Am I fit for the vaccine?

Some vaccines stop you from getting symptomatic disease, but others stop you from getting infected too, which is also known as ‘sterilizing immunity’, in which the virus cannot infect the body because the immune system stops the virus entering cells and replicating. In his 14th January 2021, session on FAQs on Vaccines, eminent Cardiologist and Padma Shree Awardee, Dr. KK Aggarwal responded to various questions from the audience to understand “Am I fit for the vaccine?”

We, at Health Patrol are happy to respond to any COVID related queries you may have for yourself or your friends and family members, because our mission is to put an end to fake news. Herein, we have enlisted some of the key concerns shared by patients and public on the COVID vaccines. Further details and full session can be accessed at https://www.facebook.com/drkkaggarwal/videos/147595213673184

1. I am a thyroid patient taking Levothyroxine for 7 years. Can I take the COVID-19 vaccine?
   • Yes, everyone needs the vaccine. Levothyroxine is used to treat hypothyroidism (condition where the thyroid gland does not produce enough thyroid hormone). It is also used with surgery and radioactive iodine therapy to treat thyroid cancer. Levothyroxine is in a class of medications called hormones and it does not affect adversely if the COVID vaccine is taken.
2. My grandfather is 92 years old. He takes hypertension and diabetes medicines. Can he take the COVID-19 vaccine?
   • Age >80 years adds to the risk of COVID-19 infection, therefore, people aged more than 60 years have been put on the priority list for vaccination drive in India. Yes, this patient can take the COVID vaccine.
3. I was recently diagnosed with PCOS and I am on metformin. Can I take the COVID-19 vaccine?
   • Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. It is a common condition in women of reproductive age, but this does not make them at risk for the vaccine. They can take the vaccine and continue with their medications as usual.
4. I am 55 years old on hypertension medicines for 5 years. Can I take the COVID-19 vaccine?
   • Growing data shows a higher risk of COVID-19 infections and complications in people with high blood pressure. Analysis of early data shows that high blood pressure is the most commonly shared pre-existing condition among those hospitalized, affecting between 30% to 50% of the patients. Hypertension patients therefore are at risk for the infection and need to take the vaccine as soon as it is available to them.

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The combination of getting vaccinated and following the guidelines to protect yourself and others will offer the best protection from COVID-19.

It is advisable to get the COVID-19 vaccination because it will help keep you from getting COVID-19. In fact, according to the Advisory Committee on Immunization Practices (ACIP)¹, the independent committee that advises the Centers for Disease Control and Prevention (CDC) on how best to control vaccine-preventable diseases in the US, even a previous COVID-19 infection should NOT rule out a person from getting the vaccine. In a report² from the CDC meeting on December 12, the committee noted that data from clinical trials suggests that vaccination is “safe and likely efficacious” in people who have previously been infected with COVID-19, whether they displayed symptoms or not.

Based on the knowledge we have regarding vaccines for other diseases and early data from clinical trials, experts believe that getting a COVID-19 vaccine may also help keep you from getting seriously ill even if you do get COVID-19.Getting vaccinated yourself may also protect people around you, particularly people at increased risk for severe illness from COVID-19, such as elderly and people with medical conditions. Experts continue to conduct more studies about the effect of COVID-19 vaccination on severity of illness from COVID-19, as well as its ability to keep people from spreading the virus that causes COVID-19.

COVID-19 vaccination is a safer way to help build protection and it is much needed given that currently, all reports suggest COVID-19 can have serious, life-threatening complications,  and there is no way to know how COVID-19 will affect you. And if you get sick, you could spread the disease to friends, family, and others around you.

Getting COVID-19 may offer some natural protection, known as immunity. Current evidence suggests that reinfection with the virus that causes COVID-19 is uncommon in the 90 days after initial infection. However, experts don’t know for sure how long this protection lasts, and the risk of severe illness and death from COVID-19 far outweighs any benefits of natural immunity. COVID-19 vaccination will help protect you by creating an antibody (immune system) response without having to experience sickness.

Most importantly, if we are to defeat this virus and come out of this pandemic with flying colors, COVID-19 vaccination will be an important tool to help stop the pandemic. Wearing masks, good hand hygiene and social distancing help reduce your chances of being exposed to the virus or spreading it to others, but as we are aware, these measures alone have not been enough. Vaccines will work with your immune system so it will be ready to fight the virus if you are exposed.

Add – gap of 28 days between two doses of COVID-19 vaccine and its effectiveness will begin 14 days after the second dose. So, preventive measures need to be continued and strictly adhered to.

Source

1 https://www.health.com/condition/infectious-diseases/coronavirus/if-you-already-had-covid-do-you-need-vaccine
2 https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/slides-12-12/COVID-03-Mbaeyi.pdf

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A few days ago, Health Patrol carried out the update on the UK variant of the Coronavirus.¹ According to the Ministry of Health & Family Welfare², India, a new variant of SARS- CoV 2 virus [Variant Under Investigation (VUI)-20212/01] has been reported by the Government of United Kingdom (UK) to the World Health Organization (WHO). This variant is estimated by European Center for Disease Control (ECDC) to be more transmissible and affecting younger population and is defined by a set of 17 changes or mutations. Till date, there are 109 confirmed cases of the virus and scientists want to understand why these variants seem to be spreading so quickly. Adding to the sense of urgency is the worry that the variants could weaken immune responses triggered by vaccines and previous infection. This has also led to the question if this diminishes the potency of vaccines or overcomes natural immunity and lead to a spate of reinfections.³

The good news is that an 08th January update⁴ suggests the Pfizer–BioNtech vaccine is effective against a mutated form of the SARS-CoV-2 virus. Biotech firm Moderna in Cambridge, Massachusetts, which has developed an RNA-based vaccine, has said that it expects their vaccine to work against the UK variant and that tests are under way. Likewise, eminent evolutionary biologist Dr. Jesse Bloom³ from the Fred Hutchinson Cancer Research Center in Seattle, and other scientists are hopeful that the mutations in the variants will not substantially weaken the performance of vaccines. The vaccine shots produce a large number of neutralizing antibodies, so a small variation in the mutation should not affect the potency of the vaccine, they believe.

Source

1 https://healthpatrol.in/2021/01/08/the-uk-virus-cannot-infect-indians/
2 December 2020. https://www.mohfw.gov.in/pdf/SOPforSurveillanceandresponseforthenewSARSCov2variant.pdf
3 Ewwin Callaway. Nature2021;589:177-78.
4 Greaney AJ et al. 2021;Preprint at bioRxiv https://doi.org/10.1101/2020.12.31.425021

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A growing body of evidence is suggesting that children’s immune systems are better equipped to handle the Coronavirus, than adults. A recent report¹ published in a leading medical journal, Nature, analyzed this. The report says that young children account for only a small percentage of COVID-19 infections² and this data has perplexed scientists across the globe.

According to eminent immunologist, Dr. Donna Farber, “Children are very much adapted to respond — and very well equipped to respond — to new viruses and even when they are infected with SARS-CoV-2, children are most likely to experience mild or asymptomatic illness”.³ Both resistance to infection and resistance to disease appear to be much stronger in children than in adults. The apparent resistance to infection might actually reflect a more rapid clearance of the virus so that the chance to detect cases is diminished.4

Another indication that children’s response to the virus differs from that of adults is that some children develop COVID-19 symptoms and antibodies specific to SARS-CoV-2 but never test positive for the virus on a standard RT-PCR test. For e.g., in a study⁴ of three children under the age of 10, from the same family who developed SARS-CoV-2 antibodies— and two of them even experienced mild symptoms — but none tested positive on RT-PCR, despite being tested 11 times over 28 days while in close contact with their parents, who had tested positive.

Studies^5-7 report that even in children who experienced the severe but rare complication in response to SARS-CoV-2 infection, the rate of positive results on RT-PCR ranged from just 29-50%.

Another recent study⁸of 32 adults and 47 children aged 18 years or younger, found that children mostly produced antibodies aimed at the SARS-CoV-2 spike protein, which the virus uses to enter cells, while adults generated similar antibodies, but also developed antibodies against the protein that is essential for viral replication. Since children lack this protein that supports viral replication, they are not experiencing widespread infection. The study inferred that children’s immune responses seem to be able to eliminate the virus before it replicates in large numbers, which is why they may be able to evade COVID-19 or at least be affected only mildly.

Source

1 Nogrady B. Nature 2020;588:382
2 Wu Z, et al. J Am Med Assoc. 2020;323:1239–42.
3 Dong, Y, et al. Pediatrics 2020;145:e20200702.
4 Fisher A. Mucos Immunol. 2020;13:563-65.
5 Tosif S, et al. Nature Commun. 2020;11:5703.
6 Dufort EM, et al. N Engl J Med. 2020;383:347–58.
7 Feldstein LR, et al. NEngl J Med. 2020;383:334–46.
8 Whittaker ED, et al. J Am Med Assoc. 2020;324:259-69.
9 Weisberg SP, et al. Nature Immunol. 2020;https://doi.org/10.1038/s41590-020-00826-9

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We at Health Patrol have been flooded with queries about how soon people can go back to their pre-COVID pandemic life after getting the vaccine. Two doses of vaccine, 28 days apart, are needed. This needs to be taken by all to complete the vaccination schedule. Protective levels of antibodies will generally develop two weeks after receiving the second dose of Covid-19 vaccine. While the news is encouraging and Indian vaccination schedule has begun on 16^th January 2021, experts still believe the pre-COVID times will take time to resume.

As we covered recently,a report¹ published in the New York Times carried information stating the new vaccines will probably prevent you from getting sick with COVID-19, butno one knows yet whether they will keep you from spreading the virus to others so until that information is clear, it is pertinent to maintain the same social distancing, hand hygiene and mask measures, that we have been following since the pandemic, because some vaccinated people could get infected without developing symptoms, and could then silently transmit the virus — especially if they come in close contact with others or stop wearing masks.

Another report² published in the Business Insider also emphasizes that avaccine is the first step to helping us return to pre-COVID normality, but it is still not the end-all. Experts have projected that aspects of pre-COVID life will begin to resume in spring 2021 and inch closer to the old normal by the year’s end.

If vaccinated people are silent spreaders of the virus, they may keep it circulating in their communities, putting unvaccinated people at risk.Experts are not yet sure how long the vaccine will be effective, and at this time the recommendation is to get both doses and then continue to wear a mask and practice social distancing and good hygiene.Moreover, trials that have been conducted on and around the vaccines have shown that the vaccine could prevent people from becoming sick, but whether people who have been vaccinated can still transmit the virus, is still not researched in detail.

Which is why eminent cardiologist and Padma Shree Awardee, Dr. KK Aggarwal emphasizes in each of his weekly shows that we need to continue with the social distancing and hygiene measures that we have been carrying out since the beginning of 2020. The Ministry of Health & Family Welfare also states that after receiving the COVID-19 vaccine, we must continue to take all precautions like use of face cover or masks, hand sanitization and ‘do gajkidoori’ – physical distancing of at least 6 feet.3

Health Patrol carried out an extensive report on wearing masks even after the vaccination. Access the report on https://healthpatrol.in/2021/01/13/do-i-still-need-to-wear-a-mask-after-the-vaccine/

Source

1 https://www.nytimes.com/2020/12/08/health/covid-vaccine-mask.html
2 https://www.businessinsider.in/science/news/what-you-can-and-cant-do-after-getting-the-coronavirus-vaccine/articleshow/79652928.cms
3 https://www.mohfw.gov.in/pdf/FrequentlyAskedQuestionsonCOVID19vaccineFLWEnglish.pdf

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