COVID-19, according to a spokesperson for the public health department.
Early data in Israel suggests that booster shots given in recent weeks reduce the risk of infection in older people compared to those who have only received two doses.
Even without a recall, Israeli doctors say vaccinated patients tend to recover faster.
“The vaccinated patients I treated usually left the intensive care unit after about three days. Unvaccinated patients took a week or two to stabilize,” said Yael Haviv-Yadid, head of the intensive care unit at Sheba Medical Center near Tel Aviv.
Even though the vaccine didn’t keep them from getting sick, it may have alleviated their illness, said Alex Rozov, head of the coronavirus department at Barzilai Medical Center in Ashkelon.
“Our cautious impression is that vaccinated patients suffer from an easier course of the disease – treatment is more effective in those who have the antibodies.”
(Additional reporting by Alistair Smout and Josephine Mason in London, Carl O’Donnell in New York; Editing by Michele Gershberg and Dan Grebler)
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