The HAS recalls that immunocompromised people, in whom the risk of severe form and death from Covid-19 is high, must be vaccinated as a priority against SARS-CoV-2.
However, because of their immunosuppression, their immune response to vaccination is often reduced making this vaccination less effective, the HAS recommends that a strategy of "cocooning" (vaccination of those around them) be implemented around immunocompromised people. adults and children.
The current data concerning the vaccine response of these patients are incomplete. However, it seems that this “cocooning” strategy must currently target as a priority:
- people who have transplanted solid organs or hematopoietic stem cells,
- people on lymphopenic chemotherapy,
- people receiving treatment with anti-CD20
- people on chronic dialysis.
On a case-by-case basis, people on immunosuppressants who do not fall within these categories or who are carriers of a primary immunodeficiency should also be concerned after specialist advice.
The entourage of immunocompromised people to be vaccinated is represented by all people living under the same roof as a subject in the above list and people contributing to their care (health personnel, home helpers, auxiliaries life, etc.) and people likely to provide care (maternal assistant, family, nurse, etc.). These people must therefore be considered a priority for vaccination against Covid-19 and be vaccinated as soon as possible and preferably in the same circle as the immunocompromised people with whom they are close.
RNA vaccines and the Janssen vaccine, whose impact on transmission appears to be greater according to current data, should be favored in this indication,
The entourage of immunocompromised people, siblings or children, under the age of 16 should be vaccinated as soon as the marketing authorizations allow it.
The “cocooning” strategy is fully in line with the vaccination campaign carried out according to the strategy defined by the HAS and must be carried out in complementarity with the maintenance of barrier and physical distancing measures to effectively fight against the SARS-CoV epidemic. -2.
This opinion is likely to change depending on future data, in particular on immunogenicity.