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The third dose of the vaccine is for people with severe immunodeficiency

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The government has decided that people with severely compromised immune systems will be offered a third dose of the Covid-19 vaccine. After dialogue with health institutions and professional circles, the National Institute of Public Health developed a plan for the implementation of the offer.

Who will be offered the third dose of the vaccine?

There are mainly two different groups of patients with severely compromised immune systems who will be offered a third dose.

1rd Group

Everyone in this group will be given a third dose as soon as possible. This includes the following conditions:

- Organ transplant

- Bone marrow transplant in the last 2 years

- Severe and moderate hereditary immunodeficiency

- Severe renal failure (stage 5) or on active dialysis

- Advanced or untreated HIV infection

2rd Group

The need for a third dose and the adjustment of immunosuppressive therapy prior to vaccination should be considered in each group. Vaccinations for this group will begin as soon as specialist medical communities within specialist health care have identified and decided which patients should be recommended for the third dose. Applies to:

- Cancer patients with active or recent immunosuppressive therapy.

- Patients undergoing significant immunosuppressive therapy for other reasons.

- Patients who are considered by the responsible specialist physician to have severely compromised immune systems and who do not belong to any of the above groups.

Third dose only for adults with a severely weakened immune system

"Basically, only adults with severely compromised immune systems should be offered a third dose of the vaccine," said Sara Viksmoen Watle, chief physician at the National Institute of Public Health.

Watle explains that there is no basis for recommending a third dose of the vaccine to children with severely compromised immune systems at the group level, but there may still be some patients for whom this is deemed necessary. Such decisions should be made by the pediatrician.

Who gives the vaccine? 

The specialist health service will first of all determine who should be offered the third dose of the vaccine. Interested persons will receive a written offer from the hospital informing them that they can contact their municipal immunization service to receive a third dose. Some will be called to be vaccinated in hospital. They do not need to contact their GP.

Most of the people concerned will be able to be vaccinated in their home municipality. Patients who are hospitalized or have ongoing treatment or a complicated course of treatment will receive vaccination through hospitals, Watle says.

The vaccines for use in the third dose are mRNA vaccines from Pfizer and Moderna.

Municipalities will receive inquiries from patients who have received a letter from their treating doctor stating that a third dose is recommended and the municipality must have clear information on how to contact the municipality's vaccination offer, for example on the municipality's website. The patient will receive from a doctor keeping documentation confirming belonging to the appropriate disease groups and a third dose is indicated.

The vaccines for use in the third dose are the Comirnata mRNA vaccines by BioNTech-Pfizer and Spikevax by Moderna. Both vaccines can be used, irrespective of which vaccine was given for the first and second dose.

There should be an interval of at least 4 minutes between the second and third doses weeks

To date, no adverse effects were observed after the third dose in these patient groups, other than those previously known after the first and second doses.

An additional dose of the vaccine may improve the immune response in severely immunocompromised patients. There is reason to believe they will get better protection from an extra dose. How well an additional dose of vaccine will be followed in future studies both in Norway and elsewhere. The FHI does not recommend routine antibody testing after the third dose.

People who have a severely weakened immune system should continue to live in a safer place when there is a lot of infection in society. Even with an additional dose of the vaccine, they may be prone to serious illness. In addition, it is important that close relatives in the same household consent to the vaccine. This could help reduce the likelihood of infection in household members who may have a weaker response to the vaccine, concludes Watle.

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