This important presentation encompasses all the vaccines of COVID at current point of time; it's mechanism of action, its efficacy data's and advantages and disadvantages
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Low Lee Lee, Infectious Disease Physician at the Hospital Sultanah Bahiyah, Ministry of Health Malaysia.
This slide presentation historically, statistically and attractively explains various vaccines for covid19 available in India. (Please update the statistical data to current values)
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr.Benedict Sim Lim Heng is a Consultant Infectious Disease Physician at the Sungai Buloh Hospital, Ministry of Health Malaysia.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Low Lee Lee, Infectious Disease Physician at the Hospital Sultanah Bahiyah, Ministry of Health Malaysia.
This slide presentation historically, statistically and attractively explains various vaccines for covid19 available in India. (Please update the statistical data to current values)
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr.Benedict Sim Lim Heng is a Consultant Infectious Disease Physician at the Sungai Buloh Hospital, Ministry of Health Malaysia.
COVID-19 I Coronavirus Disease I Harshit JadavHarshit Jadav
This presentation highlights all the basic information regarding the current pandemic COVID-19.
This presentation includes an introduction, recent stats, the structure of coronavirus, pathogenesis of coronavirus, diagnosis, treatment and preventive measures of COVID-19
Ebola virus disease (EVD; also Ebola hemorrhagic fever, or EHF), or simply Ebola, is a disease of humans and other primates caused by ebolaviruses. Ebola virus disease is a serious illness that originated in Africa, where there is currently an outbreak
this presentation is prepared with the intention to create an insight about coronavirus among the undergraduate medical students in their pre and para clinical years
This PPT comprises of brief history of vaccines and its details, concentrated on adverse reactions due to various vaccines, and briefly bout the cold chain.
COVID-19 VACCINESMyths Vs Facts
Vaccines types
How they work ?
Recombinant vaccines
Why Covid Vaccines?
Covid Vaccines
Vaccine Usage in the world
In the discussion
Facts vs Myths-
Some Tips for Vaccination
COVID-19 I Coronavirus Disease I Harshit JadavHarshit Jadav
This presentation highlights all the basic information regarding the current pandemic COVID-19.
This presentation includes an introduction, recent stats, the structure of coronavirus, pathogenesis of coronavirus, diagnosis, treatment and preventive measures of COVID-19
Ebola virus disease (EVD; also Ebola hemorrhagic fever, or EHF), or simply Ebola, is a disease of humans and other primates caused by ebolaviruses. Ebola virus disease is a serious illness that originated in Africa, where there is currently an outbreak
this presentation is prepared with the intention to create an insight about coronavirus among the undergraduate medical students in their pre and para clinical years
This PPT comprises of brief history of vaccines and its details, concentrated on adverse reactions due to various vaccines, and briefly bout the cold chain.
COVID-19 VACCINESMyths Vs Facts
Vaccines types
How they work ?
Recombinant vaccines
Why Covid Vaccines?
Covid Vaccines
Vaccine Usage in the world
In the discussion
Facts vs Myths-
Some Tips for Vaccination
Beyond Compliance - Vaccine Update for Manufacturers with David Acheson, MDSafetyChain Software
Thankfully, the COVID-19 vaccine machine is in motion, but where are manufacturers positioned in the rollout plan? What new data is emerging about the safety and efficacy of the two North-American vaccines?
Mechanism of different types of vaccines in developmentEmilioMolina23
Recap of certain vaccines technologies against Covid-19
Introduce MOA of current and in development Covid-19 vaccines
Ever since the first vaccine was developed in 1796 to treat smallpox, several different methods have been created to develop successful vaccines. Today, those methods, known as vaccine technologies, are more advanced and use the latest technology to help protect the world from preventable diseases.
Depending on the pathogen (a bacteria or virus) that is being targeted, different vaccine technologies are used to generate an effective vaccine.
In total, there are five different vaccine technology platforms in this presentation each with its own benefits, and examples.
This presentation deals with the various approaches of medical nutrition therapy in Diabetes, comparison of the ADA, RSSDI and ICMR guidelines. It also talks about the various calorie counting apps as well.
COVID vaccination and prevention strategiesShinjan Patra
This presentation deals with all the vaccines available for COVID-19 at current times; It has a special mention and discussion about the Indian vaccines and it's utilities and uses
This presentation deals with the physiological aspect of Calcium and phosphate metabolism, it's relationship with the various types of rickets and possible remedies
This powerpoint presentation deals with the chief recommendations of ISBMR osteoporosis recommendations. It also encompasses relevant articles which have been cited for formulation of the article.
Case Review of Adult-onset Congenital Adrenal Hyperplasia due to 21-OH defici...Shinjan Patra
I have presented a case of adult-onset 21-OH deficiency CAH who presented withj Primary Amenorrhea. Additionally i have also covered the aspects of Diagnosis, neoboen screening, treatment and monitoring of 21-OH deficiency CAH
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Introduction
• COVID-19 has been the cause of distress &
ailment all throughout the globe for last 18
months
• Clinical manifestations progressed from
pneumonia to ARDS
3. Complications
• Typically associated with the phenomenon of
Cytokine storm
• Lung injury leads to reduced surfactant &
reduced gas exchange in the alveoli
• Leads to massive vascular inflammation,
shock, hypotension, disseminated
intravascular coagulation & multi-organ
dysfunction
• Vaccination holds the key to tackle his
epidemic
4. Outline
• Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending
authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
5. Early days
• Vaccine for an infectious disease never been produced in
less than several years
• No vaccine existed for preventing a corona virus infection in
humans
• Established body of knowledge about the structure and
function of corona-viruses causing diseases like SARS CoV-1
& MERS
• Enabled accelerated development of various vaccine
technologies during early 2020
• On 10 January 2020, the SARS-CoV-2 genetic sequence data
shared
• By 19 March, the global pharmaceutical industry
announced a major commitment to address COVID-19
6. Initiation
• Since January 2020, vaccine development
expedited via unprecedented collaboration in
the multinational pharmaceutical industry and
between governments
7. Basic steps
• Safety
• Targeting vulnerable populations
• Need for vaccine efficacy breakthroughs
• Duration of vaccination protection
• Special delivery systems (such as oral or nasal,
rather than by injection)
• Dose regimen
• Stability and storage characteristics
• Dissemination of the licensed vaccine
8. Challenges
• Urgency compressed schedules that shortened
the standard vaccine development timeline
• Compromising safety assurance
• Research at universities obstructed by physical
distancing and closing
• Virus proved to be a "moving target" of changing
transmission rates across and within countries
• Compete for trial participants
9. • Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
10. Authorization
• 17 vaccines authorized by at least one
national regulatory authority for public use
RNA vaccines Pfizer–BioNTech Viral Vector Vaccines Oxford-AstraZeneca
Moderna Sputnik Light
CVnCoV Sputnik V
Inactivated vaccines BBIBP-CorV Johnson & Johnson
CoronaVac Convidecia
Covaxin Protein subunit
vaccine
EpiVacCorona
WIBP-CorV RBDDimer
CoviVac
Minhai-Kangtai
QazVac
11. Others in pipeline
• 308 vaccine candidates are in various stages of
development
• With 73 in clinical research
24 in Phase I trials
33 in Phase I–II trials
16 in Phase III development
12. First approval
• On 2/12/20 UK’s Medicines and Healthcare
products Regulatory Agency (MHRA) gave
temporary regulatory approval for the Pfizer–
BioNTech vaccine
• On 1/01/21, (DCGI) approved emergency use
of the Oxford–AstraZeneca vaccine
(Covishield) in India
13. • Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending
authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
14. Platform & target
• Most of the platforms of vaccine candidates in
clinical trials focused on the spike protein and its
variants as the primary antigen
• Platform Being developed in 2020 involved
nucleic acid technologies (nucleoside-modified
messenger RNA and DNA), non-replicating viral
vectors, peptides, recombinant proteins, live
attenuated viruses and inactivated viruses
15.
16. Next generation strategies
• Precise targeting of COVID-19 infection
mechanisms
• Use a 2P mutation to lock the spike protein
into its prefusion configuration, stimulating an
immune response to the virus before it
attaches to a human cell
17. RNA vaccine
• When introduced into a tissue, acts as mRNA
to cause the cells to build the foreign protein
and stimulate an adaptive immune response
• Delivery of mRNA is achieved by a co-
formulation of the molecule into lipid nano-
particles which protect the RNA strands and
help their absorption into the cells
18. Approval status
• First to be approved in US, UK, EU
• In January 2021, Pfizer–BioNTech and the
Moderna got approval
• In February 2021, the CVnCoV RNA vaccine
from CureVac got authorization in EU
• Allergic reactions rare
19. Inactivated virus vaccines
• Consist of virus particles that have been
grown in culture and then are killed using a
method such as heat or formaldehyde to lose
disease producing capacity, while still
stimulating an immune response
20. Adenovirus vector vaccines
• Non-replicating viral vector vaccines, using an
adenovirus shell containing DNA that encodes
a SARS-CoV-2 protein
• Convidecia and the Johnson & Johnson
COVID-19 vaccine are both one-shot vaccines
which offer less complicated logistics and can
be stored under ordinary refrigeration for
several months
21. Subunit vaccines
• Present one or more antigens without
introducing whole pathogen particles
• Antigens involved are often protein subunits,
but can be any molecule that is a fragment of
the pathogen
22. Other types
• In clinical trials include
Virus-like particle vaccines
Multiple DNA plasmid vaccines
Lentivirus vector vaccines
Conjugate vaccine
Vesicular stomatitis virus displaying the
SARS-CoV-2 spike protein
23. Formulation
• To enhance immunogenicity
• Particularly effective for technologies using
the inactivated virus and recombinant protein-
based or vector-based vaccines
• Aluminum salts, the first adjuvant used for
licensed vaccines, the adjuvant of choice in
some 80% vaccines
24. Outline
• Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
25. Efficacy
• Not straightforward to compare the efficacies
of the different vaccines because the trials
were run with different populations,
geographies and variants of the virus
26.
27. Lineage B.1.1.7 (alpha)
• Identified in Dec’20 in UK
• Results suggest protection from the Pfizer-
BioNTech and Moderna vaccines
• Oxford–AstraZeneca had an efficacy of 42–89%
versus 71–91% against non-B.1.1.7 variants
Wang P, Nair MS, Liu L, Iketani S, Luo Y, Guo Y, et al. (March 2021). "Antibody Resistance of SARS-CoV-2 Variants B.1.351 and B.1.1.7". Nature. 593 (7857):
130–35
Emary KR, Golubchik T, Aley PK, Ariani CV, Angus BJ, Bibi S, et al. (2021). "Efficacy of ChAdOx1 nCoV-19 (AZD1222) Vaccine Against SARS-CoV-2 VOC
202012/01 (B.1.1.7)
28. Lineage B.1.351 (Beta)
• First detected in Dec’20 in South Africa
• Decreased neutralizing activity of Moderna and
Pfizer-BioNTech vaccines
• On 1 April 2021, an update on a Pfizer/BioNTech
stated that the vaccine 100% effective
• Johnson & Johnson, reported the level of
protection 72% in the United States and 57% in
South Africa
• Reduced efficacy of the Oxford–AstraZeneca
Hoffmann M, Arora P, Gross R, Seidel A, Hoernich BF, Hahn AS, et al. (March 2021). "1 SARS-CoV-2 variants B.1.351 and
P.1 escape from neutralizing antibodies". Cell. 184 (9): 2384–2393.e12
29. Lineage P.1 (Gamma)
• Initially identified in Brazil
• Seems to partially escape vaccination with the
Pfizer- BioNTech
Hoffmann M, Arora P, Gross R, Seidel A, Hoernich BF, Hahn AS, et al. (March 2021). "1 SARS-CoV-2 variants B.1.351 and P.1 escape from
neutralizing antibodies". Cell. 184 (9): 2384–2393.e12
30. Lineage B.1.617 (Kappa & Delta)
• First discovered in India
• Mostly detected after Jan’21
• Spike mutations D111D, G142D,P681R, E484Q
and L452R,the latter two of which may cause it to
easily avoid antibodies
• Neutralized by Covaxin
• Covishield 60% effective
Principles of epidemiology, Section 8: Concepts of disease occurrence". U.S. Centers for Disease Control and Prevention (CDC). 18 May
2012. Archived from the original on 6 April 2020. Retrieved 6 May 2020.
31. • Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending
authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
32. Oxford–AstraZeneca
(Vaxzevria, Covishield)
Developers Country of
origin
Technology Doses (
Interval)
Storage Pre-marketing study Post-marketing
study
University
of Oxford,
AstraZenec
a, CEPI
US,
Sweden
Adenovirus
vector
2 doses
4–12
weeks
2–8 °C Phase III (30,000)
Interventional;
randomized,
placebo-controlled
study for efficacy,
safety, and
Immunogenicity.
Overall efficacy of
76% after the first
dose and 81% after
a second dose
taken 12 weeks or
more after the
first
Phase IV
(10,000)
Interventional,
Nonrandomized
undergoing
Voysey M, Costa Clemens SA, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. (March 2021). "Single-dose administration and the influence of
the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised
trials". Lancet. 397 (10277): 881–91. doi:10.1016/S0140-6736(21)00432-3
33. Pfizer–BioNTech
Developers Country
of origin
Technology Doses (
Interval)
Storage Pre-marketing
study
Post-marketing
study
BioNTech,
Pfizer
Germany
US
RNA
(modRNA in
lipid
nanoparticles)
2 doses
3–4
weeks
−70 ± 10
°C
Phase III (43,448)
Randomized,
placebo-controlled.
Positive results
from an interim
analysis were
announced on
18/11 2020
and published on
10/12/ 2020
reporting an
overall
efficacy of
95%
Phase IV
(10,000)
Interventional,
Nonrandomized
undergoing
Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. (December 2020). "Safety and Efficacy of the BNT162b2 mRNA Covid-19
Vaccine". The New England Journal of Medicine. 383 (27): 2603–15. doi:10.1056/NEJMoa2034577
34. Sputnik V
Developers Country of
origin
Technology Doses (
Interval)
Storage Pre-marketing study Post-
marketing
study
Gamaleya
Research
Institute of
Epidemiology
and
Microbiology
Russia Adenovirus
vector
(recombinant
Ad5 and
Ad26 )
2 doses
3 weeks
≤−18 °C Phase III (40,000)
Randomized double
blind,
Placebo controlled
to
evaluate efficacy,
immunogenicity,
and safety.
Interim analysis
from the trial
published in The
Lancet, indicating
91.6% efficacy
without unusual side
effects
Logunov DY, Dolzhikova IV, Shcheblyakov DV, Tukhvatulin AI, Zubkova OV, Dzharullaeva AS, et al. (February 2021). "Safety and efficacy of an
rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in
Russia". Lancet. 397 (10275): 671–81. doi:10.1016/S0140-6736(21)00234-8
35. BBV152 (Covaxin)
Developers Country of
origin
Technology Doses (
Interval)
Storage Pre-marketing study Post-
marketing
study
Bharat
Biotech,
Indian
Council of
Medical
Research
India Inactivated
SARS-CoV-2
(vero cells)
2 doses
4 weeks
2–8 °C Phase III (25,800)
Randomised,
observer-blinded,
Placebo controlled.
Bharat Biotech reported
an interim
efficacy of 78% in
its phase 3 trial
Koshy, Jacob (21 April 2021). "Updated data from Covaxin phase 3 trial shows 78% efficacy". The Hindu. ISSN 0971-751X
36. Moderna
Developers Country
of origin
Technology Doses (
Interval)
Storage Pre-marketing study Post-
marketing
study
Moderna,
NIAID,
BARDA, CEPI
US RNA
(modRNA in
lipid
nanoparticles)
2 doses
4 weeks
−20 ± 5 °C Phase III (30,000)
Interventional;
randomized, placebo-
controlled
study for efficacy,
safety, and
immunogenicity.
Positive results
from an interim
analysis were
announced on
15/11/2020
and published on
30/12/2020
reporting an overall
efficacy of
94%.
Phase IV
(10,000)
Interventiona
l non-
randomized
undergoing
Promising Interim Results from Clinical Trial of NIH-Moderna COVID-19 Vaccine". National Institutes of Health (NIH). 15 November 2020.
37. Johnson & Johnson
Developers Country
of origin
Technology Doses (
Interval)
Storage Pre-marketing
study
Post-marketing
study
Janssen
Vaccines
(Johnson &
Johnson),
BIDMC
US
Netherlan
ds
Adenovirus
vector
(recombina
nt
Ad26)
Single dose 2–8 °C Phase III (40,000)
Randomized,
double-blinded,
placebo-controlled
Positive results
from an interim
analysis were
announced on
29/1/2021. An
efficacy
of 66% against mild
and moderate
symptoms, and
85% against severe
symptoms
Janssen COVID-19 Vaccine – ad26.cov2.s injection, suspension". DailyMed. U.S. National Institutes of Health. Retrieved 15 March 2021.
38. CoronaVac
Develope
rs
Countr
y of
origin
Technology Doses (
Interval)
Storage Pre-marketing study Post-
marketing
study
Sinovac China Inactivated
SARS-CoV-2
(vero cells)
2 doses
2–3 weeks
2–8 °C Phase III (33,620)
Double-blind,
randomized, Placebo
controlled
to evaluate efficacy
and safety.
Final Phase III
results from various parts of
globe reported efficacy
below 70% but more
effective in
preventing severe
cases
"Estudo clínico que comprova maior eficácia da Coronavac é enviado para Lancet". CNN Brasil (in Portuguese). Retrieved 18 April 2021
39. Other approved vaccines
Vaccine Developers/Country Remarks/Usage/Efficacy
Sputnik Light Russia On emergency use; undergoing phase III trial
WIBP-CorV China Phase III trial showed 72.3% efficacy
EpiVacCorona Russia On emergency use; undergoing phase III trial
QazCovid-in Kazakhstan On emergency use; undergoing phase III trial
Minhai COVID-
19 vaccine
China On emergency use; undergoing phase III trial
CoviVac Russia 2 doses only 2 weeks apart; undergoing
phase III trial
EpiVacCorona Russia On both full time & emergency use; Phase III
trail reports pending
RBD-Dimer China Only vaccine to have 3 doses; Phase III trials
reports pending
40. Approved COVID-19 vaccines in Phase
I–III trials
Vaccine Developer
s/Country
Type Trial phase Emergency use
Authorisation
Novovax US Subunit Undergoing phase III US EU NZ Aus
Sanofi-GSK UK France Subunit Undergoing phase III US EU Canada
Cure-Vac Germany RNA Undergoing phase III EU
CoVLP Canada Subunit Undergoing phase III Canada
SOBERANA 02 Cuba Subunit Undergoing phase III Cuba
VLA2001 France Subunit Phase III trial started EU
41. Other vaccines awaiting emergency
use authorization
Vaccine Developers/Country Type Trial phase
ZyCoV-D India Subunit III
COVIran Barakat Iran Subunit III
CIGB-66 Cuba Subunits III
Nanocovax Vietnam Subunit II
Bio E COVID-19 India US Subunit II
UB-612 Brazil Subunit II
GRAd-COV2 Italy Adenovirus vector II
MVC-COV1901 Taiwan Subunit II
COVAX-19 Australia Subunit II
AG0302 Japan DNA plasmid II
IIBR-100 Israel Vesicular
stomatitis virus
Pre-clinical
HGC019 India US RNA Pre-clinical
BBV154 India Adenovirus vector Pre-clinical
42. • Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending
authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
43. Distribution
• 1.9 billion COVID-19 vaccine doses administered
worldwide
• Licensed vaccines should be available and
affordable for people at the frontline of
healthcare and having the greatest need
• Several companies plan to initially manufacture a
vaccine at artificially low pricing, then increase
prices for profitability later if annual vaccinations
are needed and as countries build stock for future
needs
44.
45. Inequality concerns
• WHO, CEPI, and GAVI have expressed concerns
that affluent countries should not receive priority
access to the global supply of eventual COVID-19
vaccines
• Although 9 percent of the world's population
lives in the 29 poorest countries, these countries
received only 0.3% of all vaccines administered
• Brazil vaccinated twice more white than black
people and noticed the fact that the mortality of
is higher in the black population
46. Misinformation & hesitancy
• Anti-vaccination activists and other people
spread a variety of rumors, including
overblown claims about side effects
47. Encouragement by public figures
• Current and former heads of state and
government ministers have released photographs
of their vaccinations, encouraging others to be
vaccinated including Joe Biden, Barack Obama,
Narendra Modi, the Dalai Lama, Justin Trudeau,
Kyriakos Mitsotakis, Zdravko Marić, Olivier Véran
• Many musicians, actors,TV personalities, athletes
also encouraged
48. Adverse events
• Injection-site events mainly grade 1 or 2 in
severity
• Lasted a mean of 2.6 and 3.2 days after the
first and second doses respectively
• M/C pain after injection > 80%
• Rest fever, headache, fatigue, myalgia,
arthralgia, nausea, vomiting ; severe grade
rarely
• Hypersensitivity reaction rarely crosses 1%
49. • Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
50. Initiation
• As of early May 2020, there were over 30
vaccine candidates in development in India,
many of which were already in pre-clinical
trials
51. Serum Institute of India & Covishield
• World's largest vaccine maker
• In Feb’2020, SII had begun animal trials of
vaccine candidates
• In Aug’2020, SII received approvals for phase 2
and phase 3 trials of its version of a vaccine
being developed by AstraZeneca and the
University of Oxford's
• Planned to manufacture 1.5 and 2.5 billion
doses per-year
52. Bharat Biotech & Covaxin
• ICMR partnered with Bharat Biotech in May 2020
to develop a COVID vaccine entirely within India
• In June 2020,received DCGI approval to begin
phase 1 and phase 2 trials on its vaccine
• On 3 March 2021, Bharat Biotech reported that
Covaxin showed an efficacy of 78% in its phase 3
trial
• Expanded its production capabilities for Covaxin
to 700 million doses per-year
Covaxin showed 81% efficacy in third phase trials, says Bharat Biotech" (https://scroll.in/latest/ 988469/covaxin-showed-81-efficacy-in-third-
phase-trials-says-bharat-biotech). Scroll.in. 3 March 2021. Retrieved 4 March 2021.
53. Cadila Healthcare
• Began vaccine development in March 2020
• Including a viral vector vaccine and a DNA
plasmid vaccine
• In mid-July 2020 held early human trials of its
vaccine candidate ZyCoVD
• Received approval for phase 3 trials in January
2021
• Expecting to receive emergency authorization
shortly
54. Dr Reddy’s
• Partnered with the Russian Direct Investment
Fund (RDIF) to conduct phase 3 trials of the
Sputnik V vaccine
• Also working with the RDIF on approval of
"Sputnik Light"—a regiment of Sputnik V
consisting only of the first dose
55. Launching vaccination programme
• On 1/01/21, the DCGI approved emergency use
of the Covishield
• On the following day, the Covaxin also approved
• Standard emergency use authorization to Covaxin
later on in March’21
• On 12 April, the DCGI approved Russia's Sputnik V
vaccine for emergency use
• Began its vaccination program on 16th January
operating 3,006 vaccination centers on the onset
• Concerns about low turnout, due to a safety
concerns
56. Second phase
• From 1st march covering all residents over 60
• Between the ages of 45 and 60 with one or more
qualifying co-morbidities
• Any health care or frontline worker that did not
receive a dose during phase 1
• From 1 April, eligibility extended to all residents
over 45
• PM called for a four-day “Teeka Utsav" from 11 to
14 April to encourage vaccination
57. Third phase
• From 1st may
• Eligibility to all residents over the age of 18
• On 25 May, India exceeded 200 million vaccine
doses administered
58. Vaccine Maitri
• Humanitarian initiative from Jan’21
• Aims to leverage the country's pharmaceutical
industry to export Indian-manufactured
vaccines to other countries
• Had donated over 64.5 million vaccines to 85
countries
• Canada, Bahrain, Brazil, South Africa,
Argentina, Iran notable recipients
• WHO heaped praise for this great effort
59. State wise data’s
• Gujarat, Karnataka, Maharasthra, Rajasthan,
Uttar Pradesh & West Bengal are the states
with more than 10 million jabs
• Tripura & Ladakh have vaccinated more than
it’s 15% of the populations
60. • Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
61.
62. • Super-spreading events
• Transmission of infection in Quarantine hotels
• Infection from Asymptomatic & pre-
symptomatic individuals
• More indoor transmission than outdoor
transmission
• Nosocomial infection despite adequate
personal protection
63. • Viable SARS-CoV-2 detection in the air; stayed
infectious in the air for up to 3 h with a half-life of 1·1 h
• Identified in air filters and building ducts in hospitals
• Transmission between caged animals connected only
through air duct
• No strong or consistent evidence to refute the
hypothesis of airborne SARS-CoV-2 transmission
• Limited evidence to support other dominant routes of
transmission: respiratory droplet or fomite
Lednicky JA, Lauzard M, Fan ZH, et al. Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. Int J Infect Dis 2020; 100: 476–82.
64. Modes of prevention
• Hand hygiene
• Respiratory hygiene
• Social Distancing
• High risk group
65. Home quarantine rules
• Stay in well-ventilated room
• Restrict movement
• Using separate bathroom
• Follow respiratory hygiene/hand hygiene specially if
symptomatic
• Avoid visitors in house
• Household members use separate bathroom &
bedroom
• Avoid sharing household items
• To remain free from any kinds of rumour & stigma
66. • Planning & development
• Current scenario
• Vaccine types & mechanisms
• Efficacy & action against variants
• Chief vaccines & trial results
• Other approved vaccines & vaccines pending authorization
• Distribution & inequality concerns
• India’s vaccine development & distribution
• General prevention strategies
• Hospital preparedness
67. Components
How Should U.S. Hospitals Prepare for Coronavirus Disease 2019 (COVID-19)? Ann Intern Med. Published online March 11,
2020. doi:10.7326/M20-0907
68. Preparing for Triage
• At healthcare facility entrance to direct patients to
– Telemedicine facility
– Those with fever and respiratory symptoms like cough or
breathing difficulty – immediately proceed to triage or
registration desk
• Additional symptoms to consider
– Chills
– Repeated shaking with chills
– Muscle pain
– Headache
– Sore throat
– New loss of taste or smell
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
69. Protecting the healthcare personnel
• Install physical barriers (e.g. glass/plastic
screens) at registration desk with 1 m at-least
distance
• Identify isolation rooms or separate well-
ventilated rooms for suspected patients
• Provide masks/ face covers for all patients
visiting the HCF
• Convenient access to hand hygiene products
• Should wear gowns, gloves, face mask, and
eye protection
• Only doing emergency procedures
• Mandatory telemedicine facilities
72. Fans in isolation wards – key factors
• Cool ambient temperature
through dissipation of
radiant heat
• Provide directionality in
order to improve
ventilation
• Direction of fans should
deflect air away from
health care workers
73. How to ensure surgeons safety
• Elective surgeries should be postponed
• Take precautions when performing Aerosol-
Generating Procedures (AGPs)
• Operating rooms should be allocated and
signs posted on the doors to minimize staff
exposure
• If no general anesthesia:
– Patient should continue to wear the surgical
mask
• If general anesthesia used:
– Place a HEPA filter between the Y-piece of the
breathing circuit and the patient's mask,
endotracheal tube or laryngeal mask airway
– If available, use a closed suction system during
airway suctioning
https://journals.lww.com/annalsofsurgery/Documents/Managing%20COVID%20in%20Surgical%20Systems%20v2.pdf
https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus
https://doi.org/10.1007/s12630-020-01617-4
74. Take home messages
• COVID vaccination is one of the greatest & fastest scientific
discovery of mankind
• India didn’t lag behind in technological expertise to build a
top quality vaccine indigenously
• US EU nations have vaccinated in pretty organized manner
• India had started vaccination in a quite efficient manner
but anti-vaccination campaigning dampened the spirit
initially
• The second wave & appearance of variants have compelled
citizens to take jabs currently
• Prevention strategies should be very proper in health care
settings
• Telemedicine facilities needs to be encouraged
77. Hand hygiene
DO
• Hand washing with soaps &
water for at-least 40 sec or
using alcohol based
handrubs
• Especially after you have
been in a public place, or
after blowing your nose,
coughing, or sneezing
• Of your hands and rub them
together until they feel dry
DONT
Touch your eyes, nose, and
mouth with unwashed
hands
touch surfaces like door knobs
and door bells, elevator
buttons,handrails, support
handles, chair backs, atm ,
mobiles
78. Respiratory hygiene
Do
• Use handkerchief/tissue
while coughing/sneezing
• Throw the tissue
immediately in dustbin
• Cover sneeze into bent
upper arm
• Wash hands immediately
DONT
• Spit in open
• Use other ways of covering
face
79. Social distancing
Do
• STAY AT HOME UNLESS
ABSOLUTELY NECESSARY
• KEEP A DISTANCE OF AT
LEAST ONE METER
BETWEEN YOURSELF AND
ANOTHER PERSON
Dont
• DO NOT HOLD EVENTS
WHEREPEOPLE HAVE TO
GATHER (EVEN IF IT IS A
CORNER MEETING WITH
THREE OR FOUR FRIENDS, OR
AN EVENING CHAT ON THE
CHAUPAL)
• •DO NOT GO TO CROWDED
PLACES LIKE MARKETS,
SHOPPING, MELAS, PARTIES
• •DO NOT USE PUBLIC
TRANSPORT
80. ZyCoV-D vaccine
• DNA vaccine
• Plasmid expressing SARS-CoV2 protein
• First of its kind
• On its way to becoming the 1st DNA vaccine to
get approval
• 1st vaccine to get authorization between age
group 12-18
81. Vaccines approved below 18 yrs of age
• Pfizer approved for age 12-16
• Pfizer/Moderna/Novavax/Johnson undergoing
trial for children from 6 months to 11 years
• Covaxin undertaking trial in children
• Bharat biotech’s nasal vaccine incorporated
children
82. Clotting abnormalities in OA vaccines
• Blood coagulation with thrombocytopenia to be listed
as very rare S/E of Vaxzevria
• Generally occurring within 2 weeks
• Mostly in women < 60 years
• Among 20 million vaccination, only 25 cases reported
• Examples: CVT/splanchnic venous thrombosis
• Pathology similar to HIT
• Possibly antibody developing against P4
• All cases notified from Europe only; notably UK
• Benefit outweighs risk