CME INDIA Presentation by Admin.

The Mega Launch

16th January has been recorded in history now. Some got vaccinated and more are in waiting list. Triumph over virus is palpable. Some doubts remain regarding its efficacy and side effects. However, Dr. Rakesh Sahay, eminent endocrinologist, Hyderabad shares in CME INDIA after getting the vaccine: Everything fine as of now, strongly advocate everyone to go for it as soon as your turn comes but Dr Ambrish Mithal, DM Endo, Delhi says – phir wahi sawaal… mera number kab aayega🤔😄…

Those who got Vaccinated:

What will Change now onwards?

• The vaccine will prevent— severe disease.
• It will convert Covid-19 from the global threat to a simple common cold.
• Protection becomes apparent just 10 to 14 days after the first dose.

Booster

• We do not have information about the durability of protection.
• There is currently no specific recommendation for booster doses.

Several good reasons to be optimistic about the vaccines

Can vaccinated persons infect other normal or immuno compromised persons? If yes, how long will the post vaccination spreaders be in infectious phase?

Dr Mahadev Desai, Ahmedabad:

Till they continue to shed virus, which we all know is usually 10 to 14 days, unless they had recent severe infection (where in they would not have ideally been vaccinated).

Dr H D Sharan, Ranchi:

Vaccine does not stop virus from entering the body. It minimizes its effect. So, if you get a virus, you will be able to transmit it also. The infectious period will be same as for asymptomatic or mild cases i.e., 10 to 14 days.

• Up to 40% of people who get infected with SARS-CoV-2 have no symptoms but may still transmit the virus to others.
• Even after one dose, the vaccine has a protective effect in preventing asymptomatic infection.
• We should continue to emphasize to our patients that vaccination does not allow us to stop other important measures to prevent the spread of Covid-19.

HOPE for REACTOGENIC Response

Dr Manisha Singh, Nephrologist, USA:

1. I do not know if I can be counted – I took 2 doses of Pfizer vaccine – 3 weeks apart. Got mine last week Thursday.
2. The side effects for the first vaccine were like tetanus vaccine – pain in arm. Then had headaches and diarrhea for 2 days – aspirin helped. After second dose the headaches were way worse, had body aches and chills, also diarrhea – this lasted 3 days. I took call over this period so was busy enough to focus away. Also, took scheduled paracetamol /8 hourly.
3. I took the call over this period
4. I am sharing only to update about the side effects – I know things in India would be different.

• No vaccine (actually, nothing in medicine) is 100% safe.
• “Reactogenic” — meaning that they will cause some side effects in some people who receive them, reflective of the brisk immune response
• Spotlight for some time — these are new vaccines for a new disease. Rare events will appear in the news, amplifying attention and worry disproportionate to the actual risk.
• Physician’s task will be to put these uncommon events into perspective, underscoring that these risks are far lower than the risk of getting sick with Covid-19.
• Hypersensitive reaction the current leading suspect in causing these reactions is polyethylene glycol, a compound present in both vaccines. Because of these rare events, administration of the vaccines includes a period of 15 minutes of observation after vaccination — 30 minutes for those with a history of severe allergic reactions of any sort.
• It’s critically important to emphasize that allergic reactions are uncommon — the current estimate is that anaphylaxis will occur at approx. 1 in 100,000 doses.

What will vaccine will do in long-term? Is it safe?

• We have only months, not years, of follow-up.
• Long-term side effects with vaccines have not been seen with other vaccines.

Missing the 2nd dose

• The schedule does not need to be precise; a “grace period” of 4 days around the 21- or 28-day interval for the second dose is considered valid.
• If a patient misses this grace period for the second dose, no length of interval between the first and second dose for either vaccine invalidates the first dose. In other words, there is no need to start over; just give the second dose as soon as possible after the 21- or 28-day target.
• Prime it, Boost it
• The goal of the first vaccine is too “prime” the immune response; the second “boosts” it. Although most participants in the trials received their second dose on or close to the scheduled time, there is no biological reason why receiving the second dose late would diminish the effectiveness of the vaccine, provided it’s received before too long an interval. In practice, the second dose should be given as soon as possible after the missed scheduled dose

Get the same vaccine as 2nd dose

• It should be completed with the same vaccine on the recommended schedule.
• There are no safety or efficacy data on using one vaccine for the first dose and a different vaccine for the second

Post convalescent plasma therapy: Caution

• Monoclonal antibodies or convalescent plasma for treatment of Covid-19 could theoretically reduce the efficacy of the vaccines.
• Anyone who has received these treatments should delay receiving the vaccine for at least 90 days.

30 minutes Watch if history of Allergy

• Someone with a history of allergies can definitely receive the vaccine — it doesn’t matter whether it’s an allergy to other vaccines or medications or to bee stings or food or pollen. However, people with these histories should be observed for 30 minutes after receiving the vaccine, rather than the usual 15 minutes.
• There have been rare cases of severe allergic reactions to the first dose. When this occurs, the second dose should not be given.

Immunocompromised

• Vaccine effectiveness depends on an intact host response; as a result, immunization might be less effective in immunocompromised hosts than in the general population.
• When immunizing immunocompromised patients for Covid-19, we should counsel them about this potential difference and hence about the continued importance of other prevention measures, such as mask wearing, social distancing, avoidance of crowds, and hand washing. Household members of those with weakened immune systems should also be immunized if possible.
• We will need to consider holding or delaying immunosuppression on a case-by-case basis, depending on the seriousness of the underlying condition and the urgency of its treatment.

Pregnancy and Lactation

• Although pregnant and breastfeeding women were not enrolled in the Covid-19 vaccine trials and as a result there are limited data about safety
• There is no theoretical reason why vaccines would be harmful to the mother during pregnancy, to a developing fetus, or to a breastfeeding infant.
• Also reassuring is that gestating rats receiving the Moderna vaccine did not demonstrate any safety concerns related to fetal or embryonal development.
• Pregnant women should be informed that observational studies show that pregnancy is a risk factor for severe illness due to Covid-19, much as it is for influenza.
• On the basis of this information and the likelihood they have of Covid-19 exposure, along with information about the limited safety data available to date, pregnant women can make an educated decision about whether to accept the vaccine.

Should paracetamol or nonsteroidal anti-inflammatory drugs be taken prior to vaccination to prevent post-vaccination symptoms?

• Although these drugs could decrease subjective side effects, theoretically they could also blunt immune response and make the vaccines less effective — hence they are not recommended before vaccination.
• They are useful, however, in diminishing side effects once they occur. Paracetamol is preferred for pregnant women.

Delayed if a patient has any symptoms or is actively ill?

• Vaccination should be deferred in people with acute illness, preferably until after they recover.
• However, people with chronic diseases and stable symptoms are eligible to receive the vaccine; examples would be people with COPD and dyspnoea on exertion or those with inflammatory bowel disease and gastrointestinal symptoms.
• Many of the participants in the phase 3 clinical trials had underlying medical problems, and although they were not acutely ill, some presumably had symptoms from their diseases — that’s the nature of chronic medical conditions.

If exposed to Covid-19, can you receive the vaccine in order to prevent the disease?

• Currently there are no data to support use of the Covid-19 vaccines acutely to prevent disease after a known exposure to an active case.
• Since the incubation period for Covid-19 averages around 5 days, it is unlikely that the vaccine would elicit an immune response quickly enough to block infection.
• As a result, people who have been exposed to Covid-19 should finish their 10- to 14-day quarantine before undergoing immunization.

Recovered from Covid-19 – take the vaccine?

• Yes, take the vaccine.
• Some of the people who participated in the clinical trials had evidence of prior SARS-CoV-2 infection (based on a positive antibody test), and the vaccines were safe and effective.
• Re-infection after recovery from Covid-19 is rare in the first 90 days, some people may wish to defer immunization for this long — however, if they wish to be immunized sooner, there is no contraindication.

Diagnosed with Covid-19 shortly after the first dose -what to do with second scheduled dose?

• The vaccine begins to generate protective immunity 10 to 14 days after the first shot.
• After their immunization, and we naturally wonder whether they should proceed with the second shot as originally scheduled if got the acute disease.
• The current recommendation is that people with current infection should wait until they have recovered from the acute illness

How does the vaccine affect the evaluation of a patient and diagnostic testing for possible Covid-19?

• The Covid-19 vaccines will not influence the results of PCR or antigen testing for the disease. The vaccines do generate antibodies to SARS-CoV-2, which are directed at the spike protein. Some available serologic assays test for this antibody; others do not.

After people receive the vaccine, should there be any testing to determine whether the vaccine worked?

• People vaccinated with the Covid-19 vaccines develop antibodies to the spike protein of SARS-CoV-2. However, there is currently no recommendation for postimmunization serologic testing.

Does our status become RT PCR positive after taking full dose of vaccine and attaining full immunity?

Dr Anupama Ramkumar Physician, Clinical Researcher, Ahmedabad:

• No, that won’t happen. The PCR is assaying the antigen… the vaccine will generate antibodies, rather trigger the generation of the antibody response.
• The various vaccines have 58 to 95 % efficacy. So, if someone contracts the infection in spite of the vaccine- the RT PCR will remain a valid test for them too.

Is it safe to vaccinate?

Dr N K Singh:

• One of my friends at Delhi says – I got vaccinated 24 days back with covishield with excellent Antibodies response even after first dose.
• If we remain humble and grounded in nature’s wisdom, our mind will guide us safely through the confines of unawareness and the blindness of ignorance. 

We can expect that God willing; vaccination will prevent the second wave.

Update by Dr H D Sharan, Ranchi:

Friday, 15/1/2021

Total New COVID-19 cases in India-15164

57.8 percent of total cases came from these 2 states. No other state had new cases in 4 digits. These two were followed by:

Compared to November

Reduction in number of cases in India 62%>

Reduction in number of cases in Kerala and Maharashtra just 16%

We can expect that God willing; vaccination will prevent the second wave.

So, if we put all our efforts and resources to control spread of infection in Kerala and Maharashtra and be strict about people coming from abroad having RT PCR Negative Certificate, we should be able to control the Pandemic by first half of April.

Remember, my prediction about cases coming down from 3rd week of September was proved to be true.

HCQ attenuates the antibody response to vaccine

Dr Awadhesh K Singh, DM, Endo., Kolkata:

• Please note that: HCQ attenuates the antibody response to vaccine – at least some data hinted to that!
• Congratulations to all vaccine recipient – first day, first show. Waiting for our turn, but I don’t know how would I get informed about the date time and place!

CME INDIA Tail Piece

By ✍️ Dr. Amit Manohar, Internist, Aurangabad, Bihar:

• 16 January, 2021.We have done. ✌️👍👌👏
• Today We start the World’s ever greatest Vaccination 💉 Programme against #CoViD19.
• We’ve invented not only a single but a couple types of indigenous #CoronaVaccines.
• All the credits go to the #Doctors, scientists, other consulted persons and above all……. No one but our all-time best leadership. Prime Minister Mr. Narendra Damodar Modi.
• And above all…. We condemn all the political persons & parties, social & religious people & organizations and irrelevant movements /andolans /statements against our benevolent PM since the first day of the Corona pandemic. The only & only motto was /is /will to derail the field of the national development and the crusade against the COVIDVirus.
• We’ve successfully crossed the phase of the scarcity of PPE kits, masks, sanitizers, testing kits etc. and now we don’t import but are self-efficient and sufficient. But we the Nationalist people of India have not only set them aside but have been hitting the bouncers over the fences for 6s.
• We all the citizens of the great nation are almost unite and will never give wall to the scoundrels in coins.
• We’ve melted the stones and now have 2 arsenals i.e., #CoronaVaccines in record time. This is world’s best quality #CoronaVaccine and most easy to transport, to carry, to maintain the cold chain and to administer.
• We’re going to start the immunization programme firstly with the #Doctors, paramedics, nursing staffs of Government and Private organizations. then the concerned people with security & sanity. then the senior citizens & people suffering from severe illnesses……. and lastly the remaining.
• We are not only the world’s no. 1 in the vaccine’s productions but the cheapest & most affordable producer since years. We’re taking care of the globe too and are going to export the #CoronaVaccines, firstly to the neighboring countries and then the rest.
• Form is temporary but class is permanent……. You’re well acquainted with the dictum……… But nowadays…… Not only our form but the class also remains permanent… under the scintillating leadership of our PM
• Tribute to the #CoronaWarriors who sacrificed their lives to save the mankind. The nation will never forget your martyrdom. 🙏🙏
• #Beware…2 doses of #CoronaVaccine are compulsory with one month interval and the immunity will start 2 weeks after the last dose. You must take care of all the previously suggested safety precautions #SocialDistancing #Handwashing #Sanitization #Wear_Mask etc. etc.
• We’re #Aatmanirbhar…… Yessss…!!!!! India is Aatmanirbhar! We’ve done it and will definitely be chanting the triumphs… 💯✌️
• Sarve Bhavantu Sukhinah…Sarve Santu Niramayah…!!! Jay Hind!!! Vande Mataram!!!

Further Reading

https://www.nejm.org/covid-vaccine

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