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Let’s meet the new vaccines on the block: Sinopharm & Sputnik

Let’s meet the new vaccines on the block: Sinopharm & Sputnik

With the COVID third wave in Sri Lanka arriving at the same time as the need for the AstraZeneca second jab, there has been some public dismay on the limited supply of Astrazeneca doses. The Serum Institute stopped exporting the vaccine from India after the pandemic tsunami hit its shores in late March. India is now the global epicentre of the pandemic and needs to vaccinate its own population.

What does that mean for countries like ours that were relying on Indian exports?

The Sri Lankan government has procured 15,000 Sputnik and 600,000 SinoPharm doses from Russia & China, respectively in the absence of Indian AstraZeneca supplies. Whilst we await trial data from Germany & Russia on the ability to mix and match vaccines, we take a closer look at these two new vaccines on the block. 

Starting with Russia’s Sputnik 🇷🇺

Since the release of its Phase 3 data in February 2021, Sputnik has been approved by over 60 countries for emergency use. It has not yet received authorisation by the WHO.

What is it? Similar to AstraZeneca, Sputnik is also a two-dose viral vector vaccine. It uses an inactivated virus (usually something like a chimp cold virus) to deliver the Sars-CoV-2 spike protein genetic information into the body to generate an immune response. These inactivated viruses are changed so they can’t replicate in the body. Unlike AstraZeneca, Sputnik uses two different vector viruses in its two doses.

Does it prevent sickness? The Gamelaya Institute conducted 33,000 person Phase III studies in Russia in September 2020. Preliminary study results showed the vaccine has 91.6% efficacy in preventing symptomatic sickness. As with most of the vaccines approved so far, Sputnik showed 100% efficacy to prevent severe disease.

What does that mean? After getting the second dose of the vaccine, if you get infected with COVID19, the probability of you developing a cough, fever or the major symptoms of the disease is 8.4% and the need to be hospitalised to 0%. 

What about safety? No severe adverse reactions occurred during the study. There were four unrelated deaths during the study (2 already had COVID when they signed up and had self-medicated whilst the other died of a spinal fracture).

What about older people? The study looked for efficacy and safety data in the over 60 population. Although the sample size was small (10%), the efficacy was the same in this group as for the younger ages. 

What about Sputnik in the real world? 3.8 million Russians have received Sputnik since January 2021 and vaccine effectiveness is seen at 97.6% after two doses. No severe adverse reactions have occurred due to the vaccine.

As of May’21, Russia has also now developed Sputnik Lite, a single dose version of its vaccine with a claimed efficacy of 80%. Data is yet to be made publicly available. 

Next up, China’s SinoPharm 🇨🇳

For the longest time, SinoPharm has been that elusive emo kid in a corner at your cousin’s 16th birthday party. Whilst the Sputnik team released its interim reports publicly in the most prestigious medical journal, The Lancet, SinoPharm is yet to release any data directly to the public on its Phase 3 trials.

With the WHO authorisation for emergency use, there was finally some data publicly available. 

What is it? SinoPharm is a 2 dose whole virus vaccine. The whole virus vaccine means an inactivated form of Sars-CoV-2 is used to trigger the body’s immune response. This contrasts with the other vaccines (Pfizer to AstraZeneca to Sputnik), which only uses the genetic information of the spike protein. However, as it’s an inactivated version, it cannot replicate and cause disease in the body. 

As of the time of writing, 45 countries have approved the emergency use of the vaccine, and 65 million doses have been administered globally.

Does it prevent sickness? As per the WHO report, 13,000 people have been enrolled in the trial to assess efficacy, of which only 200 (or 0.01%) were over 60. Vaccine efficacy is at 78.1% in the under 60s with insufficient data to assess the over 60 age group. Studies in the UAE shows efficacy at 86% however further details have not been published.

What does that mean? As per WHO, the probability that you will show symptomatic sickness if you contract COVID19 after being fully vaccinated with SinoPharm is around 22% if you are under the age of 60. WHO cannot tell whether the SinoPharm vaccine will have a protective effect for the over 60s with the data available. 

What about safety? Two severe adverse effects were reported to be possibly linked to the vaccine (serious nausea and inflammatory myelination syndrome). As always it’s a risk-benefit analysis and we should consider the high probability of lung and other organ damage as a result of COVID19 when weighing up any low risks of vaccine adverse effects. 

What about older people? Whilst the study doesn’t provide much data to go on, the post-authorisation use showed 1.1m doses have been given to people over 60 in China. 45 adverse reactions (dizziness, headache, fatigue) were attributed to the vaccine.

Mass vaccinations are one of the few ways we can stop this pandemic from continuing to ravage our lives for years to come. If a vaccination becomes available in your area and after speaking with your doctor about any medical concerns, we recommend getting the jab. It’s not over till we are all vaccinated so even if vaccinated, remember to wear face masks, avoid indoor gatherings, wash hands and stay home!

If you’d like to discuss your vaccination options with a medical professional, our on-demand GPs are available 24/7. Download the oDoc app today.

Sources

  1. Status of COVID19 vaccinations within WHO EUL/PQ Evaluation processes, WHO 
  2. Logunov, D et al., (2020), Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia., The Lancet., 397: 671-681
  3. Sputnik, Covid19 Vaccine Tracker
  4. Is Russia’s COVID-19 vaccine safe? Brazil’s veto of Sputnik V sparks lawsuit threat and confusion, Science Magazine (2021)
  5. Efficacy of Sputnik V amounts to 97.6%, TASS (2021)
  6. SinoPharm Evidence Assessment, WHO (2021)
  7. Chinese Covid-19 vaccine has 86% efficacy, UAE says, The Guardian (2020)
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ප්‍රභේද, ප්‍රභේද, නමුත් එයින් අදහස් කරන්නේ කුමක්ද?? 

ප්‍රභේද, ප්‍රභේද, නමුත් එයින් අදහස් කරන්නේ කුමක්ද??

COVID-19 2020 මාර්තු මාසයේදී ශ්‍රී ලංකාවට පැමිණි විට, අපෙන් ඉතා සුළු පිරිසක් සිතුවේ මෙය වසර ගණනක් නොව මාස කිහිපයක දෙයක් බවයි. අයහපත් තත්වයක් තවත් නරක අතට හැරෙන ප්‍රභේද විකෘති කොට නිර්මාණය කළ හැකි බව අපේක්‍ෂා කළේ එයින්ද ඉතා සුළු පිරිසකි. කෙසේ වෙතත්, වසංගතයක ස්වභාවය වන්නේ වසර කිහිපයක් පුරාවට (මාස නොව) වෛරස් බහුලව පැතිරී යන ආසාදන භාවිතා කර වඩා ප්‍රබල අනුවාදයක් බවට පත්වීමයි. 

මේ හේතුවෙන් මාස 14ක කාලයක් තුල ලොවට දැන් SARS COV-2 රෝග කාරකයේ ප්‍රභේද අටක් පමණ තිබේ. නමුත් එයින් අදහස් කරන්නේ කුමක්ද? 

කෙටි පිළිතුර: වෛරසය පැතිරීමට ඉඩ දෙන තරමට, ප්‍රතිශක්තිකරණ ප්‍රතිචාරය මග හැරීම සඳහා එය වැඩි විකෘති ඇති කරයි. එක්සත් රාජධානිය, දකුණු අප්‍රිකාව සහ බ්‍රසීලය යන රටවලින් අප දුටු ප්‍රභේද වඩාත් බෝවන හා මාරාන්තිකය. මෙම ප්‍රභේද එන්නත් ප්‍රතිචාරය සාර්ථකව මඟ හැරියහොත්, අපි නැවත මෙම ගැටළුවේ මුලටම යනු ඇති.එනිසා, ආසාදන පැතිරීම සීමා කිරීම වසංගත ප්‍රතිචාරයේ අනිවාර්ය අංගයක් ලෙස පවතී. 

මේ පිටුපස ඇති හේතුව දැන ගැනීමට අවශ්‍යද? 
 
අපි නැවත මුලික කරුණු වෙත යමුCOVID19 යනු Sars-CoV-2 රෝග කාරකය නිසා ඇතිවන රෝගයකිවෛරසයේ RNA පටියක් අඩංගු වේඑහි ජානමය තොරතුරු 30,000 ක් පමණ ඇතමෙම RNA අපගේ සෛල තුළට ඇතුළු වී,  ප්‍රතිවර්තනය කරවැඩි වෛරස් සෛල නිර්මාණය කර ශරීරයේ සැරිසරයි. 
 
නමුත් සමහර විටමෙම ප්‍රතිවර්තන ක්‍රියාවලියේදීආසාදිත සෛලය දත්ත පිටපත් කිරීමේදී දෝෂ ඇති කරයිමෙම දෝෂ විකෘති ලෙස හැඳින්වේPCR පරීක්ෂණ වල ජානමය අනුක්‍රමණය මෙම විකෘති පිළිබඳව සොයා බැලීමට උපකාරී වේප්‍රමාණවත් තරම් වෛරස් වලට එකම විකෘතියක් තිබේ නම් ඒවා ප්‍රභේදයක් ලෙස හැඳින්වේමෙම ප්‍රභේදවල ඇති විකෘති ප්‍රමාණවත් තරම් වෙනස් වී ඒවායේ ක්‍රියාකාරිත්වය වෙනස් 
කරන්නේ නම්වික්‍රියා ඇති වේ.  
 
Sars-CoV-1 2001 SARS වසංගතයට හේතු වියඑය දැන් පවතින වසංගතයට හේතුවන Sars-CoV-2 වඩා වෙනස් වේඅවාසනාවකට මෙන්, Sars-CoV-2 ලෝකයේ විවිධ ප්‍රදේශවල ප්‍රමාණවත් විකෘති වලට භාජනය වී ඇත.  
මෙය ගැටලුවක් වන්නේ කවදාද? 
 
විකෘති සාමාන්‍යයිඅපගේ DNA අපගේ සෛල මගින් ප්‍රතිවර්තනය කළ විට පවා විකෘති සිදු වේකෙසේ වෙතත්විකෘතියේ බලපෑම් වඩාත් වැදගත් වේCDC/WHO ප්‍රභේද මෙලෙස වර්ගීකරණය කරයි, i)උනන්දු විය යුතු ප්‍රභේද, ii)සැලකිලිමත් විය යුතු ප්‍රභේද, iii)ඉහළ ප්‍රතිවිපාක ප්‍රභේද 
 
Sars-CoV-2 හි විකෘති 8 ක් සොයාගෙන ඇතත්මෙම ප්‍රභේද 3 ක් දැනට සැලකිලිමත් වන ප්‍රභේද ලෙස වර්ගීකරණය කර ඇතසැලකිලිමත් විය යුතු ප්‍රභේද වඩාත් දරුණු රෝග ඇති කරන හා වඩාත් බෝවන අතර එන්නත් ප්‍රතිචාරයද මග හැරිය හැකඉතිරිය උනන්දුවක් දක්වන ප්‍රභේද ලෙස වර්ගීකරණය කර ඇත: ඒවා වඩාත් ආසාදිත තත්වයට පත්විය හැකියකෙසේ වෙතත්ඒවා තවමත් සම්පූර්ණයෙන් වටහාගෙන නොමැත.
ඉන්දියාවේ සිදුවන්නේ කුමක්ද? 
 
සති කිහිපයක් ඇතුළත ඉන්දියාව වසංගතයේ ගෝලීය කේන්ද්‍රස්ථානය බවට පත්ව ඇතදිනකට නව රෝගීන් 400,000 ක් වාර්තා වේසම්ප්‍රේෂණය වීමේ වේගය සහ අධික මරණ සංඛ්‍යාව වසංගතයේ දරුණුම කාලය අවසන් වී ඇති සිතූ ලෝකයක් කම්පනයට පත් කර තිබේ.  
 
ඉන්දියාව පුරා වෛරසයේ ද්විත්ව විකෘතියක් සොයාගෙන ඇත – බී 1.617 ca. අනුක්‍රමික PCR වලින් 80%  හමු වී ඇත. 
 
මෙම විකෘති මඟින් වෛරසයට එන්නත ප්‍රතිශක්තීකරණ ප්‍රතිචාරය සහ පූර්ව ආසාදනයෙන් ජනනය වන ප්‍රතිශක්තිය මග හැරීමට ඉඩ ලබා දෙන්නේද යන්න තීරණය කිරීම සඳහා දැනට අධ්‍යයන සිදු වෙමින් පවතී. 

Image source: Hindustan Times

එන්නත් ප්‍රභේදයන්ට එරෙහිව ක්‍රියා කරයිද? 

මෙය එක් එක් ප්‍රභේදය හා විකෘතිය සමඟ නිරන්තරයෙන් විමසා බලන තීරණාත්මක ප්‍රශ්නයකි. අවාසනාවකට මෙන්එන්නත සහ ප්‍රභේදය අනුව මේ දක්වා සොයාගැනීම් වෙනස් වී ඇත.  
 
නව ප්‍රභේද හමුවේ Pfizer අධික ලෙස ශක්තිමත්ව පවතීAstraZeneca එන්නත එක්සත් රාජධානියේ ප්‍රභේදයට එරෙහිව ශක්‍යව පවතින නමුත් දකුණු අප්‍රිකානු ප්‍රභේදයට ඊට අඩුවෙන් ක්‍රියාකාරී වේ. බ්‍රසීලියානු ප්‍රභේදය දැනටමත් COVID19 තිබූ පුද්ගලයින්ගේ ප්‍රතිශක්තිකරණ ප්‍රතිචාරය මග හරින බව පෙනේ.  
 
 
ඉතින් මේ සියල්ලෙන් ශ්‍රී ලංකාවේ අපට ඇති අර්ථය කුමක්ද? 
 
ප්‍රතිවර්තනය කිරීමට ඉඩ දෙන විට වෛරස් විකෘති වේජනගහනයක් හරහා වේගයෙන් ව්‍යාප්ත වීමට ඉඩ දී ඇති විට එය නැවත නැවත අනුකරණය වීමට වැඩි අවස්ථාවක් ලබා දේමෙම විකෘති බොහොමයක් තවදුරටත් හානියක් නොකරයිකෙසේ වෙතත්එන්නත් කිරීම සහ ප්‍රතිශක්තිය වැඩි කිරීම වෛරසයට නොනැසී පැවතීම දුෂ්කර වන විටවිකෘති වඩාත් ප්‍රබල විය හැකියඑය පරිණාමයයි! 

Image Source: BBC

ශරීරයේ ප්‍රතිශක්තිකරණ පද්ධතිය වෛරසයට ප්‍රබල විරුද්ධවාදියෙකු ලෙස සිටියද – විකෘති නොසලකා – වෛරසය විකෘති වීමට ඇති අවස්ථා අඩු කිරීම තීරණාත්මක වසංගත ප්‍රතිචාරයකි.  
 
අපට නම් එයින් අදහස් කරන්නේ මහජන සෞඛ්‍ය මාර්ගෝපදේශ පිළිපැදීමයි: 
  • අපේ නිවසින් පිටත මුහුණු ආවරණ පළඳින්න
  • අත් සේදීම
  • ඉහළ ස්පර්ශක ස්ථාන විෂබීජහරණය කිරීම සහ ගමනාගමනය අඩු කිරීම

මේ දේවල් කිරීමෙන් අපි වෛරසය බෝවන ස්ථාන ඉවත් කරසෑම කෙනෙකුටම එන්නත ලබා ගත හැකි වන තෙක් එන්නත් වල කාර්යක්ෂමතාව පවත්වා ගෙන යන්නෙමුඑයින් COVID19 සරල සෘතුමය උණක්  දක්වා අඩු කර ගැනීමට හැකි වනු ඇති.

පරිස්සමින් ඉන්නගෙදර ඉන්න. 

ඔබට වෛද්‍ය උපදෙස් අවශ්‍ය නම්රෝහලට යාමෙන් වැළකී අපගේ පළපුරුදු වෛද්‍යවරුන් 1,000 දෙනාගෙන් එක් අයෙකු සමඟ වීඩියෝ ඇමතුමක් හරහා කතා කරන්න. 

අදම Download oDoc කරගන්න.  

Sources
  1. Davies N.G. et al (2021), Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7, Nature
  2. Volz, E et al (2021) Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: Insights from linking epidemiological and genetic data., Preprint MedXRiv
  3. Dasgupta, B (2021) ‘Double mutant’ most common variant now: India’s genome data., Hindustan Times
  4. Coronavirus Variant Tracker, New York Times
  5. Xieping, X et al., (2021) Neutralization of SARS-CoV-2 spike 69/70 deletion, E484K, and N501Y variants by BNT162b2 vaccine-elicited sera, BioXRiv Preprint
  6. Emary, K et al., (2021), Efficacy of ChAdOx1 nCoV-19 (AZD1222) Vaccine Against SARS-CoV-2 VOC 202012/01 (B.1.1.7). The Lancet, Preprint
  7. Sabino E et al., (2021), Resurgence of COVID-19 in Manaus, Brazil, despite high seroprevalence, The Lancet, 397: 452-455.
  8. Roberts, M (2021) What are the Indian, Brazil, South Africa and UK Variants? BBC News
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COVID-19 is airborne

COVID-19 වාතය හරහා බෝවිය හැකිය.

ඔබ සහ ඔබගේ ආදරණීයයන් ආරක්ෂා කරන්නේ කෙසේද?

අපි දැනටමත් එය බොහෝ වාරයක් අසා ඇත්තෙමු. මුහුණු ආවරණයක් පළදින්න. සෑම විටම ඔබේ අත් සෝදන්න. සමාජීය දුරස්ථ භාවය රැකගන්න. ජනාකීර්ණ ස්ථානවලට යාමෙන් වළකින්න. සමහර විට අපි සෞඛ්‍ය නීති රීති වලට ඇහුම්කන් දෙන්නේ නැති තරම්. නමුත් COVID-19 රෝගීන් ගණන ඉහළ යාම, වැඩි රෝගීන් පිරිසක් රෝහල්ගත වීම හා තරුණ රෝගීන් ගණන වැඩි වීමත් සමඟ, අපට නැවත අප දන්නා දෙය වෙත අවධානය යොමු කිරීමට වී තිබේ. COVID-19 එතරම් ලෙහෙසියෙන් පහව යන්නේ නැති අතර 3 වන රැල්ල දැනටමත් අපේ රටට වේගයෙන් බලපෑම් ඇති කර ඇත.

සැමවිටම මෙන්, COVID-19 පිළිබඳ නවතම තොරතුරු සහ ඔබ සහ ඔබගේ ආදරණීයයන් ආරක්ෂාකාරීව තබා ගැනීම සඳහා හොඳම උපදෙස් ඔබට ලබා දීමට oDoc බැදී සිටී.

COVID-19 aerosols droplets

COVID-19 වාතය හරහා බෝවිය හැකිය

COVID-19 ශ්වසන ජල බිඳිති සහ එයරොසෝල් මගින් වාතය හරහා පැතිරෙයි. වෛරසයේ බෝවීමේ හැකියාව වැඩි කිරීමට එයරොසෝල් සැලකිය යුතු කාර්යභාරයක් ඉටු කරයි. දුර්වල වාතාශ්‍රය සහිත ස්ථානවල මෙම කුඩා ජල බිඳිති පැය ගණනක් වාතයේ රැදී පවතී. විශාල ශ්වසන ජල බිඳිති තත්පර කිහිපයකින් බිමට වැටෙන අතර ආසාදිත නොවන පුද්ගලයෙකුට ආශ්වාස කිරීමේ අවස්ථාව අඩු කරයි.

ඔබ සුපිරි වෙළඳසැලකට යන බව සිතමු. සමහර විට ඔබ කාර්යබහුල නොවන සහ අවට බොහෝ පුද්ගලයින් නොමැති අවස්ථාවක වෙළඳ සැලට යනවා යැයි සිතන්න. ඔබේ මුහුණු ආවරණය ඉවත් කර ඇවිදින්න පුළුවන් යැයි ඔබට සිතෙනු ඇත. COVID-19 ආසාදිත පුද්ගලයෙකු පැය කිහිපයකට පෙර සුපිරි වෙළඳසැලේ සිටියා නම්, ඔවුන්ගේ ආසාදිත ශ්වසන ජල බිඳිති තවමත් වාතයේ තිබිය හැක. විශේෂයෙන් එම ස්ථානයේ දුර්වල වාතාශ්‍රයක් තිබේ නම් හා වාතය සංසරණය වීමට විවෘත කවුළු හෝ විදුලි පංකා නොමැති නම් වැඩි ප්‍රවනතාවක් තිබිය හැක. 

ඔබට පහසුවෙන් එම ජල බිඳිති ආශ්වාස කර COVID-19 ආසාදනය විය හැකිය. එබැවින් නිශ්චිත මොහොතක ගෘහස්ථ අවකාශයක ඔබ වටා වෙනත් කිසිවෙකු නොමැති වුවද, පැය කිහිපයකට පෙර එම අවකාශයේ සිටි ආසාදිත පුද්ගලයින් විසින් ඔබට තවමත් COVID-19 වැළඳිය හැකිය.

විශේෂයෙන් සංවෘත ගෘහස්ථ අවකාශයන් වලදී දැඩි ලෙස මතකයේ තබා ගත යුතු කරුණු:

ද්විත්ව මුහුණු ආවරණ! ශ්වසන කාන්දුවීම් සඳහා ඉඩක් නොමැතිව ආරක්ෂිත මුහුණු ආවරණ පැළඳ ඇති බවට වග බලා ගන්න. ඔබ KN95 හෝ N95 මුහුණු ආවරණ පැළඳ සිටී නම්, ඔබට මුහුණු ආවරණ දෙකක් අවශ්‍ය නොවේ.
mask enclosed
ඔබ වෙනත් පුද්ගලයෙකු අසල සිටින විට පමණක් නොව නිවසින් බැහැරව සිටින සෑම විටම ඔබේ මුහුණු ආවරණය පළඳින්න.
social distancing
බෝවන අංශු එළිමහනේ විසිරී යාමේ හැකියාව වැඩි බැවින් හැකි නම්, වෙනත් අය එළිමහනේ හමුවන්න. සබන් යොදා ඔබේ අත් සෝදන්න හෝ නිතරම අත් සනීපාරක්ෂක භාවිතා කරන්න. අඩි 6 ක භෞතික දුරස්ථභාවයක් පවත්වා ගන්න.

ඔබේ නිවසේ නොවන වෙනත් අය ඇතුළත් වන සංවෘත අවකාශවලට ඇතුළු වීමෙන් වළකින්න. ඔබට යම් ගෘහස්ථ ස්ථානයකට යෑමට අවශ්‍ය නම්, එම ස්ථානයේ වාතාශ්‍රය සඳහා විවෘත කවුළු කිහිපයකින් නිසි ලෙස වාතාශ්‍රය ඇති බවට වග බලා ගන්න. තවද එම ස්ථානයේ ගත කරන කාලය අවම කරන්න. ඔබ එම ස්ථානයේ ගත කරන කාලය, ආසාදනය වීමේ වැඩි ඉඩක් ඇති කරයි!

no enclosed indoor spaces
ventilation

ඔබ හෝ ඔබ ආදරය කරන කෙනෙකු කිසියම් COVID-19 රෝග ලක්ෂණ අත්විඳින්නේ නම්, ඔබේ රෝග ලක්ෂණ වඩා හොඳින් තේරුම් ගැනීමට oDoc යෙදුමේ අපගේ COVID-19 තක්සේරු කිරීමේ මෙවලම භාවිතා කරන්න. විකල්පයක් ලෙස, ඔබට COVID-19 තිබිය හැකි යැයි ඔබ විශ්වාස කරන්නේ නම් ඊළඟ පියවර තේරුම් ගැනීමට ඔබට oDoc හි වෛද්‍යවරයෙකුගෙන් උපදෙස් ලබා ගත හැකිය.

 

References:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00869-2/fulltext
https://www.bmj.com/content/373/bmj.n913
https://www.bmj.com/content/370/bmj.m3206
https://www.indiatoday.in/world/story/sri-lanka-new-covid-corona-variant-highly-transmissible-airborne-1794632-2021-04-24

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Is My Baby Drinking Enough Milk?

Is my baby drinking enough milk?

Milk supply myths debunked!

Nicole Parakrama | BSc Hons Molecular Cell Biology, UCL (UK) | 17th April 2021 | <5 minute read

“Aney why is he crying so much?”…

…“Hungry-da?”…..

Mothers of infants might find this line of questioning familiar!

In our culture, we tend to cajole and bribe our children into eating more, with the goal of making them as chubby as possible. However, when we don’t allow our children to regulate their hunger for themselves, this can lead to unhealthy eating patterns (see this study here) with repercussions all the way into adulthood (some other great longitudinal studies here and here). We do our children a great disservice when we don’t take into account their varying body structures, feeding patterns, and metabolisms when considering when and how often we feed them.

“Aney why is he crying so much?”…

…“Hungry-da?”…..

Mothers of infants might find this line of questioning familiar!

In our culture, we tend to cajole and bribe our children into eating more, with the goal of making them as chubby as possible. 

 This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had

However, when we don’t allow our children to regulate their hunger for themselves, this can lead to unhealthy eating patterns (see this study here) with repercussions all the way into adulthood (some other great longitudinal studies here and here). We do our children a great disservice when we don’t take into account their varying body structures, feeding patterns, and metabolisms when considering when and how often we feed them. This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had the most

the most significant impact on Perceived Inadequacy of Milk (PIM)”.  In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?”  This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case.

This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had the most significant impact on Perceived Inadequacy of Milk (PIM)”.  In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?”  This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case.

significant impact on Perceived Inadequacy of Milk (PIM)”. In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?” 

This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case. 

A longitudinal study by Nielsen et al studied the milk intake of 50 healthy, exclusively breastfed babies over 6 months, and found the milk intake and fulfilment of energy values to be in excess of literature values.

Unfortunately, it is this fear of having a low supply which can become a roadblock in our breastfeeding journeys, far more often than it being an actual medical issue.

At a very high level, the rule of thumb is – if your baby comes off the breast looking relaxed, and if the number of heavy, wet diapers in 24 hours is more than or equal to the number of days old (for newborns up to one week), and 5-6 thereafter, your baby is very likely getting adequate milk (check out this comprehensive presentation by the Sri Lanka College of Pediatricians, particularly slides 41-46).

There are 9 common occurrences that may worry mothers, but which are not necessarily an indication of inadequate milk supply:

1. My baby wants to nurse very frequently

Breast milk is actually digested very efficiently (usually within 1.5-2 hours) and frequent feeding is common as a result.  Some babies are also more ‘sucky’ than others or require more skin contact.

2. My baby suddenly nurses more frequently, or for longer durations

This may be a growth spurt, which usually lasts a few days to a week. Since milk production is supply & demand-based, allowing your baby to feed extra will result in your breasts producing more milk to catch up.

3. My baby suddenly nurses less frequently, or for shorter durations

With age, as your baby gets more efficient at extracting milk, and the size of their little tummy increases, this will happen and is not an indicator of low supply.

4. My baby guzzles down a bottle of milk after nursing

Many babies will take a bottle of milk even after a full breastfeed, due to their suckling reflex, and then fall asleep due to exhaustion rather than satiation.

5. My breasts don’t leak milk, or only leak a little, or have stopped leaking

Leaky breasts have nothing to do with your milk supply adequacy. Leaking often stops once your milk supply has adjusted to your baby’s needs, and/or as the feeds become more predictable.

6. My breasts seem softer, or don’t get engorged anymore

Again this often happens once your milk supply has adjusted to your baby’s needs, and/or as the feeds become more predictable.

7. I don’t feel a let down sensation

Some women may never experience a let down sensation (tingling, pins & needles or a feeling of warmth), or find that it reduces over time. This is not connected to a reduction in supply.

8. I get very little milk when i pump

There are many reasons why this could be… pumping technique, pump type, flange size etc. At the best of times, your baby’s suck will always be more efficient at draining your breasts than the pump can mimic.  Pump output should not be used as a reliable indicator of production.

Hopefully you will find some reassurance if you are in this boat of questioning your supply.  However, if you have already found it in yours or your baby’s best interest to give formula, there is no guilt or shame in that. Breastmilk, while optimal, is not the only way to feed your baby. There are many circumstances where combination feeding (formula + breast milk) or only formula is necessary, and your child will be none the worse for it.  A well-fed baby combined with a happy mother really is the best end result.

How I became ‘The Milk Coach’

When my first child was born, I was quite unprepared for what lay ahead.  Particularly when it came to breastfeeding – I was naïvely expectant that I could just place him onto my chest, and let nature take its course.  What a surprise I was in for!  Cracked nipples from sub-optimal positioning, and my milk taking its own time to come in, led to terrible pain.  This pain became excruciating when my son developed oral thrush which travelled through to my milk ducts.  Fortunately, thanks to a lot of research and some wise mum friends, I was able to power through those awful first few months.  Most crucially, I was able to advocate for myself with health professionals (and I’m thankful for the ones who listened to me when I did!).

This birthed a passion to peer-to-peer counsel, share with and advocate for my fellow Sri Lankan mums, to support them to achieve their breastfeeding goals. To this end I am working to add to a science background (in Molecular Cell Biology) with an accreditation by La Leche League International (LLLI). 

Join the conversation, follow @themilkcoach on Instagram or Facebook.

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Confused over AstraZeneca news? We break it down in one minute!

AstraZeneca, long regarded as the problem child of the COVID vaccines, is plagued again by negative news. So what’s happened? What does it mean for you?

Short read:

The overall risk of blood clots is ca. 4 for every 1,000,000 people. The benefits of AstraZeneca vaccine outweighs the risks posed by COVID19 and the vaccine itself for over 40s. Anyone who didn’t suffer from clots should receive their second vaccine when offered.

However, as the risks posed by COVID19 to under 30s are lower, alternate vaccines are more prudent for use in this population. This is not out of safety concerns but utmost caution.

Want more details? We break it down into bite sized pieces below:

What’s happened?

In early March 2021, a slew of European countries paused administering the AstraZeneca vaccines after some reports of blood clots began to appear.

As per protocol, all severe adverse effects have to be investigated by the relevant medical authorities. When investigating, authorities look for signs of causation – did A cause B? Or did A and B happen to occur at the same time?

Most often, they do this by analysing the rates of occurrence of the event in the general population (or in the specific demographic) and then compare that to the rate of occurrence in the corresponding vaccinated population.

Here’s a simplified fictional example of what that means:

In the general population, say 1% of people over 50 suffer from heart attacks in a one month time period. In the vaccinated population, if this rate is the same or lower, then the event is deemed to not be caused by the vaccine. But if this rate is higher in the vaccinated population, then further investigations or ending of the vaccine trials or drives are required.

What did the investigations show?

On March 19th, EU & British regulators stated that the benefits of the AstraZeneca vaccine in preventing COVID19 outweighs any risks posed by it. They investigated ca. 30 cases of clots out of the 20,000,000 people who had received the vaccine in the EU & UK.

Following this, Germany, Italy and a number of other countries recommenced their vaccine drives with prudent processes in place.

So what’s the latest news about?

On April 7th, The UK’s major medical body, the MHRA held a press conference in collaboration with the EU’s major medical body, the EMA to discuss their findings.

There was confirmation that blood clots have been identified as a “potential side effect” in “an extremely small number of people” (emphasis added).

For example, in the 40-49 age group, 0.5 harms can be caused for every 100,000 people. This compares to 51.5 ICU entries with COVID19 in the same age group for every 100,000 people.

Most importantly, the benefits of AstraZeneca vaccine was found to far outweigh the risks for the majority of people.

What are the key things to remember about this event?

  1. The vaccine is still safe to administer to the vast majority of people over the age of 30. If you’ve had the first dose and haven’t had the below symptoms, you should take the second dose.
  2. If you have a known blood disorder, speak to your doctor before going for vaccination. 
  3. Anyone who has the below symptoms four days after vaccination should seek prompt medical advice.
  4. Symptoms to look out for include: 
    • new onset of a severe or persistent headache
    • Blurred vision
    • Shortness of breath
    • Chest pain
    • Leg swelling
    • Persistent abdominal pain
    • Unusual skin bruising or pinpoint spots beyond injection site

No medicine or vaccine is without risk. But knowing the destruction caused by COVID19 (even to those that present with no symptoms), it is always a matter of weighing the benefits against the risks. Agencies continue to monitor safety and will continue to act expeditiously when necessary. 

Concerned about clots or any of the above symptoms? Speak to an on demand GP on oDoc within 3 minutes.

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  1. “MHRA issues new advice concluding a possible link between COVID19 vaccine Astrazeneca and extremely rare unlikely to occur blood clots”, MRHA website, April 2021
  2. Under 30s won’t be given Astrazeneca vaccine over “extremely rare” risk of blood clots, ITV, April 2021

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