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CMAAO Coronavirus Facts and Myth Buster: Unanswered questions on COVID-19 vaccine

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Dr KK Aggarwal    08 February 2021

With input from Dr Monica Vasudev

1349: HCFI Round Table Expert Zoom Meeting on “Unanswered questions on COVID-19 vaccine!”

30th January, 2021, 11am-12pm

Participants: Dr KK Aggarwal, Dr AK Agarwal, Dr Shashank Joshi, Prof Mahesh Verma, Dr Anita Chakravarti, Dr Jayakrishnan Alapet, Dr DR Rai, Mr Bejon Misra, Ms Balbir Verma, Dr KK Kalra, Dr Suresh Mittal, Ms Ira Gupta, Dr S Sharma

 

Consensus Statement of HCFI Expert Round Table

 

  • Lot of information circulating in the social media has led to vaccine hesitancy among people.
  • Although the government has released a set of FAQs, there are still many unanswered questions. Fear needs to be replaced by facts and logic.
  • People with asthma hesitate to take the vaccine because of history of allergy.
  • People who have history of allergies should be vaccinated as per standard allergy protocol (montelukast day before, on the day of vaccination and the day after along with H1 and H2 blocker + scratch test on the day of vaccine administration or intradermal test (1 in 100 dilution) to detect hypersensitivity; can also be done prior to COVID vaccine similar to a sensitivity test done for penicillin).
  • Colchicine may help to prevent COVID reaction in immunocompromised people. Colchicine increases activity of dendritic cells and makes antigen presenting cells more active. It is immunomodulator and increases vaccine efficiency. Colchicine enhances immunogenicity of the vaccine.
  • People who died in Norway after vaccination had vaccine reactogenicity and could not tolerate even the mild Th1 response.
  • People who have CRP more than 1 and are high risk, should take colchicine before taking the vaccine.
  • Is mild corona better than vaccination? The answer is no; as post-COVID symptoms may last for more than 9 months according to a latest study.
  • The binding antibody response seen after a vaccine is much more than the response to a natural infection.
  • Binding antibodies can be detected by IgG S antibodies as a screening method and antibody-specific binding antibody test after the vaccine.
  • A leading Immunologist has warned US FDA on the immunological danger of COVID-19 vaccination in recently convalescent and asymptomatic carriers, especially those who are elderly, frail or have significant cardiovascular risk factors. Colchicine can be the answer for this.
  • J&J vaccine is 66% effective in global trial but 85% effective against severe disease.
  • The message should be that vaccines are 100% effective against severe disease.
  • Vaccine will convert severe illness into mild illness. We have yet to see a case of vaccine failure COVID dying.
  • Another question is why one should take a vaccine when we are approaching herd immunity. The answer to this comes from Brazil. There is a second COVID wave in Brazil despite herd immunity (76%) by natural infection. Four reasons have been given for this: overestimation of herd immunity, waning immunity, immunity-evading mutations and highly transmissible virus (South Africa variant). Therefore, a second wave can come even after vaccine or after natural immunity. This will be a mild disease.
  • Germany recommends AstraZeneca vaccine only for those under 65 years. Older and high risk individuals will not be given the vaccine as they will not be able to tolerate the vaccine reactogenicity. The answer to this is colchicine, montelukast, H1 and H2 blocker.
  • Novavax vaccine may not be effective against South Africa strain. Previous infection may not protect against reinfection. In persons with HIV, the vaccine may not be effective.
  • Novavax uses a nanoparticle technology along with a proprietary adjuvant with the recombinant protein. It is a subprotein vaccine and can be stored at 2 to 8 degree centigrade. It is a recombinant version of the coronavirus spike protein and produced in the lab in insect cells. It is using the D614G protein.
  • This vaccine candidate showed almost 90% efficacy against COVID-19 in UK where half the cases were due to the new UK variant. But, in South Africa trial, the overall vaccine efficacy was under 50% against cases largely due to the South Africa variant. Prior infection with the wild-type strain may not fully protect against new infection from the variant strain.
  • In the UK arm of the trial, almost 90% efficacy was achieved against confirmed and symptomatic COVID-19. Out of the 15,000 participants, 56 infections occurred in the placebo group, while six cases occurred in the group given the active vaccine. Of these 62 cases, only one was classified as severe. Half of the 62 cases were UK variant. The vaccine efficacy was 95.6% against the original COVID-19 strain and 85.6% against the UK variant. So, there was 10% vaccine failure in protecting against the UK strain.
  • In the South Africa arm of the trial, which had 6% HIV-positive participants, the vaccine showed 60% efficacy in HIV-negative persons and it was much less effective in the HIV-infected participants resulting in around 50% efficacy overall. There were 29 COVID infections in the placebo group and 15 in the vaccine group. Most cases were due to South Africa variant.
  • The Novavax study highlights the need for a bivalent or quadrivalent vaccine for the new strains.
  • COVID-19 and MERS have same spike protein; the difference between the COVID virus, MERS virus and the SARS virus is in the RBD. There are 239 amino acids in MERS RBD and only 182 in COVID virus RBD.
  • The South Africa strain has more mutations in RBD and RBM.
  • The new virus strains may become more severe like MERS or may become more infectious.
  • Colchicine is the drug of choice for NLRP pathway.
  • Low dose aspirin does not diminish the immune response to monovalent H1N1 influenza vaccine in older adults.
  • ICMR has clarified that those patients on blood thinners are not a contraindication for vaccine.
  • Every contraindication can be converted into an indication. For this, the government must open up vaccine in the private sector; people with history of allergies should go to an allergy center for vaccine.
  • Role of vaccine is also therapeutic, i.e., it will prevent severity of infection.
  • Strict pharmacovigilance is required; it will also serve as a useful source of information.
  • Do a CBC (look at eosinophil levels), IgE and CRP. If eosinophils and IgE are high but CRP is less than one, take H1 and H2 blocker with montelukast and go ahead with the vaccine. Stay at least for 2 hours in the vaccination center after the vaccine.
  • If CRP is elevated, then colchicine is added.
  • There should not be vaccine hesitancy even among persons with allergies.
  • Masking is still important after vaccine. Vaccine is protective but not preventive all the time. One can get asymptomatic or mild infection.
  • Vaccination is a rule, exception is extraordinarily rare and in most people, contraindication can be converted into indication under supervision of an allergy specialist.

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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