Podcasts about chadox1 ncov

Sarah Gilbert is the Said Professor of Vaccinology at the University of Oxford. She works on vaccines for many different emerging pathogens, including influenza, Nipah, MERS, Lassa, Crimean-Congo haemorrhagic fever, and in 2020, she initiated the SARS-CoV-2 vaccine project. Working with Oxford colleagues she is able to take novel vaccines from design to clinical development, with a particular interest in the rapid transfer of vaccines into manufacturing and first in human trials. She is the Oxford Project Leader for ChAdOx1 nCoV-19, a vaccine against the novel coronavirus, SARS-CoV-2 which is now in use in many countries around the world. Read more in her book Vaxxers: A Pioneering Movement in Scientific History

More than a million people in the United States have been killed by COVID-19 in the past 3 years. The numbers would be much higher, but the vaccines were developed with amazing speed. Time and again, the vaccines have been shown to be safe and effective. Yet some people persist in claiming the mRNA vaccines are causing an epidemic of stroke. The data is clear. They do not. If you want to reduce your chances of stroke, get the vaccine. The new thing that causes stroke over the past few years is COVID-19 itself. If you want to decrease your chances of having a stroke (or another stroke) don't get a severe COVID-19 infection. And the simplest thing you can do to reduce your chances of getting a severe COVID-19 infection is to get the COVID-19 vaccine. If you do catch COVID-19 despite the vaccine, the data shows it will be much less severe and much less likely to be fatal.  In addition to protecting yourself, you are also helping to protect others who may not be medically eligible to get the vaccine. The COVID-19 mRNA vaccines are saving lives every day. In this episode ... In this episode, I talk with data scientist and epidemiologist Dr. Remle Crowe about the research studies coming out now that show what we already knew from earlier research: the COVID-19 vaccine does not increase your risk stroke. We talk about several studies, and we talk about how you can do your own research on the credibility of these studies and evaluate how well they reflect the scientific reality of our world. In this post, you'll also find links to a bunch of these studies that you can read for yourself. Start by listening to this conversation. If you don't seed the audio player below visit http://Strokecast.com/MSN/vaccine to listen to the whole conversation.   Click here for a machine-generated transcript   I got my Bivalent COVID-19 booster and my 2022 Flu shot on the same day in October. Who is Dr. Remle Crowe? Dr. Remle Crowe is an expert in EMS research and quality improvement. From truck clutches to clinical care, she has shown how research and improvement science work to solve problems across fields. Prior to earning a PhD in Epidemiology, her EMS career began with the Red Cross in Mexico City as a volunteer EMT. She has authored numerous peer-reviewed publications related to prehospital care and the EMS workforce. Now, as a research scientist with ESO, Dr. Crowe routinely uses EMS data to improve community health and safety. Dr. Crowe previously appeared on the Strokecast in episode 132 to discuss the AHORA pneumonic to help Spanish speakers recognize and respond to a stroke. When it comes to stroke, Time is Brain regardless of which language you speak. A Sampling of the Studies When we claim the data indicates that the vaccine doesn't cause an increase in stroke, what data are we talking about? How did "they" analyze it? Who reviewed the studies to ensure they were accurate? Where can you read the details yourself? As Dr. Crowe explained, there are currently a whole bunch of studies that are coming out. That makes sense; it's roughly 18 months since the vaccines against COVID-19 became widely available. To conduct sound research, you need a large pool of people to look at. You need to take some time to see the results. You need to write up those results. Then you need to submit them for publication. Publications will then need to review before publishing them. That brings us to where we are today with all these studies now becoming available. Let's take a look at a few of them, and I encourage you to click through to the details and read them yourself. Click the study titles for more. Surveillance for Adverse Events After COVID-19 mRNA Vaccination This study published in JAMA (Journal of the American Medical Association) looked at nearly 12 million doses of the mRNA vaccine given to more than 6 million people. This is what they learned: "The incidence of events per 1 000 000 person-years during the risk vs comparison intervals for ischemic stroke was 1612 vs 1781 " In other words, the time period at greatest risk for stroke did not see an increased risk. They concluded: "In interim analyses of surveillance of mRNA COVID-19 vaccines, incidence of selected serious outcomes was not significantly higher 1 to 21 days postvaccination compared with 22 to 42 days postvaccination. While CIs were wide for many outcomes, surveillance is ongoing." COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence — 25 U.S. Jurisdictions, April 4–December 25, 2021 We talked about this report from the CDC Morbidity and Mortality Weekly Report during the episode. This study looked at infections and deaths among vaccinated folks and unvaccinated folks. The rate of infection and death from COVID-19 was much higher among unvaccinated folks than among vaccinated or vaccinated and boosted folks. The report says: "Rates of COVID-19 cases were lowest among fully vaccinated persons with a booster dose, compared with fully vaccinated persons without a booster dose, and much lower than rates among unvaccinated persons during October–November (25.0, 87.7, and 347.8 per 100,000 population, respectively) and December 2021 (148.6, 254.8, and 725.6 per 100,000 population, respectively) (Table 2). Similar trends were noted for differences in the mortality rates among these three groups (0.1, 0.6, and 7.8 per 100,000 population, respectively) during October–November." Even though the vaccine does not guarantee a person will avoid COVID-19, it greatly increases their chances of avoiding infection. And if they do become infected, the vaccine greatly increases their chances of survival. Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review This study in the Journal of Neurological Sciences looked throughout the published literature and found just 43 incidents of stroke following the vaccine administration. "AIS has been reported as a rare complication within 4 weeks post COVID-19 vaccination, particularly with viral vector vaccines. Health care providers should be familiar with this rare consequence of COVID-19 vaccination in particular in the context of VITT to make a timely diagnosis and appropriate treatment plan." The report specifically called out the risk of “viral vector vaccines” (and, again, it's a shockingly small risk). The most common viral vector COVID-19 vaccines are those from Johnson & Johnson and from Oxford-AstraZeneca. The mRNA vaccines from Moderna and Pfizer are not viral vector vaccines., indicating that those appear to be even safer. The recommendation is not to avoid vaccination. It's an extremely rare complication. The recommendation is to watch for signs of stroke, which is something we should be doing all the time anyway. Association Between Vaccination and Acute Myocardial Infarction and Ischemic Stroke After COVID-19 Infection This article, published in JAMA looked at what happens after a COVID-19 infection for both vaccinated and unvaccinated folks. If someone does get infected and, does their vaccination status reduce the impacts of infection? Yes, it does. In fact, folks who got the vaccine and the got COVID were LESS likely to have a stroke or heart attack after their COVID infection. "This study found that full vaccination against COVID-19 was associated with a reduced risk of AMI [heart attack] and ischemic stroke after COVID-19. The findings support vaccination, especially for those with risk factors for cardiovascular diseases." Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study This study in the UK looked at patients who had been infected with COVID-19 or who had received the vaccine. More than 30 million people were part of the study. The conclusions were clear: "Increased risks of haematological and vascular events that led to hospital admission or death were observed for short time intervals after first doses of the ChAdOx1 nCoV-19 and BNT162b2 mRNA vaccines. The risks of most of these events were substantially higher and more prolonged after SARS-CoV-2 infection than after vaccination in the same population." Even if there is a slight risk from vaccination, the risk from the actual disease is much higher. COVID-19 vaccine not linked to increased risk of stroke Not all research becomes available without a subscription. Researchers at Cedars-Sinai have found similar results to other studies though and have come to the same conclusion. "Newly compiled data evaluated by researchers in the Department of Neurology and the Smidt Heart Institute at Cedars-Sinai shows that COVID-19 vaccines do not raise stroke risk--but that severe COVID-19 infection does. Physician-scientists hope this growing body of evidence, highlighted today in an editorial in the peer-reviewed journal Neurology, will ease the minds of individuals still hesitant to be vaccinated." Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex We talked about this study in the conversation with Dr. Crowe. At first glance it is concerning. This is the conclusion: "Overall, the risk of myocarditis is greater after SARS-CoV-2 infection than after COVID-19 vaccination and remains modest after sequential doses including a booster dose of BNT162b2 mRNA vaccine. However, the risk of myocarditis after vaccination is higher in younger men, particularly after a second dose of the mRNA-1273 vaccine." That does seem scary for young men, and there are a couple things to keep in mind. First, the number of events was so small that it's tough to draw firm conclusions. When you get down to such low numbers, that stats can do weird things. Second, this was based on the adverse event reporting system. That does not prove causality. It just flags something to look at more closely if there are large numbers. Which there are not. The point of all this research, though, is to learn more and compile more and more evidence. And ultimately to let the body of evidence guide decision making and recommendations. What we know at this point is that the risk of stroke after a COVID-19 infection is much higher than the risk of stroke following a vaccination. And the risk of stroke after COVID-19 infection is much lower in folks that have been vaccinated than it is in those who have not been vaccinated. COVID-19 is not gone. It is still out there in the world infecting people, killing people, and giving people strokes. Billions of vaccinations later, this is what the data tells us. The simplest way to reduce your risk of stroke is to get the vaccine and stay boosted. Do Your Own Research We talked about a bunch of research in the podcast, and we looked at a bunch of reports above. You don't have to just accept my commentary or Dr. Crowe's. You can read the reports yourself and look at the data and see why the vast majority of medical professionals have concluded the vaccines are safe and effective. Dr. Crowe offered a number of tips to help you do your research. You'll find them and more in this list. Tip 1 Search research focused search engines and directories to find studies and resources. Google Scholar and PubMed are great places to start. Tip 2 Look at the Publication that publishes the research. Is it well known for scientific rigor? Does it have a strong requirement for peer review of articles? Or can someone publish in it by simply paying a fee? Tip 3 Search for the publication's Impact Factor. The more other publications that cite its work, the higher the number. A publication with a higher impact factor is likely more credible. Tip 4 When you get to the actual study, look at what type it is. If it was a case study, that's interesting. If it was a randomized, double-blind, placebo-controlled study on a large scale, that's even better. If it was a systemic review evaluating hundreds of other studies, that's stronger still. Tip 5 Look at how many people were part of the study. A few dozen is interesting. A few million is much more likely to yield credible results. Tip 6 Look at the results of the study, relative to the size of the study. A few results out of a dozen is one thing. A few results out of millions of subjects is another matter altogether. Tip 7 Look at the goal of the study. What were the authors hoping to demonstrate? Did they succeed? Why or why not? Tip 8 Consider confounding. Studies generally deal with a subset of the population -- a limited number of people -- and seek to extrapolate those results and draw conclusions about the broader population.  For those conclusions to be valid, though, the group studied needs to be similar to the group the study extrapolates to. The more different the groups are, the less reliable the results. Tip 9 Finally, does the study demonstrate causality or just coincidence? There's a reason folks will often say, “Correlation does not equal causation.” For example, the FDA Adverse Event Reporting System (FAERS) Public Dashboard is a collection of negative things that happen to a person after they get a vaccine. It's not a list of events caused by the vaccine. If a person gets hit by a bus after getting the vaccine, that can go in the database. It's an adverse event. That doesn't mean the vaccine caused the bus accident. Read the study carefully to see if the authors claim a causal relationship and if that relationship is supported by the evidence in the study. AHORA The last time Dr. Crowe was on the show was to talk about the AHORA messaging to help Spanish speakers recognize and respond to stroke. It's basically the equivalent of the BEFAST messaging we talk about a lot in English. Here is the stroke warning pneumonic device in Spanish. Download it and share it far and wide. Reconocer los signos de un accidente cerebrovascular y responder rápidamente. ¡Llame a una ambulancia si observa estas señales! Let's look at a translation. Letter Abbreviation for Spanish Description In English A Andar Tiene dificultad para andar? Tiene problemas con el equilibrio? Do they have difficulty walking? Do they have problems with balance? H Hablar Tiene dificultad para hablar o entender? Usa palabras que no tienen sentido? Do they have difficulty speaking or understanding language? Do they use words that don't make sense? O Ojos Tiene algün cambio de vista? Tiene visiön doble? Tiene dificultad para ver con ambos ojos? Do they have some change in vision? Do the have double vision? Do they have difficulty seeing with both eyes? R Rostro Tiene la mitad del rostro caido? Tiene un repentino dolor de cabeza como nunca se ha sentido? Do they have one-sided facial droop? Do they suddenly have the worst headache of their life? A Ambos Brazos Tiene dificultad para levantar un brazo o una pierna? Tiene debilidad en un brazo o una pierna? Do they have difficulty lifting an arm or a leg? Do they have weakness in an rm or a leg? And, of course, here is the BE FAST messaging for English speakers. Recognize the signs of a stroke and respond quickly. Call an ambulance if you observe these signs! Both sets of symptoms look for the same thing. The AHORA messaging includes legs and headaches. The BE FAST messaging specifically calls out calling an ambulance. Regardless, the more people that can recognize a stroke as it is happening, the better off we will all be. Pop Culture Moment During the conversation, Remle mentioned she is a big fan of the movie Sliding Doors. It's an examination of how simple moment can change the course of your life. What path lies ahead if we catch that train or miss it? https://www.youtube.com/watch?v=Da-Mizk86AE&ab_channel=Shout%21Factory Or what happens if we turn right instead of turning left? https://www.youtube.com/watch?v=YnzbuU5I7RI&ab_channel=DoctorWho In reflecting on the past, it's easy to get fixated on thing were so much better back then, but it's never that simple, is it? Billy Joel reminds us that: "The good old days weren't always good, and tomorrow ain't as bad as it seems." https://www.youtube.com/watch?v=ph7oZnBH05s&ab_channel=billyjoelVEVO Other Shows Journal Club Remle mentioned her show, PCRF Journal Club, which is a journal review webinar that meets each month. They go deep into looking at the latest research studies that are coming out. The focus is on research around EMS -- the ambulance and transport industry. If you'd like to learn more, check out its site here: https://www.cpc.mednet.ucla.edu/pcrf Successful and Disabled I was also recently featured on another podcast focused on being successful as a person with disabilities. I joined host Christ Mitchell on the Successful and Disabled podcast to share my story and discuss how I use mindset to drive my recovery and other goals in life. Listen to it here. If you don't see the audio player below, visit http://Strokecast.com/MSN/Vaccine to listen to the conversation: Hack of the Week Reading a paper book can be challenging with one functional hand. It's even harder if you try to do that while eating a meal. Why? Because books don't always want to stay open on their own. You have to hold them open, which makes it harder to pick up your cheeseburger. I use my phone to address this problem. I open the book and then lay my phone across the open pages. It's just heavy enough to keep the book from snapping shut so I can enjoy feeding my belly as I also enjoy feeding my mind. Give it a try. Links  Where do we go from here? Check out the links above to learn more about why getting the vaccine is safer than not getting the vaccine Share this episode with someone you know by giving them the link http://Strokecast.com/vaccine Do you have a recent win or victory in your recovery? Share it by calling 321-5 STROKE Get your vaccine and booster to protect against COVID if your doctor advises it Don't get best…get better

In this week's episode we'll discuss the factors influencing the development of immune thrombocytopenia after administration of the ChAdOx1 nCov-19 vaccine, learn about the genomic features underlying anti-CD19 CAR T-cell treatment failure in lymphoma, and introduce a new predictive model for risk assessment before CAR T-cell therapy for large B-cell lymphoma.

Dr Peter A. McCullough, MD, MPH, is a board-certified cardiologist, internist, epidemiologist who has testified before committees of the US and multiple State Senates regarding the treatment of COVID-19 and management of the ongoing pandemic. He has been in practice for over 40 years as an active treating physician combined with a decorative academic career that has placed him the most published cardiologist of all time. Join us as we explore:If it is safe to vaccinate your children The very real risk of myocarditis If you can get C-19 twice, why vaccinating post-COVID infection is dangerous, a huge amount of false + cases, C-19's mass psychosis The overwhelming evidence natural immunity is “complete, robust and durable” and “infinitely” superior to vaccinationMENTIONS:Avolio, E., et al. (2021). The SARS-CoV-2 Spike protein disrupts human cardiac pericytes function through CD147 receptor-mediated signalling: a potential non-infective mechanism of COVID-19 microvascular disease. Clinical science (London, England : 1979), 135(24), 2667–2689. https://doi.org/10.1042/CS20210735 SARS-CoV-2 mRNA Vaccination-Associated Myocarditis in Children Ages 12-17: A Stratified National Database Analysis. Tracy Beth Høeg, et al.medRxiv 2021.08.30.21262866; doi: https://doi.org/10.1101/2021.08.30.21...    Lim, Y., Kim, M. C., Kim, K. H., Jeong, I. S., Cho, Y. S., Choi, Y. D., & Lee, J. E. (2021). Case Report: Acute Fulminant Myocarditis and Cardiogenic Shock After Messenger RNA Coronavirus Disease 2019 Vaccination Requiring Extracorporeal Cardiopulmonary Resuscitation. Frontiers in cardiovascular medicine, 8, 758996. https://doi.org/10.3389/fcvm.2021.758996 Choi, S., Lee, et al.  (2021). Myocarditis-induced Sudden Death after BNT162b2 mRNA COVID-19 Vaccination in Korea: Case Report Focusing on Histopathological Findings. Journal of Korean medical science, 36(40), e286. https://doi.org/10.3346/jkms.2021.36....Professor Mattias Desmet https://www.ugent.be/psync/en/who/des...Shedding of Infectious SARS-CoV-2 Despite VaccinationKasen et al. medRxiv 2021.07.31.21261387; doi: https://doi.org/10.1101/2021.07.31.21... 141 Studies Showing Natural Immunity (up from 128)https://brownstone.org/articles/79-re... https://www.thegatewaypundit.com/2021... “Risks of Vaccines for Those Recovered from COVID-19 – Krammer, Raw & Mathioudakis”https://www.americaoutloud.com/risks-...  Cohn, B. A., et al (2021). SARS-CoV-2 vaccine protection and deaths among US veterans during 2021. Science (New York, N.Y.), eabm0620. Advance online publication. https://doi.org/10.1126/science.abm0620Effectiveness of heterologous ChAdOx1 nCoV-19 and mRNA prime-boost vaccination against symptomatic Covid-19 infection in Sweden: A nationwide cohort study. Peter Nordström, et al. The Lancet Regional Health – Europe.  December 2021. https://www.thelancet.com/journals/la...  “Failure of Vaccines and Truth Revealed”. https://www.americaoutloud.com/failur... COVID-19-associated hospitalizations among vaccinated and unvaccinated adults ≥18 years – COVID-NET, 13 states, January 1 – July 24, 2021. Fiona P. Havers, et al. medRxiv 2021.08.27.21262356; doi:https://doi.org/10.1101/2021.08.27.21...Antigenic minimalism of SARS-CoV-2 is linked to surges in COVID-19 community transmission and vaccine breakthrough infections. A.J. Venkatakrishnan, et al. medRxiv 2021.05.23.21257668; doi:https://doi.org/10.1101/2021.05.23.21...Kostoff, R. N., et al. (2021). Why are we vaccinating children against COVID-19?. Toxicology reports, 8, 1665–1684. https://doi.org/10.1016/j.toxrep.2021...Disclaimer policy for all of our videos. https://madetothrive.co.za/terms-and-...

Featuring articles on daprodustat in patients undergoing dialysis and in those not undergoing dialysis, chemotherapy in node-positive breast cancer, a phase 3 trial of the ChAdOx1 nCoV-19 vaccine, vaccine effectiveness among U.S. health care personnel, and a hot and tactile Nobel Prize; a review article on pulmonary arterial hypertension; a case report of a woman with abdominal pain, weight loss, and memory impairment; and Perspective articles on a failure to disseminate transformative science, on E66.01 and our culture of shame, and on Ms. Omega One.

台灣一開始衝第一劑覆蓋率為主，僅有第一到第三類先打第二劑。第二劑覆蓋率，從九月底開始這兩個月從4.5%衝到45%。因此算來，我們第一第三類的朋友，第二劑後六個月該考慮打加強針的時間，會落在明年1~3月之間。其他絕大多數的人，是從明年3月開始陸續滿6個月。 阿中部長上周在記者會上回答關於加強針的問題說，"會讓民眾以接種同廠牌的疫苗為主，但也不排除混打"，這回答不太精確。 世界各國加強針都是以mRNA疫苗為主。AZ兩劑後再以AZ作為加強針，幾乎沒資料。且連施打AZ最多的英國，都是這樣建議的： 1.不管前兩劑打什麼，首選都是一劑BNT（30微克），或是半劑量莫德納（50微克）。 2.若前兩劑AZ者，對於mRNA疫苗使用有禁忌症，則可以用AZ作為加強針。 英國是根據加強針混打研究 COV-BOOST trial做出以上決定。連英國自己都沒有用AZ主要用於加強針，部長的觀念該改改了。 很可惜的是，COV-BOOST到目前都沒有完整公布。這是在AZAZ還有BNTBNT之後，打七種疫苗做為加強針。全世界都在做加強針的決定，應該很需要這資料，英國不知道為何藏成這樣... 至於美國嬌生疫苗加強針打什麼呢？根據NIH進行的小規模混打研究，再打嬌生疫苗產生的抗體遠不及施打mRNA疫苗。因此美國是建議加強針選三種疫苗皆可。並沒有以同廠牌疫苗為主喔。 腺病毒載體疫苗適合先施打，然後以mRNA疫苗加強。這已經是趨勢了。因為身體會產生對於腺病毒外殼的抗體，第三次以上再打同樣疫苗，理論上效果有限了。 牛津大學有一篇去做了三針AZ的結果，收案90人，其IgG抗體和T細胞免疫大概可達第二劑後最高值的兩倍，針對變種病毒的中和抗體也有升高。這篇研究很有名，就是第二針還拖到44~c45週打的那篇。但英國還是建議打mRNA。我相信他們都考量過了這些資料。至於AZ的次世代疫苗，詢問過葉醫師，的確也有在規劃做研究，但估計應該是趕不上在多半台灣朋友需要施打的明年三月，如果你考慮臨床試驗，採購還有疫苗來到台灣的時間。 至於是否可以用次單位蛋白疫苗來做為加強針？不良反應較少的蛋白疫苗應該是很適合作為後續接種的加強針。高端自己已經有三劑高端的初步結果（還去ＷＨＯ報告過），我也很期待國內臨床試驗針對高端做為第三劑（長庚將進行兩劑AZ後以不同疫苗作為第三劑的研究，台大也在規劃中），還有COV-BOOST用Novavax做為兩劑AZ後加強針的結果。 美國CDC的建議 https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html 英國JCVI的建議 https://www.gov.uk/government/publications/jcvi-statement-september-2021-covid-19-booster-vaccine-programme-for-winter-2021-to-2022/jcvi-statement-regarding-a-covid-19-booster-vaccine-programme-for-winter-2021-to-2022 COV-BOOST trial 網頁 https://www.covboost.org.uk/about Reactogenicity and immunogenicity after a late second dose or a third dose of ChAdOx1 nCoV-19 in the UK: a substudy of two randomised controlled trials (COV001 and COV002) https://www.thelancet.com/article/S0140-6736(21)01699-8/fulltext 追加第3劑疫苗有望 陳時中：最快明年1月底 https://health.ltn.com.tw/article/breakingnews/3742050 小額贊助支持本節目： https://pay.firstory.me/user/linshibi Powered by Firstory Hosting

Sjefredaktør Are Brean gir deg en oppdatering på forskning på blant annet covid-19-vaksinenes effektivitet, potensielle senskader og problemer med distribusjon og prioriteringer. I tillegg får du høre om konsekvensene av luftforurensning, en systematiske analyse av mortalitet hos unge, og betydningen av å ha et kosthold med høy biodiversitet.Tilbakemeldinger kan sendes til stetoskopet@tidsskriftet.no.       Stetoskopet produseres av Lisa Dahlbak Jacobsen, Are Brean og Julie Didriksen ved Tidsskrift for Den norske legeforening. Ansvarlig redaktør er Are Brean.       Lydtekniker: Håkon Braaten / Moderne Media   Coverillustrasjon: Stephen LeeArtikler nevnt:Association of Receipt of the Ad26.COV2.S COVID-19 Vaccine With Presumptive Guillain-Barré Syndrome, February-July 2021BNT162b2 and ChAdOx1 nCoV-19 Vaccine Effectiveness against Death from the Delta VariantCovid-19: Vaccines are highly effective in preventing deaths from delta variant, study indicatesWaning Immunity after the BNT162b2 Vaccine in IsraelCovid-19: global vaccine production is a mess and shortages are down to more than just hoardingCovid-19: Protect healthcare workers with vaccines, urges WHO after 115 000 die worldwideHMG-CoA reductase inhibitors and COVID-19 mortality in Stockholm, Sweden: A registry-based cohort studyChanges in exposure to ambient fine particulate matter after relocating and long term survival in Canada: quasi-experimental studyCut particulate air pollution, save livesGlobal, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease Study 2019Food biodiversity and total and cause-specific mortality in 9 European countries: An analysis of a prospective cohort study

台灣也即將對一般人開放AZ混打BNT或莫德納疫苗，目前混打疫苗有多少保護力？資料也陸續出來了，整理這篇給大家參考。但先說在前面，以下這些研究追蹤時間尚短，短時間內能有很高的保護力很好，但到底可以維持多久，這需要繼續追蹤下去。且這幾個研究比較缺乏的是針對重症的保護力，還有安全性資料都沒什麼報告。 1.丹麥　2021.7.28 丹麥554萬人的資料庫，AZ/mRNA 針對感染的保護力是88% 沒有固定施打時間，第二劑時間多半落在105天之內 一劑的AZ在14~83天可以維持大概29~44%的保護力（此研究沒有分有症狀或無症狀） 丹麥做過另外兩個BNT/BNT在醫護人員的研究，保護力是80%和90% 此研究只追蹤到2021.6.23，多半是alpha變種株 2.加拿大 2021.9.29 加拿大延遲第二劑並混打疫苗，只要施打了AZ，BNT，莫德納任兩劑疫苗，對於住院都有約95%的保護力。 AZ/AZ對Delta保護力70%，AZ/BNT 91%，BNT/BNT 92%，莫德納/莫德納 93%。 追蹤第二劑四個月保護力並未降低。 3.瑞典 2021.10.17 瑞典344萬人的資料庫，檢視各種組合針對有症狀感染的保護力，且經過年齡還有種種背景條件校正。（這很重要，因為疫苗政策關係，施打AZ/AZ組的平均年齡較大） AZ/莫德納 79% AZ/BNT 67% AZ/AZ 50% 莫德納/莫德納 87% BNT/BNT 78% 4.法國　2021.10.21 針對13121位醫護人員 AZ/BNT相隔12週施打，BNT相隔4週施打 AZ/BNT組2512人，發生10例感染（0.40%） BNT/BNT組10,609人，發生81例感染（0.76%） BNT/BNT得到突破性感染的風險是AZ/BNT的2.03倍。 AZ/BNT組和BNT/BNT組相比，有較佳的中和抗體，還有免疫記憶Ｂ細胞。 AZ施打後雖然抗體沒有BNT高，但產生的T細胞免疫較佳，兩種疫苗可互補。 出處： 1.丹麥　2021.7.28 Vaccine effectiveness when combining the ChAdOx1 vaccine as the first dose with an mRNA COVID-19 vaccine as the second dose https://www.medrxiv.org/content/10.1101/2021.07.26.21261130v1 2.加拿大 2021.9.29 https://linshibi.pros.is/3rbz3w 3.瑞典 2021.10.17 Effectiveness of heterologous ChAdOx1 nCoV-19 and mRNA prime-boost vaccination against symptomatic Covid-19 infection in Sweden: A nationwide cohort study https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00235-0/fulltext 4.法國　2021.10.21 Immunogenicity and efficacy of heterologous ChadOx1/BNT162b2 vaccination https://www.nature.com/articles/s41586-021-04120-y 新冠疫苗混打懶人包 https://linshibi.com/?p=39613 小額贊助支持本節目： https://pay.firstory.me/user/linshibi 林氏璧醫師的電子名片 https://lit.link/linshibi Powered by Firstory Hosting

What happens when pharmacy law and patient care don't align? As a pharmacist during the COVID-19 pandemic, you are dealing with balancing legal liability and vaccine administration daily through ever-changing rules and regulations. This week's episode shares hypothetical patient cases that David Brushwood, pharmacist attorney, and Jake Galdo, clinical pharmacist review. Together, they'll address the legal and clinical considerations for common COVID-19 vaccine scenarios you face in practice – which can often be in conflict. For access to the full CE Course that includes ACIP recommendations, workplace legal liability and PREP Act discussion get a CEimpact Membership.The following patient scenarios are discussed; David and Jake address what the right thing to do is from both a practice perspective and a regulatory perspective. **This debate was recorded in September. FDA and CDC continue to update and change the COVID-19 vaccine recommendations, which may affect the legal and clinical considerations presented in this episode. However, this materials helps providers triage the next patient care conundrum Hypothetical Scenario #1A pregnant pharmacist refuses to be vaccinated despite mandates from the state and from the pharmacy.Hypothetical Scenario #2 A pharmacist has become burned out from the long hours, stress of the pandemic, and staffing shortages. The pharmacist administered the J&J COVID-19 vaccine to a patient as closing. When billing after hours, the DUR showed “do not mix vaccines.” The pharmacist refuses to do further vaccines in the current conditions out of concern for patient welfare. Hypothetical Scenario #3 A pharmacist decided to “take a break” when COVID immunizations began, saying “I have heard that the vaccine is worse than the disease, and I can't do harm to patients.” The pharmacist has now requested a return to work and is claiming a religious exemption from administering immunizations. Hypothetical Scenario #4 A new patient comes to the pharmacy and states they previously received ChAdOx1 nCov-19 in the UK but would like to get a dose of BNT162b2 now.  Hypothetical Scenario #5 A regular patient presents a ‘prescription' to the pharmacy, and it states the following: “‘Patient' has previously received J&J Covid vaccine. Unfortunately, she was a chemotherapy patient at that time. She has no measurable antibodies. I have recommended that she be vaccinated as is she'd never been vaccinated before. She should receive 2 doses of either the Pfizer or Moderna vaccine. Thank you.”  Hypothetical Scenario #6A pharmacy's staff all have young children (ages 5 - 7 years old).  The staff conduct their own research, and they conclude that the mRNA vaccines are safe for young children. They consider using leftover doses of vaccine for their own children, as opposed to wasting these valuable doses. Hypothetical Scenario #7Your neighbor, a physician, has been caring for her elderly parents and children as her fulltime job. She was fully vaccinated in January during the first phase and comes in the pharmacy for a booster on mRNA1793. You know she is not immunocompromised.  Interested in the learning more? Get a CEimpact membership for access to the full course and CPE Credit for The Great COVID Debate.

Episode 65: Delta Variant.    Harendra and Dr Arreaza present current evidence regarding the delta variant of SARS-CoV-2 (COVID-19), effectiveness of vaccines, and more.  Introduction: Booster shots for the COVID-19 vaccine.  The Department of Health and Human Services (HHS) announced in a statement dated August 18, 2021, that “a booster shot will be needed to maximize vaccine-induced protection and prolong its durability.”This fall people may start getting their booster shots of mRNA vaccines (i.e. Pfizer and Moderna) as long as 8 months have passed since their second dose of the vaccine. The estimated date to start giving booster shots is the week of September 20, 2021.It is anticipated that patients who received the J&J vaccine will also need a booster shot, but more data is needed to make it official. So, stay tuned for updates.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.___________________________Delta Variant – The Science By Harendra Ipalawatte, MS4, and Hector Arreaza, MD. A growing concern and much of the recent talk about COVID 19 has been revolving around the emerging delta variant as well as other noted virus around the world different from the alpha strain. Much like the influenza virus and swine flu, SARS-CoV-2 seems to be changing and adapting in its current form.On July 27, 2021, the CDC recommended to urgently increase COVID-19 vaccination and reinforced the need to wear a mask in public indoor places in areas of high risk for transmission, even for fully vaccinated people. Concerns about DeltaCDC issued this new guidance due to several concerning developments and newly emerging data signals.There is a reversal in the downward trajectory of cases. CDC has seen a rapid and alarming rise in the COVID case and hospitalization rates around the country. In late June 2021, the 7-day moving average of reported cases was around 12,000. In contrast, on July 27, the 7-day moving average of cases reached over 60,000. This case rate looked more like the rate of cases we had seen before the vaccine was widely available. New data shows the delta variant is more infectious even in vaccinated individuals. Data was taken from CDC and unpublished surveillance data that will be posted soon. Delta causes more infections and spreads faster than early forms of SARS-CoV-2. Delta has shown to be more than 2x as contagious as previous variants. The delta variant might cause more severe illness than previous strains in unvaccinated persons. In two different studies from Canada and Scotland, patients infected with the delta variant were more likely to be hospitalized than patients infected with alpha or the original virus strains. Delta is currently the predominant strain of the virus in the United States.   Unvaccinated people are considered the greatest concern  Breakthrough infections (i.e., infections in patients who are fully vaccinated) happen less often than infections in unvaccinated people, all symptomatic patients infected with the delta variant can transmit it to others.  CDC is studying the data on whether fully vaccinated people with asymptomatic breakthrough infections can transmit the infection. However, the greatest risk of transmission is among unvaccinated people who are much more likely to contract and transmit the virus. Fully vaccinated people with delta breakthrough infections can spread the virus to others. However, vaccinated people appear to be infectious for a shorter period.  Previous variants typically produced less viral load in the body of infected fully vaccinated people, but the delta variant produces the same high amount of viral load in both unvaccinated and fully vaccinated people.  Effectivity of vaccines against delta In one recent study, infection rates in India were analyzed which showed the BNT162b2 (Pfizer-BioNtech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines were effective against the delta variant. Data on all symptomatic sequenced cases of Covid-19 in England were used to estimate the proportion of cases with either variant according to the patients' vaccination status. The effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant than among those with the alpha variant. The results were similar for both vaccines.  With the Pfizer vaccine, the effectiveness of two doses was 93.7% among persons with the alpha variant and 88.0% among those with the delta variant.  With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% among persons with the alpha variant and 67.0% among those with the delta variant. Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccination with two doses among vulnerable populations. (study was funded by Public Health England)Vaccines available in the USVaccines in the US are highly effective, including against the delta variant – Pfifzer especially showing to be 88% effective after two doses. Vaccines reduce a person's risk of contracting COVID-19, including the delta variant. The COVID-19 vaccines authorized in the United States are highly effective at preventing severe disease and death, including against the delta variant. They are not 100% effective, and some fully vaccinated people will become infected (called a breakthrough infection) and experience illness. For such people, the vaccine still provides them strong protection against serious illness and death. Given what we know about the Delta variant, vaccine effectiveness, and current vaccine coverage, layered prevention strategies, such as wearing masks and social distancing, are needed to reduce the transmission of this variant ConclusionVaccines are playing a crucial role in limiting spread of the virus and minimizing severe disease. Although vaccines are highly effective, they are not perfect and there will be vaccine breakthrough infections. Millions of Americans are vaccinated, and that number is growing. This means that even though the risk of breakthrough infections is low, there will be thousands of fully vaccinated people who might become infected and able to infect others, especially with the surging spread of the delta variant.Low vaccination coverage in many communities is driving the current rapid and large surge in cases associated with the Delta variant, which also increases the chances that even more concerning variants could emerge.____________________________Now we conclude our episode number 65 “Delta variant.” Harendra did a great job by presenting the most current evidence about this newer strain of SARS-CoV-2. Vaccinated people are not 100% protected against the delta variant but are more likely to get a mild disease and spread the virus for a shorter period. Vaccinations continue to be the best weapon we have against this destructive pandemic. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza and Harendra Ipalawatte. Audio edition: Suraj Amrutia. See you next week! _____________________References:Delta Variant: What We Know About the Science. Centers for Disease Control and Prevention, updated on August 26, 2021. https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html. Lopez Bernal J, Andrews N, Gower C, Gallagher E, Simmons R, Thelwall S, Stowe J, Tessier E, Groves N, Dabrera G, Myers R, Campbell CNJ, Amirthalingam G, Edmunds M, Zambon M, Brown KE, Hopkins S, Chand M, Ramsay M. Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. N Engl J Med. 2021 Aug 12;385(7):585-594. doi: 10.1056/NEJMoa2108891. Epub 2021 Jul 21. PMID: 34289274; PMCID: PMC8314739. https://pubmed.ncbi.nlm.nih.gov/34289274/

台大公衛本周有提到牛津這篇研究，AZ疫苗延後接種第2劑產生的抗體還更高，這集podcast來詳細講一下。 1.先提醒這是預印本，還沒正式發表。這篇研究探討兩個部分，延後第二劑施打，還有打第三劑。 Tolerability and Immunogenicity After a Late Second Dose or a Third Dose of ChAdOx1 nCoV-19 (AZD1222) https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3873839 2.此研究中一個重點是僅施打一劑之後免疫力維持的狀況。抗體方面，追蹤到180天時降到28天時最高濃度的54%，到320天時則降到30%。T細胞免疫方面，到182天都還測得到。 3.延後第二劑施打： 受試者分為3組，分別間隔8至12週（267人）、15至25週（24人）以及44至45週（30人）。結果顯示，間隔44至45週的組別，抗體濃度最高。三組分別是923 [IQR 525-1764]，1860 [IQR 917-4934] 還有 3738 [IQR 1824-6625]。 4.打第三劑：90人在第二劑後8個月左右施打第三劑，中和抗體可以從第二劑後28天的319 [IQR 176-591]提升到 612 [IQR 351-920]) 。 （請注意以上測的抗體不同，前者是一般抗體，後者是中和抗體，數字無法比較） 也有去做T細胞反應，施打第三劑後28天也可以回升到施打第二劑後差不多的水準。 5.以上第二劑或第三劑施打後的不良反應，都比第一劑為低。 6.結論指出，延後AZ第二劑施打時間反而會有更高的抗體。另外打第三劑後不管在抗體或是T細胞反應都可以達到打完第二劑時差不多的水準。 04b解讀： 1.AZ疫苗因為是腺病毒載體疫苗，和別的疫苗不同，學理上的確擔心兩劑打的時間太接近會影響第二劑的效力。因為人體也會對腺病毒外殼產生抗體，疫苗再次遇到時可能會被免疫力摧毀而減少效力。這也是為何嬌生疫苗一開始就只想做打一劑的疫苗，還有俄羅斯的史普尼克V疫苗故意兩劑用不同腺病毒的原因！ 2.此研究要小心解讀的地方是，收案的是18~50歲的年輕族群，且延後施打組的人數很少，因此下結論要很小心。 3.雖說抗體似乎越往後面的組別越高，但IQR是四分位距，你可以看出測出的抗體其實範圍很大，每人各別差異很大。 4.國際上目前對於是否應該施打第三針討論很多。美國FDA已同意讓免疫力低下族群接種追第三劑，但是否所有人都需要第三劑，目前還沒有確切證據需要。主要是因為雖然看到應對Delta有症狀感染的保護力有所下降，但目前針對重症的保護力看起來都還足夠。 5.對台灣的朋友我想傳達兩個訊息： 第一，延後AZ施打時間超過目前公認的8~12週不需要太心急，這篇有證據延後再打後續抗體生成反而更好。看後續到貨狀況可以接AZ，或是mRNA疫苗混打，也有醫院會去做高端混打研究。不須擔心後續接種問題。 第二，這些第三針的問題是國際上疫苗很早就打完的國家遇到的，某些疫苗在某些人群施打6~8個月之後似乎遇到較多突破性感染保護力降的問題。對我們來說，目前首要目標是擴大第一劑覆蓋率，到一定程度之後開始衝第二劑覆蓋率。第三劑的問題，對我們來說應該是明年以後才會遇到的問題，目前不需要太擔心！ 本集後半提到的BNT相隔12週施打在80歲以上老人家抗體可以高3.5倍的研究 Delaying second Pfizer vaccines to 12 weeks significantly increases antibody responses in older people, finds study https://www.birmingham.ac.uk/news/latest/2021/05/covid-pfizer-vaccination-interval-antibody-response.aspx 相關報導： 張上淳：AZ疫苗2劑間隔逾12週 免疫反應仍好 https://www.cna.com.tw/news/firstnews/202108110279.aspx COVID-19疫苗供貨吃緊，2劑疫苗間隔時間受關注，指揮中心專家諮詢小組召集人張上淳今天說，國外研究顯示，2劑AZ疫苗間隔超過12週，仍有很好的免疫反應。 牛津大學疫苗研究團隊為曾接種過1劑AZ疫苗30名受試者，分別相隔8至12週、15到25週、44到45週後，才施打第2劑AZ疫苗，並測試不同的間隔時間是否會影響接種者的抗體濃度。 台大公衛團隊今天引述英國牛津大學研究，針對阿斯特捷利康（AZ）疫苗拉長2劑間隔的可能性，受試者分為3組，分別間隔8至12週、15至25週以及44至45週。結果顯示，間隔44至45週的組別，抗體濃度最高。 中央流行疫情指揮中心專家諮詢小組召集人張上淳今天在疫情記者會表示，根據國外試驗資料，看起來即使第2劑接種間隔超過12週，免疫反應還是不錯，預防效果也不錯。 張上淳說，目前指揮中心規定，2劑AZ疫苗間隔時間為10到12週；張上淳說，若有特殊情況，即使超過12 週才接種第2劑，也沒什麼問題。 牛津：AZ疫苗延後接種第2、3劑 可提高免疫力 https://www.cna.com.tw/news/firstnews/202106280333.aspx 英國牛津大學今天發表研究報告指出，AZ疫苗若將第2和第3劑施打時間延後，可提高接種者的免疫力。 法新社報導，牛津大學研究發現，AZ疫苗若將第1和第2劑接種間隔最多拉長到45週，可產生較強的免疫反應，而非讓免疫力減弱。 這份尚未經過同儕審查的預印本報告還指出，接種第2劑AZ疫苗後，若間隔6個月以上施打第3劑，也可引發抗體「顯著增加」，令接種者的免疫反應「大大提升」。 牛津大學試驗的主持人波拉德（Andrew Pollard）表示：「對於疫苗供應量偏低的國家來說，這應該是令人鬆一口氣的消息。這些國家原本可能擔憂無法及時讓國人接種第2劑。接種第一劑疫苗後，甚至延長到10個月再施打第2劑，（免疫）反應也相當好。」 研究人員並表示，AZ疫苗第3劑施打時間若延後，結果也佳。尤其一些疫苗接種進度較快的國家，正在考慮是否有必要施打第3劑追加劑來延長免疫力。 研究的資深第一作者藍姆（Teresa Lambe）指出：「目前仍不知道，未來是否因為免疫力下降或為了提高對抗變異病毒株的免疫力，而有必要接種追加劑。」藍姆解釋，研究顯示，AZ疫苗的「耐受性良好，並能大幅增強免疫反應」。且「如果我們發現有必要施打第3劑」，AZ疫苗的效果也樂觀。 AZ疫苗因接種後出現少數非常罕見的嚴重血栓案例，引發外界疑慮。但牛津的研究指出，普遍來說，這支疫苗引發的副作用「在相當可容忍的範圍內」，且「接種第2和第3劑後發生不良反應的機率，比第一劑更低」。 給長輩的AZ疫苗懶人包 https://linshibi.com/?p=39590 高端 聯亞 國產疫苗懶人包 第二期結束就緊急授權可行嗎？ https://linshibi.com/?p=39547 新冠快篩懶人包 普篩 抗體快篩 抗原快篩 https://linshibi.com/?p=36564 新冠肺炎疫情下的防疫須知 常見問題解答FAQ https://linshibi.com/?p=35408 新冠疫苗常見問題懶人包 https://linshibi.com/?p=38945 林氏璧醫師的電子名片 https://lit.link/linshibi 歡迎贊助我喝咖啡 https://pay.firstory.me/user/linshibi Powered by Firstory Hosting

On this episode, broadening of immune responses to SARS-CoV-2 after mRNA vaccine booster to ChAdOx1 nCoV-19, five-fold underestimation of the number of cases in the US during the first six months of the pandemic, and a monoclonal antibody that broadly neutralizes many different sarbecoviruses. Hosts: Vincent Racaniello and Amy Rosenfeld Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Immune responses after heterologous COVID-19 vaccine boost (Nat Med) Undiagnosed SARS-CoV-2 infections in US (Sci Transl Med) Broadly neutralizing sarbecovirus antibody (Nature) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv

On this episode, broadening of immune responses to SARS-CoV-2 after mRNA vaccine booster to ChAdOx1 nCoV-19, five-fold underestimation of the number of cases in the US during the first six months of the pandemic, and a monoclonal antibody that broadly neutralizes many different sarbecoviruses. Hosts: Vincent Racaniello and Amy Rosenfeld Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Immune responses after heterologous COVID-19 vaccine boost (Nat Med) Undiagnosed SARS-CoV-2 infections in US (Sci Transl Med) Broadly neutralizing sarbecovirus antibody (Nature) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv

最近疫苗的新研究滿多的，媒體也都有報導，來整理一下。 有時間我會把這幾個研究再文字化，先用說的。 1.牛津：AZ疫苗延後接種第2、3劑 可提高免疫力 https://www.cna.com.tw/news/firstnews/202106280333.aspx 牛津大學研究發現，AZ疫苗若將第1和第2劑接種間隔最多拉長到45週，可產生較強的免疫反應，而非讓免疫力減弱。這份尚未經過同儕審查的預印本報告還指出，接種第2劑AZ疫苗後，若間隔6個月以上施打第3劑，也可引發抗體「顯著增加」，令接種者的免疫反應「大大提升」。牛津大學試驗的主持人波拉德（Andrew Pollard）表示：「對於疫苗供應量偏低的國家來說，這應該是令人鬆一口氣的消息。這些國家原本可能擔憂無法及時讓國人接種第2劑。」 Oxford vaccine produces strong immune response from booster shot https://www.reuters.com/business/healthcare-pharmaceuticals/oxford-covid-vaccine-produces-strong-immune-response-booster-shot-study-2021-06-28/ Tolerability and Immunogenicity After a Late Second Dose or a Third Dose of ChAdOx1 nCoV-19 (AZD1222) https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3873839 2.輝瑞、莫德納疫苗 保護力可能長達數年 https://www.cna.com.tw/news/firstnews/202106290349.aspx 科學家今天表示，輝瑞/BioNTech疫苗與莫德納疫苗，能在人體引發持久免疫反應，可能可以抵禦新型冠狀病毒數年之久。目前已有愈來愈多證據顯示，只要新冠病毒及其變異株演化結果不會跟現在差太多，接種這2款mRNA疫苗的大部分人可能不須追加注射。最新研究再度呼應這項看法。此外，即使病毒確實大幅變異，接種疫苗前曾染疫康復的人，可能也不需要追加劑量。 「紐約時報」（The New York Times）報導，帶領上述研究的美國聖路易華盛頓大學（Washington University in St. Louis）免疫學家艾里貝迪（Ali Ellebedy）表示：「這種疫苗能讓我們免疫力如此持久，這是個好跡象。」研究結果已刊登在「自然」（Nature）期刊上。 為了找出問題解答，艾里貝迪團隊觀察了記憶細胞的來源─淋巴結。人體在染疫或接種疫苗後，淋巴結會形成一種叫作「生發中心」（germinal center）的特殊結構。生發中心猶如B細胞的訓練營，能讓B細胞更熟練地發揮作用，並學習辨識多種病毒基因序列。這些細胞練習的序列愈多、時間愈久，就愈有可能擊退可能出現的變異株。 艾里貝迪團隊一共找來41名接種過兩劑輝瑞（Pfizer）/BioNTech疫苗的人參與實驗，其中8人有染疫史。在這41人當中，有14人於接種首劑疫苗後的3、4、5、7、15週，由研究團隊從淋巴結取得樣本。發現，在接種首劑後的第15週，這14 人的生發中心仍高度活躍，而且認得新型冠狀病毒的記憶細胞數量並未下滑。 SARS-CoV-2 mRNA vaccines induce persistent human germinal centre responses https://www.nature.com/articles/s41586-021-03738-2 3.牛津研究：先打AZ隔4週打輝瑞 效果優於兩劑AZ https://www.cna.com.tw/news/firstnews/202106290103.aspx 英國牛津大學今天發表的研究顯示，先打AZ疫苗4週後，再打輝瑞疫苗，會比施打兩劑AZ疫苗產生更有效的免疫反應。由於一些個案接種AZ疫苗後出現罕見血栓，部分歐洲國家替民眾施打第2劑時，開始提供AZ以外的選項，而牛津這項研究資料支持了這些國家的決定。 執行試驗的牛津教授史內普（Matthew Snape）說，這些發現能讓新冠疫苗接種計畫可以更有彈性，但研究規模不夠大到足以建議廣泛更改臨床認可的接種計畫。史內普對媒體表示：「在混打計畫下，抗體和T細胞反應看起來不錯，這當然令人振奮。」但他也說，「我認為必須維持已證實有效的原定計畫，除非有其他很好的理由」；原定計畫意指經臨床試驗評估兩劑均施打同一款疫苗的計畫。 研究結果顯示，最強的抗體反應出現在接種兩劑輝瑞疫苗的民眾身上，而先打輝瑞再打AZ、或先打AZ再打輝瑞，都比打兩劑AZ疫苗產生更好的抗體反應。先打AZ再打輝瑞的方案產生了最佳T細胞反應，抗體反應也比先打輝瑞再打AZ的方案強。 這項研究涵蓋830名受試者，不同方案的兩劑疫苗接種間隔為4週。這項研究也在探討以12週為間隔的混打時程，史內普提到，一般認為AZ疫苗接種間隔拉長，能產生較佳免疫反應。 英國官員建議40歲以上民眾間隔8週接種兩劑疫苗，其他年齡段的成人則間隔12週。英格蘭副首席醫療官范-塔姆（Jonathan Van-Tam）表示，由於英國的疫苗供應穩定，目前沒有理由改變接種計畫。 Safety and Immunogenicity Report from the Com-COV Study – a Single-Blind Randomised Non-Inferiority Trial Comparing Heterologous And Homologous Prime-Boost Schedules with An Adenoviral Vectored and mRNA COVID-19 Vaccine https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3874014 英國混打AZ/BNT也可看新聞面對面節目上的解說 https://youtu.be/uSyzE2BKV3Y?t=1042 給長輩的AZ疫苗懶人包 https://linshibi.com/?p=39590 高端 聯亞 國產疫苗懶人包 第二期結束就緊急授權可行嗎？ https://linshibi.com/?p=39547 新冠快篩懶人包 普篩 抗體快篩 抗原快篩 https://linshibi.com/?p=36564 新冠肺炎疫情下的防疫須知 常見問題解答FAQ https://linshibi.com/?p=35408 新冠疫苗常見問題懶人包 https://linshibi.com/?p=38945 林氏璧醫師的電子名片 https://lit.link/linshibi 歡迎贊助我喝咖啡 https://pay.firstory.me/user/linshibi Powered by Firstory Hosting

Featuring articles on wolbachia-infected mosquito deployments for dengue, Ad26.COV2.S vaccine efficacy against Covid-19, thrombotic thrombocytopenia after ChAdOx1 nCoV-19 vaccination, variant SARS-CoV-2 infection after vaccination, and on diabetes treatment and control in U.S. adults from 1999 to 2018; a review article on recent advances in the treatment of melanoma; a case report of a woman with pain, swelling, and ecchymosis of the left arm; and Perspective articles on HIPAA at 25, on HIPAA and the leak of “deidentified” EHR data, and on what did I sign up for?

The Oxford Astra Zeneca vaccine has been associated with a rare complication of cerebral venous sinus thrombosis. Dr Colin Mahoney, JNNP Podcast Editor, interviews Prof David Werring, Professor of Clinical Neurology, UCL Queen Square Institute of Neurology, UK, about the new evidence which supports an association between vaccination and more common large vessel arterial stroke. They also discuss several cases, including treatment, and emerging biological evidence relating to causation. Read the paper "Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopaenia", on the JNNP website: https://jnnp.bmj.com/content/early/2021/05/20/jnnp-2021-326984. Related editorial paper: https://jnnp.bmj.com/content/early/2021/05/20/jnnp-2021-327057

The Oxford Astra Zeneca vaccine has been associated with a rare complication of cerebral venous sinus thrombosis. Dr Colin Mahoney, JNNP Podcast Editor, interviews Prof David Werring, Professor of Clinical Neurology, UCL Queen Square Institute of Neurology, UK, about the new evidence which supports an association between vaccination and more common large vessel arterial stroke. They also discuss several cases, including treatment, and emerging biological evidence relating to causation. Read the paper "Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopaenia", on the JNNP website: https://jnnp.bmj.com/content/early/2021/05/20/jnnp-2021-326984. Related editorial paper: https://jnnp.bmj.com/content/early/2021/05/20/jnnp-2021-327057

Featuring articles on left atrial appendage occlusion during cardiac surgery, thrombosis after ChAdOx1 nCoV-19 vaccination, adjuvant nivolumab for invasive urothelial carcinoma, a meningococcal X vaccine in Mali, and irritable bowel syndrome and immunity; a review article on HIV infection; a Clinical Problem-Solving describing a hypertensive heartbreak; and Perspective articles on women’s health; on institutional problems, individual solutions; and on merging mortalities.

Featuring articles on efficacy of the ChAdOx1 nCoV-19 vaccine against the B.1.351 variant, NVX-CoV2373 vaccine efficacy against B.1.351 in South Africa, endovascular therapy for basilar-artery stroke, intensive or standard blood-pressure control, and on gene editing for congenital neutropenia; a review article on monoclonal gammopathy of renal significance; a case report of a woman with nausea, diarrhea, and acute kidney failure; and Perspective articles on minority tax reform, on training future health justice leaders, and on finding a way to break through the fog.

What’s in the OncTimesTalk, May 2021 Edition? New clinical findings on: Nivolumab in gastro-esophageal cancer, CDK4/6 inhibition for breast cancer, COVID-19 vaccination limitations, sitagliptin/graft-versus-host disease, breast cancer individualization, neo-adjuvant chemotherapy for rectal cancer. Featuring: Ronan Kelly (Austin TX), Erica Mayer (Boston MA), Sibylle Loibl (Frankfurt, Germany), Shabir Madhi (Johannesburg South Africa) and Thierry Conroy (Nancy, France). Interviews in this edition: Ronan J Kelly MD MBA, Baylor University Medical Center, Dallas Adjuvant Nivolumab “Practice Changing” in Resected Gastroesophageal Cancer Ronan Kelly tells OncTimesTalk about a big reduction in the risk of death, and doubling of median disease-free survival, from using nivolumab as adjuvant therapy for patients with esophageal, and gastro-esophageal junction, cancers after chemoradiotherapy plus surgery in the placebo-controlled phase-three CheckMate 577 study. https://www.nejm.org/doi/full/10.1056/NEJMoa2032125 Erica L. Mayer MD, Dana-Farber Cancer Institute, Boston, MA Palbociclib Added No Benefit to Breast Cancer Adjuvant Endocrine Therapy Erica Mayer discusses the PALLAS study findings with OncTimesTalk that adding the CDK 4/6 inhibitor palbociclib to endocrine therapy failed to improve invasive disease-free survival among patients with early breast cancer despite its proven efficacy in metastatic disease. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30642-2/fulltext Breast Cancer: A Guide to Therapy Individualization  Sibylle Loibl, Professor of Obstretrics and Gynaecology, University of Frankfurt, CEO and Chair, German Breast Group. Sibylle Loibl discusses her expert panel’s findings with OncTimesTalk about optimizing the many powerful methods for managing breast cancer to individualize treatment. “Future research in breast cancer will focus not only on new drugs, but even more on the individualization of therapy for every single tumor in every single patient,” she wrote in “The Lancet”. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32381-3/fulltext Sherif S. Farag MD PHD, Director of the Stem Cell Transplant and Cellular Therapy, Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, in Indianapolis Sitagliptin Reduced Graft Versus Host Disease in Stem Cell Transplantation A non-randomized 36-patient phase-two clinical study found a big reduction in acute graft-versus-host disease after adding the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (a long established antiglycemic agent) to immunosuppression for allogeneic stem-cell transplantation.  Sherif Farag discusses the study findings with OncTimesTalk. http://www.nejm.org/doi/full/10.1056/NEJMoa2027372 Shabir A. Madhi PhD, Professor of Vaccinology and Director of the Vaccines & Infectious Diseases Analytics Research Unit at the University of Witwatersrand in Johannesburg, Co-Director of African Leadership in Vaccinology Expertise. SARS-CoV-2 Vaccine Was Ineffective Against B.1.351 (“South African”) Variant A “first-generation” vaccine for COVID-19 failed to prevent mild or moderate disease caused by the B.1.351 coronavirus variant in South Africa in a randomized, double-blind, controlled trial of the ChAdOx1 nCoV-19 vaccine among relatively young adults. Shabir Madhi tells OncTimesTalk, however, that vaccination with such first-generation vaccines should still protect against severe disease and death from the new variant because T-cell responses had been preserved in the South African variant. https://www.nejm.org/doi/full/10.1056/NEJMoa2102214 Thierry Conroy MD, Professor, Department of Medical Oncology, Institut de Cancérologie de Lorraine, 54519 Vandoeuvre-lès-Nancy, France Neoadjuvant Chemotherapy Before Preoperative Chemoradiotherapy in Locally Advanced Rectal Cancer A multi-center, randomized, open-label, phase-three trial has shown that outcomes for patients with rectal cancer can be improved still further by using neoadjuvant chemotherapy before the current standard of care (chemo-radiotherapy and surgery).  Professor Thierry Conroy, from the Cancer Institute in Nancy, gives OncTimesTalk the details on why they decided to try an additional treatment and the benefit it brought. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00079-6/fulltext

La thrombocytopénie thrombotique immunitaire induite par certains vaccins contre la COVID, dont ceux produits par AstraZeneca et Johnson et Johnson, a fait couler beaucoup d'encre dans l'actualité. Quels sont les risques réels, les symptômes à surveiller et la conduite à adopter pour le pharmacien ? Pierre Lemieux, pharmacien au CIUSSS de la Mauricie et du Centre du Québec, a bien voulu nous éclairer sur le sujet. Références : 1. Thrombocytopénie immunitaire prothrombotique induite par le vaccin – TIPIV (ou TTIV) en contexte de vaccination contre la COVID-19. INSPQ. Version du 19 avril 2021 https://publications.msss.gouv.qc.ca/msss/fichiers/directives-covid/dgaumip-030-rev1_thrombocytopenie-tipiv-%20vaccin-covid-19.pdf 2. Comité consultatif national de l'immunisation (CCNI). Recommandations sur l'utilisation des vaccins contre la COVID-19. Mise à jour du 23 avril 2021. https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/recommandations-utilisation-vaccins-covid-19-fr.pdf 3. Mahase E. AstraZeneca vaccine: Blood clots are “extremely rare” and benefits outweigh risks, regulators conclude BMJ 2021; 373 :n931 doi:10.1136/bmj.n931 https://www.bmj.com/content/373/bmj.n931 4. Les thromboses (caillots sanguins) et les vaccins contre la COVID-19. Thrombose canada Foire aux questions. Avril 2021. https://thrombosiscanada.ca/wp-uploads/uploads/2021/04/COVID-19-vaccine-and-Thrombosis-FAQs-April-2-2021_FR.pdf 5. Tacquet et al. Cerebral venous thrombosis: a retrospective cohort study of 513,284 confirmed COVID-19 cases and a comparison with 489,871 people receiving a COVID-19 mRNA vaccine, preprint https://osf.io/a9jdq/ 6. Katsanos et al. The Impact of SARS‐CoV‐2 on Stroke Epidemiology and Care: A Meta‐Analysis Ann Neurol. 2020 Dec 9 : 10.1002/ana.25967 (2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753413/ ; 7. Andreas Greinacher et coll. Anti-SARS-CoV-2 Spike Protein and Anti-Platelet Factor 4 Antibody Responses Induced by COVID-19 Disease and ChAdOx1 nCov-19 vaccination, 09 April 2021, PREPRINT (Version 1) available at Research Square https://www.researchsquare.com/article/rs-404769/v1 8. Scully et coll. Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination. NEJM April 16, 2021. DOI: 10.1056/NEJMoa2105385 https://www.nejm.org/doi/full/10.1056/NEJMoa2105385 9. Gowthami M et coll. Heparin-Induced Thrombocytopenia A Focus on Thrombosis. Arteriosclerosis, Thrombosis, and Vascular Biology. 2021;41:141–152 https://www.ahajournals.org/doi/pdf/10.1161/ATVBAHA.120.315445 10. CDC. Coronavirus Disease 2019 (COVID-19) Vaccines https://www.cdc.gov/vaccines/acip/meetings/slides-2021-04-23.html 11. The Gamalaya Center Statement https://sputnikvaccine.com/newsroom/pressreleases/the-gamaleya-center-statement/ 12. Greinacher A. et coll. Towards Understanding ChAdOx1 nCov-19 Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT). 2021. Preprint. https://assets.researchsquare.com/files/rs-440461/v1/8eabf306-6fd4-4a89-a7a3-8f4d06c89a55.pdf

The Whole View, Episode 454: J&J and AstraZeneca Covid-19 Vaccines Welcome back to episode 454! (0:28) This is the next part in a series of shows where Sarah and Stacy discuss the science behind the Covid-19 vaccines. They strive to present you with all the information available to make an informed decision about whether receiving the vaccine is right for you. Sarah plans to go through the show with the assumption that listeners have background/base knowledge about vaccines and how they work. So if you have not yet listened to the previous shows in this series, Sarah highly recommends you do before listening to this episode. Previous Covid-19 Shows In episode #440, Sarah and Stacy examined the history of vaccines and the very real statistics on vaccine-induced injury. They also looked at the advances that led to mRNA vaccine technology and the inherent advantages of this platform. Episode #441 explored the safety and efficacy data from the phase 2/3 clinical trials for both the Pfizer/BioNTech and the Moderna covid-19 vaccines. In episodes #443 & #444, Sarah and Stacy answered listener FAQ. This included concerns about adverse events, including autoimmune disease, fertility, and antibody-enhanced infection. They also examined safety concerns for pregnancy and children and addressed common myths circulating on the internet. Stacy and Sarah took a data-driven approach for all four episodes, presenting the science and facts with context, detail, nuance, integrity, compassion, and as objectively as possible. Fact vs. Opinion on The Whole View Stacy underlines that they are not here to convince you of a certain mindset or push a vaccine agenda in this show. Although Stacy and Sarah may share their personal opinions on vaccines, they remind the audience that their opinions are just that - opinions. And what's right for them might not be right for you. They strive to take this same scientific approach today and next week with the J&J and AstraZeneca Covid-19 vaccines. (Yes! You're getting two more vaccine shows!) Stacy also reminds listeners of Sarah's credentials and that she had a Ph.D. in research science. Like the other shows, they will address the rumors, concerns, and myths. It's critical to walk through the facts first. And remember- facts don't have opinions. Stacy and Sarah's primary agenda is to give the data for you to interpret for yourself.   Adenovirus Vector Vaccines J&J and AstraZeneca Covid-19 vaccines are both DNA vaccines that use an adenovirus vector. The concept is similar to the mRNA vaccines but not wholly the same. (5:20) Sarah reminds the audience that to make proteins, DNA is first transcribed into mRNA, which is then translated into protein. So, both J&J and AstraZeneca vaccines deliver instructions to make the full-length covid-19 spike protein. Only slightly different from the instructions for the mRNA vaccines, which have a couple of mutations to stabilize the tertiary structure into what's called the postfusion conformation and the transmembrane anchor added Both adenovirus vaccines encode full-length spike protein without the postfusion conformation stabilization mutations (say that 5 times fast!) but still add the membrane anchor. Sarah recommends this source for more information. So, these work similarly to the Pfizer/BioNTech and Moderna mRNA vaccines.  However, J&J and AstraZeneca Covid-19 vaccines require two steps to make the spike protein instead of one. They also require a special delivery agent to get into the cell nucleus. That's where adenoviruses kick in! Adenovirus Vectors Research There are about 50 years of research on adenovirus vectors as DNA delivery vectors. (8:48) Adenoviruses are basically common cold viruses that can cause illnesses ranging from cold-like symptoms to bronchitis, gastroenteritis, and conjunctivitis. They are non-enveloped DNA viruses that can't alter our DNA because (unlike retroviruses such as HIV or lentiviruses) wild-type adenoviruses do not carry the enzymatic machinery necessary for integration into the host cell's DNA.  Basically, they do not enter our cell's DNA. Adenoviruses deliver DNA that can enter the cell nucleus, are transcribed into mRNA, leaves the nucleus, and then translated into protein. That's exactly what makes them good vaccine platforms for infectious diseases. I used adenovirus vectors (Ad 5, the same used in the Russian sputnik V and China's CanSino covid-19 vaccines) for gene therapy research during my Ph.D. and even have a patent using them! Different Adenovirus Serotypes There are at least 88 human adenovirus types. Most serotypes cause mild illness, although data links adenovirus serotype 7 with more severe illness. (12:25) When used for gene therapy research or vaccines, research engineers them to be incapable of replicating and causing disease. There are adenovirus vector vaccines already in use. The rabies vaccine our pets get and the Ebola vaccine. One problem with using adenoviruses in vaccines is that people may already have antibodies to them, overwhelming them before they can do their assigned work.  Researchers get around that issue by using adenoviruses that humans are unlikely to have encountered before. The AstraZeneca/Oxford vaccine uses the ChAdOx1 platform based on a modified version of a chimpanzee adenovirus (causes colds in chimps and nothing in humans). The Johnson & Johnson & Janssen (J&J) vaccine uses a proprietary AdVac platform made up of recombinant human adenovirus (adv26).  It's the same platform used in the company's Ebola virus vaccine (approved in Europe) and its investigational Zika, RSV, and HIV vaccines.   Adjuvants in J&J and AstraZeneca Covid-19 Vaccines Like the mRNA vaccines, J&J and AstraZeneca Covid-19 vaccines don't require an adjuvant. (14:40) Stacy and Sarah talked about adjuvants in-depth in previous episodes. The viral vector itself helps to prime the immune system in a specific way to fight a virus- not generally the way aluminum-based adjuvants do. Then the real stimulant is the spike protein our cells make. The interesting thing about viral vector DNA vaccines is that our bodies react to it the same way as if we were actually sick with the illness.  Therefore, we get the same immune benefits as natural illness, minus the coronavirus's ability to manipulate the immune system and even more robust and durable immunity. Stacy shares that she was very surprised at how clean they were when she reviewed the vaccine ingredients. Sarah confirms this, saying newer vaccines (such as the recent ones for Covid) are missing many ingredients from early vaccines that cause many people to be hesitant about getting vaccinated. Ingredients in J&J: Recombinant, replication-incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein Citric acid monohydrate and trisodium citrate dihydrate - pH buffering, both naturally found in citrus fruit Ethanol 2-hydroxypropyl-β-cyclodextrin (HBCD), cyclic oligosaccharide containing seven D-(+)-glucopyranose units that are widely used to improve the aqueous solubility of various compounds, especially those containing a phenyl group, toxicology studies show very safe Polysorbate-80, emulsifier, pretty safe option Sodium chloride (aka salt) Source for Reference  Both AstraZeneca and J&J Covid-19 vaccines have reported that their vaccines were well tolerated with no serious safety concerns. However, there have been recent reports of blood clot issues, which Sarah and Stacy will cover.   J&J and AstraZeneca Covid-19 Vaccines Clinical Trial Results Like the mRNA vaccines, scientists could develop them quickly because of the decades of research scientists built from. (22:50) It's the same technology used in rabies vaccines for our pets and the Ebola vaccine (the only widespread vaccine used in humans). Johnson & Johnson One-shot (they are testing a 2-shot version test for efficacy increase) Stable at normal refrigerator temperatures, so cold-chain requirements are easier J&J Vaccine Fact Sheet FDA Fact Sheet for J&J Safety and Efficacy of Single Dose Efficacy against symptomatic disease 66.9% Vaccine efficacy was higher against severe–critical Covid-19 (76.7% and 85.4%) Prevented 100% of deaths from covid-19  No observable differences in vaccine efficacy according to sex, race, or ethnic group Similar to mRNA vaccines, no red flags from a safety perspective came up -- The incidence of serious adverse events balanced between the vaccine group and placebo. AstraZeneca Two shots 62% effective against symptomatic disease 100% against severe disease, hospitalization, and death Again, no red flag from a safety perspective Source for Reference    What About Adverse Side Effects? Stacy points out that the media always leads with the lowest number of something potentially problematic instead of leading with the bigger number, such as preventing 100% of deaths. (24:50) Sarah adds that the risk of developing a treatable reaction isn't the worst thing if the same treatment is keeping you from something way more serious - such as death. Stacy shares that it's not just the death toll, it's the risk of future complications and the way the symptoms can linger for months- two things she has personally experienced after having Covid last spring. She hates how the media is so ready to focus on the drama of the vaccine but completely skips over how much it's actually doing to protect us despite those few risks. AstraZeneca Not Approved In US Sarah explains that AstraZeneca's US trial is still ongoing and not yet approved for use. (34:00)  However, she points out that no "red flags" were presented during the clinical trials for either of these vaccines. That's important to put into context since both have shown complications when used in the community (which researchers expected, and Sarah explains why). The delay in the AstraZeneca trial lasted nearly seven weeks in the fall due to an adverse reaction in a UK participant. This was later determined as unrelated to the vaccine.  The initial trial results in November puzzled many experts from all around the world: The company combined data from its Brazil and UK groups, even though they had different sample sizes and demographics.  It also averaged the results of two different dosing regimens (one administered by mistake). Just 12% of participants in AstraZeneca's UK and Brazil trials were over 55 (but one quarter will be in US trial) Now, scientists hope that results from AstraZeneca's US trial will clear up much of the world's confusion.  According to a press release, key interim results of the trial, which included more than thirty thousand participants, and the data looked excellent. The vaccine appeared to be 79% effective at preventing "symptomatic COVID-19."  The press release said that no one given the vaccine in the trial became severely ill, hospitalized, or died due to COVID-19. Also, the study did not turn up any serious safety concerns. They'll likely apply for an EAU in the states in the next month or two. Why The Pauses Were Important The pause allowed the collection of more data to see how prevalent this adverse effect is. This way, they can find more cases, and the total was 15 out of about 8 million doses had this effect. The pause gives researchers time to educate patients on what to look out for and doctors on what to test for and how to treat. Sarah stresses that this is so important! Here's some perspective:  For one million J&J shots, researchers expect about 2 cases of TTP This contrasts with over 2,000 fewer deaths and 6,000 fewer Covid-related hospitalizations It's important to know that the agencies tasked with community monitoring are actually doing their job. This is how it's supposed to work! New stories have called this pause a bad thing, which has increased vaccine hesitancy. The media then inflamed the issue in an inaccurate and unhelpful way. Yes, plenty of people way they want Moderna or Pfizer instead of J&J right now. However, it takes time to educate people. Journalists need to focus on how the system works the right way to protect us instead of increasing fear. Just because AstraZeneca isn't approved yet doesn't mean it's unsafe. It means researchers want to devote enough time to understand the data as much as possible. Moderna, Pfizer, J&J and AstraZeneca Covid- 19 Vaccines Sarah explains that it's impossible to make an accurate comparison of efficacy between these trials. (47:10) Tests performed at different times, in different countries, with some variants may have impacted results. For example, the USA tested Moderna first, and now we see it undergoing testing elsewhere. The USA and Germany originally tested Pfizer (before B.1.1.7 became dominant). It is now undergoing testing elsewhere.  Argentina, Brazil, Chile, Colombia, Mexico, Peru, South Africa, and the United States tested the J&J vaccines. Brazil, South Africa, and the UK tested AstraZeneca initially. It is now running trials in the US, Japan, Russia, Kenya, and Latin America. Also, many areas define "symptomatic reactions" often vary. Sarah explains that to actually and accurately compare, we'd need a head-to-head trial with far fewer variables.   What About the Blood Clots? Stacy decides now is the time to talk about the elephant in the room: the reported risk of blood clots from the J&J vaccine. (52:45) Sarah explains that this is nowhere near clot risk from birth control pills (some many women take regularly), which is 1:1000. Also, it isn't a good comparison. "Run-of-the-mill" embolisms or thrombosis are easily treated. However, large ischemic stroke or myocardial infarctions, pulmonary embolism are more serious.  The rates of these types of blood clots after the vaccines are about what you'd expect in the population normally.  However, this rare adverse event following J&J and AstraZeneca Covid-19 vaccines is NOT run-of-the-mill.  https://www.bmj.com/content/372/bmj.n774 Cerebral venous thrombosis and portal vein thrombosis risk is 10x higher after covid-19 than after AstraZeneca vaccine https://www.bmj.com/content/373/bmj.n931 Immune Thrombotic Thrombocytopenia (ITT) Sarah underlines that calling this side effect "blood clots" isn't entirely accurate. What's actually happening ITT- an autoimmune response. Immune Thrombotic Thrombocytopenia (ITT) is blood clotting at the same time as low platelets. However, if treated properly and promptly, ITT is very treatable! This is so important because the normal way you treat blood clots (blood thinners like heparin) can cause death by hemorrhage.   With ITT, mortality is high (~90%) if untreated. The median age of onset 40 years and, like most autoimmune diseases, has a 3:1 female-to-male ratio. Stacy also reminds listeners that autoimmune diseases cannot be "caused" by something. Immune diseases are latent in the system until triggered, which is bound to happen at some point regardless. Autoimmune suffers aren't necessarily at higher risk. Some HLA risk alleles for other autoimmune diseases protect against TTP, and many don't increase risk at all. GREAT REVIEW PAPER  https://www.nejm.org/doi/full/10.1056/NEJMe2106315 https://www.nejm.org/doi/full/10.1056/NEJMoa2104882   Importance of J&J and AstraZeneca Covid- 19 Vaccines First, it's cheaper to make, ship, and store. So, they can get to places that are really tough to get the mRNA vaccines to, like rural America and developing nations. (1:12:10) Stacy and Sarah remind the audience that the pandemic isn't over until the whole world is protected. The high infection rates lead to the variants of concern, which we'll talk a bit more about next week.  This virus mutates slowly, but it has so many opportunities to mutate because of high infection rates, including in the USA. J&J is great for people who dislike needles, unhoused people, and people with schedules that make getting the second shot hard (e.g., truckers or flight attendants who travel a lot).  More References for J&J and AstraZeneca Covid-19 Vaccines Watanabe, Y. et al. (2021) Native-like SARS-CoV-2 Spike Glycoprotein Expressed by ChAdOx1 nCoV-19/AZD1222 Vaccine. ACS Central Science, ​See source here https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31604-4/fulltext   Final Thoughts These vaccines are just more tools in our toolbox to get through this pandemic. (1:15:10) Stacy and Sarah have dedicated the last 8 years to do this podcast to focus on everyone's health, safety, and wellness. Stacy adds that we often get so caught up in our own health, wellness, and safety that we forget part of what a vaccine does is protect others.  It's easy to be fearful and hesitant because there's so much to the science that an average person might not easily understand. And the more the media talks about it from a negative perspective, the less confident people get to go and get something that might be lifesaving- not just for themselves but others around them. Stacy takes a minute to talk about the difference between one mild/moderate complication right after the vaccine (heavier period) compared to more long-term complications from "long hauler syndrome" (brain fog, i.e., brain damage). Stacy reminds listeners that Patreon is a great way to connect. So if you haven't joined the family yet, be sure to pop over for bonus content like how Stacy and Sarah really feel about the topics they discuss. Thanks so much for listening, and we'll see you next week!

Dr Philip Smith, Digital and Education Editor of Gut and Consultant Gastroenterologist at the Royal Liverpool Hospital, interviews Dr Tariq Ahmad and Dr Nick Kennedy, both from the Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, UK. This special Gut podcast is focused on ‘Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab’ which is published in paper copy in Gut in May 2021 and the recently published paper ‘Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines’. Acknowledgements: The CLARITY IBD team would like to thank the CLARITY IBD team in Exeter, all of the 92 CLARITY IBD sites and over 7000 participants in the study. We are grateful to support from the NIHR CRN, Crohn's & Colitis UK and our funders. The related links: https://gut.bmj.com/content/early/2021/04/25/gutjnl-2021-324789 https://gut.bmj.com/content/70/5/865

Dr Philip Smith, Digital and Education Editor of Gut and Consultant Gastroenterologist at the Royal Liverpool Hospital, interviews Dr Tariq Ahmad and Dr Nick Kennedy, both from the Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, UK. This special Gut podcast is focused on ‘Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab' which is published in paper copy in Gut in May 2021 and the recently published paper ‘Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines'. Acknowledgements: The CLARITY IBD team would like to thank the CLARITY IBD team in Exeter, all of the 92 CLARITY IBD sites and over 7000 participants in the study. We are grateful to support from the NIHR CRN, Crohn's & Colitis UK and our funders. The related links: https://gut.bmj.com/content/early/2021/04/25/gutjnl-2021-324789 https://gut.bmj.com/content/70/5/865

Hva vet vi hittil om hvorfor noen blir alvorlig syke etter å ha tatt AstraZenica-vaksinen? Og hva vet vi om senfølgene etter covid-19? Vil dette viruset utvikle seg til å bli et tilbakevendende sesongvirus? Hva var de vanligste dødsårsakene i USA i 2020? Sjefredaktør Are Brean forteller om noen av artiklene som har stått på trykk i andre vitenskapelige tidsskrifter den siste tiden.Tilbakemeldinger kan sendes til stetoskopet@tidsskriftet.no.    Stetoskopet produseres av Irene Rønold, Are Brean og Julie Didriksen ved Tidsskrift for Den norske legeforening. Ansvarlig redaktør er Are Brean.      Lydtekniker: Håkon Braaten / Moderne Media    Coverillustrasjon: Stephen LeeArtikler nevnt:Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 VaccinationThrombotic Thrombocytopenia after ChAdOx1 nCov-19 VaccinationEfficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 variant of concern 202012/01 (B.1.1.7): an exploratory analysis of a randomised controlled trialBlood neurofilament light concentration at admittance: a potential prognostic marker in COVID-19Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health recordsThe Potential Future of the COVID-19 Pandemic: Will SARS-CoV-2 Become a Recurrent Seasonal Infection?The Leading Causes of Death in the US for 2020China's response to COVID-19: a chance for collaborationThe world must learn from COVID before diving into a pandemic treaty

A trial finds one of the major COVID vaccines ineffective against a circulating strain. Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant

Science Book Movement - Notion360Revisión Online del Paper Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial - Pedro M. Folegatti, MSc Invitada: MSc. Camila Isabel Palma Tovar. Licenciada en Bioquímica de la Universidad Mayor de San Andrés, con Maestría en Ciencias Biológicas y Biomédicas. Actualmente trabaja como docente en la Universidad Católica Boliviana San Pablo. Participa como voluntaria en iGEM Bolivia (como tutora) y en Chicas Waskiris (como responsable de pedagogía y metodología de videos educativos) y es miembro activo en OWSD (Organization for Women in Science for the Developing World: Organización para Mujeres en Ciencia para el Mundo en Desarrollo). Inscríbete aquí para recibir los enlaces, notificaciones y todo el material durante el evento https://notion360.co/registro See acast.com/privacy for privacy and opt-out information.

JULY 21- DAILY SHOW: Happy Tuesday! There was a medical journal posted last night about the progress of Oxford University's Coronavirus vaccine, ChAdOx1 nCov-19. James breaks down the study and what it means for overall vaccine progress. THANKS FOR LISTENING. He's not a scientist, but you can read all about the Oxford study here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31604-4/fulltext#seccestitle10 or at thelancet.com. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app