Today am going to discuss a very important and relevant topic in current times and yes, it is vaccination in COVID. The discovery of vaccines is the greatest gift in the history of the progress of medicine. Way back in the 17th century Edward Jenner first laid the stone for the development of vaccination when he first observed that infection with cowpox vaccine prevents serious smallpox infections. Over the last 2 For centuries lot of vaccines have been developed which has prevented many diseases and it is one of the greatest achievements of medical science.
In the last 2 and half years, entire humanity is shattered all over the world due to the COVID pandemic. Science and medical scientist have developed multiple candidate vaccines and this is the fastest evident vaccine development in history and which is helping hundreds and thousands of patients.
The information which I have penned down here is as per the data and research studies did so far and published till 21st May 2021. As science is a continuous evolving subject the information’s may change in next few years after we get more research data’s.
Here is a quick overview on vaccines in COVID
Covishield we all know it is developed by Astra Zeneca in oxford but it is manufactured in India in Serum Institute Pune, India. This is a very good vaccine because it is a viral vector vaccine. Viral vector vaccine means in a virus which is otherwise not infectious or causes any disease to the human body the specific RNA is genetically engineered and injected into the virus so that when someone takes a vaccine the virus gets proliferated inside our body and they produce some specific antigen against which our immune system produces antibodies. Covishield is a viral vector vaccine that has used chimpanzees adenovirus which is not known to be infectious in the human being as a vector. On this chimpanzee adenovirus, some spike proteins mRNA has been introduced so that when this virus will be introduced in our body some spike protein of COVID 19 will be produced and our immune system will produce antibodies against this spike protein and by that it will protect. This vaccine is recommended to be taken in two doses. Intramuscular 0.5ml each dose, preferable in the deltoid region and there must be a gap of 90 days i.e 12 weeks. Earlier when the vaccine came into the market the gap was 4-6 weeks but later on, it was found that if the second dose is delayed by 90 days a better immune response is expected. Now the question comes what is the level of protection with this vaccine? In the oxford Astra Zeneca Covishield vaccine, the overall protection level was reported to be 70.4% in some study but some study it has shown 90% efficacious, so it varies between 70-90% in terms of overall protection. Now the question comes to everybody’s mind how long the protection last? We really still don’t know that after one complete course of vaccination that is with two shorts of vaccine when we do recommend for the second dose of vaccination. For example, in the case of the influenza vaccine, it is recommended to take it every year but shall COVID vaccine be taken every year? So far the research data is not clear in this regard.
Covaxin is another vaccine available in India and developed by Bharat biotech in collaboration with the Indian council of medical research and the National Institute of Virology Pune. This is an inactivated vaccine where the whole virion is inactivated and it has been cultured in Vero cell technology and the protection it offers is roughly 81% and again the gap between the two doses is 28-42 days. This vaccine is recommended for anybody who is more than 12 years and above whereas Covishield is recommended for someone who is 18 years and above. so, these are the two vaccines.
Recently due to the scarcity of vaccines in India govt of India has imported a Russian vaccine called Sputnik. This vaccine is developed by Gamaleya Research Centre, Russia and again this vaccine is a viral vector vaccine just like Covishiled, but here different vectors have been used. An interesting part in sputnik b is instead of using a single vector they have used two different adenovirus strains as a vector so it is a mixture of two vectors. The first shot should be given by one vector and the second shot by the second vector and yes there is a science behind it. The adenovirus 26 and adenovirus 5 are the two viruses that do not cause serious disease in a human being. It has been chosen as a vector for the delivery of the spike protein mRNA into the human body. Sputnik initially was recommended to be taken as 2 doses at 21 days gap but very recently the Gamaleya Research Center informed they have done some immunogenicity study and informed that even at the 90 days if the vaccine is taken the immune response is much better. The efficacy reported by the vaccine is roughly 91.6% a bit higher from Covishield and Covaxin.
Now all these 3 vaccines can be stored at the normal refrigerator, at 2-8 C so they are good for a tropical country like India.
The other vaccines which are available in US and UK have different storage principle than Indian vaccine. All vaccine- Covishiled, Covaxin, and Sputnik can be taken in a gap of specific days as recommended by the vaccine manufacturer i.e in between the 2 shots of covishield there must be a 84 days; for Sputnik 21 day but also can be taken in 90 days gap and for Covaxin the gap recommended is 28-42 days. There is another variant brought by Govt of India that is Sputnik Light. The uniqueness of Sputnik Light is it requires only one dose just like Johnson’s vaccine. There are 3 more candidate vaccines all over the world they are well circulated and the rollover of these vaccines has started. One is the Pfizer Biontech vaccine. Pfizer is in US and Biontech is a research company based in China both of them collaborated and formed a new kind of vaccine the Pfizer Biotech vaccine. This vaccine has used a totally different technology we call it an mRNA vaccine. What is this? A modified mRNA was designed and that modified mRNA with a lipoprotein capsule was delivered in this vaccine so that when this vaccine is given in the body the mRNA produces the spike protein. You need to be clear on this the mRNA vaccine does not contain any live viral vector so they are just a piece of mRNA that produces spike protein responsible for corona infection. This Pfizer Biontech vaccine also requires 2 doses to be given in 21 days apart and these vaccines have been tested in 16 years old children so anybody who is more than 16 years can take Pfizer Biontech vaccine but recently they have published that they have little data for 12-year-old children so anybody who is 12 year and above can take this vaccine. This is the only vaccine tested on the youngest population and the biggest challenge with this vaccine is that the vaccine can be stored at 2-8 C only for 5 days but the largest storage needs to be kept at -70C and this is a big challenge for countries like India. India is a warm country and the availability of -70 is not everywhere and you can keep the vaccine at 2-5 C only for 5 days. So storage will be a problem but understanding the serious crisis Govt of India will make available this Pfizer Biontech vaccine in the Indian market in the 3rd quarter of 2021.
Another mRNA vaccine just like Pfizer Bionteck vaccine rolled in US is Moderna. Moderna is one company that has developed this mRNA vaccine and it is very good in terms of efficacy and it has been reported 91.4% efficacy and this vaccine can be stored at a slightly low temperature i.e -20 C for 6 months but it can be store at 2-8C for 30 days. So these are two vaccines in the pipeline to come into the Indian market soon. The third vaccine is Jhonson and Jhonson vaccine. It can be stored at 2-8 C but another uniqueness in this vaccine is it is a viral vector vaccine and it can be given as a single dose. So far the studies are concerned the protection level of the Jhonson vaccine is not very good as compared to the Pfizer, Moderna, or covishiled and it has roughly 66% efficacy. So these are the common vaccine which is available.
If I summarise it, in India we have the option to take Covishiled developed by Astra Zeneca and oxford in one of the great lab Serum Institute, we have the option of taking Covaccine which is developed by Bharat Biotech and is a killed vaccine and we have the option of taking sputnik b which is imported in India from Russia.
Now we often encounter several questions being asked on COVID vaccination and here I have jotted down few of them:
Is there a possibility that I may get COVID after vaccine?
Ans is no. There is no possibility of covid infection through vaccination whatever may be the vaccination.
My age is 60-70 years can I take the vaccine?
Yes, age is not a bar. even if you are more than 18 years you can take the vaccine. there is no age bar
Can children take vaccines?
The 3 vaccines available in India are tested to anyone older than 18 years so we do not have data and safety profile of the vaccine for anyone less than 18 years.
I am suffering from CKD can I take the vaccine?
Yes. anyone suffering from CKD must take COVID vaccine
Can a dialysis patient take the vaccine?
Yes, anyone taking hemodialysis or peritoneal dialysis must take the vaccine there is no doubt vaccine reduce the severity of the disease. One simple note for hemodialysis patients as this vaccine is given in the muscle and the patient takes heparin there is a possibility of developing a hematoma.
Can patients with heart disease take a vaccine?
Yes, there is no contraindication. On the contrary patients with comorbidities like diabetes, hypertension, bronchial asthma, COPD, heart disease, liver disease, kidney disease, any malignancy must take vaccine on priority.
If I take blood thinner can I take vaccine?
Yes, if you take aspirin, clopidogrel, eliquis, whatever maybe the medicine you can take the vaccine
I am planning for renal transplant in the next 3-4 month can I take vaccine?
Yes, those who are preparing for transplant must take the vaccine however if your transplant is immediate in 2 months or 3 months or maybe 7 days down the line please talk to your nephrologist because 2 doses of vaccine need a gap of 90 days and it may happen so you take one dose prior to transplant and the second dose after transplant and in between your immunosuppression is high response will be less. Consult with your nephrologist if you are planning for a transplant. if your planning for a transplant after 3 months there is no contraindication but if you are planning within 3 months consult with your nephrologist.
Can transplant recipients take the vaccine?
Initially when the vaccine started to roll out there was no data if these vaccines are safe on solid organ transplant especially kidney transplant recipient but of let there are significant studies and many data came and it has been found that these vaccines are safe in transplant recipient.
Which vaccine is safe in transplant recipients?
So far the data is concerned we got few data on covishield i.e. Astra Zeneca vaccine that this vaccine is safe in transplant recipient. In terms of Covaxin there is scarcity of published data. In the west, they have tested Pfizer Biontech vaccine and Moderna on solid organ transplant and John Hopkins did an interesting study with nearly 658 recipient but the response of antibody generation of those vaccines on solid organ recipients is low compared to the normal population. So in nutshell in Indian transplant recipient covishiled and in the west can take Pfizer Biontech vaccine has some decent evidence for recommendation.
I am suffering from nephrotic syndrome can I take a vaccine?
The majority of Nephrotic syndrome are children and we don’t have data for efficacy on age below 18 years so it is not recommended, but in adult Nephrotic syndrome if steroid the dose is low ie less than 15mg they can safely take the vaccine.
There is a concern after taking the vaccine is there a possibility of relapse, yes the possibility is there. That needs to be judged by the nephrologist. However recently one case study published in AJKD reported 50 years old gentleman after taking Pfizer Biontech vaccine got admitted in an emergency with swelling of the face and pedal edema and on the biopsy found MCD. Henceforth vaccination of COVID is safe in Nephrotic syndrome on remission. It must be judged by a nephrologist.
Can IgA nephropathy patients take vaccines?
Yes they can take provided they are on low-dose steroids less than 15 mg. In high-dose steroids, the response of the vaccine will be inadequate.
If I take the Influenza vaccine Can I take COVID vaccine?
After influenza at least 2 weeks gap. If you are at risk of influenza and need a vaccine in between two COVID vaccine doses you can take COVID vaccine after 4 weeks from 1st dose.
Can a pregnant woman take the vaccine?
No data is available on the pregnant population regarding the safety of vaccines. If a pregnant lady is at risk of getting COVID and is a healthcare worker then WHO recommends taking vaccine otherwise we do not have safe data in a pregnant woman. However Lactating mothers can safely take vaccines. They must take the COVID vaccine.
When to take 2nd dose of covid vaccine?
For all the 3 vaccine second days must be taken at a a gap of 90 vaccine
Can I take covishiled as first dose and second dose with covaxin?
As of now in Australia they are mixing covishiled and Pfizer vaccine and in Spanish study covishiled and phizer showed a better immune response but no data is available with covishiled and covaxin. So it is better to avoid mixing of two vaccine
If I get covid infection shall I take the vaccine?
Yes, the gap between recovery from covid and taking vaccination should be 90 days
After 1st dose, someone got positive what What they should do?
If someone gets an infection in between 1st and 2nd dose he/she has to wait 90 days from recovery for the second dose. The effect of 1st dose will never be nullified.
So many mutant strains are coming will the current vaccine protect?
Phizer biotech did a research study with 44000 people they found spike protein are protective against all mutant at least minimize the severity of infection so if you take the vaccine, it will be protect you from all strain.
Does vaccination have an impact on medication?
I got convalescent plasma do I need the vaccine?
Yes, you have to take a vaccine. After convalescent plasma the therapy you must wait for 90 days for the vaccine dose.
Do I have to take a vaccine every 90 days?
We do not have data and is still not clear.
What are the side effects of the vaccine?
The vaccines are safe. Sometimes mild tiredness, headache, low-grade fever, flu-like symptoms, muscle pain, immediate after vaccination anaphylaxis, hypotension has been reported. There are few studies that have mentioned vaccine-induced thrombotic thrombocytopenia(VITT). In few stary events reported in the literature some ischemic event some criticality, these are stary events don’t avoid vaccination. these are uncommon 1 in lakhs
Can diabetics take vaccines?
Yes, they must take the vaccine.
Vaccination prevents seriousness of the covid infection but doesn’t prevent covid infection, After vaccination maintain social distancing, wear the mask, maintain covid safety protocol.
I have specially designed a deep breathing exercise training program “Boost your lung health” where I have sequentially taught the steps of breathing exercises. There are nearly 20 sets of exercises which will be a tremendous boon to heal the lung health. Below is the link to join my program.