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Covid jabs found to be effective for pregnant women and their babies – Kent Live

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Covid vaccines are proving highly effective in pregnancy, according toa newly published studyin the American Journal of Obstetrics and Gynecology. It has also found that mothers who have been vaccinated are passing on precious immunity to their newborns.

A group of researchers in Massachusetts studied pregnant women’s response to two approved mRNA vaccines – Pfizer/BioNTech and Moderna/NIH. The women were vaccinated either during pregnancy or while breastfeeding, and their ability to produce virus-specific antibodies was compared to that of vaccinated, non-pregnant women.

While the small number of women included in this study – 131 – is a limiting factor, it nonetheless provides very important early insight into the safety and effectiveness of COVID-19 vaccination in pregnancy. This matters, because new infectious diseases can come with all kinds of risks for women during pregnancy and childbirth, as well as in the neonatal phase. All of these risks need to be considered when making healthcare decisions related to pregnant women and, in particular, when considering vaccine strategies.

Known risks

While there remains a lot that we don’t yet know about the effects of COVID-19 on pregnant women and their babies, there are some things we do know.

In early pregnancy, the virus is not associated with an increased chance of miscarriage. Vertical transmission – where the virus passes from the mother to the baby in the womb – is relatively rare. And babies seldom get sick.

We also know that, overall, pregnant women tend to have milder symptoms than the general population. However, they remain at greater risk of complications including placental inflammation and can become very ill. This in turn can lead to an increased likelihood of being admitted to intensive care and giving birth prematurely. As within the general population, pregnant women who are Black or Asian, as well as those who are obese, are at greater risk of severe COVID-19.

Now, of course, vaccination would prevent these outcomes. However, women are typically not included in any early vaccines trials if they’re pregnant. It is only now that data relating specifically to the response to the vaccine of pregnant and breast-feeding women are emerging. The work published in this paper is the first study to address this, making it incredibly valuable.

Antibody response

The Massachussets study focused on 84 pregnant women, 31 who were breast-feeding and 16 who were neither. The women each received two doses – what is known as prime and boost – of one of the vaccines. They had blood taken with each dose, and again up to six weeks after the second.

These blood samples were used to track the women’s antibody responses to the virus. The results were conclusive. All the women – both pregnant and breast-feeding – were found to have robust immunity, comparable to that of the non-pregnant women. And, this immunity increased with time, post-vaccination.

The researchers compared these findings with the antibody response in pregnant women who had contracted the virus naturally. This enabled them to show that the level of antibodies made in response to the vaccines far exceeded those made in response to natural infections.

Passive immunity

One important reason to vaccinate pregnant women is so they can in turn provide their antibodies to the baby. This is known as passive immunity and it occurs when a mother is infected naturally or when she is vaccinated. The antibodies she produces are passed to her baby through the placenta or via breast milk. This affords the baby protection against infectious diseases it might come in contact with while its own immune system is still maturing. It is one of the reasons, for example, that pregnant women in many countries, including the UK, are encouraged to be vaccinated for flu and whooping cough.

When the babies in the study were delivered, the researchers studied blood samples from their umbilical cords. They found virus-specific antibodies in every sample. This shows that vaccinated mothers are passing antibodies to their babies through the placenta, in keeping with what we know from studies in natural infection. They also found virus-specific antibodies in breast milk from the women who were breastfeeding when vaccinated, which means that passive immunity is taking place via this route as well.

The investigators in this study were also able to provide some insight into when in pregnancy might be the best time to vaccinate pregnant women. Vaccinating women in different trimesters of their pregnancies did not affect antibody levels. This suggests that women can make a robust response to the vaccine at any stage of pregnancy.

In contrast, the analysis of umbilical cord blood shows that the second dose of a vaccine is important for maximising passive immunity for the baby. The lowest levels of antibodies in the umbilical cord samples came from a woman who delivered her baby before the second dose. The ability of the antibody to stop the entry of the virus into cells and cause infection also seems to need the boost dose. This suggests that having both doses before giving birth is critical to ensuring the baby gets the most protection possible.

Next steps

There have been recent calls for pregnant women to be included at the early stages of vaccine trials, in order to limit delays in protecting them and their newborns. This study supports those calls.

It also highlights important next steps. Larger studies are needed to investigate when the best time in pregnancy is to vaccinate. These should include more detailed analysis of how the mothers respond to the vaccine at different stages of pregnancy, whether the vaccine prevents placental inflammation and preterm birth, and what effects this timing might have for passive immunity in newborns.

It points to other important questions too. How effective is the immunity transferred to the infant? And how long-lived is vaccine-induced viral immunity in the mother when the vaccination is made during pregnancy? We will need more studies to answer these questions.

Catherine Thornton, Professor of Human Immunology, Swansea University and April Rees, PhD Researcher in Immunology, Swansea University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Canada will not restrict AstraZeneca COVID-19 vaccine, says benefits outweigh risk

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OTTAWA (Reuters) – Canada‘s health ministry said on Wednesday it would not restrict use of AstraZeneca Plc’s COVID-19 vaccine after a review showed the benefits outweighed the very rare risk of blood clots.

A separate advisory council had earlier recommended Canada stop offering the vaccine to people under 55. The panel is now reviewing that advice, the health ministry said in a statement.

Denmark on Wednesday became the first country to stop using the vaccine altogether over a potential link to the rare blood clots. Other nations have imposed limits on its use.

But Health Canada, the federal health ministry, said in a statement that a review of data from Europe, Britain and AstraZeneca had not identified specific risk factors.

“Therefore, Health Canada is not restricting the use of the vaccine in any specific populations at this time … The potential risk of these events is very rare, and the benefits of the vaccine in protecting against COVID-19 outweigh its potential risks,” it said.

Canada on Tuesday said it had recorded its first case of blood clotting with low platelets after someone received the AstraZeneca shot. The patient in question, a woman from Quebec, is recovering. (Graphic on vaccines: https://tmsnrt.rs/3tUM8ta)

COVID-19 cases are surging in Canada with the country reporting a near-record number of new cases recently. (Graphic on cases: https://tmsnrt.rs/34pvUyi)

 

(Reporting by David Ljunggren in Ottawa and Allison Martell in Toronto; Editing by Lisa Shumaker)

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Factbox-Some countries limit AstraZeneca vaccine use, US pauses J&J shot

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(Reuters) -Some countries are restricting use of the AstraZeneca COVID-19 vaccine to certain age groups or suspending use after European and British regulators confirmed possible links to rare blood clots.

Denmark became the first country to stop using the vaccine altogether, as it said results of investigations showed “real and serious side-effects”.

Johnson & Johnson’s single-shot vaccine has also been hit by concerns over blood clots, with European regulators reviewing such cases and U.S. federal health agencies recommending pausing its use for a few days. J&J noted no clear causal relationship had been established between the clots and its vaccine.

The developments pose a risk to vaccination plans in Europe.

Regulators have said the benefits of the AstraZeneca shot outweigh risks.

Anglo-Swedish drugmaker AstraZeneca said it was working with regulators to list the possible brain blood clots as “an extremely rare potential side effect” on the vaccines labels.

As of April 4, the European Medicines Agency had received reports of 169 cases of a rare brain blood clot known as cerebral venous sinus thrombosis (CVST), after 34 million doses had been administered in the European Economic Area. Most cases were in women under 60 years of age.

ASTRAZENECA VACCINE BEING USED, WITH OR WITHOUT RESTRICTIONS

AUSTRALIA

Said on April 8 it recommends people under 50 should get Pfizer’s COVID-19 vaccine in preference to AstraZeneca’s shot.

AUSTRIA

Has resumed use.

BRAZIL

Authorities said they would not limit use of the AstraZeneca vaccine, saying benefits outweigh risks.

BRITAIN

The Joint Committee on Vaccination and Immunisation has said an alternative to the vaccine should be given for people under 30 where possible, but people should continue to have a second shot if they have received a first dose.

BULGARIA

Resumed inoculations from March 19.

CYPRUS

Resumed inoculations on March 19.

CANADA

Authorities said in early April they would pause offering the vaccine to people under 55 and require a new analysis of the shot’s benefits and risks based on age and gender. On April 13, the country said it had recorded its first case of blood clotting with low platelets.

ESTONIA

Suspended use of the vaccine for people under 60 on April 7.

FRANCE

Approved resumption of the vaccine on March 19 but said it should be given only to people aged 55 and over. On April 9, recommended that recipients of a first dose of the AstraZeneca shot who are under 55 should receive a second dose with a messenger RNA vaccine.

FINLAND

Resumed using the AstraZeneca vaccine from March 29, but only for people aged 65 and over.

GEORGIA

Has limited use of the vaccine following the death of a nurse from anaphylactic shock, and vaccinations will continue only in full-fledged medical centres, Russian news agency TASS reported on March 19.

GERMANY

Sticking to its guidance from March 31 to limit use of the vaccine to those aged over 60. On April 1, Germany’s vaccine commission recommended people under 60 who have had a first shot of the vaccine should receive a different product for their second dose.

HUNGARY

Continuing the vaccine’s rollout.

ICELAND

Resumed use on March 25 after suspending it on March 11.

INDONESIA

Resumed using the vaccine on March 22 but warned against its use in people with a low blood platelet count.

IRELAND

On April 12, the country said it was restricting use of the vaccine to those over 60.

ITALY

Has recommended the vaccine be used only for people over 60, the country’s top health adviser said.

LATVIA

Announced it was restarting administering the shots from March 19.

LITHUANIA

Restarted use on March 19.

MEXICO

Drug regulator Cofepris said on April 7 it did not “at this time” plan to limit the vaccine’s use but was investigating the information raised by Britain.

NETHERLANDS

Limited use of the vaccine to people over 60, the Dutch government said on April 8.

NORTH MACEDONIA

Health minister said on March 31 the vaccine would be limited to people aged over 60 as a precautionary measure.

PHILIPPINES

Suspended use of the vaccine for people under 60 on April 8.

ROMANIA

Has resumed use of the vaccine after temporarily stopping vaccinating people with one batch of the vaccine on March 11.

SOUTH KOREA

Resumed use of the shot for people aged 30 or older on April 12. On April 7, it had suspended providing the AstraZeneca shot to people under 60.

SPAIN

From April 8, it was giving the vaccine only to people over 60.

SWEDEN

Resumed use of the vaccine on March 25 for people aged 65 and older.

THAILAND

Began use on March 15 after delaying rollout the week before.

COUNTRIES WHERE ASTRAZENECA VACCINE USE SUSPENDED

CAMEROON

Suspended administration of the vaccine it was scheduled to receive on March 20 as part of the global vaccines sharing scheme COVAX, the health ministry said.

DENMARK

In a world first, Denmark decided to stop using the AstraZeneca vaccine altogether after initially suspending use of the shot.

NORWAY

Authorities said on March 26 Norway would delay a decision on use of the vaccine, with a decision expected by April 15.

J&J VACCINE DELAYS AND RESTRICTIONS

UNITED STATES

On April 13, U.S. federal health agencies recommended pausing use of J&J’s COVID-19 vaccine for at least a few days after six women under the age of 50 developed rare blood clots after receiving the shot.

EUROPEAN UNION

The company said it would delay the rollout of the vaccine to Europe, after regulators said they were reviewing rare blood clots.

Widespread use in the EU had not yet started after the company began delivering the doses in the week beginning April 12. The European drug regulator recommended storing doses already received until its safety committee issues an expedited recommendation

SOUTH AFRICA

Suspended use of J&J’s vaccine on April 13.

(Reporting by Pushkala Aripaka, Yadarisa Shabong, Manas Mishra, Vishwadha Chander, Amruta Khandekar and Mrinalika Roy in Bengaluru; editing by Josephine Mason, Alison Williams, Timothy Heritage, Larry King, Barbara Lewis)

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Ontario hospitals may have to withhold care as COVID-19 fills ICUs

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By Allison Martell and Anna Mehler Paperny

TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.

Canada‘s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.

The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.

Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.

Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.

The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.

“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.

“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”

In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.

Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.

“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”

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