Let’s not worry too much: IMA on safety and efficacy of covid vaccines

Agencies
January 12, 2021

New Delhi, Jan 12: Amid the ongoing debate around the safety and efficacy aspects of Covid vaccines, the president of Indian Medical Association (IMA) has advised the public to not worry too much about it.

Speaking to IANS, Dr. J.A. Jayalal, president, IMA said, "We should not be too worried about the safety and efficacy of the vaccines since enough evidence is available to prove its credibility.

"The vaccines are never 100 per cent protective and efficacious at any time. It helps us to some extent in getting ahead of the disease but eventually, herd immunity will set in to control the viral spread. So let's not worry too much about the safety and efficacy part," he said.

"What we know from the trials is that the vaccines approved for inoculation in India are found safe and elicit an immune response. The technology of harnessing vaccines from inactivated viruses is a proven science. Our least expected efficacy criteria is 50 per cent while at the same time, other drugs we have been using for years are even below this benchmark of efficacy. We use influenza and vaccines against Tuberculosis but still people contract it," Jayalal explained.

"Even natural infection cannot determine the level of antibodies it would create in the body. Some may develop less antibodies, some may exhibit high titers of it while a few may never develop at all. Good thing is that the vaccines are producing antibodies and it's enough at this stage," he added.

Jayalal also said that the vaccine would work against the current and mutant strains of the coronavirus. Such claim was earlier made by Bharat Biotech for its Covid vaccine, Covaxin, which is approved for restricted emergency use in a clinical trial mode'. However, the firm is yet to present the data confirming its claim.

The apex association of modern medicine practitioners in the country has come out publicly endorsing the safety and efficacy of Covid-19 vaccines. In a statement issued on Monday, it said that the association stands with the scientists to endorse the safety and efficacy of both Covaxin and Covishield for public awareness and to counter myths on vaccine percolating in social media.

The IMA has also appealed to its its 3.5 lakh members in 1,800 local branches to actively take part in the mission of Covid vaccination programme rolled out by the Government of India. "Come out to get vaccinated first to show to the world that these vaccines are safe and efficacious," it had said.

Despite the efficacy of both the vaccines still unknown, the IMA has endorsed the vaccines. When asked about it, Jayalal said the association had a detailed discussion on such aspects with the government agencies. "After analyzing all the scientific data, we have decided to come out firmly in support of the vaccines," he added.

India's drug regulator has approved two Covid vaccine candidates -- Covishield by Serum Institute of India and Covaxin by Bharat Biotech -- for the massive inoculation drive against the Covid-19.

The immunization drive will start from January 16. The vaccines have already reached many of the primary hubs to be distributed further before the roll-out.

Till now, a total 1,51,327 people have succumbed to the deadly disease while it has infected 1,04,79,179 people in the country.

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Agencies
January 20,2021

UK Coronavirus Strain Detected in At Least 60 Countries: WHO

Geneva, Jan 20: The UK coronavirus strain has been detected in at least 60 countries, the World Health Organization said Wednesday, 10 more than a week ago.

With the global death toll now well past two million, and new variants of the virus causing deep concern, countries across the world are grappling with how to slow infections until vaccines become widely available.

The South African strain, which like the UK one is believed to be more infectious, has now been reported in 23 countries and territories, the WHO also announced in its weekly update.

It added that the number of new deaths climbed to a record high of 93,000 over the previous seven days, with 4.7 million new cases reported over the same period.

The arrival of mass vaccination campaigns in the US and Europe had brought hope that the end of the pandemic was in sight; the European Union said Tuesday it was aiming to inoculate 70 percent of its adult population before the end of August.

But many EU countries -- and other nations including India and Russia -- have struggled to get their inoculation programmes off the ground.

The United States remains home to the world's worst outbreak in overall numbers, and US President-elect Joe Biden made clear he would be taking no chances following his inauguration on Wednesday.

Recent days have also seen a renewed focus on the initial outbreak a year ago, with China defending its handling of the virus on Tuesday after independent experts criticised the speed of its response.

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Dr. Suneetha
January 20,2021

Being pregnant and welcoming a new baby is like beginning of all new things in life. Priorities change, expectations from life, and partner change. Women disorganize their lives to organize a new life. In these emotional times, if a new expecting mom is diagnosed with cancer and that too in the child-bearing uterus, the whole world comes to a standstill, and words cannot express that grief.

Pregnancy complicated with cervical cancer is very rare. About 1 to 3 % of women suffering from cervical cancer are diagnosed either in pregnancy or immediate postpartum and majority of patients present with complaints of bleeding per vaginum. Often this is mistaken for threatened abortion.

Once a patient comes with these symptoms, they will be immediately evaluated for confirmation of diagnosis with a biopsy from the cancerous mass with some basic blood tests and as all X-Rays and CT scans are contraindicated in pregnancy. For staging the patient, an ultrasound or MRI abdomen would be advised.

Treatment of cervical cancer depends on different stages of cancer, the term or stage of pregnancy and as well as on the wishes of the mothers. A pre- invasive cancer treatment can wait till the pregnancy is completed but if preservation of pregnancy is not contemplated, then termination of pregnancy followed by surgery or chemo-radiation according to the stage of the disease is advised. 

Majority of the patients present in early stage of the disease continue the pregnancy by delaying the treatment till baby matures and attempt a cesarian section to deliver the baby.

In this period to keep the disease under control, patients are given chemotherapy drugs which can be safely given during pregnancy. Curing the disease is the main objective, and the maternal survival should not be compromised in favour of holding the pregnancy while at the same time giving a fair chance to the little one to see the sunlight.

By Dr. Suneetha is a Radiation Oncologist at American Oncology Institute

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Dr. Th. Tomcha
January 18,2021

Cervical cancer, also known as Womb Cancer, is the fourth most common cancer in females worldwide and the third most common in both India and Manipur. Approximately 1 lake new cases are diagnosed worldwide every year. Luckily, the disorder is on the decline. A decade back, it happened to be the most common female cancer in both India and Manipur. It is one of the leading causes of death in women.

Risk Factors: Exposure to these increases the chances of developing the disease.

•    Human Papilloma Virus (HPV): It has the highest risk factor associated with more than 90% of cervical cancer. The most common HPV variants associated with cervical cancer are HPV 16 & 18. The presence of the virus to the husbands also exposes their wives equally.
•    Early Marriage: Early marriage before 18 years increases the chances of developing the disease. If sex life is started before 16 years, the increase is very significant.
•    Multiparity: There is exponential increase in risk factor with more childbirths (more than 2).
•    Multiple Sexual Partners: Having sexual relations with multiple partners increases the risk factor.
•    Smoking: Increases the chances of developing the disease.
•    Hygiene: Hygiene of private parts of both husband and wife is related with the disease
•    HIV: As HIV positive women has a low immunity, they have higher chances of developing cervical cancer.
•    Mothers who took hormone replacement therapy like Diethylstilbestrol increases the incidence of the disease in their daughters.
•    Low and Middle Income group: 90% of cervical cancer develops in this group. This is because of lack of micronutrients in their diet and private bathrooms thereby compromising with personal hygiene.

Presenting Symptoms: 
•    Bleeding after Intercourse: This is the first symptom of cervical cancer and must be regarded as a warning sign.
•    Vaginal Discharge (May or may not be foul smelling): This is the commonest symptom.
•    Bleeding per Vagina: Unusual bleeding like in post-menopausal ladies (When menstruation has been stopped) and bleeding in between menses in pre- menopausal ladies are suspicious symptoms of the disease.
•    Pain Lower Abdomen: Due to the tumour mass effect, there may be pain in lower abdomen. This pain may be referred to the back and later to upper thigh even.
•    Constipation: The tumour mass may cause compression of rectum and cause constipation.
•    Constitutional Symptoms: Weakness, loss of appetite, pallor, fever, loss of weight, body ache etc. may be present.
•    Systemic Symptoms: When the disease has spread to different parts (Systems) of the body, it can lead to all types of symptoms related to the system where disease has spread.

Management: Cervical cancer is regarded as a mostly preventable disease and when possible, it is the best approach. The adage “Prevention is better than cure” holds equally true in this disease. Next to prevention, early detection is of utmost importance. Once detected early, the disease is mostly curable.

Prevention: 
•    Avoidance of the risk factors stated above will eliminate the disease from appearing to a great extent.
•    Routine Pap Smear and DNA testing for HPV 16, 18: By these tests, we can detect in the pre-cancer stage. Luckily in cervical cancer, we get a buffer time of 10-15 years to become cancerous from pre-cancer stage. By instituting proper treatment during this period, we can prevent from developing frank cancer disease. 
•    HPV Vaccination: As more than 90% of cervical cancers are caused by HPV, eliminating this virus from the body by preventive HPV vaccination, we can prevent cervical cancer to a great extent. The recommended time of having the vaccine is 9-14 years before sex life starts. It is not useful if dine beyond 26 years.
Early Detection:
Next to prevention, early detection is the 2nd best strategy. When detected early (Stage I, II), more than 60% cervical cancers can be cured.
•    Being alert to warning signals and promptly reporting to concerned doctors.
•    By having timely Pap Smears. Present recommendation (National Cancer Institute and American College of Gynaecologists) is:
o    Start Pap smear by age 21
o    From 21-29 years of age, have it every 3 years
o    Starting at age 30, Pap smear and HPV DNA test must be done every 5 years till 65.
o    Women above age 65, who had regular screening over last 10 years with consistently normal results may consider stopping screening.

•    Visual Inspection with Acetic acid and Lugol’s Iodine. This is to be done by doctors or trained nurses.
•    Annual pelvic examination by doctors

Treatment:
Once the diagnosis has been confirmed and the necessary investigations and staging have been completed, treatment should be started as early as possible. Surgery and radiation treatment are curative forms of treatment with equal efficacy. The role of chemotherapy is adjunct to surgery or radiation or palliative therapy.
•    Surgery: The applicability of surgery is limited and is confined only in the early stages (Stage I, IA).
•    Radiation Treatment: It is applicable in all stages (I-IV). In advanced stages, a combined treatment with chemotherapy gives better results.
•    Chemotherapy: It is used as an adjuvant to surgery or radiation to enhance beneficial effects. Standalone, it is not curative in cervical cancer. It is also used as palliative treatment (Symptom relieving).

 

Dr. Th. Tomcha is a Sr. Consultant, Radiation Oncology at American Oncology Institute at Babina Speciality Hospital, Imphal

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