TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Narayana Holla
  2. Programme management
  3. Sunday, 12 July 2020

Dear all 

Greetings from KVG team and wish to share the following with the viewers for needful.

Write-up

As per World Health Organization (WHO) there is "no evidence" that the BCG vaccine protects against COVID-19. Initially, WHO also stated that there were no enough evidences of airborne transmission of COVID-19.

However, an international team of researchers from India, China, Italy and the United States has found “association” between populations who had high levels of bacillus Calmette-Guérin (BCG) vaccinations, a common tuberculosis vaccine, and lower levels of COVID-19 mortality by manifold.

To study the impact of BCG vaccination on COVID-19 pandemic, in terms of i) cases and ii) deaths per million population among 5 age groups, viz. below 15yrs, 15-44, 45-64, 65-79, and above 80 years; based on world data from the “BCG Atlas” as of may 2020, the countries were classified into following three groups:

1) countries that never adopted a national BCG vaccination program,

2) countries that had a mass BCG vaccination program but discontinued it, and

3) countries with an active national BCG immunization policy.

The study revealed "significant differences in mortality in all age groups found between the vaccinated and unvaccinated countries, although there were no differences between the unvaccinated countries and those that have discontinued vaccination".

Epidemiologist from WHO expressed that "several countries now have rapidly escalating COVID-19 outbreaks with dynamic data / situation. So, it is dangerous to make conclusions in such a dynamic situation with ecologic correlations”.

Hope the authorized research teams will develop a sound research protocol for obtaining further evidences for universal acceptance or rejection or otherwise -- (region/country specific).

Added to this, in the recent past, quite a few studies were shared through social media iterating that live attenuated vaccines like MMR are also partially if not fully effective in favorably modifying the outcome of COVID-19.

Doctors including pediatricians and physicians have started getting themselves vaccinated with MMR/MR with a faith that they will be at least partially protected against Corona virus [SARS-CoV-2].

Vaccinating to “Immunize”: 

Whether the live attenuated vaccines through their specific protection or “extra-specific protection” help in preventing the specific diseases and COVID-19 in addition depends on the quality of vaccination services at the delivery points from outreach to Medical Colleges. CDC insists “7 Rights” of Vaccine administration to be adhered for ensuring optimal “immunization” of the beneficiaries, to this KVG team added the 8th right as country specific – the 4 key messages and now the 9th – COVID-19 guideline compliance.

Coming to the home district and the state, ~70% birthing are occurring in the private facilities. BCG is administered once in life time, currently as newborn vaccine along with Zero OPV and HepB birth dose. However the quality of service is not uniform. Generally in the public sector, a vaccine carrier with all these vaccines are placed in the labor room, the newborn gets vaccinated within 24 hrs adhering to all the guidelines as per WHO/GoI/GoK. ~30% of the newborns, born in the public sector are the blessed ones to get properly vaccinated, all 3 vaccines dressed with VVM too. But in private sector, some of the pioneer medical colleges have not yet started administering newborn BCG vaccine, permanently depriving the opportunity, some are not administering both BCG and HepB birth dose. This was repeatedly shared with the stakeholders from local to central level.

In this regard KVG team posted “The Scar – Am I Immunogenic or Ulcerogenic” in the past [https://www.technet-21.org/en/forums/discussions/the-scar-am-i-immunogenic-or-ulcerogenic]  

Evidences are ever green; anyone with a standard supportive supervision checklist can document both for qualitative and or quantitative purposes anywhere and anytime in the district / state / country for collecting data for appropriate instantaneous & sustained action.  

Solution: Is very simple, through proactive and active participation by the stakeholders from both the sectors to acquire the knowledge and skill – especially administration of BCG intradermally is the key to success. Regular supportive supervision of service delivery in both the sectors will sustain the quality forever, through extra specific protection or extra vaccinal properties, population may get benefitted even against adult DM, tropical Buruli ulcer, now against COVID-19 as claimed.

Expectation: Hope the designated / dedicated authorities & service providers will look in to the quality for their own and their children’s health promotion.       

 With regards

Holla n Team

 

Narayana Holla Accepted Answer

Thank you for raising a quiery.

Live attenuated vaccines like BCG elicit innate and adaptive immunity responses. Extra vaccinal or extra specific properties of BCG are available in the WHO vaccine position paper also not aginst corona in particular. Now ICMR has approved astudy on this in India wherein as per available news, BCG will be administered to old people as they are facing high mortality rate.

On reading similar study reports on MMR, doctors have started getting themselves vaccinated with MMR in India. Few Physicians came to our dedicated vaccination clinic demanding for MR vaccine and were administered as a part of adult vaccination schedule whether it helps in providing protection against COVID-19 or not is immeterial for us and the same is made clear to the recepients while administering to avoid "false security" if any.

Regarding Innate and Adaptive responses, immunologists can convincingly responded in detail. .

However, administering any vaccine in potent condition along with other standards of delivery services is mandatory.

The concern is that in some pioneer medical colleges and tertiary care centers in India, BCG is denied to the newborns and a few have denied / delayed HepB birth dose also though included in the National Immunization schedule / IAP schedule.

As expressed by private practitioners, costlier vaccines are “pushed” with little adherence to either the approved schedule or the “rights” to be observed. e.g. in private sector VVM is available for OPV and Rota vaccine in liquid form, rest are yet to be dressed with VVM in India. BCG reconstituted with diluent at room temperature / with distilled water for injection when proper diluent was not available. Often reconstiuted multidose MCVs are administered on following day(s) also. Many such evergreen programmatic errors occurring especially in the private sector, affecting mainly the children of elites (doctors/engineers/nurses/corporates….); may not protect the beneficiaries even against specific diseases.

These are avoidable and correctable. In the near future, vaccine for COVID-19 may be available as we got limited doses (1,24,200 doses of H1N1 – Panenza vaccine for Karnataka State, administered by the trained HCWs from the state government) in 2010.

Vaccines need to be administered (not pushed) as per quality guidelines for its expected outcome.   

best wishes

  1. more than a month ago
  2. Programme management
  3. # 1
Narayana Holla Accepted Answer

Thanks for raising this query.

Immunologists and the researchers in this field are the better persons to explain this.

Whether specific or extra specific (non-vaccinal), Concern is quality of vaccination services; should be of acceptable standard to administer the antigen in potent condition, timely as per schedule........... e.g. in the field many programmatic errors were found and happening like using wrong diluent, diluent kept at room temperature, Sub-cutaneously instead of Intra-deramal route, using reconstituted vials even on following days.......; vaccine not included in the newborn vaccination schedule in some pioneer medical colleges in India etc.

These are correctable through sustained supportive supervision / country specific operational measures.

Shortly the world may be using vaccine for COVID-19 too. The culture of administering vaccine (not pushing vaccine) adhering to the recommeded standard has to happen at service delivery point irrespective public or private sector.

best wishes    

  1. more than a month ago
  2. Programme management
  3. # 2

How can the live attenuated vaccines through their specific protection or “extra-specific protection” help in preventing the specific diseases and COVID-19 in addition depends on the quality of vaccination services at the delivery?

  1. more than a month ago
  2. Programme management
  3. # 3


There are no replies made for this post yet.
Be one of the first to reply to this post!