National Vaccination Guidelines Second Edition

The core adjustment logic of the "Second Edition of the National Vaccination Guidelines" is based on the mutation characteristics of the new coronavirus strain, population-wide infection and basic immunity coverage data from 2020 to 2023. The vaccination goal has been shifted from "blocking the spread of the virus to the greatest extent" to "focusing on reducing the risk of severe illness and death". It has optimized vaccination priorities, dose intervals, and adapted vaccine types to better suit the prevention and control needs of the current normalized epidemic stage of the new coronavirus.

I was on duty at the vaccination site at the community health service center last week. In the morning, I met 7 residents who came to ask questions with the 2021 version of the old vaccination notice. The most common question was "I have already received 3 injections before, do I need a fourth injection now?" 」There is actually no one-size-fits-all answer to this question in the guide. There are currently two parallel mainstream opinions in the public health field: One group believes that as long as they are over 60 years old or have underlying diseases, regardless of how many injections they have received before or whether they have been infected, they should receive booster injections as long as they are separated by 6 months. After all, the risk of severe illness in this group of people is 27 times that of healthy young people. ； The other group believes that for healthy people aged 18-59, the mixed immunity formed by infection and vaccination is sufficient to deal with the current circulating strains, and no additional vaccination is needed unless going to high-risk areas or engaging in high-exposure work. Both views are supported by large sample data, so the second edition of the guide does not impose mandatory requirements, but only gives clear priority suggestions.

I was particularly impressed by Uncle Zhang who came last week. He is 78 years old and has a history of chronic obstructive pulmonary disease. He had a sun infection last winter and was hospitalized for a week. He had received three doses of Beijing Biotech’s inactivated vaccine before. According to the first version of the guidelines, he had to wait 12 months before taking booster shots. In the second version, the interval for booster shots for the elderly with underlying diseases was directly reduced to 6 months. His blood oxygen level was normal that day and he was not in the acute attack stage. After the shot, he sat in the observation area and chatted with me, saying that he didn’t dare to take the shot before for fear of aggravating his lung disease. Now the doctor said it’s no problem. At least he doesn’t have to worry about being hospitalized in the ICU next time if he gets positive.

Speaking of which, when the first edition of the guidelines was published in 2021, the virus strain was still Delta, with strong transmissibility and high severe disease rate. At that time, there was no immune barrier for the entire population, so the priority was to first cover the entire population over 18 years old, and then expand it to 3-17 years old. The dose interval was also strict, fearing that the effect would be ineffective if given early. It’s different now. More than 90% of the people in the country have been infected or vaccinated, and the severe disease rate of the Omicron strain is more than 80% lower than that of Delta. Therefore, the second edition directly places the highest priority on the elderly over 60 years old, people with serious underlying diseases, people with low immunity, medical care and other high-exposure groups. Other healthy people can choose according to their own needs and do not need to rush to vaccinate. And now there are studies that have confirmed the immunoblotting effect, that is, the immune memory formed by previous vaccinations or infections will preferentially recognize the antigens of old strains. If healthy people frequently take booster shots of the same type, their protection against new mutant strains may be weakened. There is really no need to get a shot just for nothing.

Regarding the issue of vaccination for children under 3 years old, there is indeed considerable disagreement among academic circles. Pediatric experts have conducted a two-year follow-up study and said that the seriousness rate of healthy children under 3 years old after being infected with Omicron is only about 0.01%, which is almost the same as ordinary influenza. There is no need for routine vaccination. ； However, some immunologists believe that vaccination is still recommended for children with congenital heart disease, blood diseases, and immune deficiencies, which can reduce the risk of severe illness by more than 70%. Therefore, the second edition of the guidelines does not make any mandatory requirements, but only leaves the right of choice to parents and clinicians. As long as there are no vaccination contraindications, anyone can be vaccinated.

Oh, by the way, many people asked if they had received inactivated vaccines before, can they use other technical routes now? The guidelines make it clear that it is possible. The immune effect of sequential boosting is about 30% higher than that of homologous boosting. However, there are currently not many XBB strain-adapted vaccines approved in China. Most community sites still stock recombinant protein vaccines and inactivated vaccines. If you want to take mRNA, it is best to call the vaccination site in advance to see if it is in stock, so as to avoid a wasted trip.

To be honest, the vaccine guide is actually like a medicine box at home. At the peak of the epidemic, antipyretics, cough medicines, and antigens had to be prepared for fear of not being enough. Now that things have stabilized, we just focus on preparing emergency medicines and chronic disease medicines needed by the elderly and children. Ordinary people prepare as needed and do not need to stock up. The principle is the same.

Yesterday, a mother who had just given birth came to ask if I could take an injection while breastfeeding. I showed her the terms in the guide and said that it would not affect breastfeeding. She hesitated for twenty minutes before taking the injection. She said that the elderly in the family were in her hometown. If she became pregnant and no one took care of the child, it was always good to have an extra layer of protection. In fact, there is no perfect guide. They are all adjusted little by little according to changes in the virus and the needs of the population. The core has never changed: give the most limited resources to those who need protection the most.