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Breastfeeding is not a contraindication for COVID-19 vaccine

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According to the Ministry of Health & Family Welfare India, lactating women should not receive the COVID-19 vaccine.1 However, recently, experts, including the WHO, believe it is most likely safe to get an mRNA COVID-19 vaccine in breastfeeding women. Although breastfeeding people were not included in the vaccine trials, the statement comes in the wake of the mechanism of mRNA vaccines and experience from other vaccines suggesting the vaccine can be taken by breastfeeding women.

According to the latest guidance by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) also, pregnant and breastfeeding women can receive the covid-19 vaccine. An article published in the journal BMJ Opinion2, reports how the MHRA had previously recommended that breastfeeding women should not be given the vaccine, which may have been interpreted by the National Health Service (NHS) in the UK as a blanket ban. But around the end of December 2020, it was reported that the MHRA had revised its recommendation and that lactating or breastfeeding women could be given both the Pfizer-BioNTech vaccine and the Oxford-AstraZeneca vaccine.3

According to a January 2021 report published in the journal British Medical Journal, the Royal College of Obstetricians and Gynaecologists (RCOG) said that the new guidance meant that pregnant women who were frontline health or social care workers could discuss the option of vaccination. It also meant that frontline health and care workers who were breastfeeding should be offered vaccination, according to the College. Their President, Dr. Edward Morris, further highlighted that for frontline health and social care workers, and other priority groups, informed decision making should be facilitated. It is important that women continue to be offered occupational protection during pregnancy, regardless of their vaccination choice. While Dr. Morris believes vaccination is alright to proceed with for breastfeeding women, he also added that along with the Royal College of Midwives and other professional organizations, the RCOG was calling on the UK government to fund research studies to establish the suitability of any approved covid-19 vaccines for pregnant and breastfeeding women.

It also said that the vaccines could be considered for use in pregnancy but only when the potential benefits outweighed any potential risks for the mother and baby. As with all vaccines or treatments, lactating mothers are advised to discuss the benefits and risks of having the vaccine with their healthcare professionals and reach a joint decision based on individual circumstances.

Source

1 https://www.mohfw.gov.in/pdf/LetterfromAddlSecyMoHFWregContraindicationsandFactsheetforCOVID19vaccines.PDF
2 Hare H, Womersley K. Why were breastfeeding women denied the covid-19 vaccine? BMJ Opinion 2021 Jan 5. https://blogs.bmj.com/bmj/2021/01/05/why-were-breastfeeding-women-denied-the-covid-19-vaccine/.
3 Medicines and Healthcare Products Regulatory Agency. Oxford University/AstraZeneca covid-19 vaccine approved. 30 Dec 2020. https://www.gov.uk/government/news/oxford-universityastrazeneca-covid-19-vaccine-approved.
4 Rimmer A. Covid-19: Breastfeeding women can have vaccine after guidance turnaround. BMJ 2021;372:n64

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Coronavirus

New COVID Guidelines in Mumbai

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This is true. Mumbai has witnessed a 36.38% rise in the active COVID-19 cases since 8 February, as perthe Brihanmumbai Municipal Corporation (BMC).In light of this rise in COVID- 19 cases, the BMC has issued guidelines for strict action against citizens found violating safety guidelines. BMC has laid stricter action rules against people found without masks in public, and will take action against function halls, gymnasiums and other establishments that don’t follow safety norms.

According to the guidelines, Mr. Suresh Kakani, the Additional Municipal Commissioner said, if function halls, gymnasiums and restaurants are found to be seating people beyond the permissible limit, there will be hefty fines to pay. He further emphasized that these establishments will be prosecuted if they continue to flout the norms.

Key points from the guidelines:

  • Guests at function halls limited to 50
  • Restaurants to operate at 50% seating capacity at any given time
  • Residential buildings with more than 5 cases will be sealed
  • Masks made mandatory for public places, social gatherings, etc.
  • Strict action to be taken against those in parks and playgrounds without masks
  • Number of marshals checking offenders without masks, etc. will be doubled
  • Asymptomatic patients in home quarantine will be stamped as earlier

Not only establishments, BMC Commissioner Mr. Iqbal Singh Chahal stated that the BMC has deployed additional marshals on suburban trains and also directed to ramp up testing.

BMC has furtherdecided to resume stamping of the hands of people who are placed under home quarantine, and in case of violation, an offence will be registered against them.Similar action will be taken against those who flout the rules at weddings and other social gatherings in the city and BMC teams will raid event venues.  BMC has also confirmed that it plans to double the number of clean-up marshals, who can impose fine on those who do not wear mask in public, from 2,400 to 4,800.

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COVID vaccine for senior citizens to be available from 01st March 2021

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On 24th February 2021, the Government gave a go-ahead for the second phase of COVID-19 vaccination from Monday, March 1, 2021. This was announced by Minister of Environment, Forest and Climate Change, Minister of Information and Broadcasting and Ministry of Heavy Industries and Public Enterprises, Mr. Prakash Javadekar at a press conference at the National Media Centre.

He also said that people above the age of 60, and those over 45 years with comorbidities can get the vaccine shots at government as well as private clinics. While the vaccine shots at private hospitals will be on a chargeable basis, the government clinics across the country will administer the vaccines for free.

At the briefing, Mr. Ravi Shankar Prasad, current Union Minister holding the Law and Justice, Electronics and Information Technology and Communications portfolios in the Government of India highlighted how the government has expedited the current vaccination drive due to the alarming rise in cases indicating a second wave of infections.

Recent data have shown the seven-day average of new cases across India dropped to its lowest on February 11, when it touched 10,988, but it has shown a sustained increase of 18% since then to reach 12,971 on Monday, 22 February 2021.

Source

1 https://www.livemint.com/politics/policy/cabinet-briefing-live-prakash-javadekar-and-ravi-shankar-prasad-announces-govt-decision-11614157764015.html
2 https://www.hindustantimes.com/cities/mumbai-news/maharashtra-likely-to-get-3rd-batch-of-covid-vaccine-on-monday-101613068460114.html
3 https://www.hindustantimes.com/india-news/govt-tells-states-to-expedite-covid-vaccination-drive-what-prompted-the-action-101614141825184.html

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Vaccine more efficacious if second dose timed 3 months later

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A recent news item published across leading Indian dailies covered the news update from UK stating that the Oxford University and AstraZeneca’s COVID-19 vaccine showed in a study it had 76% efficacy against symptomatic infection for three months after a single dose, which increased if the second shot is delayed. These findings have come up as a pre-print with The Lancet, ahead of peer-review. However, this analysis is still a work in progress for a wide range of reasons — some of which include lack of data on efficacy among the oldest, whom the British government have given highest priority in its vaccine rollout.

World News Agency Reuters reported that Dr. Andrew Pollard, Chief Investigator of the Oxford Vaccine Trial, has said that the data showed the 12-week interval between doses was “the optimal approach to roll out”.The results for the AstraZeneca/Oxford vaccine, gathered from trials in Britain, Brazil and South Africa, showed that immune responses were boosted with a longer interval to the second dose among participants aged 18 to 55 years.

The pre-print has concluded that vaccination programs aimed at vaccinating a large proportion of the population with a single dose, with a second dose given after a 3-month period may be an effective strategy for reducing disease and may be the optimal for rollout of a pandemic vaccine when supplies are limited in the short term.

While the AstraZeneca’s research chief has said 8-12 weeks between doses seems to be the “sweet spot” for efficacy, Pfizer has stated that such an interval has not been seen or checked with the vaccine it has developed with Germany’s BioNTech.

The pre-print has mentioned that the vaccine efficacy after a single standard dose of vaccine from day 22 to day 90 post vaccination was 76%, and that protection did not wane during this initial 3-month period. Similarly, antibody levels were maintained during this time with minimal waning. The paper further stated that the vaccine efficacy was 82.4% with 12 or more weeks to the second dose, compared to 54.9% for those where the booster was given under 6 weeks after the first dose.

Nevertheless, while this news and analysis brings hope for delayed vaccine doses or missed vaccine doses for some, it is still too early to conclude anything in this regard. Currently, the two doses of the vaccine are administered at a gap of 28 days.  

Watch this space for more recent updates and progress on this subject.

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World News Agency Reuters reported that Dr. Andrew Pollard, Chief Investigator of the Oxford Vaccine Trial, has said that the data showed the 12-week interval between doses was “the optimal approach to roll out”.The results for the AstraZeneca/Oxford vaccine, gathered from trials in Britain, Brazil and South Africa, showed that immune responses were boosted with a longer interval to the second dose among participants aged 18 to 55 years.

The pre-print has concluded that vaccination programs aimed at vaccinating a large proportion of the population with a single dose, with a second dose given after a 3-month period may be an effective strategy for reducing disease and may be the optimal for rollout of a pandemic vaccine when supplies are limited in the short term.

While the AstraZeneca’s research chief has said 8-12 weeks between doses seems to be the “sweet spot” for efficacy, Pfizer has stated that such an interval has not been seen or checked with the vaccine it has developed with Germany’s BioNTech.

The pre-print has mentioned that the vaccine efficacy after a single standard dose of vaccine from day 22 to day 90 post vaccination was 76%, and that protection did not wane during this initial 3-month period. Similarly, antibody levels were maintained during this time with minimal waning. The paper further stated that the vaccine efficacy was 82.4% with 12 or more weeks to the second dose, compared to 54.9% for those where the booster was given under 6 weeks after the first dose.

Nevertheless, while this news and analysis brings hope for delayed vaccine doses or missed vaccine doses for some, it is still too early to conclude anything in this regard. Currently, the two doses of the vaccine are administered at a gap of 28 days.  

Watch this space for more recent updates and progress on this subject.

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Nasal disinfectants are useful for COVID-19 prevention

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SARS-CoV-2, the coronavirus that causes COVID-19, infects, replicates, sheds, and gets transmitted from the nose. Nasal mucosa represents a vulnerable area for coronavirus to colonize for its abundant blood vessels, mucinous glands and serous glands which create a humid environment. Which means the nose is a portal of entry for the Covid-19 virus. Coronavirus may infect nasal mucosa cells if basal layer is exposed due to nasal mucosa barrier breakdown which blocks the nose in simpler terms as this is likely to impair mucociliary clearance. Damage to the respiratory epithelium, may occur without overt clinical symptoms due to coronavirus infection. Therefore, it is mandatory to pay attention to the protection of upper respiratory tract and nasal cavity.

High loads of the coronavirus are shed from the nasal cavity of infected individuals both pre-symptom and post-symptom onset, including from asymptomatic individuals. Disinfecting the nasal cavity of those who do or do not already suffer from COVID-19 may help to lessen contagiousness or act as a preventative.

Numerous nasal disinfectants are available, many of which are specifically intended to combat a particular infection. Cegolon et al. (2020) performed a thorough review of published literature from the last decade to scrutinize 8 different types of nasal disinfectants as a COVID-19 preventative agent, taking into account the mechanism of action, toxicity, and in vivo and in vitro evidence against similar viruses. Results have shown that the use of nasal disinfectants on those who do or do not already suffer from COVID-19 may help to lessen contagiousness or act as a preventative.

Note: This article contains information from preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or be treated as established information.

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Favipiravir is a good addition for COVID-19 treatment

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The COVID-19 pandemic brought a lot of drugs and management approaches to the fore that were otherwise being used for other disease conditions. For the same reason, scientists across the globe have been studying drugs such as Favipiravir repurposed for the treatment of COVID-19. The good news is there are encouraging results for this drug from recent reports published in various journals.

Favipiravir was approved for new and re-emerging pandemic influenza in Japan in 2014 and showed potent in vitro activity against severe acute respiratory syndrome coronavirus-2. It has a wide therapeutic safety margin and has shown rapid viral clearance in comparative studies as well. While multiple countries including India, are evaluating the drug, Favipiravir has shown promising results in clinical studies in China, Russia, and Japan. In fact, treatment guidelines from many countries such as Japan, and some states from India have included Favipiravir in the treatment protocol. In June 2020, it has been approved in India by the Indian Drug Regulator under accelerated approval process for the treatment of mild to moderate COVID-19 under restricted emergency use. The main advantages of Favipiravir are that it is administered orally and that it can be given in patients who are symptomatic but not ill enough to be hospitalized. As most COVID-19 patients (85%) have mild to moderate disease and can be treated at home, this drug could potentially be used in large numbers of patients. 

Considering the approved status, evidence on the safety and key indicators of efficacy of Favipiravir in COVID-19 from trials/registries in Russia, Japan, China, and Thailand, it appears to be useful in the management of COVID-19, particularly mild to moderate disease; however, large randomized controlled trials are required to demonstrate whether this effect translates to clinical benefits like shortening the disease course, early hospital discharge, and reducing the need for oxygen requirement. It is now commercialized in many countries like Russia, Bangladesh, Pakistan, Jordan, Egypt, and Saudi Arabia for COVID-19 treatment. The rapid viral clearance, higher clinical recovery rate, and availability as an oral drug with proven safety profile make Favipiravir a promising option repurposed to treat COVID-19. The worldwide ongoing clinical studies on Favipiravir will further provide insights on its clinical efficacy, safety, and therapeutic place in the overall management of COVID-19.

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