COVID-19 Archives

CORONAVIRUS VACCINE COMPARISON

Covid-19·March 1, 2021February 25, 2021

Coronavirus Vaccine Comparison – All of vaccines are typically need years for research and testing before it can be used clinically. But some of situation not required that because of emergency state happen in this pandemic era of Corona virus. The emergency of needing the vaccine as one of the prevention step to stop the spreading of the virus so each country developed their own research to make the best vaccine to help their own country and to help our world so we can fight and stand against the COVID-19 together.

So many vaccines are developed in each country around the world. But not all the vaccines are ready to be used. Researchers are currently testing 67 vaccines in clinical trials on humans, and 20 have reached the final stages of testing. At least 89 preclinical vaccines are under active investigation in animals. Some of us maybe didn’t understand about clinical trials, vaccine trials etc. But here some of the information about coronavirus vaccine comparison.¹

I. The Vaccine Testing Process

An ideal SARS-CoV-2 vaccine, to ﬁght the pandemic, should have the following features:²

Elicit long-lasting protective immune responses;
Should be given to everyone regardless of comorbidity or age, immune status, pregnancy/breastfeeding status;
Lack the potential to cause antibody dependent enhancement (ADE) or pulmonary immunopathology;
Should be thermostable in order to enable transportation and storage in developing countries with poor refrigeration facilities;
Be highly immunogenic in the general population including a population with preexisting anti-vector antibodies.

An experimental vaccine is first tested in animals to evaluate its safety and potential to prevent disease. It is then tested in human clinical trials, in three phases:

Phase I – in phase I, the vaccine is given to a small number of volunteers to assess its safety, confirm it generates an immune response, and determine the right dosage.
Phase II – in phase II, the vaccine is usually given hundreds of volunteers, who are closely monitored for any side effects, to further assess its ability to generate an immune response. In this phase, data are also collected whenever possible on disease outcomes, but usually not in large enough numbers to have a clear picture of the effect of the vaccine on disease. Participants in this phase have the same characteristics (such as age and sex) as the people for whom the vaccine is intended. In this phase, some volunteers receive the vaccine and others do not, which allows comparison to be made and conclusions drawn about the vaccine.
Phase III – in phase III, the vaccine is given to thousands of volunteers – some of whom receive the investigational vaccine, and some of whom do not, just like in phase II trials. Data from both groups is carefully compared to see if the vaccine is safe and effective against the disease it is designed to protect against.

Once the results of clinical trials are available, a series of steps is required, including reviews of efficacy, safety, and manufacturing for regulatory and public health policy approvals, before a vaccine may be introduced into a national immunization program.³

Early or Limited Approval : many countries have given emergency authorization from their government based on preliminary evidence that they are safe and effective.¹

Approval : regulators review complete trial results and plans for vaccine’s manufacturing, and decide wheter to give it full approval.¹

Combined Phase : one way to accelerate vaccine development is to combine phases. Some vaccines are now in Phase ½ trials, for example, which this tracker would count as both Phase 1 and Phase 2.¹

Paused or Abandoned : if investigation observe worrying symptoms in volunteers, they can pause the trial. After an investigation, the trial may resume or be abandoned.¹

II. CORONAVIRUS VACCINE COMPARISON

Table 1. Lead SARS-Cov-2 candidate vaccines with EUA granted, in phase III trials, or licensed (prior to phase III trials)³.

φ Storage or transportation temperature. * SU not deﬁned in trial. A amount of 3 µg was proposed for a phase III trial [30]. 1x = 1 immunization. 2x = 2 immunizations. VP = virus particles. NA = not applicable. ** Phase I/II studies used two different doses: 5×1010 and 1×1011 virus particles [31]. *** Phase I/II studies used 1×1011 virus particles/dose [32]. # Two versions are available: a frozen version and a lyophilized version, Gam-COVID-Vac-lyo, to be reconstituted. % Approved for use in Chinese military. € Approved for use in Russia. ∑ EUA granted. $ NAAT = nucleic acid ampliﬁcation test.

NO	COMPANY	VACCINE NAME
1.	Pfizer(New York) and BIONTECH (German)	Comirnaty (also known as tozinameran or BNT162b2
2.	Moderna(Boston) and National Institute of Health	mRNA-1237
3.	AstraZaneca(Swedish company) and University of Oxford (England)	AZD1222 (also known as Covishield in India )
4.	Gamaleya Research Institute (Russia)	Sputnik V (also known as Gam-Covid-Vac)
5.	Sinovac Biotech (China)	CoronaVac (formerly PiCoVacc)
6.	Johnson & Johnson/Jensen	Ad26.COV2.S
7.	Novavax	NVX-CoV2373

Coronavirus vaccine comparison by name.

Pfizer-BioNTech⁴

The Pfizer-BioNTech COVID-19 vaccine was sent to the FDA for possible Emergency Use Authorization (EUA) on Friday, November 20 and authorized on December 11. It is an mRNA vaccine that codes for the virus’s spike protein and is encapsulated in a lipid nanoparticle. Once injected, the cells churn out the spike protein, triggering the body’s immune system to recognize the virus. In Phase III trials, it demonstrated 95% efficacy. The Pfizer-BioNTech vaccine requires storage at about -94 degrees F, which requires specialized freezers.

Type: mRNA

Doses: 2, 21 Days Apart

EUA Date: December 11, 2020

Price: $19.50 per dose for first 100 million doses

Efficacy: About 95%

Status: Approved in Several Countries-Emergency use in U.S, and elsewhere

2. Moderna

On November 16, Moderna issued a preliminary data readout out of its COVID-19 vaccine, suggesting an efficacy rate of 94.5%. It was authorized by the FDA on December 19. Like the Pfizer-BioNTech vaccine, it is an mRNA vaccine. Unlike that vaccine, however, the Moderna vaccine is stable at 36 to 46 degrees F, about the temperature of a standard home or medical refrigerator, for up to 30 days and can be stored for up to six months at -4 degrees F. It is expected to go to the FDA for consideration for an EUA within days.

Type: mRNA

Doses: 2, 28 Days Apart

EUA Date: December 18, 2020

Price: $25-$37 per dose

Efficacy: About 95%

Status: Approved in Switzerland, Emergency use in U.S., E.U., Elsewhere

3. AstraZeneca-University of Oxford

On November 23, AstraZeneca and the University of Oxford announced high-level results from an interim analysis of their COVID-19 vaccine, AZD1222. The analysis was from the trials in the UK and Brazil and demonstrated efficacy of up to 90%. The vaccine was effective at preventing COVID-19, with no hospitalizations or severe cases in people receiving it. There were a total of 131 COVID-19 positive cases in the interim analysis group. One dosing regimen was given at a half dose and demonstrated 90% efficacy, followed by a full dose at least one month apart. Another dosing regimen demonstrated 62% efficacy when given two full doses at least one month apart. The combined analysis showed average efficacy of 70%. The AstraZeneca vaccine can be stored, transported and handled at normal refrigerated conditions, about 36-46 degrees F for at least six months and administered within existing healthcare settings.

The AstraZeneca and University of Oxford’s vaccine uses technology from an Oxford spinout company, Vaccitech. It deploys a replication-deficient chimpanzee viral vector based on a weakened version of a common cold virus (adenovirus) that causes infections in chimpanzees. It contains the genetic materials of the spike protein. After vaccination, the cells produce the spike protein, stimulating the immune system to attack the SARS-CoV-2 virus.

Type: Adenovirus-based

Doses: 2, 28 Days Apart

Likely EUA Date: Authorized in Europe on January 12, 2021, and other countries, but unlikely in the U.S. until spring

Price: $25-$37 per dose

Efficacy: Currently about 70% overall

Status : Emergency use in Britain, E.U., Elsewhere

4. Russia’s Sputnik V Vaccine

Around November 11, Russia’s National Research Center for Epidemiology and Microbiology, which Russia authorized for use in August ahead of even beginning a Phase III trial claimed had an efficacy rate of 92% after the second dose. It was based on a first interim analysis 21 days after the first injection during the ongoing Phase III study. On November 24, the organization claimed 95% efficacy based on new preliminary data. On December 14, 2020, they reported efficacy of 91.4%. It also offered to share one of its two human adenoviral vectors with AstraZeneca to increase the efficacy of the AstraZeneca vaccine.

Russia’s Gamaleya research institute appears to be focused on potentially marketing their vaccine worldwide. Even the name of the vaccine has emphasized the idea of a race. The organization has indicated a dose of the vaccine will cost no more than $10, about half the cost of the Pfizer vaccine. The organization has also predicted they could produce 1 billion doses in the next year. At this time, aside from Russia, it will potentially be sold in India, Korea, Brazil, China, and Hungary. The Hungarian government is the only European Union country to express interest to date.

Type: Adenovirus-based

Doses: 2

Likely EUA Date: Not applicable in the U.S.

Price: $10 per dose

Efficacy: 91.4%

Status: Early use in Russia, Emergency use Elsewhere

5. Sinovac Biotech

On January 13, 2021, China-based Sinovac Biotech reported that its COVID-19 vaccine had a 50.38% efficacy in late-stage clinical trials in Brazil. The company’s clinical trials are demonstrating dramatically varying efficacy rates. In Indonesia, a local trial demonstrated an efficacy rate of 65%, but the trial had only 1,620 participants. Turkey reported an efficacy rate of 91.25% in December 2020. Another trial in Brazil run by a local partner, Butantan Institute, reported last week a 78% efficacy rate in mild cases while 100% against severe and moderate infections. It is an inactivated vaccine that uses inactivated SARS-CoV-2 viruses.

Type: Inactivated SARS-CoV-2 virus

Doses: 2

Likely EUA Date: Not applicable in the U.S.

Price: $13,6 (Indonesia)⁵

Efficacy: 50.38% to 91.25%, depending on the clinical trial

Status: Approved in China, Emergency use Elsewhere

6. Johnson & Johnson

Johnson & Johnson announced on November 15 that it initiated a second global Phase III trial of its Janssen COVID-19 vaccine. They expect to enroll up to 60,000 volunteers worldwide.

Whereas all of the other three vaccine candidates require two doses about 28 days apart, the J&J vaccine only requires a single dose. Interim results from its Phase I/IIa trial demonstrated a single dose of the vaccine induced a robust immune response and was generally well-tolerated. The ENSEMBLE 2 study evaluated a two-dose regimen as well.

The vaccine uses the company’s AdVac technology platform, which it used to develop its approved Ebola vaccine and its Zika, RSV and HIV investigational vaccine candidates. It revolves around the use of an inactivated common cold virus, similar to what the AstraZeneca-University of Oxford program utilizes.

On February 4, Johnson & Johnson announced that it has filled for an emergency use authorization in the U.S. The FDA has scheduled a meeting of the committee that makes vaccine recommendations on February 26, and a decision could follow shortly afterward.

Type: Adenovirus-based

Doses: 1

Likely EUA Date: Possibly March or April 2021

Price: $10 per dose

Efficacy: 72% in the U.S., 66% overall, 85% for preventing severe disease

Status: Phase 3

7. NOVAVAX

Maryland-based Novavax makes vaccines by sticking proteins onto microscopic particles. They’ve taken on a number of different diseases this way; their flu vaccine finished Phase 3 clinical trials last March. The company launched trials for a Covid-19 vaccine in May, and the Coalition for Epidemic Preparedness Innovations invested $384 million to support research on the vaccine. In July the U.S. government awarded Novavax another $1.6 billion to support the vaccine’s clinical trials and manufacturing.

On January 28, 2021, Novavax announced that its COVID-19 vaccine, NVX-CoV2373, hit the primary endpoint with a vaccine efficacy of 89.3% in its Phase III trial in the UK. The vaccine is a protein-based COVID-19 vaccine candidate. It also has data from the South Africa Phase IIb trial and several Phase I, II and III trials. It has demonstrated high clinical efficacy against the UK and South Africa variants as well.

The vaccine contains a full-length, prefusion spike protein made using the company’s recombinant nanoparticle technology and its proprietary saponin-based Matrix-M adjuvant. It is stable at 2 to 8 degrees C and shipped in a ready-to-use liquid formulation.

Type: Protein-based vaccine

Doses: 2

Likely EUA Date: Possibly in March or February 2021 in the UK; possibly Q1 2021 or later in the U.S.

Price: $16 in the US

Efficacy: 89.3%

That’s it. The article about Coronavirus Vaccine Comparison. If you like to see another article, please follow the link below.

Also Read Delaying second dose of coronavirus vaccines is ‘risky gamble’: according to experts

Coronavirus Vaccine Comparison

REFFERENCES

Carl Zimmer, Jonathan Corum, Sui-Lee Wee. Coronavirus Vaccine Comparison Tracker.2 February 2021. https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html?auth=link-dismiss-google1tap
Gregory A.Poland, MD; Inna G. Ovsyannikova, PhD; Stephen N.Crooke. SARS-CoV-2 Vaccine Development: Current Status. 2020. Mayo Clinic. Access: 6 February 2021. https://doi.org/10.1016/j.mayocp.2020.07.021
WHO. Vaccines and Immunization: What is vaccination?. Access: 4 February 2021. https://www.who.int/news-room/q-a-detail/vaccines-and-immunization-what-is-vaccination?adgroupsurvey={adgroupsurvey}&gclid=CjwKCAiA9vOABhBfEiwATCi7GA4Q0gma7eld7lLLdXFkF64O_a9BqrMusUos10__fOldtUZX9fbpfhoCpxAQAvD_BwE)
Mark Terry. UPDATED Comparing COVID-19 Vaccines: Timelines, Types and Prices. Access: 4 February 2021. https://www.biospace.com/article/comparing-covid-19-vaccines-pfizer-biontech-moderna-astrazeneca-oxford-j-and-j-russia-s-sputnik-v/
Milton Lum, Dr. Covid-19 Vaccine Prices. Code Blue, Health is Human Right. December 2020. Access : https://codeblue.galencentre.org/2020/12/25/covid-19-vaccine-prices/ 16 February 2021

PEDIATRIC ASTHMA AND COVID-19

Covid-19·February 26, 2021February 25, 2021

Pediatric Asthma And Covid-19 – Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory.

I. DEFINITION Of ASTHMA

Asthma is the most prevalent chronic respiratory disease worldwide, affected people all ethnic groups throughout all ages. Asthma also the most common chronic disease in children. Asthma can’t go away, but it can be reduced to become more severe. But its still become significant public health problem. Furthermore, asthma disproportionately affects minorities and socioeconomically disadvantages children.²

II. EPIDEMIOLOGICAL AND PREVALENCE

From epidemiological and experimental studies shows that there is relationship between environmental factors and allergic r4espiratory disease such as rhinitis and asthma.³Air pollution could be the reason of each asthma cases in the Asia Pacific especially in urban cities with rapid developing economics, increasing infrastructure, numbers of vehicles, and reduced green spaces. Fossil fuel and transportation are the main sources of air pollution (e.g., sulfur oxide and nitrous) released into the atmosphere leading to health problems. A global study that 9–23 million and 5–10 million annual asthma emergency room visits globally in 2015 could be attributable to O3 and particulate matter (PM) with a diameter of 2.5 μm or less (PM2.5), respectively, representing 8%–20% and 4%–9% of the annual number of global visits, respectively.³

The top 3 countries for both asthma incidence and prevalence in Asia were India, China, and Indonesia, driven largely by population size nearly half (48%) of estimated O3-attributable and over half (56%) of PM2.5-attributable asthma emergency room visits were estimated in Southeast Asia (includes India), and western Pacific regions (includes China). Of all countries globally, India and China had the most estimated asthma emergency room visits attributable to total air pollution concentrations, respectively contributing 23% and 10% of global asthma emergency room visits estimated to be associated with O3, 30% and 12% for PM2.5, and 15% and 17% for nitrogen dioxide (NO2). In this global study,16 million new pediatric asthma cases could occur globally each year due to anthropogenic PM2.5 concentrations, translating to 33% of global pediatric asthma incidence. The percentage of national pediatric asthma incidence that may be attributable to anthropogenic PM2.5 was estimated to be 57% in India, 51% in China, and over 70% in Bangladesh.³

Asthma affects 1 in 12 US children aged 0 through 17 years. After decades of increases, the prevalence of asthma in this group plateaued between 2010 and 2012, decreased in 2013 from 9.3% in 2012 to 8.3%, and remained stable through 2016. In contrast, pediatric asthma prevalence in black children increased between 2001 and 2009, leveling off by 2013. In 2016, asthma prevalence in black children rose sharply to 15.7% (a 2.3% increase from 2014 and 2015), twice that of white children. This rate surpassed that of Puerto Rican children, who previously had the highest prevalence of asthma of all US children. The prevalence of asthma in children in poverty did not decrease between 2001 and 2013 and remained high in 2016 (10.5%).²

pediatric asthma and covid — **Picture 1**. Asthma Prevalence in Indonesia, 2013-2018

Percentages asthma more higher in the city than villagers

Asthma has become an issue of international development as its economic and social cost have been recognized. Asthma is one of the chronic respiratory diseases (CRDs), CRD’s ) including asthma cause 15% of world deaths. Strangely we still didn’t understand exactly what can cause number of asthma increasing each year.

III. RISK FACTORS ASTHMA IN CHILDHOOD

Microbial Exposure

Hygiene and environment have been suggested to become cause problem increasing the risk of asthma. Accordingly, children raised in modern environment with a scanty natural microbial burden may be prone to develop allergic diseases in view of an under stimulation of the immune system. Indeed, recent evidences showed that exposure to some microbes can protect from atopy, whereas others seem to promote allergic diseases. The timing of exposure to as well as the properties of the infectious agent, in addition to the genetic susceptibility of the host, may influence the future development of asthma.⁵

Data from the Copenhagen birth cohort first showed that infants carrying 3 major pathogenic bacteria in their nasopharynx (ie, Streptococcus pneumoniae, Moraxella catharralis, and Haemophilus influenzae) were more likely to develop asthma by the age of 6 years than those not carrying these microbes.⁶

2. Atopy

Word atopy originally from the Greek “atopos” meaning out of place.(William C. Shiel Jr., MD, FACP, FACR, Medical Definition of Atopy. Atopy is typically associated with heightened immune responses to common allergens, especially inhaled allergens and food allergens. ATOPY DEFINITION, American Academy of Allergy Asthma & Immunology). Data from epidemiological studies showed the strong link between asthma and atopy. Indeed, the family history of atopy is considered one of the most relevant risk factors for developing asthma.⁵Atopy refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma, atopic dermatitis (eczema) .

From a study showed that children who were sensitized to 1 or more aeroallergens by age 1 year had the highest rate of asthma at year 13. Children who were not sensitized at year 1 but sensitized to 1 or more aeroallergens by age 5 years had a 40% rate of asthma at age 13 years.⁷

3. Environmental Exposure

The increasing case of asthma in metropolitan areas was possibly because of their air pollution. An evidence from a study showed evidence that increased childhood exposure to PM_2,5 and black carbon was associated with increased risk of asthma at age 12 years.⁵ According to the WHO, nearly one million of the 3.7 million people who died from ambient air pollution in 2021 lived in South-East Asia. Several areas in Indonesia such as Sumatra and Borneo island resulted in spikes of increased pollution and health hazard by produced smoke haze.³ Several studies have linked the smoke and haze produced by the fires to chronic respiratory problems.

Living in an environment where the number of smokers are high mainly can cause lung damage eventually when it happens near of children area or even to a pregnancy. Several negative effects of nicotine exposure on structural and functional development of the fetal lung were established, such as alteration of the alveolar phase, damage of the epithelial cells of type I, inhibition of fibroblast proliferation, reduction of the small airways caliber, increase of the muscular tone, and reduction of lung compliance. Exposure during pregnancy may be responsible for permanent modifications of the respiratory tract that can persist into adulthood and might culminate in chronic obstructive pulmonary disease.⁷

IV. COVID-19 IN CHILDREN WITH ASTHMA

In fact, there is still no reported cases of asthma in pediatric can be the risk factor of covid-19. Children are less commonly symptomatic with coronavirus disease-2019 (COVID-19) than adults. Those who are symptomatic less commonly require hospitalization. Among 96% of cases where age was known, only 8,1% was among children less than 18 years of age. A report of 12.055 COVID-19 patients in Italy also supports a lower risk in children, although noting that COVID-19 can affect children of any age, including infants.⁸

Multiple international organizations including the CDC list asthma as a prognostic factor for COVID-19 outcomes such as morbidity and mortality. There is also a theoretical risk that COVID-19 could trigger viral-induced asthma exacerbations but still no data to support.

The clinical course of COVID-19 in children is usually milder than in adults. A study stated that 23% of children with severe form of the disease have an underlying condition.⁹

PEDIATRIC ASTHMA AND COVID-19 DIAGNOSIS

Diagnosis of pediatric asthma and covid -19 during COVID-19 Pandemic may be complicated by a similarity in symptoms between COVID-19 (dry cough, shortness of breath) and worsening asthma. As a result, even if cough history is consistent with asthma, screening protocols for COVID-19 should be applied to all children who have worsening cough or shortness of breath, and appropriate personal protective equipment worn.⁸

lung function test such as spirometry is specific test for diagnosing a asthma, but in terms of COVID-19 pandemic The North American guidance on passed resumption of allergy care during COVID-19 notes that for Phase 2 rollout (community infection risk declining/stable) “spirometry is still contraindicated in most scenarios because of the aerosolization risk, except in highly individualized situations in which it would be essential for immediate treatment decision that could not otherwise be made without such information and where it can be performed with appropriate precautions and room/equipment disinfection.⁸

What is parents have to know if their kids develop an asthma during this Corona Virus pandemic?

Differentiating COVID-19 from worsening asthma, or an asthma exacerbation, is challenging. As a result, pediatricians and families have an essential role in ensuring that children with asthma maintain good asthma control during this time.¹⁰

Multiple international guidelines support children with asthma remaining on their maintenance asthma medications, such as inhaled corticosteroids or antileukotrienes, during COVID-19 if they are well controlled. A statement from the European Academy of Allergy Asthma and Clinical Immunology (EAACI) notes that “since asthma itself may be a risk factor for the severity of COVID‐19 disease and since the use of ICS does not pose an increased risk for pulmonary or systemic infections in children with asthma, their regular use is unlikely to increase the risk of acquiring the infection or increasing the severity of the present infection.⁸

Children and adolescents with asthma should remain on their current asthma medications and still practice social distancing and make sure to avoid aeroallergen also exposure to second-hand cigarette smoking¹⁰, because it can increase the expression of the ACE2 receptors in the lower respiratory tract, which is the coronavirus receptor. Which ACE2 as the receptor for Sars-CoV-2 means it will increase susceptibility to contract the COVID-19 infection and potentially to develop a more severe form.⁸

pediatric asthma and covid

REFERRENCES

GINA committees. POCKET GUIDE FOR ASTHMA MANAGEMENT AND PREVENTION for adults and children older than 5 years.2019. Access : https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf
Shilpa J. Patel, MD,MPH, Stephen J. Teach, MD, MPH. Asthma. Pediatrics in Review, An Official Journal of the American Academy of Pediatrics. Vol 40 No II November 2019. Division of Emergency Medicine, Children’s National Medical Center, Washington, DC. Access : http://pedsinreview.aappublications.org/
Ruby Pawankar, Jiu-Yao Wang, I-Jen Wang, Francis Thien. White Paper 2020 on Climate Change, Air Pollution, and Biodiversity in Asia-Pacific and Impact on Allergic Disease. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. 2020. Jan;10(1):e11. Access : https://doi.org/10.5415/apallergy.2020.10.e11
Kementerian Kesehatan RI. Hasil Utama RISKESDAS 2018. Penyakit Tidak Menular, Prevalensi Asma. Access : https://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf
Giuliana Ferrante and Stefania La Grutta. The Burden of Pediatric Asthma. Frontiers in Pediatric. June 2018. Volume 6. Article 186. Access : Frontiers | The Burden of Pediatric Asthma | Pediatrics (frontiersin.org)
Fernando D. Martinez, MD. Childhood Asthma Inception and Progression Role of Microbial Exposures, Susceptibility to Viruses and Early Allergic Sensitization. Elsevier Ltd. Volume 39, Issue 2. 2019. P 141-150. Access : Childhood Asthma Inception and Progression: Role of Microbial Exposures, Susceptibility to Viruses and Early Allergic Sensitization – ScienceDirect
Frederick J. Rubner, MD, Daniel J. Jackson, MD, Michael D. Evans, MS. Early life rhinovirus wheezing, allergic sensitization, and asthma risk at adolescence. 2017. The Journal of Allergy and Clinical Immunology. Asthma and Lower Airway Disease. Volume 139, issue 2, P501-507. Early life rhinovirus wheezing, allergic sensitization, and asthma risk at adolescence – Journal of Allergy and Clinical Immunology (jacionline.org)
Elissa M.Abrams MD, FRCPC. Ian Sinha MBBS, FRCPCH, PhD. Pediatric Asthma and COVID-19: The known, the unknown, and the controversial. Wiley Periodicals LLC: Pediatric Pulmonology. 2020; 55:3573-3578. DOI: 10.1002/ppul.25117
M. Kamali Aghdam, M. Sadeghzadeh, S. Sadeghzadeh and K. Namakin. Challenges in A Child with Asthma and COVId-19. Elsevier Ltd. 2020. New Microbe and new Infections, Vol 37 Number C. Access : Challenges in a child with asthma and COVID-19 – ScienceDirect
Elissa M. Abrams, MD, MPH, and Stanley J. Szefler, MD. Managing Asthma during Coronavirus Disease-2019: An Example for Other Chronic Conditions in Children and Adolescents. The Journal of Pediatrics. Vol 222. July 2020. Access: https://www.jpeds.com/article/S0022-3476(20)30528-X/fulltext

COVID-19 and DIABETES

Covid-19·February 20, 2021February 16, 2021

I have Diabetes, should I go for COVID-19 vaccination?

Covid-19 and Diabetes – In December 2019, a novel coronavirus, SARS-CoV-2, was identiﬁed as the pathogen causing coronavirus disease (COVID-19) in Wuhan, China (11, 51, 55). On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization. As of March 27, 2020, there have been a total of 103,942 conﬁrmed cases with 1689 deaths in the United States. Globally, 27,324 deaths have been reported among 595,800 conﬁrmed cases.

On 21^st January 2021 there have been 95,612,831 confirmed cases of COVID-19, including 2,066,176 deaths, reported to WHO. As of January 2021, there have been 24.037.236 confirmed cases in the United States, 3.505.758 confirmed cases in the United Kingdom, 951.651 confirmed cases in Indonesia.

In 2019, approximately 463 million adults (20-79 years) were living with diabetes; by 2045 this will rise to 700 million. The proportion of people with type 2 diabetes is increasing in most countries 79% of adults with diabetes were living in low- and middle-income countries. 1 in 5 of the people who are above 65 years old have diabetes. 1 in 2 (232 million) people with diabetes were undiagnosed. Diabetes caused 4.2 million deaths. Diabetes caused at least USD 760 billion dollars in health expenditure in 2019 – 10% of total spending on adults. More than 1.1 million children and adolescents are living with type 1 diabetes. More than 20 million live births (1 in 6 live births) are affected by diabetes during pregnancy, 374 million people are at increased risk of developing type 2 diabetes.

Also Read Things People With Diabetes Must Know About the COVID-19 Vaccines

Diabetes is a serious threat to global health that respects neither socioeconomic status nor national boundaries. People living with diabetes are at risk of developing a number of serious and life-threatening complications, leading to an increased need for medical care, a reduced quality of life, and undue stress on families. Diabetes and its complications, if not well managed, can lead to frequent hospital admissions and premature death. Globally, diabetes is among the top 10 causes of death.

Source : Pusdatin **Figure 1. Prevalence of Diabetes age 20-79 in 2019**

The pathophysiology of SARS-CoV-2 and Potential mechanisms that increase the risk of COVID-19 in Diabetes

The genetic sequence of SARS-CoV-2 showed more than 80% shared identity to SARS-CoV and 50% to the MERS-CoV, and both SARS-CoV and MERS-CoV originate in bats and infect humans and wild animals. CoV is made up of four structural proteins: spike (S), membrane (M), nucleocapsid (N), and envelope (E) proteins. The S protein mediates receptor binding on the host cell membrane through the receptor-binding domain (RBD) in the S1 domain and membrane fusion through the S2 subunit. Angiotensin-converting enzyme 2 (ACE2) is the cellular receptor for SARS-CoV and SARSCoV-2, in contrast to MERS-CoV, which utilizes dipeptidyl peptidase 4 (DPP4) as its cellular receptor. This interaction thus determines host tropism and ultimately clearance of the virus. ACE2 is expressed in the upper respiratory system, type I and II alveolar epithelial cells in the lungs, the heart, endothelial cells, kidney tubular epithelium, enterocytes, and the pancreas. After binding to ACE2, proximal serine proteases such as TMPRSS2 are involved in S protein priming and cleavage of the spike. Proteases such as Furin subsequently release the spike fusion peptide, and the cellular virus enters through an endosomal pathway . The low pH and presence of proteases such as cathepsin-L characteristic of the endosomal micro environment favor the delivery of SARS-CoV-2 genome into the cytosol where further viral replication leads to the formation of mature virions and subsequent spread. Infected cells undergo apoptosis or necrosis and trigger inﬂammatory responses marked by the activation of proinﬂammatory cytokines or chemokines, which leads to the recruitment of inﬂammatory cells. CD4+ T helper (Th1) cells regulate antigen presentation and immunity against intracellular pathogens such as CoV through interferon gamma (IFN-ℽ) production. Th17 cells induce the recruitment of neutrophils and macrophages by producing interleukin-17 (IL-17), IL-21, and IL-22. SARS-CoV-2 infects circulating immune cells and increases apoptosis of lymphocytes (CD3, CD4, and CD8 T cells), leading to lymphocytopenia. Indeed, the degree of lymphocytopenia is associated with the severity of SARS CoV-2 infection. Lower T cell function relieves the inhibition on innate immune system leading to secretion of high amounts of inﬂammatory cytokines in what is known as a “cytokine storm”. In fact, circulating levels of cytokines/chemokines [IL-6, tumor necrosis factor-α (TNF)] and chemokines [CXC-chemokine ligand 10 (CXCL10) and CC-chemokine ligand 2 (CCL2)] involved in the cytokine storm syndrome are elevated and may play a role in SARSCoV-2-driven hyperinﬂammation leading to multiorgan failure.

Potential mechanisms that increase the risk of COVID-19 in diabetes. It is now well recognized that older age and the presence of diabetes, hypertension, and severe obesity (BMI =40 kg/m2 ) increase morbidity and mortality in patients with COVID-19. Considering the high prevalence of cardiovascular disease (CVD), obesity, and hypertension in patients with diabetes, it is unknown whether diabetes independently contributes to this increased risk. However, plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Potential mechanisms that may increase the susceptibility forCOVID-19 in patients with diabetes include: 1) higher afﬁnity cellular binding and efﬁcient virus entry, 2) decreased viral clearance, 3) diminished T cell function, 4) increased susceptibility to hyperinﬂammation and cytokine storm syndrome, and 5) presence of CVD. Augmented ACE2 expression in alveolar AT2 cells, muscle of the heart, kidney, and pancreas may favor increased cellular binding of SARS-CoV-2. Increased expression of ACE2 has been demonstrated in the lung, kidney, heart, and pancreas in rodent models of diabetes. Insulin administration attenuates ACE2 expression, while hypoglycemic agents such as glucagon-like peptide-1 (GLP-1) agonists (liraglutide) and thiazolidinediones (TZDs; pioglitazone), antihypertensives such as ACE inhibitors, and statins upregulate ACE2. Until recently, whether diabetes was causally linked to ACE2 expression levels in the lung in humans was unknown.

Fig. 3. Cellular entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The initial step in cellular entry of the virus is the binding of SARS-CoV-2 spike protein to cell surface angiotensin converting enzyme 2 (ACE2). Cellular proteases such as TMPRSS2 and furin are involved in priming of the S protein, which involves cleavage at the S1/S2 domains. This allows the fusion of the virus to the cell surface. Virions are taken up into endosomes, where SARS-CoV-2-S is cleaved and possibly activated by the pH-dependent cysteine protease cathepsin L. Once inside the cell, SARS-CoV-2 uses the endogenous cellular machinery to replicate itself. ACE catalyzes the conversion of angiotensin(Ang)ItotheoctapeptideAngII,whereasACE2 converts Ang II to Ang1–7. AngII through the activation of Ang II type 1a receptors induces vasoconstriction and proliferation,whereasAng1–7 stimulates vasodilatation and suppresses cell growth.

Fig. 4. Putative mechanisms contributing to increased susceptibility for coronavirus disease (COVID-19) in patients with diabetes mellitus (DM). Following aerosolized uptake of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), invasion of the respiratory epithelium and other target cells by SARS-CoV-2 involves binding to cell surface angiotensin converting enzyme 2 (ACE2). Increased expression of ACE2 may favor more efﬁcient cell binding and entry into cells. Early recruitment and function of neutrophils and macrophages are impaired in DM. Delay in the initiation of adaptive immunity and dysregulation of the cytokine response in DM may lead to the initiation of cytokine storm.

There is a paucity of data in the world (including Indonesia) regarding comorbidities and COVID-19 outcomes and mechanism that modulate viral pathogenesis. But here is our mainly concern that people with comorbidities likely have chance to get COVID-19, so its mainly our concern that people with Diabetes should get vaccinated.

COVID-19 vaccine prioritization for type 1 and type 2 diabetes

Several clinical reports have described greater morbidity and mortality from COVID-19 in people with diabetes, often accompanied by obesity. Most of this information is from individuals with type 2 diabetes, with less known about the risk in type 1 diabetes, a phenotypically distinct disorder. Experts have cautioned against extrapolating from studies of type 2 diabetes to individuals with type 1 diabetes. In the USA, the Centers for Disease Control and Prevention (CDC) currently categorize type 1 and type 2 diabetes differently in terms of risk for severe illness from COVID-19, with people with type 2 diabetes considered “at increased risk for severe illness” and those with type 1 diabetes categorized as “might be at increased risk”. Importantly, several recent studies have shown that both people with type 2 diabetes and those with type 1 diabetes have an increased vulnerability to serious illness from SARS-CoV-2 compared with people without diabetes. In relative terms, patients with type 1 diabetes and those with type 2 diabetes had similar adjusted odds ratios (ORs) for hospitalization (3·90 for type 1 diabetes vs 3·36 for type 2 diabetes), severity of illness (3·35 vs 3·42), and in-hospital mortality (3·51 vs 2·02). In a population-based study in Scotland, the risk of fatal or critical care unit treated COVID-19 was increased for both diabetes types (OR 2·4 with type 1 diabetes vs 1·4 with type 2 diabetes).

Abbreviation: COVID-19 = coronavirus disease 2019.

* Data sources for each group: health care personnel (American Community Survey, 2019; ); long-term care facility residents (Minimum Data Set. Centers for Medicare & Medicaid Services; ); frontline and other essential workers (American Community Survey, 2019; ); age-specific groups (U.S. Census; ); high-risk medical conditions (Behavioral Risk Factors Surveillance System, 2018; ).

† Excludes persons who were recommended to receive vaccine in an earlier phase (e.g., persons aged 65–74 years who are living in long-term care facilities or who are health care personnel, who would have been included in Phase 1a) and accounting for overlap between groups within the same phase (e.g., essential workers with high risk medical conditions).

§ Estimates for frontline and other essential workers are approximate and derived from prepandemic survey data; relative proportions will vary by state.

¶ As of December 18, only the Pfizer-BioNTech COVID-19 vaccine is authorized for use in persons aged 16–17 years.

Based on ongoing review of the literature, CDC has identified medical conditions or risk behavior that are associated with increased risk for severe COVID-19. The risk for COVID-19 associated hospitalization increases with the number of high-risk medical conditions, from 2,5 times the risk for hospitalization for person with one condition to 5 times the risk for those with three or more conditions.

As we can see from the table above that Person aged 65-74years and Person aged 16-64years with high-risk medical conditions are included in Phase 1c to receive COVID-19 vaccine. So we conclude that person with diabetes are included in Phase 1c.

Indonesian Society of Internal Medicine(PAPDI) made the recommendations regarding COVID-19 vaccination (Sinovac) in patients with concomitant disease/comorbidities. People with diabetes are included to get vaccination which they described it all patient with controlled type 2 diabetes and HbA1C below 58 mmol/mol or 7,5%, vaccine can be given.

REFERENCES

Ranganath Muniyappa and Sriram Gubbi. 2020. COVID-19 pandemic, coronaviruses, and diabetes melitus. American Physiological Society. doi:10.1152/ajpendo.00124.2020
Who.int.(2021,22 January). WHO Coronavirus Disease (COVID-19) Dashboard.
Infeksiemerging.kemkes.go.id(2021,22 January). COVID 19.
idf.org(2021, 21 January). Internatinal Diabetes Federation: About Diabetes.
kemkes.go.id.(2021, 21 January). Diabetes Melitus-Kementerian Kesehatan.
Kathleen Dooling, MD, Mona Marin, MD, Megan Wallace, DrPH. 2021. The Advisory Committee on Immunization Practices’ Updated Interim Recommendation for Allocation of COVID-19 Vaccine -United States, December 2020. US Department of Health and Human Services/Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Vol.69, No.51-52.
Alvin C POwers, David M Aronoff, Robert H Ecked. 2021. COVID-19 vaccine prioritization for type 1 and type 2 diabetes. The Lancet Diabetes Endocrinal 2021. https://doi.org/10.1016/ S2213-8587(21)00017-6
Papdi.or.id(2021, 22 January). Rekomendasi PAPDI tentang Pemberian Vaksinasi COVID-19.

Things People With Diabetes Must Know About the COVID-19 Vaccines

Covid-19, Uncategorized·February 14, 2021February 15, 2021

People with diabetes are at a higher risk of developing complications of COVID-19, making it all the more important that they are vaccinated against the disease as soon as possible.

It’s a new year, and COVID-19 vaccines offer hope for those wanting to protect themselves, especially people with underlying health conditions such as diabetes.

You may have questions about these new vaccines, including when you can get them and what questions you should ask your doctor about them. Experts we talked with say the vaccines are safe, effective, and important for people with diabetes.

“The most important thing is that people with diabetes get vaccinated as soon as it becomes available to them,” says Robert Gabbay, MD, PhD, chief science and medical officer for the American Diabetes Association (ADA) in Arlington, Virginia.

1. When Will I Be Able to Get the Vaccine if I Have Diabetes?

It depends on where you live. At a federal level, the Centers for Disease Control (CDC) makes recommendations about who should receive priority for vaccination. It is then up to each state to use those recommendations to plan for and distribute vaccines to counties and residents.

Even so, guidelines are changing. In mid-January, U.S Health and Human Services (HHS) Secretary Alex Azar said Americans 65 years and older and those who are younger but have underlying health conditions should receive priority, as AARP reports.

If your state is following the CDC’s recommendations, healthcare workers and nursing home residents are receiving first priority for the vaccine. Next, the CDC recommends vaccinating frontline workers such as firefighters, teachers, and grocery store workers, along with people over 75.

Then, the CDC recommends vaccinating people with type 2 diabetes and other underlying medical conditions due to their increased risk of severe COVID-19-associated illness.

People with type 1 diabetes do not currently have the same priority vaccination with the CDC. But groups including the Juvenile Diabetes Research Foundation (JDRF) and the ADA are advocating for this priority at a federal and state level.

Justin Gregory, MD, assistant professor of pediatrics at Vanderbilt Children’s Hospital in Nashville, who has type 1 diabetes, says that people with type 1 diabetes should have the same priority for vaccination as people with type 2 diabetes because both groups have a similarly increased risk for dangerous and deadly COVID-19 illness.

In the end, states make their own decisions about vaccination priority, so check your state and local health department’s website to find out when you are eligible. The ADA has also assembled links to individual states’ vaccination plans as part of its COVID-19 Vaccination Guide.

2. Does Having Another Health Condition With Diabetes Affect My Place in Line?

Potentially. The CDC notes notes that the risk for hospitalization increases with the more “high-risk” medical conditions a person has — it’s 2.5 times for a person with one condition and 5 times for people with three or more conditions. Nevertheless, having comorbidities, such as heart and kidney disease, does not mean you will be allowed to get vaccinated before someone with only diabetes or another single health condition. Again, it comes down to where you live.

In Massachusetts, for example, people with two or more underlying conditions are prioritized to get a COVID-19 vaccine before those with only one condition. Other states do not designate priority by the number of underlying medical conditions.

3. Are COVID-19 Vaccines Free for People With Diabetes?

The COVID-19 vaccine is free for everyone, regardless of diabetes status, according to the CDC. However, some providers administering the vaccine may charge a fee, which can be reimbursed by your public or private health insurance, or by the Health Resources and Services Administration’s Provider Relief Fund if you do not have insurance.

4. Why Is It Important to Get the Vaccine if You Have Diabetes?

“It’s quite clear that people with diabetes do much worse than people without diabetes in terms of their outcomes with COVID,” says Dr. Gabbay. Early in the pandemic, a study from the CDC found that roughly half of people who died from COVID-19 under age 65 had diabetes.

The protective effects of vaccines are critical for people with diabetes who are at increased risk for severe and deadly infection from COVID-19, says Dr. Gregory. His December 2020 study in Diabetes Care found that people with type 1 or type 2 diabetes are 3 times more likely to be hospitalized or experience severe COVID-19 illness compared with people without diabetes.

Two studies from the United Kingdom showed similar risk. An October 2020 study in The Lancet Diabetes & Endocrinology found that people with type 1 or type 2 diabetes were 2 to 3 times more likely to die from COVID-19 in the hospital than people without diabetes. And a December 2020 study in The Lancet Diabetes & Endocrinology found that people with type 1 or type 2 were more likely to die or to be treated in the intensive care unit for COVID-19.

5. Are the Vaccines Safe and Effective for People With Diabetes?

Two COVID-19 vaccines are currently available in the United States — and people with diabetes were included in both the vaccine trials. Both require two doses spaced either 21 days (Pfizer-BioNTech vaccine) or 28 days (Moderna vaccine) apart. With their two doses completed, these vaccines are over 90 percent effective and received emergency use authorization from the U.S. Food and Drug Administration (FDA) in December 2020.

“We wanted to make sure we recruited a number of individuals who had the types of underlying medical conditions that can make COVID more severe,” says C. Buddy Creech, MD, MPH, director of the Vanderbilt Vaccine Research Program in Nashville and part of the phase 3 trials of the Moderna COVID-19 vaccine.

That included people with diabetes, hypertension, and obesity, says Dr. Creech. People with type 1, type 2, and gestational diabetes were included in the Moderna clinical trial, he adds. The FDA filing from Pfizer-BioNTech says the trial included but does not specify among types.

The vaccines were well-tolerated, highly efficacious, and elicited an immune response in people with underlying conditions, such as diabetes, says Creech.

“People with diabetes are going to be prioritized [for COVID-19 vaccination] because we know they’re at increased risk for disease. And they should feel confident that someone a whole lot like them was enrolled in the clinical trial so that we can say with a greater degree of certainty that they can effectively get this vaccine,” says Creech.

Gabbay says that the data do not suggest the COVID-19 vaccines pose particular risk for people with diabetes. He also says there is no reason to think there would be interactions with insulin or other medications that people with diabetes might take.

6. What Side Effects of the Vaccine Should People With Diabetes Pay Attention To?

In general, the most common side effects of both vaccines are pain, swelling, and redness at the injection site. Other common side effects are chills, tiredness, and headaches. Most of these side effects were mild, but some people had more severe reactions that interfered with daily activities.

Gabbay says side effects of the COVID-19 vaccines are similar to those of flu vaccines. For someone living with diabetes, keeping a sick-day kit with extra medications and supplies is beneficial in case you do not feel well.

7. What Questions Should People With Diabetes Ask Their Healthcare Teams About the COVID-19 Vaccines?

Gabbay says the first question patients should ask their providers about the COVID-19 vaccine is, “When can I get it?”

Be proactive in calling your provider to ask for the vaccine, says Gabbay. Check the websites of your state and local health departments to find out about local vaccine distribution. “Being patient, persistent, and informed is the best approach,” says Gabbay.

REFERENCES :

Everydayhealth.com
By Kate Ruder Medically Reviewed by Justin Laube, MD

How Effective is a Single Vaccine Dose Against Covid-19 ?

Covid-19, Uncategorized·February 12, 2021February 15, 2021

Single Vaccine Dose, How Effective it is ? – The cases are already beginning to emerge.

When 85-year-old Colin Horseman was admitted to Doncaster Royal Infirmary in late December, it was for a suspected kidney infection. But not long afterwards he caught Covid-19 – at the time, roughly one in four people in hospital with the virus had acquired it there. He developed severe symptoms and was eventually put on a ventilator. A few days later, he died.

At first glance, Horseman’s situation may seem fairly typical, though no less tragic for it. After all, at least 84,767 people have now succumbed to the disease in the UK alone at the time of writing. But, as his son recently explained in a local newspaper, less than three weeks earlier he had been among the first people in the world to receive the initial dose of a Covid-19 vaccine – the Pfizer-BioNTech version. He was due to receive the second dose two days prior to his death.

In fact, most vaccines require booster doses to work.

Take the MMR – measles, mumps and rubella – vaccine, which is given to babies around the world to prevent these deadly childhood infections. Around 40% of people who have received just one dose are not protected from all three viruses, compared to 4% of those who have had their second. People in the former group are four times more likely to catch measles than those in the latter – and there have been outbreaks in places where a high proportion of people have not completed the full MMR vaccination schedule.

“The reason that people are so keen on boosters and consider them so vital is that they kind of send you into this whole other kind of fine-tuning mode of your immune response,” says Danny Altmann, professor of immunology at Imperial College London.

How Booster Vaccines Work

When the immune system first encounters a vaccine, it activates two important types of white blood cell. First up are the plasma B cells, which primarily focus on making antibodies. Unfortunately, this cell type is short-lived, so although your body might be swimming in antibodies within just a few weeks, without the second shot this is often followed by a rapid decline.

Then there are the T cells, each of which is specifically tailored to identify a particular pathogen and kill it. Some of these, memory T cells, are able to linger in the body for decades until they stumble upon their target – meaning immunity from vaccines or infections can sometimes last a lifetime. But crucially, you usually won’t have many of this cell type until the second meeting.

The booster dose is a way of re-exposing the body to the antigens – the molecules on pathogens that trigger the immune system. “So, once you’ve had your boost you’ll have a higher frequency of memory T cells and ditto to some extent for the size of the pool of memory B cells you’ll have. They’ll also be making higher quality antibodies.”

On second exposure to the same vaccine or pathogen, the B cells that remain from before are able to rapidly divide and create a menacing throng of descendants, leading to a second spike in the amount of antibodies circulating.

The second dose also initiates the process of “B cell maturation”, which involves selecting the immature ones with the best receptors for binding to a particular pathogen. This happens while they’re still in the bone marrow – where white blood cells are made – and afterwards they travel to the spleen to finish developing. This means B cells are not only more numerous afterwards, but the antibodies they produce are better targeted.

Memory T cells, meanwhile, also proliferate rapidly. They’re already thought to have played a critical role during the current pandemic, protecting some people from developing severe Covid-19. Though the virus may have only been circulating globally since around December 2019, there’s some evidence they may have “seen” other coronaviruses before, such as those that cause the common cold – allowing them to recognize Covid-19.

REFERENCES :

https://www.bbc.com/future/article/20210114-covid-19-how-effective-is-a-single-vaccine-dose

Delaying second dose of coronavirus vaccines is ‘risky gamble’: according to experts

Covid-19, Uncategorized·February 10, 2021February 15, 2021

Delaying second dose of coronavirus vaccines is ‘risky gamble’: according to experts

Amid shortages in coronavirus vaccine supplies, some Canadian provinces have decided to delaying second dose of coronavirus, which experts have called a “risky approach” and “a gamble.”

Ontario’s government announced on Saturday that long-term care residents, staff and essential caregivers who have received their first doses of the Pfizer-BioNTech vaccine will now get the second jab within 21 to 27 days. Everyone else will receive their second dose after three weeks but before 42 days.

The time span between doses specified by Pfizer and BioNTech is 21 days.

This comes in the wake of a temporary delay in shipments of the Pfizer vaccine to Canada as the company is scaling up its European manufacturing capacity.

Last month, British Columbia said it was changing its second-dose schedule for both Pfizer and Moderna’s vaccines to 35 days to allow giving the first doses to as many people as possible right away. Moderna’s second booster shot is supposed to follow the first by 28 days.

Meanwhile, Quebec is pushing the time between the two doses to a maximum of three months in an attempt to vaccinate more seniors faster with a first injection.

These timeline changes have raised concerns and questions about the impact this may have on the effectiveness of the vaccines.

“There is a risk in this approach,” said Dr. Alberto Martin, professor of immunology at the University of Toronto.

“It’s possible that a large fraction of these individuals will not develop full immunity and thereby waste many of these doses,” he told Global News.

While there is a buffer and wiggle room for a few days and weeks between vaccine doses, experts have cautioned against significant delays that deviate from the prescribed time period used in the clinical trials.

“The longer you spaced that interval, the higher risk (of) … maybe not getting the full immune response possible,” said Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare in Hamilton, in an interview with Global News.

However, since this is an experiment with no sufficient data, it still remains unclear what the exact impact of the delay will be, both Chagla and Martin said.

The World Health Organization (WHO) has advised that in case of shortages in vaccine supplies, the second Pfizer dose can be extended to up to six weeks or 42 days after the first, which is what Canada’s National Advisory Committee on Immunization (NACI) has also recommended.

Currently, there is no data on the maximum interval between doses or on medium- or long-term efficacy of COVID-19 vaccines, according to NACI.

NACI experts say delaying second dose of coronavirus up to six weeks, instead of three or four, could more quickly get at least some protection against COVID-19 to more people.

The United Kingdom, where a new, more contagious variant of COVID-19 began spreading last month, has gone against the advice of the drugmakers, as well as WHO, and delayed the second dose of Pfizer and AstraZeneca’s vaccine by up to 12 weeks.

The United States, meanwhile, is taking a different approach and sticking with the originally specified timeframe of 21 days between Pfizer’s shots and 28 days for Moderna.

In a statement on its website, the U.S. Food & Drug Administration says changes in the schedules of vaccine administration without appropriate supporting data can pose a “significant risk of placing public health at risk” and “undermining the historic vaccination efforts.”

Also Read What are the differences of these various COVID-19 vaccines?

Prioritizing The Elderly

When there is an unstable supply chain, most experts agree that the priority should be to give the elderly and long-term care residents the two doses on time.

Dr. Isaac Bogoch, an infectious disease physician at Toronto General Hospital, said the focus in Ontario is to put all the resources into vaccinating those who are most vulnerable and at greatest risk of death.

“We know that people in long-term care are typically older or have other health problems, (yet) are just less likely to mount the same immune responses as otherwise healthier, younger individuals. So, the goal is really to give those two vaccine doses as per that schedule to those who live in long-term care. I think that’s very reasonable,” he told Global News.

As for the rest of the population, provinces should not purposely delay the second dose beyond the 42-day mark, he added.

“That 42 days is the maximum, it’s not the goal, … and if people can be closer to that day 21 goal, the better,” Bogoch said.

According to recent modelling data from researchers at the University of Toronto, administering most of Canada’s coronavirus vaccines now, as opposed to reserving half of them to be used later as second doses for the first recipients, could prevent a significant amount of new symptomatic COVID-19 infections.

Dr. Anna Banerji, an infectious disease specialist at the University of Toronto, said it is actually better to spread the vaccine to as many people as quickly as possible with a first dose rather than reserving the second shot in case of shortages.

“If the end goal is to save lives and prevent hospitalization and vulnerable populations, then it’s better to get the vaccine out to all the people who are at high risk, like long-term care facilities, first rather than getting two to half the amount of people,” she told Global News.

REFERENCES :
1. https://globalnews.ca/news/7585267/coronavirus-vaccine-second-dose-delay/

2. Saba Aziz

What are the differences of these various COVID-19 vaccines?

Covid-19, Uncategorized·January 12, 2021February 15, 2021

Sinovac

Various COVID 19 vaccines in Beijing-based biopharmaceutical company Sinovac is behind the CoronaVac, an inactivated vaccine.

It works by using killed viral particles to expose the body’s immune system to the virus without risking a serious disease response.

By comparison the Moderna and Pfizer vaccines being developed in the West are mRNA vaccines. This means part of the coronavirus’ genetic code is injected into the body, triggering the body to begin making viral proteins, but not the whole virus, which is enough to train the immune system to attack.

On paper, one of Sinovac’s main advantages is that it can be stored in a standard refrigerator at 2-8 degrees Celsius, like the Oxford vaccine, which is made from a genetically engineered virus that causes the common cold in chimpanzees.¹

While the three COVID-19 vaccines – from Pfizer/BioNtech, Moderna and Oxford/AstraZeneca – look set to be the most common ones for Europeans.

While they all have the same goal, there are substantial differences between the jabs, from their composition and reported effectiveness, to their price and ease of conservation and distribution.

It means that both Sinovac and the Oxford-AstraZeneca vaccine are a lot more useful to developing countries that might not be able to store large amounts of vaccine at such low temperatures.

Pfizer/BioNtech and Moderna

The Pfizer vaccine, like the Moderna one, use innovative messenger RNA technology. In short, this technology teaches our cells how to produce a protein, which is what makes the immune system react.

It is claimed their efficiency in successfully fighting COVID-19, at up to 95%, is higher than that of AstraZeneca.

Both, however, are more expensive.

The big drawback of Pfizer’s jab is that it needs to be stored in the extreme cold, at temperatures as low as -70C to -80C. Moderna’s can remain stable for 30 days at a temperature of between 2C and 8C, but for longer periods it will have to be frozen at -20C.

Oxford/AstraZeneca

Compared to Pfizer and Moderna, AstraZeneca’s jab uses a more traditional vaccine technique, using an attenuated version of the virus that causes the common cold in chimpanzees.

This virus has been genetically altered with a gene for a coronavirus protein to provoke the body’s immune reaction.

Its efficiency rate is lower at around 70%. But, under certain conditions, this can be as high as 90%.

But it is a lot cheaper and easier to store than Pfizer’s vaccine. The AstraZeneca vaccine can survive in a standard refrigerator for up to six months, whereas the Pfizer one needs temperatures of up to -80℃.²

That’s all for the various covid 19 vaccines hope this article help you!

Also Read Indonesia COVID vaccination to start Wednesday using Sinovac drug

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