COVID-19 Vaccines: Overview, Efficacy, Safety and Challenges

The rapid and extraordinary development and deployment of Coronavirus disease 2019 (COVID-19) vaccines worldwide represent an unprecedented achievement in the history of vaccine development. This chapter provides an overview of COVID-19 vaccine strategies, platforms, clinical trials, and regulatory frameworks. Vaccine safety, efficacy, herd immunity, and severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) variants are also discussed. Real world challenges confronted include the ethics of vaccine allocation, vaccine nationalism, vaccine hesitancy, and vaccine passports. © 2023 by World Scientific Publishing Co. Pte. Ltd.

Acute coronary syndromes in the era of SARS-CoV-2 Infection: A registry of the French group of acute cardiac care

Background Cardiovascular complications are frequent in SARS-CoV-2 patients. The characteristics of acute coronary syndromes (ACS) in this population have not yet been reported. Purpose We aimed to report clinical characteristics and outcome of patients with and without SARS-CoV-2 infection referred for acute coronary syndrome (ACS) during the peak of the pandemic in France. Methods We included all consecutive patients referred for ST-elevation myocardial infarction (STEMI) or NSTEMI during the first 3 weeks of April 2020 in 5 university hospitals (Paris, south and north of France), all performing primary percutaneous coronary intervention (PCI). Results The study included 237 patients (67 ± 14, 69% of male), 111 (49%) with STEMI and 121 (51%) with NSTEMI. The prevalence of SARS-CoV-2 associated ACS was 11% (n = 26) and 11 patients had severe hypoxemia on presentation (mechanical ventilation or nasal oxygen >6L/min). Patients were comparable regarding medical history and risk factors, except higher prevalence of diabetes mellitus in SARS-CoV-2 patients (53.8% vs. 25.5%, P = 0.003). In SARS-CoV-2 patients, admission for cardiac arrest was more frequent (26.9% vs. 6.6%, P < 0.001), and significant coronary artery disease and culprit artery occlusion were reported in 76.5% and 92% of STEMI patients, and 88.9% and 50% of NSTEMI, respectively. PCI was performed in the same percentage of STEMI (82%) and NSTEMI (86%) cases, regardless of SARS-CoV-2 infection, but no-reflow after PCI (19.2% vs. 3.3%, P < 0.001) was greater in SARS-CoV-2 patients. In-hospital death occurred in 7 SARS-CoV-2 patients (5 from cardiac cause) and was higher compared to non-infected patients (26.9% vs. 6.2%, P < 0.001) Conclusion SARS-CoV-2 infection is frequent in ACS patients with higher incidence of coronary occlusion and no-reflow compared to non-SARS-CoV-2 ACS, which may explain the higher in-hospital mortality, despite a similar rate of PCI.

Safety, Feasibility and Healthcare Cost Differences between Inpatient and Outpatient Mobilization Chemotherapy for Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma: A Single Center Experience

Introduction The standard of care for patients with multiple myeloma (MM) involves autologous hematopoietic stem cell transplantation (ASCT). Pre-ASCT mobilization chemotherapy for MM, vinorelbine and high dose cyclophosphamide (VC), has been historically given in the inpatient (IP) setting. Due to rising bed occupancy rates and patients' preferences for treatment in the ambulatory setting, our team has offered eligible patients an option to receive VC outpatient (OP) since 2018. Our study aims to audit the feasibility and safety of this initiative, and review potential healthcare-related cost savings. Methods Eligibility criteria for OP chemotherapy were developed by a multidisciplinary team based on patients' age, functional status, medical comorbidities and social factors (Figure 1). The chemotherapy regimen was modified for an OP setting (Figure 2), of which the main alteration involved changing the route of administration of intravenous (IV) mesna to a combination of IV and oral. A retrospective review was conducted for 35 MM patients (18 IP and 17 OP) who received VC for mobilisation at our center from 2018 to 2019. The patient characteristics were similar between the two groups (Table 1). Patient data were analyzed from the day of admission for VC (IP) or day 1 of VC (OP), to the day before admission for stem cell harvesting. Clinical charts were reviewed for unexpected complications and unplanned admissions. Costs incurred were calculated using the value-driven-outcome (VDO) informatics analysis of the hospital. Results There were no unexpected clinical complications or unplanned admissions in both groups. The median length of hospital stay for the IP cohort was 3 days, amounting to a saving of 51 hospital days over 2 years in the OP cohort. Median costs were 73% lower in the OP cohort (Figure 3). The difference was mainly due to certain costs not incurred in the OP setting. These included room charges and daily treatment fees (which accounted for an average of 46% and 19% of IP charges respectively). Investigation costs were also 55% lower in the OP cohort, which could be attributed to more investigations being performed in the IP setting such as screening for methicillin-resistant Staphylococcus aureus and nonurgent radiographs ordered after hours by the on-call physician upon admission. Conclusions Our findings show that OP mobilization chemotherapy for MM is safe, feasible and associated with improved bed utilization and cost savings. Other components of the stem cell transplantation process are also increasingly being transitioned from the IP to OP setting in our center as part of an ongoing paradigm shift in right-siting treatment services, which has been accelerated by the COVID-19 pandemic's strain on inpatient capacity. These results provide an affirmation of our efforts to optimize the utilization of healthcare resources. [Formula presented] Disclosures: Chng: Takeda: Consultancy;GlaxoSmithKline: Consultancy;Johnson & Johnson: Consultancy, Research Funding;Aslan: Research Funding;Antengene: Consultancy;Abbvie: Consultancy;Pfizer: Consultancy;Novartis: Research Funding;Sanofi: Consultancy;Amgen: Consultancy;BMS/Celgene: Consultancy, Research Funding.

Adverse reactions and safety profile of the mRNA COVID-19 vaccines among Asian military personnel

INTRODUCTION: The use of novel mRNA platforms for COVID-19 vaccines raised concern about vaccine safety, especially in Asian populations that made up less than 10% of study populations in the pivotal vaccine trials used for emergency use authorisation. Vaccine safety issues also remain a concern in assessing the clinical risks and benefits of vaccine boosters, particularly in specific age groups or segments of the population. This study describes a vaccination exercise involving Asian military personnel, and the adverse reactions and safety events observed. METHODS: Minor adverse reactions, hospitalisations and adverse events of special interest were monitored as part of the organisation's protocol for safety monitoring of COVID-19 vaccinations. All vaccine recipients were invited to complete an online adverse reaction questionnaire. Medical consults at the military's primary healthcare facilities were monitored for vaccine-related presentations. All hospitalisations involving vaccine recipients were analysed. Adverse reaction rates between doses, vaccines and age groups were compared. RESULTS: A total of 127,081 mRNA vaccine doses were administered to 64,661 individuals up to 24 July 2021. Common minor adverse reactions included fever/chills, body aches and injection site pain. These were more common after dose 2. Younger individuals experienced minor adverse reactions more frequently. Rare cases of anaphylaxis, Bell's palsy and myocarditis/pericarditis were observed. No deaths occurred. CONCLUSION: Minor adverse reactions were less common than reported in other studies, and rates of anaphylaxis, Bell's palsy and myocarditis/pericarditis were comparable. Our study supports the favourable safety profile of mRNA COVID-19 vaccines, which may help guide decisions about booster doses if required.

Innovative Interventions to Reduce the Stigma Attached to Intellectual Disabilities: A Narrative Review

The stigma attached to intellectual disabilities (ID) can have profoundly adverse effects on the lives of people who suffer from these conditions. Stigma is also a major barrier to accessing specialist services and consequently many people with ID continue to suffer in silence. A confidential inquiry into the premature deaths of people with ID in England and Wales revealed the median age at death of individuals with this condition was 13 years (for males) to 20 years (for females) younger than the median age at death of the general population. It has been posited that stigma is a factor that contributes to the mortality gap between those with ID and those who don't have this condition. The COVID-19 pandemic has created new challenges for people with ID and has further fortified the barriers to specialist services. To reduce stigma, improve the quality of healthcare that is provided to people with this condition and to break down the barriers to specialist services, we must pioneer innovative interventions that leverage the power of technology and 'virtual' contact with people who live with these conditions.

The aquaculture supply chain in the time of covid-19 pandemic: Vulnerability, resilience, solutions and priorities at the global scale.

The COVID-19 global pandemic has had severe, unpredictable and synchronous impacts on all levels of perishable food supply chains (PFSC), across multiple sectors and spatial scales. Aquaculture plays a vital and rapidly expanding role in food security, in some cases overtaking wild caught fisheries in the production of high-quality animal protein in this PFSC. We performed a rapid global assessment to evaluate the effects of the COVID-19 pandemic and related emerging control measures on the aquaculture supply chain. Socio-economic effects of the pandemic were analysed by surveying the perceptions of stakeholders, who were asked to describe potential supply-side disruption, vulnerabilities and resilience patterns along the production pipeline with four main supply chain components: a) hatchery, b) production/processing, c) distribution/logistics and d) market. We also assessed different farming strategies, comparing land- vs. sea-based systems; extensive vs. intensive methods; and with and without integrated multi-trophic aquaculture, IMTA. In addition to evaluating levels and sources of economic distress, interviewees were asked to identify mitigation solutions adopted at local / internal (i.e., farm-site) scales, and to express their preference on national / external scale mitigation measures among a set of a priori options. Survey responses identified the potential causes of disruption, ripple effects, sources of food insecurity, and socio-economic conflicts. They also pointed to various levels of mitigation strategies. The collated evidence represents a first baseline useful to address future disaster-driven responses, to reinforce the resilience of the sector and to facilitate the design reconstruction plans and mitigation measures, such as financial aid strategies.

Symmetrical drug-related intertriginous and flexural exanthema like eruption associated with COVID-19 vaccination.

This is a case of symmetrical drug-related intertriginous and flexural exanthema-like eruption following ChAdOx1 nCoV-19 (AstraZeneca-Oxford) vaccination. Investigations, including repeated skin swabs, ruled out an infectious cause. He was subsequently treated with oral prednisolone, which led to a resolution of his symptoms.

[SARS-COV-2 myocarditis. An update]. / Myocardite et maladie à COVID-19 : où en est-on ?

The outbreak of the SARS-CoV-2 virus responsible for the COVID-19 disease has given rise to a new disease whose boundaries are still to be discovered. While the first data suggested a purely respiratory infection, the most recent publications highlight a large pleomorphism of the disease, responsible for multiple organ damage, of which cardiac injury seems to be the most represented. This cardiac injury can present as acute myocarditis. Our aim was to discuss the pathophysiological rationale underlying the existence of SARS-CoV-2 myocarditis and to analyze the literature data regarding the diagnosis and treatment of this particular entity.