CME INDIA Presentation by Admin.

With new strains all over world, COVID-19 has posed a new challenge. Vaccine is 2021 new hope, but fear exists. Will new strain of virus bypass all the efforts. This story tells the ongoing conflict in physicianโ€™s mind.

We think we have figured out the winning formula and how to get efficacy that, after two doses, is up there with everybody else Chief Executive AZ-oxford/Tied-up with Serum Institute, India.

Which COVID vaccine to take?

CME INDIA Discussion

Dr Awadhesh K Singh, DM Endo., Kolkata: With the ongoing mutation in the spike protein of SARS-CoV-2 which vaccine ๐Ÿ’‰ would work more efficiently in your opinion?

  1. Pfizer
  2. Moderna
  3. AZ-Oxford
  4. Covaxin

Dr Meena Chhabra, Diabetologist, Delhi: Astra Zeneca.

Dr Awadhesh K Singh, DM Endo., Kolkata: Please feel free to answer but surely with explanation ๐Ÿ˜

Dr Satish Kumar, Cardiologist, Bokaro:

Covaxin, being inactivated total Covid Virion, some or the other antigen are more likely to cross react with those of the new strain, compared to others. But, ultimately only the time would tell I still believe the Covaxin would be the ‘lambi race ka ghoda.’

Dr Meena Chhabra, Diabetologist Delhi: Why nowhere in the world this technique was used? Inactivated total COVID-19 virion may not produce enough antibodies.

Dr Satish Kumar, Bokaro: As per the comparative chart, the antibody level was equal to Oxford/Astra and much better compared to the Chinese.

Which COVID vaccine to take?

Dr Awadhesh K Singh, DM Endo., Kolkata: These chart makes people more confusing. How can one compare phase 1/2 results of one vaccine with phase 3 results of other vaccine? ๐Ÿ˜ฌ๐Ÿ˜Š๐Ÿ˜

Dr N K Singh: 3, AZ/Oxford.

Dr Awadhesh K Singh, DM Endo., Kolkata: Why? Is it because in news ๐Ÿ˜๐Ÿ˜Š?

Dr Noni G Singha, Dibrugarh, Assam: Pfizer vaccine will be the choice. T cell mediated and Antibody formation occurs in all vaccine. Inactivated and viral vector will have antibodies to the type of strains used only and it is not sure these antibodies while work on different strain. If at all works then only percentage of similarity of spike proteins match between the strain.

Whereas Messenger RNA vaccine where RNA particular is used to produced antibodies which may cover for many different strains. Even there is a study in Germany where Pfizer vaccine has been shown to be protective in different mutants.

Dr Awadhesh K Singh, DM Endo., Kolkata: By this funda Moderna should work better ๐Ÿ˜๐Ÿ˜ท

Dr Noni G Singha: Antibody production is highest with Pfizer

Dr Awadhesh K Singh, Kolkata: That is for original virus ๐Ÿฆ  Q asked is for mutated virus ๐Ÿ˜ Moreover 100% antibody for all 3.

Dr N K Singh: The CDC says-Vaccines approved by FDA are โ€œpolyclonalโ€, producing antibodies that target several parts of the spike protein. The virus would likely need to accumulate multiple mutations in the spike protein to evade immunity induced by vaccines or by natural infection. As per WHO, laboratory studies are ongoing to determine whether these variant viruses have different biological properties or alter vaccine efficacy. There is not enough information at present to determine if this variant is associated with any change in severity of clinical disease, antibody response or vaccine efficacy. So, take anyโ€ฆ

Dr Raj Kamal Chaudhary, Asso. Prof Med, Bhagalpur: All vaccines are going to work because Vaccines train the immune system to attack several different parts of the virus, so even though part of the spike has mutated, the vaccines should still work.

Dr S S Darriya, Diabetologist, Jaipur: Covaxin.

Dr Anupam Gupta, Asansol: Covaxin.

Dr T Rekha, MD Med., Salem, TN: mRNA vaccines instruct cells to produce spike proteins which activates immune system to produce antibodies. The other types are inactivated & vector based. So, if there is mutant variant also mRNA vaccines can instruct host to act accordingly, I think.

Dr Awadhesh K Singh: If virus develops multiple mutation in spike protein (as of now 17 at least) then how come vaccine made by the manipulation of non-mutated spike protein would work?

Dr Kapil Sud,Internist, Delhi: Covaxin.

Dr Jagdeeshan, Chennai: Kindly mention the reason also, because covaxin phase 3 trial itself not yet over. It is as per phase 2,60 % effective. So, we need to wait n see phase 3 trials. Who says a vaccine should have minimum 50% efficacy. India mostly will get Oxford vaccine first. Its CEO claimed 95% efficacy.

Dr P R Parthasarathy, Chest Physician, Chennai: Theoretically speaking none of the vaccines should be effective as per their earlier estimates as the mutations has occurred in the spike protein.

All the vaccines presently available are based on this. So, their effectiveness will come down. It’s possible to make modifications in all these vaccines based on the genomic structure of the new mutated virus. We will have to wait & watch.

Dr H D Sharan, Ranchi: The one that will come later. ๐Ÿ˜€

Dr Sajeev Kumar Pathak, Ahmedabad: We have hope with:

  • RNA Vaccine (Moderna, Pfizer)
  • Viral Vector (Oxford/AstraZeneca)
  • Gamalaya-Sputnik)
  • Viral Subunit (Novavax)
  • Live Attenuated (Codagenix, Indian Immunologicals Ltd.)
  • Inactivated Virus (SinoVac, Covaxin)

I think Pfizer and moderna vaccines are developed to recognise a specific spike protein of original strain which is not the case with AZ or COVAXIN.

Which COVID vaccine to take?

Dr Awadhesh K Singh, DM Endo., Kolkata:

  • I donโ€™t know the answer since no such H2H trial exists that compared different vaccines that too in mutated strain ๐Ÿ˜Š๐Ÿ˜œ๐Ÿ˜Š
  • However, there are several theoretical assumptions that suggest spike protein-based vaccine will lose efficacy with ongoing mutation when live attenuated vaccine should still work.
  • ๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป Dr. Satish ๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป๐Ÿ‘๐Ÿป

Dr Nandini Rastogi, Kanpur: Letโ€™s hope so!

Dr Sanjeev R Pathak: Let us hope that none of the vaccines lose their efficacy against newer and newer strains.

Dr S K Goenka, Begusarai: Even if the strains do not changes, the effect of all vaccines fades away in due course of time except a few like measles, tetanus, whose effects lasts a bit longer than others.

Disclaimer:

1)Please be alert that discussions in this article is based on general perception and available scientific sources. These are not opinions of virologists or even a specialist in vaccines.

2) To avoid confusion it is to be appreciated that everyone can have an opinion, which may not be scientifically correct. Such discussions help us to peep into right direction to some extent


CME INDIA Learning Points

  • All available vaccines stimulate a primary immune response so that the body can develop memory B and T cells against the SARS-CoV-2 virus.
  • The most important fact is, the development of immune memory by vaccines is what will protect the person against subsequent COVID-19 infection
  • It is pursuit of multiple vaccines that will allow the global population to be immunized sooner.
  • Similar to live-attenuated vaccines, viral vector vaccines can stimulate strong antibody and T cell responses as the virus is able to (slowly) infect cells to produce and display the S protein on the cell surface.  This allows both B and T cells to be activated, producing strong immune responses and memory.
  • Inactivated vaccines are considered safer to use than live-attenuated vaccines with fewer side effects. as the vaccine components cannot replicate inside the body, eliminating the possibility of infection.
  • The inactivated pathogen cannot replicate inside the body, more than one dose of the inactivated vaccine is required to give the body time to develop immune memory against the SARS-CoV-2 virus. Inactivation of the pathogen may alter the shape of the antigens which may be different from the original version. Hence, the body may not generate the correct immune memory response against the original SARS-CoV-2 virus.
  • WE DO NOT KNOW the exact answer of question asked in this story. What to talk of mutating virus scenario, even we are ignorant of the following:
    • Duration of protection
    • Effectiveness against transmission
    • Vaccine effectiveness against asymptomatic infection. Data is limited to assess the effect of the vaccine against asymptomatic infection as measured by detection of the virus and/or detection of antibodies against non-vaccine antigens that would indicate infection rather than an immune response induced by the vaccine
    • Effectiveness or safety among certain high-risk populations, such as children less than 16 years of age, pregnant and lactating individuals, and immunocompromised individuals.
    • Benefits of individuals with prior COVID19 infection. But, given there is documented reinfection, the FDA stated that previously infected by people could benefit from vaccination Vaccine effectiveness against long-term effects of COVID-19 disease COVID-19 disease may have long-term effects on certain organs, and at present it is not possible to assess whether the vaccine will have an impact on specific long-term sequelae of COVID-19 disease in individuals who are infected despite vaccination. Demonstrated high efficacy against symptomatic COVID-19 should translate to overall prevention of COVID-19- related sequelae in vaccinated populations,
    • It is possible that asymptomatic infections may not be prevented as effectively as symptomatic infections and may be associated with sequelae that are either late-onset or undetected at the time of infection (e.g., myocarditis)


CME INDIA Tail-Piece:

Dilemma of Science:

Which COVID vaccine to take?


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