CME INDIA Presentation by Admin.

Have facts not social media fears – CME INDIA Appeals to All

Role of vaccine is also therapeutic. It means it will prevent severity of infection. Remember, Vaccination is a rule, exception is extraordinarily rare and, in most people, contraindication can be converted into indication.

Panic Mode Variant strain of SARS-CoV-2

• We are aware that a new variant of SARS-CoV-2, B.1.1.7, emerged as the dominant cause of COVID-19 infection in the United Kingdom. Since November 2020, it created a big alert and increased transmission, morbidity and mortality. It was so fast in transmission that Lockdown was reimposed.
• World was at loss when vaccine efficacy was discussed in relation to new strain.
• Now very important news is that “Interpretation Efficacy of ChAdOx1 nCoV-19 against the B.1.1.7 variant of SARS-CoV-2 is similar to the efficacy of the vaccine against other lineages.”
• Another great news is very illuminating. Vaccination with ChAdOx1 nCoV-19 (Indian Counterpart is COVISHIELD) results in a reduction in the duration of shedding and viral load, which may translate into a material impact on transmission of disease.

Pre-Print Study appeared on 5th of Feb 2021

• Using convalescent sera, study suggests, there may be a reduction in neutralisation activity against pseudo virus expressing B.1.1.7 spike protein compared with pseudo virus expressing wild-type spike protein.
• Preliminary data using sera of vaccinees who were immunised with mRNA vaccines (Pfizer/Biotech, Moderna) and protein vaccines (Novavax) found either no or modest reduction in neutralisation activity against pseudo viruses containing single mutations found in B.1.1.7 or B.1.1.7 whole spike protein.

STOP vaccine hesitancy among people

• Even if “The B.1.1.7 variant“ becomes a new wave in India, this study brings hope that we will be protected. Lots of Vaccination INERTIA is driving the scenario critical. If we do not go to cover the vaccination drive to appropriate level, we might lose the game.
• Worth to remember, ongoing use of ChAdOx1 nCov19 in mass vaccination programs is vital to both prevent symptomatic B.1.1.7 disease and reduce viral transmission.

Fear needs to be replaced by facts

• If your patient suffers from Asthma
  • People who have history of allergies should be vaccinated as per standard allergy protocol
  • Advice montelukast day before, on the day of vaccination and the day after along with H1 and H2 blocker + scratch test on the day of vaccine administration or intradermal test (1 in 100 dilution) to detect hypersensitivity. This can also be done prior to COVID-19 vaccine similar to a sensitivity test done for penicillin.
  • Do a CBC (look at eosinophil levels), IgE and CRP. If eosinophils and IgE are high but CRP is less than one, take H1 and H2 blocker with montelukast and go ahead with the vaccine. Stay at least for 2 hours in the vaccination centre after the vaccine.

• If Immunocompromised
  • Colchicine may help to prevent COVID-19 reaction in immunocompromised people.
  • Colchicine increases activity of dendritic cells and makes antigen presenting cells more active. It is immunomodulator and increases vaccine efficiency.
  •  Colchicine enhances immunogenicity of the vaccine.
  • People who have CRP more than one and are high risk should take colchicine before taking the vaccine.
  • A leading Immunologist has warned US FDA on the immunological danger of Covid-19 vaccination in recently convalescent and asymptomatic carriers, especially those who are elderly, frail or have significant cardiovascular risk factors. Colchicine can be the answer for this.

(Disclaimer: No clear recommendations about use of Colchicine in above statements. It is based on expert’s opinion only so common-sense wisdom to be applied)

• Mild corona is not better than vaccination
  • As post-COVID-19 symptoms may last for more than 9 months according to a latest study. So always better to be vaccinated
  • The binding antibody response seen after a vaccine is much more than the response to a natural infection.
  • Binding antibodies can be detected by IgG S antibodies as a screening method and antibody-specific binding antibody test after the vaccine.

• The message: Vaccines are 100% effective against severe disease.
  • Vaccine will convert severe illness into mild illness.
  • We have yet to see a case of vaccine failure COVID-19 dying.

India approached HERD IMMUNITY, then why Vaccine?

• Why one should take a vaccine when we are approaching herd immunity.
• The answer to this comes from Brazil.
• There is a second COVID-19 wave in Brazil despite herd immunity (76%) by natural infection.
• Four reasons have been given for this:
  1. Overestimation of herd immunity
  2. Waning immunity
  3. Immunity-evading mutations
  4. Highly transmissible virus (South Africa variant).
• Therefore, a second wave can come even after vaccine or after natural immunity. This will be a mild disease.

No Issues with ASPIRIN

• Low dose aspirin does not diminish the immune response to monovalent H1N1 influenza vaccine in older adults.
• ICMR has clarified that those patients on blood thinners are not a contraindication for vaccine.
• Every contraindication can be converted into an indication.

CME INDIA Tail Piece

Emerging Consensus with COVISHIELD

• Taking all this evidence together, the 12-week gap between first and second dose is clearly the better strategy as more people can be protected more quickly and the ultimate protective effect is greater.
• Given the poor efficacy at preventing asymptomatic infections, the vaccine will not stop transmission of covid but will still go a long way to reduce the R value and transmission because there will be far fewer symptomatic infections and people who are symptomatic are rather more infectious than those who are asymptomatic.

Dr A K Singh, Kolkata shares..

Magic of vaccination:A real case history* –

43 year old male physician detected Covid with RT-PCR confirmed diagnosis on Sept 6, 2020. Total antibody (IgM+IgG) semi quantitative report found a titer of 1.17 (Normal value <1) on September 20, 2020. IgG index become 0.57 (Normal value <1) on December 11, 2020. Vaccinated with Covishield on January 16, 2021 and total ab (IgM+IgG) Ion 21st day of vaccination (1st dose) is now 21.5 (Normal value <1).

Morale: vaccine induces antibody formation much higher than the natural infection. Everyone must be vaccinated irrespective of previous Covid infection!

Source:

https://ssrn.com/abstract=3779160 {Review under Lancet}

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