CME INDIA Presentation by Admin.

Many questions are being faced by physicians regarding COVID vaccines. When to take and when to avoid-know all at one place. Excerpts of Meeting held with Dr Raman Gangakhedkar and Expert panel of Dr Harish Moorjhani (New York), Dr SK Gupta, Dr Pankaj Chaudhary, Dr Ruby Bansal, Dr Vijay Arora, Dr Ashok on 25 Feb 2021 under aegis of East Delhi Physician Association regarding Current Vaccines and Newer Strains of Corona Virus).

One Act, Tremendous Impact

25 realities of COVID vaccination issues

CLEAR the Myths:

1. 100% Efficacy in Preventing Death

  • All approved vaccines including Pfizer, Moderna, Covishield and Covaxin have ~100% efficacy in preventing Death due to Covid.
  • Very High efficacy against Severe Covid.
  • High to moderate efficacy (60%-95%) against symptomatic Covid.
  • Poor efficacy only against asymptomatic Covid.
  • So, people should not run after efficacy data while choosing a vaccine.

2. Everyone should get vaccinated

  • Because all vaccines prevent severe covid and death. Vaccination of large cohort of population is important if we want to save the humanity from ill effects of the current pandemic.
  • Everyone should get vaccinated and encourage others to get vaccinated.

3. Nasal Vaccine may be the Answer

  • Nasal vaccines might be able to prevent even asymptomatic Covid because it generates local IgA antibodies – cutting chain of transmission and bringing an end to this pandemic.

4. Pregnant ladies can be safely vaccinated

  • Vaccination of 10000 pregnant ladies has been done in USA without any additional side effects seen up to 3 months of follow up. Hence, Pregnant ladies can be safely vaccinated.

25 realities of COVID vaccination issues

5. Allergy to food etc. – not a big deal

  • People with allergy to food, drugs, latex, venom previous non covid vaccine can safely take covid vaccine.

6. If history of severe Anaphylaxis – Say No

  • Only People with severe anaphylaxis to previous covid or non covid vaccine should avoid Covid vaccine.

7. When to vaccinate Post Covid

  • People who have had Covid in past must go for Covid Vaccination four to six weeks after recovery.
  • Data is emerging that they might need just one shot of vaccine as Robust Neutralising antibody titres and Strong T cell responses have been found in them even after single shot of vaccination.

8. If Plasma Therapy Taken – Wait at least 4 weeks

  • People who have received Plasma therapy should wait at least four weeks before taking a vaccine. Because during these four weeks the preformed antibodies transfused in external plasma will wane off and this will avoid the neutralization of virus(protein) produced by Covid vaccine.

9. If suffered from severe illness

  • People with severe disease, who have been admitted, should wait at least 4 to 10 weeks after recovery before taking any vaccine.

10. Diabetes and Vaccine

  • People with Diabetes should go for vaccination after taking food/breakfast.

25 realities of COVID vaccination issues

11. If someone is on Steroids

  • People who are on Corticosteroids should decrease dose to less than 7.5 mg per day if possible, for six weeks when taking the vaccine because higher doses act as immunosuppressive and may decease immunity development.

12. No need to taper Inhaled steroids

  • Inhaled steroids may not be tapered when taking Covid vaccine because systemic bioavailability of inhaled corticosteroid is low.

13. Bronchial Asthma poses no danger as such

  • People with nasal allergy, Bronchial asthma skin allergy can be safely vaccinated

14. If on Immunosuppressive agents

  • People on immunosuppressive agents like 🌹methotrexate should stop the drug two weeks before and two weeks after the vaccine

15. Avoid for 4 weeks if Rituximab given

  • Rituximab given for Non- Hodgkin’s Lymphoma; Rheumatoid arthritis should be avoided for at least 4 weeks {drug acts by attaching to B cells}

16. Avoid at least 3 months if BMT

  • Those being treated for Blood cancer and who have been given Bone marrow transplant should wait at least 3 months.

17. Proceed if on Monoclonal Antibodies

  • Those being given Monoclonal antibodies can be given vaccine safely as it is not alive vaccine.

18. When to monitor by Absolute Neutrophil count

  • Those without bone marrow transplant/Cell therapy should wait for vaccine till Absolute Neutrophils Count returns to normal.

19. If planning to undergo surgery

  • Those who are planning to undergo surgery should take vaccine at least 2 weeks in advance for protection

20. Patients with Autoimmune diseases

  • For patients with Autoimmune diseases like SLE Sjogren’s Syndrome, no disease specific data exists but theoretically covishield and m RNA vaccination are unlikely to increase auto immunity. Vaccination should be encouraged though extra caution should be taken.

21. Target older people as priority

  • Older people should be encouraged to take vaccine as risk of Covid mortality is high among them.

22. Neurological disorders

  • People with Dementia, paralysis etc Neurological disorders should take vaccine as their Covid appropriate behaviour is likely to be compromised.

23. Immune Response could be poor

  • Stable CKD, Cardiac failure, Liver failure can take Vaccine but their immune response may be poor.
  • Which vaccine for immunocompromised? – Immunocompromised people should preferably be given Covishield vaccine as it has a non-replicating viral vector coding for spike protein.

24. Big issue of Anti-platelets

  • People talking Aspirin and Clopidogrel need not stop these drugs before vaccination.

25 realities of COVID vaccination issues
Courtesy SAKRA World Hospital

25. Anticoagulants and vaccine

  • People on anticoagulants can be given vaccine safely.

CME INDIA Illuminating Points

The math about “Vaccination Deaths”

(By Dr Rajeev Jayadevan, Gastroenterologist, Sunrise Hospital, Cochin)

  • How many people die every year among 1,00,00,000 (1 crore) population?
  • It was 72,300 per crore per year in India in 2018. That is ~6000 deaths/month.
  • For 80,00,000 people, it is 4800 deaths/month. This is called BACKGROUND DEATH RATE.
  • In the first month of COVID vaccination, 80,00,000 (0.8 CR) people got vaccinated in India. The expected background rate of death for this population is 6000 x 0.8 = 4800.
  • In other words, this number would have died whether vaccine was given or not. By the same token, 1600 people would have had heart attacks, several people would have got neurological events including ~1500 strokes.
  • This number must be kept in mind when discussing the topic of “DEATHS FOLLOWING VACCINATION”.
  • According to news reports, 11 deaths were reported in India in the past month “following vaccination”
  • This is nowhere near the expected death rate, & should not be confused for “death due to vaccine”.
  • Hence, background rates must always be kept in mind when we interpret news reports of deaths (and illnesses) among those who had been vaccinated previously.

CME INDIA Tail Piece

  • Bharat Biotech’s homegrown Covid-19 vaccine Covaxin, has shown an interim vaccine efficacy of 81% in late-stage clinical trials, the Hyderabad-based company said on Wednesday. That’s better than Bharat Biotech’s guidance last year of around 60% and India’s benchmark of 50% for vaccines targeting the novel coronavirus.
  • The trials involved 25,800 participants and was conducted in partnership with ICMR, the Indian government’s medical research body. This was the largest ever trial conducted in India.

25 realities of COVID vaccination issues
25 realities of COVID vaccination issues
Taking the second dose of COVISHIELD on 3rd March 21. No need to panic. Vaccination is the key to bypass the greatest misery of the century – Dr N K Singh, Editor, CME INDIA.

Discover CME INDIA

Discover CME INDIA