ABSTRACT
INTRODUCTION: Inactivated, viral vector and mRNA vaccines have been used in the Nepali COVID-19 vaccination programme but there is little evidence on the effectiveness of these vaccines in this setting. The aim of this study is to describe COVID-19 vaccine effectiveness in Nepal and provide information on infections with SARS-CoV-2 variants. METHODS AND ANALYSIS: This is a hospital-based, prospective test-negative case-control study conducted at Patan Hospital, Kathmandu. All patients >18 years of age presenting to Patan Hospital with COVID-19-like symptoms who have received a COVID-19 antigen/PCR test are eligible for inclusion. The primary outcome is vaccine effectiveness of licensed COVID-19 vaccines against laboratory-confirmed COVID-19 disease.After enrolment, information will be collected on vaccine status, date of vaccination, type of vaccine, demographics and other medical comorbidities. The primary outcome of interest is laboratory-confirmed SARS-CoV-2 infection. Cases (positive for SARS-CoV-2) and controls (negative for SARS-CoV-2) will be enrolled in a 1:4 ratio. Vaccine effectiveness against COVID-19 disease will be analysed by comparing vaccination status with SARS-CoV-2 test results.Positive SARS-CoV-2 samples will be sequenced to identify circulating variants and estimate vaccine effectiveness against common variants.Measuring vaccine effectiveness and identifying SARS-CoV-2 variants in Nepal will help to inform public health efforts. Describing disease severity in relation to specific SARS-CoV-2 variants and vaccine status will also inform future prevention and care efforts. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Oxford Tropical Ethics Committee (OxTREC) (ref: 561-21) and the Patan Academy of Health Sciences Institutional Review Board (ref: drs2111121578). The protocol and supporting study documents were approved for use by the Nepal Health Research Council (NHRC 550-2021). Results will be disseminated in peer-reviewed journals and to the public health authorities in Nepal.
Subject(s)
COVID-19 , Vaccines , Humans , SARS-CoV-2/genetics , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Case-Control Studies , Nepal/epidemiology , Prospective Studies , Vaccine EfficacyABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and presents with fever, dry cough, fatigue, myalgia, and dyspnea. This study aims to is find out the understanding of COVID-19 among doctors at Patan Hospital. Method: A cross sectional was conducted among doctors at Patan Hospital, Patan Academy of Health Sciences, Nepal. The questionnaire in Google form consisted, part1 perception on COVID-19 and part2 understanding using multiple choice questions corresponding to the one to fifteen questionnaire in part1. Ethnical approval was obtained. Result: Sixty-one doctors participated in the study, of which 65.5% were directly involved in management of COVID-19. Perception and understanding regarding transmission status in country was 65.6% and 63.95% respectively, about case definition 90.1% and 62.2%, about when to do diagnostic tests 75.4% and 90.2%. Conclusion: There was difference in perception and understanding regarding COVID-19 among doctors, and areas to be reinforced were case definition, transmission classification, diagnostic tests. Keyword: COVID-19, doctors, perception, understanding
ABSTRACT
In view of preparing ourselves for the possible rise of Corona Virus Disease (COVID-19) cases, we have proposed a hypothetical model of disease course in COVID-19 patients admitted in Patan Hospital and the exit plan based on available evidences. This will give us a scientific basis of planning discharge of our future cases. According to it, patients are subjected to repeat Polymerase chain reaction (PCR) on day 20 of illness onset and then every 4 days till negative result. Patients with two negative PCR test repeated 24 hours apart are discharged and advised for 14 days’ home quarantine. Keyword: COVID-19, disease course, exit plan, Patan Hospital
ABSTRACT
Angiotensin-converting enzyme-2 receptor has been unearthed as a prime site of entry of Severe Acute Respiratory Syndrome Coronavirus 2 owing to its strong affinity towards spike protein of Severe Acute Respiratory Syndrome Coronavirus 2, resulting in down-regulation of Angiotensin-converting enzyme -2 receptors and hyperstimulation of Angiotensin-converting enzyme-1 pathway. This proposed theory has led to the birth of a new controversy regarding the use of Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in Coronavirus disease 2019 patients. A theory is against the use of Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, as it enhances the effect of Angiotensin-converting enzyme -2 pathway and upregulation of Angiotensin-converting enzyme -2 receptors resulting in a large number of internalizations of Severe Acute Respiratory Syndrome Coronavirus -2 into cells culminating into a high load of viremia with overwhelming infection and severity. The other theory considers Angiotensin-converting enzyme inhibitors / Angiotensin receptor blockers useful as it blocks deleterious Angiotensin-converting enzyme -1 pathway triggered by Severe Acute Respiratory Syndrome Coronavirus 2 and enhances Angiotensin-converting enzyme -2 receptor upregulation and activation of angiotensin-(1-7) leading to beneficial effects, i.e vasodilation, anti-apoptosis, anti-proliferative, &antifibrosis. Hence, Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers may prove beneficial in countering the Angiotensin-converting enzyme -1 mediated damage by Severe Acute Respiratory Syndrome Coronavirus 2. The recommendations by (European &American) societal guidelines still hold good of not discontinuing Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in COVID-19 patients as it is further supported by current evidence of large observational studies.