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So, can we mix and match vaccines?

So, can we mix and match vaccines?

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As the first dose recipients of the AstraZeneca vaccine started to reach the 12-week mark in May, a lot of people were dismayed that they wouldn’t be able to receive the second jab in a timely manner. A lot of conversations began to revolve around “well, what happens to my immunity?” or “can’t we use another vaccine as a second dose?” and at the time, there weren’t much scientifically sound answers to ease people’s nerves. 

The dearth of the second jab of AstraZeneca vaccine for over 500,000 in Colombo was largely due to the Indian COVID surge shutting down Serum Institute exports in late March. As India hurried to absorb all its domestic production to stop a calamitous third wave, a large number of developing countries, including ours, were left without a way forward. 

In December, Russia & the UK began a study of the safety & efficacy of following up a first AstraZeneca dose with a Sputnik booster and in the UK & Spain, researchers started studying the effects of a follow-up Pfizer booster.

Short answer: The jury is still out on exact findings but some preliminary data is available: side effects were more pronounced in intensity (however not severe and no hospitalisations) and higher antibody levels were seen after a Pfizer booster. 

Want more details? Read on: 

What do we know about safety?

In a UK trial, of the ca. 460 people (median age of 50+ years) that received the AZ jab and then a Pfizer booster 28 days later saw greater intensity in post-second jab side effects than those that received a second AZ dose (“control group”). 

More people felt feverish, had chills, felt fatigued, had joint pain and muscle aches in the study group than in the control group. Most of these effects were felt in the first 48 hours after. Efficacy data has not yet been made available. 

Safety and efficacy data of a booster shot being administered after 84 days is expected in June.

What do we know about efficacy?

A study by the Carlos III Health Institute in Madrid enrolled 663 people who had received the AstraZeneca first dose to receive the Pfizer second dose after eight weeks. The control group did not receive any booster shots. 

The results showed a much stronger immune reaction producing a higher level of antibodies in the Pfizer group than they did with the first dose of AstraZeneca. No severe side effects were reported.

What about a Sputnik booster? 🇷🇺

In December 2020, the UK & Russia began to partner on a study to test safety and efficacy of mixing these two vaccines. On May 28th, Russia announced a hold on it’s mix and match trial with Sputnik as the national ethics committee awaited further data.

What about a Sinopharm booster? 🇨🇳

No data is available at the time of publication however Bahrain has allowed mixing with a second dose of SinoPharm. 

What are other countries doing?

Some countries have already begun allowing a second dose of mRNA to supplement the first dose of another brand. On 1st June, Canada’s National Advisory Committee of Immunization announced it would allow second doses of mRNA to be administered to those that received the first dose of another brand of vaccine. 

Bahrain, Finland, France and Norway had begun allowing second doses of mRNA to be administered to those with AstraZeneca first doses.

What about us in Sri Lanka? 🇱🇰 

The health authorities have not approved the mixing of vaccines in Sri Lanka at the time of publication. The government is attempting to procure the shortfall of AstraZeneca doses by any means possible and has signed an agreement with Pfizer for 900,000 doses for delivery in July. 

The recent crowdings and altercations at AstraZeneca vaccination drives serve to be more harmful than helpful when limiting the spread of COVID19. Until sufficient data is available and vaccines are approved & available for mixing, we believe it’s most prudent for those that received the first AZ dose to adhere to strict COVID19 protocols, limit travel as much as possible and avoid crowded gatherings. 

If you or a loved one have been diagnosed with COVID19 and are awaiting transfer to an intermediate care centre or government facility, oDoc Home Care is available for you. 

With oDoc Home Care, you receive daily calls from a medical doctor for symptom monitoring & medical advice, a wellness bundle including gloves & masks, a pulse oximeter and blood pressure monitors. Click here for more details. 

Sources

  1. Shaw, R., et al (2021) Heterologous prime-boost COVID-19 vaccination: initial reactogenicity data., The Lancet., 397:2043-2046. 
  2. Callaway, E (2021) Mix-and-match COVID vaccines trigger potent immune response, Nature Magazine
  3. Miller, A (2021) Canada recommends mixing and matching AstraZeneca, Pfizer and Moderna COVID-19 vaccines, CBC
  4. Explained: Which are the countries allowing you to mix Covid-19 vaccines?, Indian Express (2021)
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You test positive for COVID-19. What Now?

You test positive for COVID-19. What now?

Updated August 12th, 2021.

Medically Reviewed by Dr. Rashmira Balasuriya BSc (Hons) MBBS PGCert (MedEd)

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With the number of COVID-19 cases rising across the country, it is more likely than ever that we have either interacted with or know of a person who has been tested positive for COVID-19. And if we’re feeling a little temperature or a sore throat, our next thought tends to be “Should I take a PCR test?”. With the amount of ambiguity and daily change of regulations, we, at oDoc, want to keep you informed and updated with the latest news regarding COVID-19 processes in Sri Lanka.

What should you do after finding out you’ve been tested positive for COVID-19?

Contacting your local PHI

You can find out who your local PHI is from this website (On the navigation bar at the top, click ‘Find PHI’ and fill in your area details) The lab or hospital where you were tested for COVID-19 will also inform your local PHI and Ministry of Health.

Things you should keep in mind for your conversation with the PHI officer:

  • COVID-19 symptoms
  • How long you’ve been having these symptoms
  • Any known medical illnesses (i.e. asthma, diabetes, etc)
  • Any medications taken for known illnesses or after becoming COVID positive
  • Any allergies
  • Any previous surgeries
  • If you’re a smoker or not
  • People you have been in contact with over the last few days
  • Have an emergency contact number of a family member/friend
pcr test

Home Isolation 

To reduce the burden on hospitals and COVID-19 care centers, the Ministry of Health has introduced the option of low risk COVID-19 patients isolating in their homes. Here are a few things to keep in mind when quarantining at home:

  • REST.
  • Remain in a separated well-ventilated room.
  • Avoid contact with others as much as possible. Identify one family member who is low risk to be in contact with you. Wear a surgical mask and wash hands before coming into contact with anyone else.
  • Do not share washrooms if possible. If sharing, you should disinfect the washroom after each use.
  • Eat a healthy diet.
  • Stop smoking.
  • Do not routinely take antibiotics or steroid medication. Only take medication prescribed by a licensed medical practitioner.
  • Have warm fluids frequently such as tea, kothamalli, jeewani
  • Steam inhalation – only for symptomatic relief and always ensure safety
  • Keep track of any new or worsening symptoms – If possible, keep a check on your basic vitals – temperature, pulse rate, respiratory rate (count the number of breaths per minute), blood pressure and oxygen saturation.
  • You should use separate cutlery, plates, dishes and bedding from the rest of the household members.
  • Clean frequently touched surfaces often.
  • Keep your bed linen and clothes in a laundry bag separate from others.
  • All household members should remain at home and avoid any contact with people who don’t live in the same household.
  • No visitors should be allowed during the home isolation period.
  • Call 1990 if you have any difficulty breathing, chest pain or loss of speech/mobility.
  • Keep emergency contact numbers close by.

How will you be accessed during home isolation?

The area MOH will be responsible for triaging COVID positive individuals who need home-based care and who need hospitalized care.  Taking care of your mental health during this period of isolation is also important and can help in making you feel better, so consider speaking to a mental health professional during this time as well.

During your home isolation period, you can purchase Home Care with oDoc. You will need to inform your local PHI if you choose to use this service.Here’s what you have access to:

  • A dedicated doctor assigned to you to virtually monitor your symptoms everyday 
  • A Pulse Oximeter and Blood Pressure Meter (both NMRA approved) to be sent to your home
  • A Wellness Package of masks, gloves, sanitizer, and a box of Panadol to be sent to your home.

Click here to find out more about Home Care with oDoc.

A minimum of 14 days is required for the home isolation period. The Ministry of Health and your doctor will make the decision on when you should stop the home isolation period. This will depend on your symptoms and how many days have passed since the onset of symptoms. If the MoH decides you can remove yourself from isolation, it is still recommended that you quarantine at home for a further 14 days.

Government/Private Care Centers

If the PHI/MoH decides that you need to be treated at a hospital or care center, there are options to stay in a government care center for free or a private care center for a fee. If you choose to quarantine at a private care center, you can find all the information on space availability, rates and medical support here.

You may have to remain at home before a bed becomes available at a COVID care center. If you need to remain at home for a few days, please follow the above guidelines. Your local PHI will transfer you to an Intermediate COVID care center when a bed becomes available to you.

How do you know when to seek immediate medical attention?

  • Progressive worsening of persistent symptoms
  • Difficulty in breathing at rest or after mild exertion
  • Oxygen levels at rest is below 96% or less than 94% after mild exertion (check with Pulse Oximeter)

If any of the above occurs, please go to the hospital immediately or call 1990 for an ambulance.

How long after you’ve recovered from COVID-19 can you take the vaccine?

If you’ve had a mild/moderate version of COVID-19, you can take the vaccine 2 weeks after recovery. If you’ve had a severe form of the disease AND received monoclonal antibody/plasma therapy as part of your treatment, you will have to wait at least 1 month before vaccination.

We will continue to update this article if and when regulations change so keep checking this space for any COVID-19 related news in Sri Lanka.

Watch our short video explaining everything you need to know about the highly contagious and transmissible Delta Variant here.

If you would like to read more about the SinoPharm and Sputnik vaccines, read more here. 

If you or a loved one would like further advice on COVID-19 symptoms, consult with our on-demand GPs who are available 24/7.  You can download oDoc here.

References:

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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

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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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Variants, variants, but what does it mean?

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Image source: Hindustan Times

Image Source: BBC

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

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no enclosed indoor spaces
ventilation
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