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
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.
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.
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. 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.
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2 questions have been asked
1. Dr Kamleshwar ftom Giridih…Can Thalassemia minor patients take vaccine
2. Can Renal Transplant patients take vaccine
Dr Kamleshwar Giridih: Can thalesemia minor can take Covid vaccine or not
Dr Sanjeev Yadav, Heamatologist,SGPGI, LUCKNOW: Off course, No contradiction
2. Regarding Q of renal transplant and vaccine
Dr SK Gupta MBBS MD(Med) CFM (France)Senior Consultant Physician,Max hosp,Delhi says: Most of Renal transplant patients are in Immunosuppressive drugs to prevent rejection
So the development of immunity likely to compromised .
Taking a killed virus vaccine with high safely profile lime Covaxin is the better option.
Secondly delay vaccination if there is super aided secondary infection.
Transplant recipients were excluded from recent SARS-CoV-2 vaccine trials, so neither efficacy, durability, nor safety are known in this patient sub-population
What is the ideal period between 1st n 2nd jab of covieshield..
Covishield dose interval fiasco: Recent data about better antibody response after the delayed 2nd dose needs to be interpreted with caution*.
In purported trial : With 6-12 week 2nd dose interval the data might be showing better efficacy but confidence interval (CI) too high (33-88) suggesting that there can be huge variation in efficacy from 33%to 88%. Govts seem to interpreting the same as per their compulsive needs.
*Given the fact that there is no shortage of vaccine in our country we should not take risk of lower limit of confidence interval (33%) and stick to old scientific principle of 28 days schedule*.
Excellent input
Nice report in easy elaborately way
Valuable information
At number 14 it is mentioned that people on methotrexate should stop 2 weeks before and two weeks after vaccination but according to ACR , Methotrexate should be witheld for one one week post vaccination . Comment please
Redponse from Dr SK Gupta
MBBS MD(Med) CFM (France) Max hosp. Delhi..
Lesser the Immunosuppressive drugs and duration better it is .
Experts may vary.
Since there is lack of direct evidence for covid vaccines in rheumatology patients, the recommendation are based on general immunologic principles observed with other vaccines to make recommendations on how to increase the likelihood of a favorable vaccine response.
Hence there may be variation. Some experts preferring Better response while others tilting in favour of managing Disease better.
And things may vary from patient to patient
The guidelines are continuously evolving. In my talk, I had mentioned it to be witheld for 2 weeks after vaccination. It is an abundant precaution…
Dr Raman Gangakhedkar
Asked by Dr Praveen,DM card,Ranchi: Can a Pt of hepatitis B take vaccine? Kindly give ur suggestion
Dr SK Gupta S K Gupta
MBBS MD(Med) CFM (France)
Senior Consultant Max,Delhi,
Yes, safely but the immunogenicity may be compromised. It may deferred in cases of Active liver damage
Cirrhotics have high case fatality rate with Covid Data with multiple non Covid vaccines suggest: cirrhotics have lower response rates with vaccines. Otherwise vaccines are well tolerated. Present recommendations from Aasld and easl supports vaccination for cirrhotics.
Patients with Platelet count more than 50000 can safely take Intramuscular injections.
Some cases of Idopathic thrombocytopenia Purpura have been reported with Pfizer vaccine and few case reports with Covishield too from Ranchi but by and large safe vaccine
Since there is lack of direct evidence for covid vaccines in rheumatology patients, the recommendation are based on general immunologic principles observed with other vaccines to make recommendations on how to increase the likelihood of a favorable vaccine response.
Hence there may be variation. Some experts preferring Better response while others tilting in favour of managing Disease better.
And things may vary from patient to patient
Some folks were given only one dose in first round of Vaccination as named were missing from the list. What should they do?
I think , now , you have option to register with cowin app and take it privately too. First ,you should try at any nearby government set up
My father aged 83 years and mother 81 years have been denied of this vaccination at one of the hospital in Ranchi. Doctor informed that no trial done beyond 76 years so they will not administer them. Is this correct? Whether people more than 76 years should not be vaccinated?
My father aged 83 years and mother 81 years have been denied of this vaccination at one of the hospital in Ranchi. Doctor informed that no trial done beyond 76 years so they will not administer them. Is this correct? Whether people more than 76 years should not be vaccinated?
Do we get intimation from the hospital for second dose date or there is a need register again