Abstract
  • The continuing aim of the vaccination programme is to reduce hospitalisations, severe disease and death from COVID-19 and to reduce the burden on the health care system particularly in winter.
  • The primary COVID-19 vaccination schedule affords very good protection against severe disease that is further enhanced by a first booster dose and/orby COVID-19 infection. Each subsequent booster dose restores protection that has waned.
  • The primary COVID 19 vaccine series is recommended for all aged five years and older and is available to those aged six months to four years. A first booster isrecommended for all aged 18 years and older and is available to those aged 12-17 years. All are encouraged to be up to date with recommended vaccines.
  • Wastewater surveillance and other surveillance systems indicate that the SARS-CoV-2virus continues to circulate in the community at relatively high levels.
  • Circulating variants are highly transmissible and more immune evasive than those previously encountered, however they do not appear to be associated with increased disease severity.
  • In 2023, the rates of COVID-19cases, hospitalisation and deaths had been decreasing in Ireland and in Europe, however a recent small increase in cases and hospitalisations has been noted.
  • The baseline number of cases between surges is remaining higher than after the first and second waves of infection, representing persistent risk for vulnerable members of the community.
  • Age is the strongest risk factor for severe COVID-19 outcomeswith the riskincreasingincrementally with age, thoseaged over 70years are at the highest risk for hospitalisation and death.
  • COVID-19 vaccination uptake rates in Ireland are among the highest in Europe, especially among those over 65 years of age.However, uptake rates have declined with each subsequent booster offer.
  • COVID-19 vaccines are very effective in preventing severe COVID-19.Protection peaks four to eight weeks after vaccinationand wanes gradually thereafter. Overall protection is sustained against hospitalisation and severe disease to at least nine months and beyond.
  • Hybrid immunity confers the most robust and durable protection against severe COVID-19 outcomes, with studies indicating protection extending beyond12months.
  • Those aged 70 years and older are least likely to have had SARS-CoV-2 infection and are more reliant on vaccination for protection than younger age cohorts. For these, modest declines in protection from vaccination are associated with greater risk of severe COVID-19.
  • Based on studies from the UK, Nordic countries, US and Israel, mainly involving those aged 50 years and older, bivalent mRNA vaccination is anticipated to modestly enhance protection compared with monovalent vaccines. Data on younger cohorts are more limited.
  • Compared to younger cohorts,the lowerlevels of hybrid immunity and greater impact of waningprotectionin older persons means that more frequent vaccinationwill berequired to sustain their protection against hospitalisation, severe disease anddeath.
  • SARS-CoV-2 seasonality is not yet established. Surges in case numbers, hospitalisations and deaths occur in all seasons. However, as the impact is potentially greatest in winter, timing the COVID-19 vaccination campaign for the autumn should maximise benefit both for the individual and the health care system.
  • Combining the roll out of influenza and COVID-19 vaccination is safe and will result in a more streamlined and efficient implementation and may increase vaccine uptake.
  • VidPrevtyn Beta, a protein based monovalent vaccine based on the Beta variant spike antigen, is authorised for use in the EU as a COVID-19 booster for adults who were previously vaccinated with a primary series of mRNA or adenoviral vector COVID-19 vaccine.
  • Clinical trials thatcomparedVidPrevtyn Betato Comirnaty(monovalent)as a booster dosereportedsimilar adverse eventsandsimilar or increased immunogenicity. No post-marketingsafetydata or studies comparingVidPrevtyn Betatobivalent mRNA vaccines are available.
  • Nuvaxovid is the preferred alternate for use in Ireland as data on VidPrevtynBeta are more limited.
  • mRNA vaccines arethepreferred COVID-19 vaccinesin Ireland. The risk of vaccine associated myocarditis that mainly occurs in those aged less than 30 years can be reduced by extending the interval between the first and second mRNA COVID-19 vaccine dose in the primary schedule.
  • Consideration must be given to the potential need for a rapid escalation of vaccination should the epidemiological situation deteriorate.
  • Recommendation
  • Europe
  • Ireland
  • COVID-19