Coronavirus Facts and Myth Buster

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Dr KK Aggarwal Research Fund

With inputs from Dr Monica Vasudev

Small risk of bleeding and clotting disorders after AstraZeneca vaccine

There is a small increased risk of immune thrombocytopenic purpura (ITP) and other bleeding and vascular events associated with the Oxford/AstraZeneca vaccine, as per a nationwide analysis of over 2.5 million Scottish adults published in the journal Nature Medicine. These participants had received a first dose of the Oxford/AstraZeneca or Pfizer/BioNTech vaccine between December 2020 and April 2021.

  • Oxford/AstraZeneca was associated with a slightly increased risk of ITP up to 27 days after vaccination.
  • The estimated frequency was 1.13 cases per 100,000 first-dose vaccinations.
  • Those at greatest risk of ITP tended to be older (median age, ≥69 years old) and had at least one underlying chronic health problem, such as coronary heart disease, diabetes, or chronic kidney disease.
  • A very small increased risk of other arterial blood clot and bleeding events associated with Oxford/AstraZeneca up to 27 days after vaccination was also seen. However, there were insufficient data to conclude that there was an association between Oxford/AstraZeneca and cerebral venous sinus thrombosis.

However, the research suggests that the risks are comparable with those seen with other vaccines, including vaccines against hepatitis B, measles, mumps and rubella and influenza.

There was no evidence of an increased risk of the adverse events studied associated with the Pfizer/BioNTech vaccine.

(Source: Dawn OShea. Scottish study estimates risk of bleeding and clotting disorders after AstraZeneca vaccine - Medscape - Jun 09, 2021)

Patients with migraine have higher Covid incidence

A cross-sectional study from the United States has reported higher incidence of Covid-19 as well as heightened COVID symptoms in people who suffer migraines. The study was presented at the American Headache Society virtual meeting.

The study included 66,585 participants, aged 18 to 65 years, in the National Health and Wellness Survey (NHWS); 77% of the respondents were female. Of these, 7,759 people had a migraine diagnosis, while 58,827 did not have migraine. Overall, 3.82% of migraine patients self-reported having COVID-19 and 1.32% said they had tested positive for COVID. In contrast, 2.42% of the group without migraine self-reported having COVID and 0.82% of that group said they had tested positive (all P<0.001). Among those with Covid-19, those who had migraine reported more and higher percentages of COVID symptoms. They also were less likely to use healthcare resources if they tested positive for COVID.

Robert Shapiro, MD, PhD, of the University of Vermont in Burlington said, “Headache is a prevalent symptom of COVID-19, of long COVID, and of post-vaccination for COVID-19. Among COVID-19 inpatients, headache is associated with a positive prognosis. IL-6 levels are lower across the disease course. Headache is associated with 1 week shorter disease course overall. And if someone is admitted with COVID with a symptom of headache, it confers positive relative risk of survival of 2.2.”

(Source: Medpage Today, June 9, 2021)

CVST risk still higher with COVID-19 than with AZ/ J&J vaccination

Rates of cerebral venous sinus thrombosis (CVST) are much higher among patients with Covid-19 compared to persons who have been vaccinated with either the AstraZeneca or the Johnson & Johnson (J&J) vaccine, suggests a study published in the Journal of the American College of Cardiology on June 8.

The rate of CVST associated with the two vaccines was estimated based on the publicly reported data, which was compared to the rate observed among patients hospitalized with Covid-19 and in comparison with the estimated incidence rates among the US population before the pandemic. Data from the United Kingdom Medicines and Healthcare products regulatory agency and the US Centers CDC was used to report the number of events per vaccinated people with the AstraZeneca and Johnson & Johnson vaccines, respectively.

The SVIN COVID-19 multinational study of cerebrovascular events was used to find CVST rates among patients hospitalized with COVID-19. Latest available data from the Nationwide Inpatient Sample database from March and April 2018 were used to report the weighted monthly incidence of CVST before the pandemic.

  • Results showed that as of April 14, 2021, there were 77 CVST cases among 21,200,000 AstraZeneca vaccine recipients reported by the UK Medicines and Healthcare Products Regulatory Agency (3.6 per million; 99% CI, 2.7 – 4.8 per million).
  • As of April 13, 2021, the Centers for Disease Control and Prevention reported six cases of CVST among 6.85 million vaccinated people (0.9 per million; 99% CI, 0.2 – 2.3 per million).
  • In the SVIN COVID-19 registry, 3 of 14,483 patients hospitalized with COVID-19 had CVST (207.1 per million; 99% CI, 23.3 – 757.7 per million).
  • In the Nationwide Inpatient Sample, the weighted average rate of CVST in the US population for March and April 2018 was 2.4 per million (99% CI, 2.1 – 2.6 per million).

The authors conclude: “CVST is rare in the general population and after adenovirus-based SARS-CoV-2 vaccination, but appears to be several-fold more common in hospitalized patients with COVID-19.

Additional research is required to fully elucidate the event rates, to understand the risk factors for vaccine-associated CVST and to identify strategies to prevent it. In the meantime, transparent realistic communication of the risk estimates will be helpful for shared decision making between patients and clinicians.”

(Source: CVST risk still higher with COVID-19 than with AZ, J&J vaccination - Medscape - Jun 10, 2021)

CMAAO Coronavirus Facts and Myth Buster – Coronavirus variant in India

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1576: Which variant of coronavirus are we most likely to encounter in India?

In Punjab and Delhi, it is more likely that the variant will be B.1.1.7, which is also known as the Kent or the British mutant. In Maharashtra and neighboring states, one is more likely to encounter the B.1.617 variant, also known as the ‘double mutant’. Although this variant was first reported from India, it has now been identified in the UK, the USA, Australia, Singapore, Belgium, Germany, New Zealand, Namibia and South Africa.

The N440K variant reported from Kerala has also been identified in Andhra Pradesh and Telangana. This variant has been detected in 16 countries. The South African and Brazilian variants have also been reported in small numbers in the country.

1577: Do vaccines work against the variant found in India?

The B.1.617 variant carries a mutation component – E.484Q – which is like E.484K that has been reported to have lower efficacy of immune response to the AstraZeneca vaccine in South Africa.

1578: Do vaccines produce IgA?

No, the vaccines do not produce IgA which is a secretory antibody with the potential to remove the virus from mucosal surfaces of the nose and throat. Therefore, a mild infection is still possible.

[Source: News18]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

CMAAO Coronavirus Facts and Myth Buster – Steroids and Vaccine

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With input from Dr Monica Vasudev

  1. There appears to be no direct evidence to state that corticosteroid injection prior to or after an adenovirus vector-based COVID-19 vaccine diminishes vaccine efficacy. Yet, clinicians may want to give elective corticosteroid injections at least two weeks before or after receiving this vaccine, reported a group of doctors writing on behalf of the Spine Intervention Society.
  2. The two-week rule is based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression after intraarticular and epidural corticosteroid injections, noted researchers in a paper published in Pain Medicine.
  3. The two week rule is also based on the timeline of reported peak efficacy of the Janssen and AstraZeneca adenovirus-vector-based vaccines against COVID-19.
  4. An interim analysis of phase 1-2a and phase 3 trial data revealed that the Janssen COVID-19 vaccine elicited cellular and humoral immune responses and conferred clinical protection as early as 14 days following administration, while the AstraZeneca vaccine elicited response 15 days following the second dose.
  5. The Janssen phase 3 trial allowed corticosteroid use at or below the equivalent of 20mg/day through ocular, topical or inhaled administration
  6. Topical or inhaled steroids were allowed in the AstraZeneca trial for up to 14 days.

[Source: https://bit.ly/3gFPHAl Pain Medicine, online April 11, 2021.]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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