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Weitzman ECHO COVID-19: Updates, Vaccines, and Lessons Learned So Far

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Weitzman ECHO COVID-19: Updates, Vaccines, and Lessons Learned So Far

  1. 1. Weitzman ECHO on COVID-19 Updates, Vaccines, and Lessons Learned So Far April 22, 2020
  2. 2. CME Credit • Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State Medical Society to sponsor continuing medical education for physicians. The Bridgeport Hospital Yale New Haven Health designates this live activity for a maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only credits commensurate with the extent of their participation in the various activities. • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State Medical Society to provide continuing medical education for physicians. • The content of this activity is not related to products or services of an ACCME- defined commercial interest; therefore, no one in control of content has a relevant financial relationship to disclose and there is no potential for conflicts of interest.
  3. 3. Weitzman ECHO on COVID-19 A Primary Care Perspective cont’d Stephen J Scholand, MD Infectious Disease Consultant 22 April, 2020 USA Today
  4. 4. Objectives - Update on epidemiology (2019-nCoV, SARS-CoV-2) - Review any good news? - Serology tests are coming - Continue the efforts to limit spread - 43,000 American Lives Saved and Counting* - Continue supporting each other *https://covidactnow.org/
  5. 5. COVID-19 in the United States 787,960 cases 4/21/20 – up from 589,048 cases last week (4/14/20) - https://coronavirus.jhu.edu/map.html
  6. 6. Keep doing what we’re doing… https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html
  7. 7. Any good news? • Serological tests are coming – IDSA statement: “The current antibody testing landscape is varied and clinically unverified, and these tests should not be used as the sole test for diagnostic decisions. Further, until more evidence about protective immunity is available, serology results should not be used to make staffing decisions or decisions regarding the need for personal protective equipment” https://www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-covid-19-antibody-testing-primer.pdf
  8. 8. All Health Care Workers are Heros • Service workers – Environmental services – Food services • Other ancillary staff – X-ray technicians – Lab personnel • Support is appreciated!
  9. 9. Stay safe -- Stay up to date • https://www.cdc.gov/coronavirus/2019-ncov/index.html https://emergency.cdc.gov/coca/calls/2020/ • https://www.who.int/emergencies/diseases/novel- coronavirus-2019 • https://covidactnow.org/ • https://coronavirus.jhu.edu/map.html
  10. 10. SARS-CoV-2 Vaccine Development @SaadOmer3 Saad B. Omer, MBBS MPH PhD FIDSA Director, Yale Institute for Global Health Associate Dean (Global Health Research), Yale School of Medicine Professor of Medicine (Infectious Diseases), Yale School of Medicine Susan Dwight Bliss Professor of Epidemiology of Microbial Diseases, Yale School of Public Health
  11. 11. What are Vaccines? “A preparation of killed microorganisms, living attenuated organisms, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease” Medline Plus Medical Dictionary 11
  12. 12. Live, Attenuated Vaccines • Microbe weakened (e.g. through serial passage/culture) – Reduced disease potential due to mutations • Replication in the body • Better for viral pathogens – Bacterial genome more complex • Examples: – Measles, Mumps, Rubella OPV, BCG, Live Intranasal Influenza vaccine Source: CDC 12
  13. 13. Viral Attenuation 13
  14. 14. Killed (Inactivated) Vaccines • Microbe killed (e.g. by chemicals, radiation, heat) • Suitable for Bacteria • Weaker immune response – Often require boosters • Examples: – Diphtheria, Pertussis (Whole Cell), Tetanus, IPV, Inactivated Influenza Vaccine, Hepatitis A Source: CDC 14
  15. 15. Subunit Vaccines • Part(s) of the microbe that induces immune response • Process: – Culture  Disrupt  Purify • Better safety/reactogenicity than whole cell vaccines • Examples: – Pertussis (Acellular), Pneumococcal Polysaccharide Vaccine Source: NIH 15
  16. 16. Recombinant Subunit Vaccines • Process: – Extract DNA Insert in yeast/bacteria  Antigen production  Purify • Flexibility in choosing antigen • High development costs • Examples: Hep. B Source: Burmester, 2003 16
  17. 17. Recombinant Vector Vaccines • Process: – Extract DNA Insert in vector (attenuated microbes) Ag expression • Flexibility in choosing antigen • High development Costs • Only experimental vaccines (e.g. HIV Vaccines) Source: Burmester, 2003 17
  18. 18. Naked DNA Vaccines • Process & Mode of Action: – Extract DNA Introduce into body  Integrated into cellular DNA  Antigen Expression • Relatively inexpensive • Only experimental vaccines – e.g. HIV, TB Source: NIH 18
  19. 19. Reassortant Vaccines • Tissue culture cells infected with two different strains – e.g. non-human & human strains • Viral replication – Multiple combinations of gene segment in offspring – Offspring with desired characteristics selected 19
  20. 20. Reassortment Approaches Webby and Sandbulte; 2008 20
  21. 21. 21
  22. 22. A Working Taxonomy of Vaccine Types Slide: Neal Halsey, MD 22 In vitro Translation
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  25. 25. Production Issues • Thousands of vaccines for trials • Immediate scaling up after licensure • Often large investments needed before efficacy is established • Good Manufacturing Practice Collins, 2005 25
  26. 26. 26 Free COVID-19 eConsults • Web-based portal • Free to all Safety Net Primary Care Practices – FQHC, FQHC-look alike, Migrant Clinicians, Healthcare for the Homeless, Free Clinics • No Protected Health Information (PHI) • Consults Addressed by: – Infectious Disease Specialists – Public Health Nurses * This initiative is supported by
  27. 27. Thank You! www.weitzmaninstitute.org/coronavirus

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