Vaccination Guidelines 2nd Edition

Compared with the first version of the guidelines released in 2021, this revision focuses on adapting to the vaccination needs of people with low immunity, the elderly group over 60 years old, and people with previous COVID-19 infection. It cancels the general recommendation of routine booster shots for healthy general population. At the same time, for the first time, non-immunization program vaccines such as herpes zoster, HPV, and pneumococcal vaccines are included in the priority ranking recommendations. All content is based on the changes in domestic epidemic strains in the past two years, the follow-up data of 1.2 million vaccinated people, and the latest WHO guidelines, taking into account the protective efficacy and vaccination cost-benefit.

Recently, I have been helping with missionary work at a community vaccination site, and the most common question I have encountered is, “I am 30 years old and usually in good health. I had an erectile dysfunction six months ago, do I still need a booster shot? ”This guide has actually made it very clear: if you are not a high-exposure group such as medical staff, cold chain employees, or staff in nursing homes, and do not have underlying diseases, you can choose according to your own needs, and there is no need to worry about "whether you must take the vaccine."

Here we must also explain the different opinions of the current academic circles, lest everyone thinks that the guidelines are based on pat decisions: One school of public health scholars advocates that the general population should be vaccinated once every autumn and winter, similar to the influenza vaccine. They believe that even if the infection cannot be prevented, the severity of the disease can be greatly reduced, especially during the Spring Festival, winter and summer vacations, which are nodes with large population movements, the protective effect is obvious； Some clinical experts believe that healthy young people have sufficient immune function, and repeated vaccination may reduce the ability of immune cells to recognize mutant strains. There is no need to receive additional vaccinations for the extremely low risk of severe disease. The research data from both groups are sound, so this time the guide simply does not make a mandatory recommendation. To put it bluntly, if you are going to a crowded place recently, or if you are afraid of infecting the elderly and children at home, get vaccinated. If you usually have few people in contact with the two points and one line, it is okay not to get vaccinated.

Last week, I met a young man who was engaged in cross-border e-commerce. He was going to Europe for three months to participate in an exhibition. He was debating whether to take the vaccine or not. I figured it out for him: the mutant strains currently circulating in Europe are quite different from those in China. He has to go to exhibitions every day to meet hundreds of people from different countries, which is a typical high exposure. I decisively suggested that he take the latest XBB strain vaccine. He himself said that taking the vaccine is more reliable than having a fever abroad and delaying work.

Compared with the entanglement of healthy young people, the priority of vaccination for the elderly and immunocompromised groups is the least controversial part of this guideline revision and the most worthy of mentioning.

Sister Zhang, the vaccination nurse at the community health service center I contacted, just gave a booster shot to Uncle Li, an 82-year-old chronic obstructive pulmonary patient, last month. Uncle Li did not dare to take the shot when the first edition of the guidelines came out for fear of adverse reactions. This time, he saw that the guide specifically mentioned that "elderly people with underlying diseases can be vaccinated as long as they are stable." In addition, several old people around me were fine after taking the shot. Sister Zhang said that the number of elderly people who have received booster shots in the past two months has tripled compared with before. Most of them came after reading the new guidelines. There were almost no serious adverse reactions during the follow-up. The most were arm pain for two days and a slight fever, which subsided in two or three days.

However, there is also a controversial point here that has not yet been unified: for people with low immunity during organ transplantation, radiotherapy and chemotherapy, how long after surgery/treatment is the most appropriate time to vaccinate? Most doctors in the transplant department recommend at least a 6-month interval, waiting for the dose of immunosuppressants to drop to a stable value before taking the drug, so as to avoid affecting the function of the transplanted organ. ； Doctors in the Department of Infectious Diseases prefer to be vaccinated within three months. They believe that the risk of severe illness after infection for this group of people is too high, and early vaccination and early protection are needed. If you encounter this situation, don't look up the information yourself. It's more reliable to go directly to your attending doctor for evaluation.

Oh, by the way, this time the guide also specifically mentions: Regardless of whether people over 60 years old have had a previous infection or have received basic injections, as long as they are 6 months old, it is recommended to receive another vaccine containing the latest mutant strain. This is a recommendation that is almost uncontroversial in the academic community. Those who have elderly people at home must be reminded.

Many people may not have noticed that the biggest change in this guideline is that it places the recommendation of non-immunization program vaccines in a very important position and no longer only mentions the COVID-19 vaccine.

Take the shingles vaccine, for example. Many people used to think that only people over 60 can get it. This time, the guidelines have clearly lowered the recommended age to 40. My aunt got shingles last year when she was 52 years old. The pain lasted for two months. It even hurt when she touched her skin when she put on clothes. After reading the new guidelines, she slapped her thigh directly and said that if she had known that she could get vaccinated at the age of 40, she had to get vaccinated first. It is not worth suffering. I would also like to mention here that there are two types of live attenuated vaccines and recombinant vaccines on the market. It is safer for people with low immunity to choose the recombinant vaccine. For healthy people, either type will work, and the protection rate will not be much different.

There is also the HPV vaccine that everyone has asked about the most. This guide also clearly states: There is no need to wait for the nine-price vaccine. Women aged 9-45 (actually it is also recommended for men, but it has not yet been approved for domestic indications) can get what is available first. The two-price vaccine has the same protection rate against HPV16 and 18, the two highest risk subtypes, as the nine-price vaccine. There is no need to wait for three to five years for the nine-price vaccine, which delays the best time for vaccination. Of course, some scholars think that if you are still young and have no sex life for the time being, it is okay to wait for nine prices. This depends on personal choice.

Finally, let me talk about two pitfalls that people often step into. They are all high-frequency problems I have encountered in the past two years of missionary work:

The first is whether to test for antibodies before vaccination? Many institutions on the market now promote antibody testing packages, which cost hundreds of dollars. They say that if the antibody test is low, then take the test. In fact, there is currently no unified standard for judging antibody protection in China. The value you test cannot indicate whether you have protection. It is a waste of money. The guidelines also clearly do not recommend routine antibody testing before vaccination.

The second question is, can I be vaccinated against COVID-19/shingles if I have just received other vaccines? You don’t have to wait too long, just 14 days apart. If you have just received urgently needed rabies vaccine or tetanus vaccine, you don’t even need to wait, just take it directly. There will be no conflict.

After all, the guideline is a reference frame for most people, and it is never a one-size-fits-all standard answer. If you are not sure whether you should get vaccinated or which kind of vaccination, go directly to the community vaccination site near your home and ask. The doctors there deal with these situations every day and can give you the most appropriate advice in three or two minutes. It is much more reliable than reading all kinds of conflicting information on the Internet.

By the way, remember to bring your ID card before vaccination. If you have underlying diseases, please bring your recent medical records or medication records to avoid running back and forth.~