Effectiveness of ChAdOx1 nCoV-19 coronavius vaccine in preventing severe disease and mortality during the second wave of pandemic:A case-case analysis from a tertiary care center in South India

Objective:To determine the real-world effectiveness of the ChAdOx1 nCoV-19 coronavirus vaccine in preventing severe disease and mortality due to COVID-19.Methods:A case-case design was used to estimate the effect of the ChAdOx1 nCoV-19 coronavirus vaccine on severe SARS-CoV-2 outcomes in individuals aged 40 years and above.Cases(n=200)were COVID-19 patients admitted to intensive care unit(ICU)or who died.Controls(n=223)were those with mild COVID-19,fit for home isolation.The logistic regression model was used to estimate adjusted vaccine effectiveness for full vaccination(two doses≥14 d)and partial vaccination status(one dose≥14 d or two doses<14 d).Results:The proportion of fully vaccinated individuals was significantly lower among cases(12,6.0%)compared to controls(30,13.5%).The adjusted effectiveness of a full dose of ChAdOx1 nCoV-19 coronavirus vaccine in preventing ICU admission or death was 81.9%(95%CI:61.3%-91.6%,P=0.001).Subgroup analysis restricted to age group,sex,and comorbidities found that ChAdOx1 nCoV-19 coronavirus vaccine had a significant positive effect in all subgroups and categories.Conclusion:COVID-19 vaccination reduces ICU admissions or death.Therefore,increased vaccine uptake may reduce the severity of the pandemic,more so in the elderly and those with comorbidities.

Rapid progressive vaccine-induced immune thrombotic thrombocytopenia with cerebral venous thrombosis after ChAdOx1 nCoV-19(AZD1222)vaccination:A case report

BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia(VITT)is a rare and potentially life-threatening condition after receiving coronavirus disease vaccines.It is characterized by symptom onset at 5 to 30 d postvaccination,thrombocytopenia,thrombosis,high D-dimer level,and antiplatelet factor 4(anti-PF4)antibody positivity.VITT can progress very fast,requiring urgent management.Only few studies have described its detailed clinical course and imaging changes.We report a typical VITT case in a patient who underwent regular repeated brain imaging examinations.CASE SUMMARY A young woman presented with headaches at 7 d after the ChAdOx1 nCoV-19vaccine(AZD1222)injection.She then showed progressive symptoms of left upper limb clumsiness.Brain computed tomography revealed venous infarction at the right parietal lobe with a hyperacute thrombus in the cortical vein.Two hours later,brain magnetic resonance imaging revealed hemorrhage at the same area.Magnetic resonance venography showed an irregular contour of the right transverse sinus.Laboratory examination revealed a high D-dimer level,thrombocytopenia,and a high titer for anti-PF4 antibodies.She was treated with anticoagulants,intravenous immunoglobulin,and steroids and analgesic agents were administered for pain control.She had a marked improvement on headaches and clumsiness after treatment along with radiological thrombus resolution.During follow-up at the outpatient department,her modified Rankin scale at 90 d was 1.CONCLUSION Clinicians should be alerted whenever patients present with persistent and progressive headaches or focal motor/sensory deficits postvaccination.

Recurrent Coronary Artery Thrombosis on Triple Anti-Thrombotic Therapy, Is There a Possible Association with ChAdOx1 nCoV-19 Vaccination?

Background: Vaccines remain the only viable and safe option to control transmission and minimise disease sequelae during the COVID-19 pandemic. Whilst multiple vaccines are available, evidence has emerged regarding the association between the ChAdOx1 nCoV-19 vaccine, platelets and thrombosis, manifesting in thrombotic thrombocytopaenia. Case Summary: We report a case of recurrent coronary artery thrombosis on triple antithrombotic therapy, namely aspirin, clopidogrel, and continuous intravenous heparin, nine days after the ChAdOx1 nCoV-19 vaccine, in a 63-year-old female with no significant history of cardiovascular disease. Conclusion: This case may suggest that the association between platelets, SARS-CoV-2, the ChAdOx1 nCoV-19 vaccine, and coronary thrombosis may remain incompletely understood and warrants further study. Clinicians should remain on high alert if presented with similar circumstances.

A rare presentation of Guillain-Barre syndrome with GQ1b positivity:A case report

Rationale:To report a case of cervicobrachial variant of acute inflammatory demyelinating polyneuropathy presenting with papilledema and GQ1b positivity.Patient concern:A 35-year-old female,68 days postpartum,presented with headache,vomiting,and gait difficulty in swallowing with bilateral upper limb weakness and difficulty in walking,13 days after ChAdOx1 nCoV-19 vaccination.Diagnosis:Guillain-Barre syndrome with GQ1b positivity.Intervention:Five cycles of plasmapheresis were given.Outcome:The patient’s clinical condition improved.Palatal weakness improved and she could walk without support.There were mild sensory symptoms involving upper limbs which gradually improved.Lessons:AIDP should be considered in case of weakness following ChAdOx1 nCoV-19 vaccination.Albumino-cytological dissociation and anti-GQ1b positivity are needed to confirmed the diagnosis.