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The BCG Vaccine protects against COVID-19

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Ecological studies have suggested fewer COVID-19 morbidities and mortalities in Bacillus Calmette–Guérin (BCG)-vaccinated countries than BCG-non-vaccinated countries. However, these studies obtained data during the early phase of the pandemic and did not adjust for potential confounders, including PCR-test numbers per population (PCR-tests).1

In the absence of specific therapy, researchers have been exploring potential preventive and therapeutic options. There was a huge  buzz about the protective effect of Bacille Calmette-Guérin (BCG) vaccine in COVID-19. Based on epidemiological correlations, many unpublished preprints hypothesized that the BCG vaccine may offer protection against COVID-19. It gained so much popularity that within 20 days three randomized controlled trials (RCTs) got registered, and many more are in the pipeline.2 However, to make an informed decision, it is critical to understand the mechanism of action of BCG, and appraise the robustness of the evidence.

The basis of the possible use of the BCG vaccine against COVID-19 lies in its non-specific effects (NSEs) over the immune system.3 The NSEs of BCG are mainly mediated by potentiating innate immune response through epigenetic mechanisms, which act as de novo enhancers to boost the immune response against a secondary challenge.3-5 This enhancing response is popularly known as ‘trained immunity’ and is very characteristic of BCG. This trained immunity also offers protection against a variety of pathogens (Salmonella, Shigella, malaria, respiratory viruses, etc.) other than Mycobacterium tuberculosis, and forms the basis of its use in bladder cancer, melanoma etc.

However, in terms of COVID-19 context, the relationship between BCG and COVID-19 is being proven by looking at correlation/ association among two data set (BCG vaccine coverage and COVID-19), without acknowledging the variables like the difference in testing strategies, reporting bias, demographics, nation’s ability to respond to the pandemic, prevalence of co-morbidities, and different stages of the pandemic across various countries might have a significant impact on these associations/correlations and must be interpreted carefully. Therefore, at this stage, this association should be considered as a hypothesis only and should be tested through appropriately designed studies. Though the epidemiological association between BCG and COVID-19 is striking, it does not prove causal relationship unless tested in well-designed clinical trials.

Also, it should be noted that the NSEs of the BCG vaccine have not been well-studied in human beings and their clinical relevance is unknown.2,3

A December 2020 study6 also states that besides unproven efficacy of the BCG vaccine, believing such reports and going for revaccination with BCG can put at serious risk patients with primary or secondary immunodeficiency. The report further states that even if the BCG vaccine is effective in preventing COVID-19 deaths or reducing its severity, the effect of this vaccine and its relevance is yet to be proven. Furthermore, It is very difficult to compare the epidemiologic data about COVID-19 in different countries. There are countless factors, mainly social and related to the healthcare system, which can be more decisive than the hypothesis of trained immunity induced by BCG. Until now, we can say that BCG’s protective role is, at least, insufficient, given many other factors that corroborate SARS-CoV-2 infection and/or its severity.

Therefore, in the absence of evidence, the BCG vaccination for the prevention of COVID-19 cannot be recommended. Despite the fact that greater BCG vaccine coverage may reduce the risk of deaths due to COVID-19, this needs to be further studied by observational studies and confirmed by randomized clinical trials.

Source:

1 Urashima M, Otani K, Hasegawa Y and Akutsu T. BCG Vaccination and Mortality of COVID-19 across 173 Countries: An Ecological Study. Int J Environ Res Public Health. 2020;17(15):5589.
2 World Health Organization. Bacille Calmette-Guérin (BCG) vaccination and COVID-19. Available from: https:/ /www.who.int/news-room/commentaries/detail/ bacillecalmette-guérin-(bcg)-vaccination-and-covid-19.
3 SAGE Working Group on BCG Vaccines and WHO Secretariat. Report on BCG vaccine use for protection against mycobacterial infections including tuberculosis, leprosy, and other nontuberculous mycobacteria (NTM) infections. World Health Organization; 2017. Available from: https://www.who.int/immunization/sage/ meetings/ 2017/october/1_BCG_report_revised_version_online.pdf. Accessed April 14, 2020.
4 Moorlag SJCFM, Arts RJW, van Crevel R, Netea MG. Non-specific effects of BCG vaccine on viral infections. Clin Microbiol Infect. 2019;25:1473-8.
5 Arts RJW, Moorlag SJCFM, Novakovic B, et al. BCG vaccination protects againstexperimental viral infection in humans through the induction of cytokines associated with trained immunity. Cell Host Microbe. 2018;23:89-100.e5.
6 Sarinho E, Goudouris E, Solé D. BCG vaccine: Worrying proposal for COVID-19. Vaccine. 2020;S0264-410X(20)31593-0. doi: 10.1016/j.vaccine.2020.12.026.

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Coronavirus

Everyone can benefit from a probiotic

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Probiotics are live microorganisms that can be consumed through foods such as curd/yoghurt and through supplemental forms. Studies show that the balance or imbalance of bacteria in your digestive system is linked to overall health and disease and probiotics promote a healthy balance of gut bacteria. They are used in managing and treating a variety of disease states. They are live microorganisms that are known to help improve gut health and include benefits for weight loss, digestive health, immune function and more.

However, current research suggests that probiotic supplements may not benefit everyone and should not be prescribed as a one-size-fits-all supplement. However, when taken in moderation according to your clinician’s advice, probiotics have a plethora of benefits reported in literature. Recent researches point out that changes in the gut microbiota would lead to a systemic inflammation that in different ways would reach the CNS modulating inflammatory pathways and especially the microglia, which could influence responses to treatments. Probiotics have therefore shown antidepressant responses and anti-inflammatory effects.

Studies also show probiotics promote mental flexibility and alleviate stress in healthy older adults, along with causing changes in gut microbiota. The probiotics exert their beneficial effects through modulation of host immune responses, maintain gut homeostasis and produce interferon thereby suppressing the virus induced cytokine storm.

Studies have also shown probiotics could significantly decrease the serum levels of high-sensitivity C-reactive protein and interleukin-6 and increase the serum albumin levels, upper arm circumference, and triceps skinfold thickness in patients undergoing peritoneal dialysis. 

What’s more – Probiotics may potentially have a beneficial role in preventing COVID-19. A recent study quotes, “The efficacy of probiotics has been studied previously on several respiratory tract viral infections. Probiotics comprise living microbes that upon oral administration benefit human health by reshaping the composition of gut microbiota. The close kinship of the gastrointestinal and respiratory tract suggests why the dysfunction of one may incite illness in others. The emerging studies suggest the capability of probiotics to regulate immune responses in the respiratory system.”

However, some studies showed that bacterial overgrowth in the small intestine related to probiotic use can lead to bloating, gas, and other adverse side effects. Additionally, some studies show that probiotic treatment following a course of antibiotics may delay the natural reconstitution of normal gut bacteria.

Therefore, it is recommended that you get a health checkup done starting from consulting your family physician who will advise if you need probiotic supplementation or not.

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Fully vaccinated individuals have lower travel risk but can be carriers

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While the debate for vaccinations continues across the globe, there is good news for those who have gotten vaccinated. Vaccination reduces risk of infection about 15-20 days after the dosing is complete. According to the new guidelines issued by the Centre for Disease Control (CDC), US, it is okay to travel domestically if you are fully vaccinated. Which means, you have completed the two doses of the two-dose vaccines or one dose of the J&J vaccine. Or as the CDC puts it’s, “you’re considered fully vaccinated 2 weeks after you receive the last required dose of the COVID-19 vaccine”.

While the US has issued statements that fully vaccinated domestic travelers don’t need to be tested before or after traveling unless their destination requires it, in India the rules for entering different states by air need to be checked well in time because a lot of states mandate a negative RT-PCR test for entry requirements. The Ministry of Health and Family Welfare in India has issued guidelines for International Travel and so has the Ministry of Civil Aviation for domestic travel on 30th March 2021. The DGCA has stated that surveillance across the airports in India will now be increased to ensure all COVID-19 protection protocols are taken into account.

On 13th April 2021, the Indian Railways has also confirmed that in view of the COVID-19 pandemic and related hygiene issues, they have also stopped service of cooked food and replaced the same with Ready to Eat (RTE) meals in trains. In addition, they have ensured that the COVID-19 related protective items such as masks, sanitizers, gloves etc. and takeaway bedroll kits/items, are available for sale through Multi-Purpose Stalls at Stations.

However, as is recommended, even fully vaccinated travelers should still follow the recommendations for traveling safely, including wearing a mask over your nose and mouth, staying 6 feet away from others and avoiding crowds, washing your hands often or using hand sanitizer, self-monitoring for COVID-19 symptoms after traveling, and isolate and get tested if symptoms develop

It is still very important to stay cautious and avoid potential exposures to the coronavirus whenever possible during travel, mainly because vaccination drives are still ongoing, and it is not recommended to travel unguarded since a lot of COVID-19 patients remain asymptomatic and can continue to spread the virus to other unvaccinated people. Also, no vaccine is a 100% fail safe yet, so a very small fraction of fully vaccinated people may still be at risk because emerging variants of the virus add a measure of uncertainty.

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Real-world data shows 90% efficacy of Pfizer-BioNTech and Moderna COVID-19 vaccines

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Pfizer-BioNTech and ModernaCOVID-19 vaccines are messenger RNA (mRNA) vaccines but are not available in India yet. These COVID-19 vaccines have been shown to be effective in preventing symptomatic SARS-CoV-2 infection in randomized placebo-controlled Phase III trials.

A new study has shown that the Pfizer-BioNTech and Moderna-NIAID vaccines are effective at preventing infections in the real world. According to the CDC, the authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.

 This study has been published March 29 in Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention (CDC) in the USA. Study analysts have seen that the two-dose vaccine regimen was 90% effective at preventing infections 2 weeks after receiving the second dose.

This new study restores faith in the COVID-19 vaccines and has shown to be highly effective at preventing symptomatic and asymptomatic infections in real-world settings. As per the study results, this data is similar to those from earlier phase 3 clinical trials published in the journal New England Journal of Medicine, which found an efficacy of more than 90% for both the Pfizer-BioNTech and Moderna-NIAID vaccines. This is encouraging news for everyone across the globe because real-world effectiveness is often conservative and therefore, lower due to a number of factors.

Dr. James H. Conway, a pediatric infectious disease specialist at the University of Wisconsin-Madison, said what we really care about is a vaccine’s effectiveness — its real-world potential. He further added that such studies are not only proving how effective the vaccines can be for the studies and research data, but also show the true power of vaccines for real-world COVID-19 pandemic. Therefore, results published in the recent report from the CDC reassure that the vaccines are working as well as they are hoped to, in curbing the pandemic and in turn, stopping the spread of the virus.

Get vaccinated today!!

Read about the vaccination registration procedure here. For details about the type of vaccine and the dosing schedule, read here.

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Sputnik V submitted for DGCI approval for emergency use authorization

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On 13th April 2021, the Drug Controller General of India (DCGI) has approved the Sputnik V COVID-19 vaccine for emergency use.  After Covishield, developed by Oxford University-AstraZeneca and manufactured by the Serum Institute of India (SII), and Bharat Biotech’s Covaxin, this will be the third vaccine against the novel coronavirus that has been granted emergency use authorization in India.

India is the 60th country to approve Sputnik V—the rollout for which is likely to begin by end of April or early May.Currently, the Sputnik V will be imported before the local production kicks in. It is hoped that this emergency approval of Sputnik V will strengthen the government efforts to scale up vaccination, as India is battling the second wave of the pandemic with close to 1.4 lac cases reported on 12th April 2021.

India is also the leading production hub for Sputnik V, since its parent manufacturer company has reached agreements with the leading pharmaceutical companies in India such as Gland Pharma, Hetero Biopharma, Panacea Biotec, Stelis Biopharma, Virchow Biotech aimed at production of more than 850 million doses per year, sufficient to vaccinate more than 425 million people around the world.

The vaccine Sputnik V ranks second among coronavirus vaccines globally in terms of the number of approvals issued by government regulators and has an efficacy of 91.6%. It has shown encouraging results in protection against severe cases of COVID-19 as demonstrated by the data published in one of the leading medical journals The Lancet.

Sputnik V uses two different vectors (adenovirus 26 and adenovirus 5) for the two shots in a course of vaccination, providing immunity with a longer duration than vaccines using the same delivery mechanism for both shots.The safety, efficacy and lack of negative long-term effects of adenoviral vaccines have been proven by more than 250 clinical studies over two decades. There are no strong allergies caused by Sputnik V and with a storage temperature of 2-8 degrees Celsius, the vaccine can be stored in conventional refrigerators without the need to invest in additional cold-chain infrastructure.

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37 vaccinated doctors are Covid-19 positive at Delhi’s Sir Gangaram Hospital

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Delhi recorded 7,437 fresh COVID-19 cases on April 8 — the highest single-day surge this year – with 24 more people dying due to the coronavirus infection, taking the death toll to 11,157, according to the Delhi Health Department. In what makes the situation worse, at least 37 doctors of Delhi’s Sir Gangaram Hospital have tested positive for coronavirus, as per the hospital sources on Thursday, 08th April 2021. These doctors had received both doses of COVID-19 vaccination during the first phase of the vaccination drive that was launched on 16th January 2021, thereby cautioning vaccinated individuals to be as cautious as ever to prevent the COVID-19 infection.

The hospital sources have confirmed that a majority of the COVID-19 positive doctors currently have mild symptoms – out of which, 32 doctors are in home isolation and 5 are admitted in the hospital.

Sir Ganga Ram Hospital in New Delhi has been at the forefront of the war against the pandemic that has crippled normal life for more than a year now. Here’s wishing all Corona Warriors a speedy recovery from Health Patrol!

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