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Questions and Answers
What is the estimated occurrence rate of Thrombosis with Thrombocytopenia Syndrome (TTS) in the general population following vaccination?
Which demographic group is most commonly affected by Thrombosis with Thrombocytopenia Syndrome (TTS)?
What was the reported rate of potential blood clot cases related to the Covishield vaccine by the Indian government in May 2021?
What classification did the WHO include.Vaccine-induced immune thrombotic thrombocytopenia (VITT) into in 2023?
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Which of the following statements accurately reflects the Indian government's stance on the Covishield vaccine?
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What immune reaction is associated with the Thrombosis with Thrombocytopenia Syndrome (TTS)?
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Why did several European countries temporarily pause the use of AstraZeneca's vaccine in March 2021?
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What was the primary reason the Indian government cautioned against the use of Covishield for certain individuals?
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What was the first confirmed death associated with COVID-19?
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Which of the following statements is true about SARS-CoV-2?
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Which organization was the first to approve a COVID-19 vaccine?
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Who developed the first laboratory-produced vaccine?
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What significant event occurred on 11 March 2020?
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In what year did the WHO adopt the goal of universal vaccination?
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Which vaccine was developed in India for plague in 1897?
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What does the acronym ICMR stand for?
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What is the mortality rate of SARS-CoV-1 approximately?
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Which of the following organizations oversees the Central Drug Standard Control Organization in India?
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What mechanism does the Oxford-AstraZeneca vaccine utilize to trigger an immune response?
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Which of the following correctly states the founder companies of AstraZeneca?
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What was the first country to suspend the AstraZeneca vaccine?
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Which side effect is associated with the AstraZeneca vaccine?
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Which type of COVID-19 vaccine is characterized by using harmless viral vectors?
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Which pandemic was the first historically recorded Old World pandemic of plague?
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From which region did the Spanish flu likely originate?
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Which virus led to the AIDS pandemic starting in 1981?
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What technique is used by the mRNA vaccines such as Pfizer and Moderna?
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What was the death toll of the Black Death pandemic?
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Study Notes
Thrombosis with Thrombocytopenia Syndrome (TTS)
- A rare adverse side effect linked to the Oxford-AstraZeneca vaccine (Covishield in India).
- Caused by an immune reaction triggered by adenovirus vectors, which are used to deliver the vaccine's genetic material.
- Characterized by a low platelet count (thrombocytopenia) and blood clotting (thrombosis).
- More common in healthy young women around thirty years old.
- Occurs at a frequency of about one to two cases per 100,000 vaccinations.
- Estimated to occur in only about two to three cases per million vaccinated people at the general population level.
- Several European countries temporarily paused the use of the AstraZeneca vaccine in March 2021 due to reported cases of blood clotting.
- European nations, the UK, USA, and Australia halted the use of Covishield due to TTS reports, despite the benefits outweighing the risks.
Covishield and the Indian Government
- India has administered nearly 1.75 billion doses of Covishield, vaccinating approximately 80% of its vaccinated population.
- The Indian government issued a fact sheet in January 2021 cautioning the use of Covishield for individuals with low platelet counts.
- In May 2021, the Indian government reported 26 potential cases of blood clots related to Covishield, with a rate of 0.61 cases per million doses.
- The government maintains that the risk of TTS is minimal and that Covishield has a positive benefit-risk profile.
- No TTS events were reported for the indigenous vaccine, Covaxin (by Bharat Biotech).
- The Ministry of Health and Family Welfare, GoI, notes that the risk of blood clotting is lower in individuals of South and Southeast Asian descent compared to those of European descent.
Oxford-AstraZeneca Vaccine
- Developed in the United Kingdom by Oxford University and AstraZeneca.
- Uses a modified chimpanzee adenovirus ChAdOx1 as a vector.
- Viral vector vaccine containing the full-length codon-optimized coding sequence of SARS-CoV-2 spike protein along with a tissue plasminogen activator (tPA) leader sequence.
- Arose from collaboration between Oxford University's Jenner Institute and Vaccitech, a private company spun off from the university.
- Funded by Oxford Sciences Innovation, Google Ventures, and Sequoia Capital, among others.
- First country to issue a temporary or emergency approval for the vaccine was the UK.
- The first person to receive the vaccine outside of clinical trials was vaccinated on 4 January 2021.
- Denmark was the first country to suspend the use of the AstraZeneca vaccine.
Other Side Effects of the AstraZeneca Vaccine
- Cerebral venous sinus thrombosis (CVST), which is the presence of blood clots in the brain.
- Guillain-Barré syndrome, an immune system disorder that attacks the nerves.
- Myocarditis and pericarditis, conditions involving inflammation of the heart tissue.
AstraZeneca: The Company
- British-Swedish pharmaceutical company headquartered in Cambridge, UK.
- Founded in 1999 through the merger of Astra AB (Sweden) and Zeneca Group (UK).
- Current chairman is Michel Demaré.
- Current CEO is Pascal Soriot.
Types of COVID-19 Vaccines
- Whole virus: Live attenuated and inactivated types. Covaxin (India) is an inactivated type.
- Protein subunit: Viral subunit mixed with adjuvants. Novavax is an example.
- mRNA (nucleic acid): RNA code of SARS-CoV-2 inserted into the host cell. Pfizer and Moderna vaccines are examples.
- Viral vector: Deliver genetic instructions to produce antigens using harmless viral vectors like adenovirus. Covishield and Sputnik V (Russia) are examples.
Pandemics
- Smallpox: 8000 BCE to 1979. Originated in northeastern Africa. Affected worldwide. Mortality rate of 30%. Caused by variola major and minor viruses.
- Antonine Plague: 165 to 180 AD. Affected the Roman Empire. Originated near the East. Smallpox or measles. Death toll estimated at 5 to 10 million.
- Plague of Justinian: 541 to 549 AD. First pandemic. Bubonic plague. Affected North Africa, Europe, and West Asia. Originated in the Tian Shan Mountains, China. Death toll estimated at 15 to 100 million.
- Black Death: 1346 to 1353 AD. Bubonic plague. Affected Europe, Asia, and North Africa. Originated in Central Asia. Death toll estimated at 25 to 30 million.
- Cocoliztli: 1545 to 1578 AD. Originated in Europe. Affected the Aztec Empire (Mexico). Ebola virus. 5 to 15 million people died.
- Syphilis: 1490s to 1928. Originated in the Americas. Affected Europe. Caused by Treponema pallidum. Deaths unreported.
- Cholera: 1846 to 1860. Originated in India. Affected worldwide. Caused by Vibrio cholerae. Millions died.
- Third Plague Pandemic: 1855 to 1960. Bubonic plague (Yersinia pestis). Affected mainly China and India. Originated in China. Death toll estimated at 12 million.
- Influenza: 1889 to 1890. Human coronavirus OC43. 1 million deaths. Affected worldwide.
- Spanish Flu: 1918 to 1920. Influenza H1N1. 17 to 100 million people died. Most probably originated in the United States.
- AIDS: 1981 to present. Originated in West Africa. Affected worldwide. HIV. 70 million infections. 36 million deaths.
- COVID-19: 2019 to present. SARS-CoV-2. Originated in Wuhan, China. WHO declared a public health emergency on Jan 30, 2020. Outbreak to pandemic on March 11, 2020. The WHO ended the PHEIC for COVID-19 on May 5, 2023. 5th deadliest pandemic in human history with confirmed 7,054,878 deaths. The first confirmed death was in Wuhan on January 9, 2020.
SARS-CoV-2
- 7th SARS-CoV to infect the world.
- Part of the coronavirus family.
- Single-stranded RNA virus.
- Caused the 2019 COVID-19 pandemic.
- Variants include alpha, beta, gamma, delta, omicron, and FLIRT.
SARS Outbreak (2002-2004)
- Severe acute respiratory syndrome coronavirus.
- Caused by SARS-CoV-1.
- Declared contained by WHO in 2003.
- Originated in Shunde, China.
- First SARS outbreak.
SARS-CoV-1
- Part of the coronavirus subfamily.
- Single-stranded RNA virus.
- Affects the epithelial cells within the lungs.
- Mortality rate around 9%, higher for infants and older adults.
- Caused the 2002-2004 SARS outbreak.
- Identified in 2003.
History of Vaccines
- First ever use was in China when people were inoculated with cowpox to treat smallpox.
- The Chinese also practiced the first form of variolation, recorded in Wan Xuanh’s Douzhen Xinfa of 1549.
- 1796: Edward Jenner injected an 8-year-old boy, James Phipps, with a cowpox vesicle in Berkeley, England.
- 1798: Jenner published An Inquiry Into the Causes and Effects of the Variolæ Vaccinæ.
- 1800: The term "vaccination" was coined by surgeon Richard Dunning in his text Some Observations on vaccination.
- Vaccination arrived in India in 1802 when Scottish physician Henelus Scott vaccinated a dozen people in Bombay.
- Anna Dusthall was the first person to be vaccinated in India.
- 1974: WHO adopted the goal of universal vaccination by 1990 to protect children against six preventable infectious diseases: measles, poliomyelitis, diphtheria, whooping cough, tetanus, and tuberculosis.
- 2000: The Global Alliance for Vaccines and Immunization was established to strengthen routine vaccinations and introduce new vaccines in countries with a per capita GDP of under US$1000.
- Dr. Haffkine developed the plague vaccine in 1897, the first vaccine developed in India.
Other Important Vaccines
- 1872: Louis Pasteur develops the first laboratory-produced vaccine: the vaccine for fowl cholera in chickens.
- 1885: Louis Pasteur successfully prevents rabies through post-exposure vaccination.
- 1921: First vaccine for tuberculosis developed by Albert Calmette.
- 1952: First vaccine for polio developed.
- 2023: First vaccine for Chikungunya developed.
Vaccine Regulation in India
- The Drugs and Cosmetics Act of 1940 and Rules of 1945 and the New Drugs and Clinical Trials Rules of 2019 specify the requirements and guidelines for CMC (chemistry, manufacturing, and controls) for all manufactured and imported vaccines.
- The Directorate General of Health Services, the Ministry of Health and Family Welfare (MoHFW), and the Government of India oversee the Central Drug Standard Control Organization (CDSCO), a national regulatory agency led by the Drug Controller General of India (DCGI).
- Current Drug Controller General of India: Dr. Rajeev Singh Raghuvanshi.
BBIL and ICMR Controversy
- Recent update: BBIL (Bharat Biotech International Limited) has initiated the process to include ICMR (Indian Council of Medical Research) as a co-owner of Covaxin after it was claimed that BBIL took sole credit for India's first indigenously developed COVID-19 vaccine.
Important Organizations
-
Serum Institute of India (SII): Partnered with AstraZeneca for Covishield production in India.
- Established in 1966.
- CEO: Adar Poonawala.
- Headquarters: Pune, India.
-
Bharat Biotech (BBIL): Developed Covaxin, India's indigenous COVID-19 vaccine.
- Established in 1996.
- Founder and Managing Director: Dr. Krishna Ella.
- Headquarters: Hyderabad, India.
-
Indian Council of Medical Research (ICMR):
- Formed in 1911 as IRFA (Indian Research Fund Association).
- Headquarters: New Delhi, India.
- Current Head: Rajiv Bahl.
- Parent organization: Ministry of Health and Family Welfare (MoHFW).
Random
- The genetic sequence of SARS-CoV-2 was available in 2020, enabling vaccine development.
- The UK became the first country to approve a COVID-19 vaccine (Pfizer-BioNTech vaccine).
- 2021: Russia announced the first registered COVID-19 vaccine for animals called Carnivac-Cov.
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Description
Test your knowledge on Thrombosis with Thrombocytopenia Syndrome (TTS), a rare side effect associated with the Oxford-AstraZeneca vaccine. This quiz covers the mechanisms, prevalence, and responses from governments, especially in India. Understand the implications of TTS in the context of vaccination.
