A cross-sectional study to assess the adverse events following immunization with CoviShield vaccine at a private medical college in South India

Background: The World Health Organization had proclaimed the outbreak of the novel coronavirus (COVID-19) as a worldwide pandemic on March 11, 2020. Immunization against the disease was the need of the hour to curtail the spread of COVID-19 pandemic. Two vaccines manufactured in India were approved for emergency use authorization initially. They are ChAdox1CoV-19 vaccine – CoviShield and Covaxin. Aims and objectives: This study aimed at assessing the occurrence of adverse effects following immunization (AEFI) among individuals who received the CoviShield vaccine. The objective of this research was to evaluate the type of AEFI among vaccinated beneficiaries and to determine the factors contributing to the development of AEFI. Materials and Methods: A cross-sectional study was done at a teaching hospital in Kerala. All beneficiaries who were administered CoviShield vaccine during the study period, that is, from January 2021 to June 2022 were incorporated in the study. Data regarding AEFI were collected from all vaccinated individuals by direct or telephonic enquiry. Results: The incidence rate of AEFI is 4.5/1000 doses (111/24925 doses). The reporting of AEFI was high among age group of 20–30 years and commonly seen in males (97.3%). The most common AEFI reported with CoviShield vaccine were fever (63%), myalgia (51%), and headache (40%). AEFI were seen commonly after administration of first dose (94%). Only 7 cases (6.3%) of serious AEFI were reported which included death, autoimmune encephalitis, Bell’s palsy, hypotension, and hypersensitivity reactions. There was no significant association between age and type of AEFI (P > 0.05) and dose of vaccine and type of AEFI (P > 0.05). Conclusion: The immunization with CoviShield vaccine is safe among adults (>18 years) with lesser incidence of serious adverse effects. Higher incidence of AEFI is witnessed after administration of first dose and it was commonly seen in males.

Paralytic poliomyelitis in a rural area of north India.

BACKGROUND: Paralysis due to poliomyelitis is common in rural areas. The extent of paralysis, type and place of treatment and effect of local treatment on children with poliomyelitis was assessed in a house-to-house survey conducted between 1990 and 1991 in a rural area of north India. METHODS: Trained field workers conducted a house-to-house survey in 9 villages of Haryana with a total population of 22,883. All cases of deformity and muscular weakness suspected to be due to poliomyelitis were examined and details regarding immunization, diagnosis, treatment and follow up were recorded. The late consequences of neglect as well as inappropriate medical advice were also assessed by physical examination and direct questioning of the parents. RESULTS: Thirty-seven cases of paralytic poliomyelitis were identified indicating a prevalence rate of 1.6 per 1000 population. Of these, 97% were paralysed before they were 2 years old and 60% had a history of intramuscular injections preceding paralysis. Only 14% of them had received either partial or complete immunization. The majority of families preferred to take treatment from traditional healers or in city hospitals but not from primary health centres. CONCLUSION: Despite the national immunization programme, paralytic poliomyelitis continues to be a significant problem in the villages surveyed. Primary health centres are an unreliable source of epidemiological data for paralytic poliomyelitis as villagers do not prefer to visit them for treatment of the disease. Injections given for treatment of fevers in rural areas may play a role in precipitating paralytic poliomyelitis. These findings highlight the urgency of a broad-based primary health care approach at primary health centres. Traditional healers and private practitioners should be trained to provide physiotherapy to children with polio and educated about the importance of not giving injections to children with minor fevers.

Role of two-dimensional echocardiography in early diagnosis of suspected acute dissection of ascending aorta.

Seven patients with acute dissection of ascending aorta are presented and the role of two-dimensional echocardiography in the early diagnosis of this condition is emphasized. There were 5 male and 2 female patients. The mean age of the patients was 36.7 +/- 11.2 years. The presenting symptoms were chest pain in 7, associated interscapular pain in 4, dyspnoea in 4 and syncopal episodes in 2 patients. Examination revealed hypertension in 3, pulses paradoxus in 2, asymetrically weak carotid and brachial pulses in 3, aortic regurgitation in 5 and neurological deficit in 2 patients. Echocardiography showed aortic root diameter of 42mm and the presence of an intimal flap in all the 7 patients and flap oscillations in 6 patients. Echocardiographic evidence of pericardial effusion was present in 6, cardiac tamponade in 3, aortic regurgitation in 5 and regional left ventricular wall motion abnormality in 1 patient. Surgical correction was done in 5 patients with 60% success rate. Two patients received only medical treatment. Aortic root dilatation of 60 mm, presence of an oscillating flap, evidence of cardiac tamponade and regional wall motion abnormality were found to be associated with poor prognosis.