Why are children not being offered the booster even though the EMA approved it? – Angie Borg
In February 2022, the European Medicines Agency, EMA recommended that a booster dose of Comirnaty may be given where appropriate to adolescents over the age of 12 years. This followed on the evaluation of safety and efficacy data and considered that the available evidence was sufficient to conclude that the immune response to a booster dose in adolescents would be at least equal to that in adults.
Malta is following the epidemiological situation. At this stage, we have not seen increased admissions of this age group with complications of COVID-19 and those with a primary schedule are not disproportionally more affected than those of older age groups with a booster dose. Therefore, we will continue to monitor the situation to see when it is best to offer the booster to the 12- to 17-year olds.
Can you please explain the criteria Malta uses to determine in which group (red or dark red) a country should be placed? – Romano Cassar
On June 30, 2020, the European Council adopted a recommendation on the gradual lifting of restrictions on non-essential travel into the EU. The main elements of the recommendation were updated on May 20, 2021 and on February 22, 2022. Malta has effectively implemented a hybrid approach, taking into account both the situation in a third country and the individual vaccination status of the person.
To classify a country as red/dark red, the first criterion is the testing rate in the country. For inclusion in the red list, a country needs to be consistently testing a high enough rate of the population per week to be in a position to detect a new wave in a timely manner and before it grows out of control and poses a threat to other countries.
If testing is adequate, that is, similar to the limit requested of EU countries by the EU Council, then the percentage of tests resulting in positive tests is taken into consideration.
If this is excessively high, then a country would be relegated to the dark red list until the epidemic wave shows clear signs of subsiding.
Travel measures in this pandemic have helped to slow down the entry of new variants, allowing Malta to pass through each wave with much lesser positivity than other countries in Europe, thus allowing the health system to cope with any increase in demand and to limit mortality which we know is very much linked to the stock of infections in the country, or our positivity rate. The red list, where vaccinated persons can travel freely to Malta, currently includes 81 non-EU countries in addition to the 27 EU member states.
The European Council-updated recommendation of February 2022 indicates that it is appropriate to start considering moving to a purely person-based approach. To give time to third countries to increase their vaccination rates, the recommendation will be reviewed by the Commission by April 30. Malta is participating in discussions on this matter with a view to further adopting travel measures.
Why are those under five being treated like non-vaccinated when it comes to quarantine? Why can they not be tested and released on day seven? What evidence is there of asymptomatic babies and young children becoming positive after a negative test seven days after exposure? – Jenny Davies
The University of Copenhagen and the Danish Statens Serum Institut looked at the transmission of Omicron subvariant BA.2 versus BA.1 in Danish households. They found an overall secondary attack rate of 39 per cent in BA.2-infected households, compared to 29 per cent in BA.1-infected households.
The risk of being infected was higher in unvaccinated persons compared with vaccinated and booster-vaccinated household members in both BA.2- and BA.1-infected households.
This clearly shows the beneficial effect of vaccination in transmission for both Omicron variants. Therefore, periods for isolation and quarantine differ for those who are vaccinated and those who are not vaccinated. This is also in line with the ECDC guidance which was recently reviewed.
What percentage of cases are of the Omicron subvariant? – Mike Vella
Omicron has rapidly replaced SARS-CoV-2 Delta in most European countries. Since Omicron can to a degree evade the protective effects of antibodies elicited by a two-dose primary vaccination or natural infection, it has resulted in sharp increases in the number of COVID-19 cases. Malta reached a peak of 16 per cent positivity rate in the first week of January 2022. The latest evidence, which includes real-world effectiveness data, shows that people who have had a booster dose are better protected than those who have only received their primary course. The wide roll-out of the booster in Malta clearly made an impact on the situation.
Omicron sublineage BA.2 has increased to become dominant in Denmark and is increasing in several European countries. For Malta, genomic sequencing of positive tests for week nine (February 28 to March 6, 2022) were 86 per cent BA.1/BA. 1.1 and 13 per cent BA.2.
Studies are ongoing to understand the reasons for this growth advantage of BA.2. From studies, BA.2 appears to be more transmissible than the initial Omicron variant. The European Medicines Agency is receiving and assessing data on effectiveness of COVID-19 vaccines and treatment against this variant. For now, vaccines seem to protect people against the BA.2 subvariant as they do against the original Omicron strain.