6^th November, 2021, 11am-12noon

Key points of HCFI Expert Round Table

• Covid-19 vaccines are effective at preventing infection, serious illness and death. Vaccinated persons are 8 times less likely to be infected and 25 times less likely to experience hospitalizations and death.
• Vaccines are not 100% effective; therefore, some people may still get Covid-19 even if they are fully vaccinated.
• Immunocompromised persons may not have adequate levels of protection after the 2-dose primary vaccine series. They should continue to take all precautions. The CDC has recommended an additional dose of the vaccine for moderately to severe immunocompromised persons.
• The CDC has defined breakthrough infection as when a person tests positive for Covid-19 at least two weeks after becoming fully vaccinated.
• Breakthrough infections are related to vaccine efficacy and immune evasion.
• A study in Washington state of more than 4 million fully vaccinated showed breakthrough infection rate of about 1 in 5000 between January 17 and August 21, 2021. But more recent studies have shown breakthrough infection rates of around one in 100 fully vaccinated people.
• It is not easy to track every case of breakthrough infection. Most studies give different figures and are not true representative of a population. According to the CDC, the breakthrough cases are underreported as many such infections are asymptomatic or mild and therefore not reported.
• The rate of fully vaccinated Americans who have experienced a breakthrough case resulting in hospitalization or death has remained below 0.01% (CDC).
• As per media reports, over 25% of healthcare workers were infected with the delta variant despite full vaccination.
• As per a German study reported in the media, the suspected breakthrough infections among symptomatic Covid-19 cases in the 18-59 age group was 8.2%.
• As per government data, 2.6 lakh people have tested positive for Covid-19 after being vaccinated in India till August 3 after administration of around 53 crore vaccine doses. While 1.71 lakh breakthrough infections were reported in people who had taken one dose of the vaccine, the number of breakthrough infections among the fully vaccinated population was 87,049. Kerala alone has recorded 40,000 breakthrough infections.
• Breakthrough infection is seen more in the elderly population.
• A study of healthcare workers has found symptomatic breakthrough symptomatic infections occurring in 15 persons (13.3%), out of which one required hospitalization (Diabetes Metab Syndr. 2021 May 3).
• A meta-analysis of 18 studies involving 228,873 HCWs found the risk of Covid-19 infection to be very low in both partially and fully vaccinated HCWs; 1.3% for fully vaccinated, 3.7% for partially vaccinated and 10.1% for unvaccinated HCWs.
• The immunocompromised persons are more at risk of developing a breakthrough infection. The CDC recommends that persons with weakened immune system receive a third dose of the vaccine 28 days after the second dose.
• It has also been suggested that being vaccinated reduces the chances of long Covid.
• Breakthrough infections can be prevented by following all safety precautions. Indoor gatherings where there is overcrowding or poor adherence to masks or are ill-ventilated should be avoided.
• The course of action after a breakthrough infection is similar to that after a covid-19 infection. Isolation is still needed.
• There are no restrictions for travelers in the US and Dubai if they are fully vaccinated and they test negative for Covid. In Dubai, 200 or less people were allowed in a hall.
• The incidence of breakthrough infections remains the same, whether they are healthcare workers, who get the infection in a healthcare facility or those who get the infection outside the healthcare facility.
• There is no perfect methodology to establish how the T cells respond.
• The HLA system responds differently in different individuals to infections as well as vaccine challenges. This is an area that needs to be studied; it may then be possible to identify persons who actually need a booster dose of the vaccine.
• Cellular protection is variable in comorbidities.
• RT PCR is 87-93% specific for Covid with different methods.
• Studies have shown that after 3 months the antibody levels start to decline and by six months, they decline significantly. People who are immunocompromised or have risk factors should be considered for a third dose. This is the right time for the Expert Committee to recommend a booster dose for HCWs in particular those who are in direct contact with Covid patients and the immunocompromised persons as well.
• We must find out what is the half-life of immunity after vaccination.
• CRP has excellent sensitivity for Covid but it is not specific to Covid.
• About 25% healthcare workers have been affected with the delta variant.
• The currently available vaccines have been shown to be effective against the delta variant, although work is ongoing to modify the vaccine as per the variants.
• Booster dose should be the same as the primary vaccination. The body should not be rechallenged.

Participants

Dr KK Kalra

Dr Ashok Gupta

Dr DP Lokwani

Dr Arun Jamkar

Dr DR Rai

Ms Balbir Verma

Ms Ira Gupta

Mr Saurabh Aggarwal

Dr S Sharma