ABSTRACT
Introduction: SARS-CoV-2 affected millions of lives globally and led to devastating impact on public health. India had also witnessed the dreadful effect of SARS-CoV-2 pandemic. Within a short span of time, various SARS-CoV-2 vaccines were developed using different platforms across the world. India has also developed one such indigenous whole-virion inactivated SARSCoV-2 vaccine named as BBV152 (Covaxin). The Covaxin has been found to be immunogenic and second most widely used vaccine in India. Recent studies have also shown significant increase in the humoral and neutralizing antibody response post the administration of booster dose against Omicron variant. Apparently, there is limited data on the long-term persistence of the immune response against the Covaxin in Indian context. Method(s): We evaluated an effectiveness of the Covaxin and comparing its specific immune responses in two categories through prospective cohorts recruited at the vaccination centre, Pune during June 2021 to March 2022. We defined the study population in two groups who were COVID-19 naive individuals (group-1) and COVID-19 recovered individuals (group-2) prior to the immunization with Covaxin. The two cohorts and the study participants were decided considering the baseline antibody titres against SARS-CoV-2, the COVID-19 positivity rate, sample power and loss to follow up. The study population was assessed during three follow-ups at second dose, one and six months post second dose to determine the immune response and effectiveness using S1-RBD IgG ELISA and neutralizing antibody response (NAbs) by plaque reduction neutralization test (PRNT). Result(s): We enrolled participants between age group of 18-80 year (median 32 years). In group-1 and group-2, we recruited 118 and 128 participants respectively. The cohort retention was found to be> 85%,>70% and>40% in 1st, 2nd and 3rd follow up respectively. Loss to the 3rd follow up was coincided with third wave with omicron variant. A rise in geometrical mean titre (GMT) of S1-RBD IgG were observed amongst the participants of both the groups at one-month post immunization (Group 1: S1-RBD: 154.4 to 446.3, Group 2 S1- RBD: 918 to 1127). However, the GMTs at six months post vaccination found to be slightly raised in Group 1 compared to one-month follow-up. Considering the hybrid immunity in group 2 participants, the GMTs of NAbs were higher than group 1 participants at each follow-up against B.1, Delta, Omicron BA.1 and BA.2. Both the groups had shown significant reduction in the levels of NAbs against Delta, Omicron BA.1 and BA.2 compared to B.1. The lowest GMTs of NAbs was observed against BA.1 variant. The IgG and NAbs persisted till six months in 90% participants in both categories except BA.1 variant. Breakthrough cases were reported at one-month (n = 1) and six-months (n = 2) post vaccination respectively from group 1. While reinfection cases (n = 3) were detected at six months post vaccination from group 2 due to Omicron BA.1 variant. Conclusion(s): A two-dose regimen of the Covaxin vaccine enhanced humoral immune response in adults with/without past COVID-19 infection and protected more than 90% adults against SARSCoV-2 infection. Additionally, IgG and NAb responses persisted for six months postvaccination.
ABSTRACT
Introduction: Endoscopic full-thickness resection (EFTR) represents a feasible and effective resection procedure for non-lifting colorectal lesions or difficult anatomic locations. However, EFTR has been associated with a non-irrelevant rate of adverse events (AEs);for this, it is commonly performed during hospitalization. The outbreak of COVID-19 forced national healthcare systems to prioritize hospitalization and treatment of COVID-19 patients, postponing the hospitalization for elective nonlife-saving procedures. So, all colorectal EFTR were performed as outpatient procedures during the first three months-national lockdown established in 2020. This retrospective analysis aimed to assess the feasibility and safety of EFTR as an outpatient procedure. Aims & Methods: Database of consecutive colorectal EFTR procedures performed at the outpatient clinic during the Italian first national lockdown (March to May 2020) was retrospectively analyzed. After 3 hours of observation at the recovery room, all patients were discharged with the advice to stay close to the hospital for 48-72 hours to ensure faster management of any delayed AEs. Patients were then scheduled for follow-up endoscopy 3-6 months after EFTR. Result(s): 12 EFTR were performed as an outpatient procedure. 4/12 (33.3%) were under antiplatelet/anticoagulant therapy. The median size of the lesions was 15.08mm +/- 3.23mm and 13.67mm +/- 3.27mm. 10/12 (83.3%) of the lesions were recurrences on the scar of previous endoscopic resection, whereas 2/12 (16.7%) were T1 carcinoma with indications for endoscopic resection. All EFTR were successfully performed with a 100% of R0 resection rate. Resection was reported to be difficult in a total of 5 (41.6%) procedures (3/12 (25%) dysfunction of the snare, 1/12 (8.3%) difficult incorporation of the lesion and 1/12 (8.3%) difficult reaching of the lesion). Intraprocedural bleeding occurred in 4/12 (33.3%) and was managed endoscopically with Argon Plasma Coagulation (APC). No perforation or delayed bleeding requiring medical or repeated endoscopic intervention occurred. One patient (8.3%) reported recurrent abdominal pain of unknown cause the night after the procedure. 3-6 months endoscopic follow-up was obtained in all patients without signs of recurrence/ residual lesion (100%). Conclusion(s): Outpatient EFTR of colorectal lesions is safe and feasible, with a similar success rate and AEs to EFTR performed in hospitalized patients. Thus, a strict self-observation with the possibility the access directly to the endoscopic service allowing an adequate and cost-effectiveness management for the post-EFTR AEs.
ABSTRACT
INTRODUCTION: COVID-19 has become a public health concern globally with increased numbers of cases of the disease and deaths reported daily. The key strategy for the prevention of COVID-19 disease is to enhance mass COVID-19 vaccination. However, mass vaccination faces challenges of hesitation to acceptance of the vaccine in the community. The youth may not be among the vulnerable population to severe COVID-19 disease but are highly susceptible to contracting the virus and spreading it. The aim of the study was to assess COVID-19 vaccine youth behavior intentions and their determinants in Kenya. METHODS: The study used a mixed method design, employing a cross-sectional survey and focused group discussions across 47 counties in Urban, Peri-Urban and Rural settings of Kenya. The interviewees were youths aged 18-35, registered in online platforms/peer groups that included Shujaaz, Brck Moja, Aiffluence, Y Act and Heroes for Change. Quantitative data was collected using Google forms. A total of 665 interviews were conducted. Quantitative data was analysed using STATA version 16. In this paper we report quantitative study findings. RESULTS: The findings of the study indicated that only 42% of the youth were ready to be vaccinated, with 52% adopting a wait and see approach to what happens to those who had received the vaccine and 6% totally unwilling to be vaccinated. The determinants of these behavior intentions included: the perceived adverse effects of the vaccine on health, inadequate information about the COVID-19 vaccine, conflicting information about COVID-19 vaccine from the social media, religious implications of the vaccine, impact of education level on understanding of the vaccine, perceived risk of contracting the COVID-19 disease, efficacy of the COVID-19 vaccine, COVID-19 affecting women than men and trust in the ministry of health to lead COVID-19 interventions. Significantly it was found that hesitancy is higher among females, protestants and those with post-secondary education. Lack of information and concerns around vaccine safety and effectiveness were main cause of COVID-19 vaccine hesitancy. Social media was the major source of information contributing to hesitancy. Other contributors to hesitancy included low trust in the MoH and belief that mass vaccination is not helpful. CONCLUSION: Vaccine hesitancy remains high among the youth but the causes of it are modifiable and health systems need to have evidence based engagements with the youth to reduce vaccine hesitancy.