1238-40

1238: Minutes of Virtual Meeting of CMAAO NMAs on “Vaccine Update: Pfizer-BioNTech COVID-19 Vaccine”

19^th December, 2020, Saturday

9.30am-10.30am

Participants: Member NMAs, Dr KK Aggarwal, President CMAAO, Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO, Dr Marthanda Pillai, India, Member World Medical Council, Dr Marie Uzawa Urabe, Japan Medical Association, Dr Angelique Coetzee, President South African Medical Association, Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association, Prof Ashraf Nizami, Pakistan, First Vice President CMAAO

Invitees: Dr S Sharma, Editor IJCP Group

Key points from the discussion

• The CDC has published information about what clinicians need to know about the Pfizer-BioNTech COVID-19 vaccine, which received emergency use approval in the US on 13th Dec. 2020 for persons aged ≥16 years.

o   Pfizer-BioNTech COVID-19 vaccine is a lipid nanoparticle-formulated mRNA vaccine encoding the spike protein.

o   mRNA technology is new but not unknown; mRNA vaccines do not contain a live virus and the mRNA does not enter the nucleus of the cell; hence, there are no genetic changes.

o   ACIP has recommended that healthcare personnel and residents of long-term care facilities be offered vaccination in the initial phase of the COVID-19 vaccination program.

o   Dose and administration: 2 doses, given intramuscularly 3 weeks apart. It is necessary to take both the doses. There is a 4-day grace period for the 2nd dose. If >21 days since 1st dose, 2nd dose should be administered at earliest opportunity (but no doses need to be repeated).

o   The Pfizer-BioNTech COVID-19 vaccine is not interchangeable with other COVID-19 vaccines.

o   It is not to be given simultaneously with other vaccines. There should be a gap of at least 14 days before or after administration with any other vaccine.

o   Persons with past infection (symptomatic or asymptomatic) should be given the vaccine.

o   Persons with active infection should defer vaccination until recovery from acute illness (if person had symptoms) and criteria have been met to discontinue isolation. They should wait for 90 days before taking the vaccine.

o   Persons with a known SARS-CoV-2 exposure in the community or outpatient setting should defer vaccination until quarantine period has ended to avoid exposing healthcare personnel (HCP) or other persons during vaccination visit.

o   Persons with underlying medical conditions who have no contraindications to vaccination may take the vaccine.

o   Data is not currently available to establish safety and efficacy of vaccine in immunocompromised persons. They may still receive COVID-19 vaccine unless otherwise contraindicated.

o   There are no data on the safety of COVID-19 vaccines in pregnant women.

o   If a pregnant/lactating woman is part of a group (e.g., healthcare personnel) who is recommended to receive a COVID-19 vaccine and is pregnant, she may choose to be vaccinated. A discussion with her healthcare provider can help her make an informed decision.

o   Routine testing for pregnancy prior to receipt of a COVID-19 vaccine is not recommended.

o   Vaccine recipients should be counseled about expected local and systemic post-vaccination symptoms prior to vaccination. Unless a person develops a contraindication to vaccination, they should be encouraged to complete the series even if they develop post-vaccination symptoms in order to optimize protection against COVID-19.

o   Protection from vaccine is not immediate; it will take 1 to 2 weeks following the second dose to be considered fully vaccinated. Hence, all persons who have taken the vaccine should adhere to protective measures (masking, physical distancing, hand washing, avoiding crowds).

o   Contraindications: Severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine.  Vaccine has to be given in a hospital with all precautions for managing anaphylaxis after informed consent. The patient has to be monitored for 15-30 minutes after the vaccine is administered for occurrence of immediate adverse reactions. Anaphylaxis with Pfizer vaccine has been hypothesized to be due to liposome containing PEG.

o   Prior receipt of the Pfizer-BioNTech COVID-19 vaccine will not affect the results of SARS-CoV-2 nucleic acid amplification or antigen tests.

• A new virus variant has been identified in South East England (VUI 202012/01 - the first variant under investigation in December 2020) with N501Y mutation (asparagine N has been replaced by tyrosine Y).
• A new variant 501.V2 has also been identified in South Africa.
• The new variants are more contagious but associated with less mortality. There is a concern of reinfection with the new variants.
• Singapore has an app for contact tracing “TraceTogether” or a physical token. The information gathered will be used only if the patient becomes positive.
• In times of pandemic, the principle of “broader good” becomes more important than individual privacy.
• Hong Kong is experiencing the fourth wave of the COVID-19 pandemic; 80-90 confirmed cases daily – asymptomatic positive by contact tracing. The origin of 20-30 cases was untraceable.
• Pakistan is now passing through a critical phase. The number of patients is very high. Within 2-3 months, vaccine should be available in Pakistan. No complications have been observed in the trials of the Chinese vaccine.
• A resolution was passed in the meeting that all CMAAO office bearers should take pictures of themselves getting a vaccine and post it on CMAAO website.

1239: - Among patients infected with SARS-CoV-2, it may seem appropriate to do tracheostomies earlier, i.e., 7 to 14 days after the patient has started on a ventilator, rather than waiting another week. In a retrospective review of records of 148 patients with COVID-19 on ventilators, early tracheostomy was found to result in a slightly shorter hospital stay, on average, suggested a report published in JAMA Otolaryngology-Head & Neck Surgery. (Medscape)

1240: SARS-CoV-2 infection can lead to croup, suggests a new case report. A 14-month-old boy presented to a community emergency department with fever, cough and stridor, and did not have pneumonia or lower-respiratory-tract infection, reported Dr. Claire E. Pitstick of Rush University Medical Center in Chicago and her colleagues in Pediatrics. (Medscape)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA