Full-dose Vaccine Research Articles

Vaccination coverage of hepatitis B and associated factors among health care workers in Gansu province

ABSTRACT The investigation was conducted to describe the status of coverage of HBV vaccination among the health care workers in Gansu province and to explore the associated factors of HBV vaccination in this study. A cross-sectional study was conducted among 1544 health care workers from 64 hospitals in Gansu province. A self-designed questionnaire was used to interview the health care workers about HBV vaccination coverage. A multivariate logistic regression model explored the associated factors with HBV vaccination. The vaccination coverage was 89.17% for health care workers, nurses (90.40%) had the highest rate, followed by administration staff (89.38%) and medical technicians (89.30%). The full-dose HBV vaccination coverage was 64.25% for health care workers, and administration staff (65.04%) had the highest rate, followed by nurses (65.00%). This study found that the associated factors with HBV vaccination and full-dose vaccination were the history of training and the detection of serological indicators. The coverage of HBV vaccination among health care workers in Gansu province was high, but full-dose HBV vaccination coverage was low. It is necessary to strengthen the HBV knowledge and training in HBV prevention and treatment among health care workers in Gansu Province.

Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis.

With the emergence of SARS-CoV-2 variants that have eluded immunity from vaccines and prior infections, vaccine shortages and vaccine effectiveness pose unprecedented challenges for governments in expanding booster vaccination programs. The fractionation of vaccine doses might be an effective strategy for helping society to face these challenges, as fractional doses may have efficacies comparable with those of the standard doses. This study aims to investigate the relationship between vaccine immunogenicity and protection and to project efficacies of fractional doses of vaccines for COVID-19 by using neutralizing antibody levels. In this study, we analyzed the relationship between in vitro neutralization levels and the observed efficacies against both asymptomatic infection and symptomatic infection, using data from 13 studies of 10 COVID-19 vaccines and from convalescent cohorts. We further projected efficacies for fractional doses, using neutralization as an intermediate variable, based on immunogenicity data from 51 studies included in our systematic review. In comparisons with the convalescent level, vaccine efficacy against asymptomatic infection and symptomatic infection increased from 8.8% (95% CI 1.4%-16.1%) to 71.8% (95% CI 63%-80.7%) and from 33.6% (95% CI 23.6%-43.6%) to 98.6% (95% CI 97.6%-99.7%), respectively, as the mean neutralization level increased from 0.1 to 10 folds of the convalescent level. Additionally, mRNA vaccines provided the strongest protection, which decreased slowly for fractional dosing with dosages between 50% and 100% of the standard dose. We also observed that although vaccine efficacy increased with the mean neutralization level, the rate of this increase was slower for vaccine efficacy against asymptomatic infection than for vaccine efficacy against symptomatic infection. Our results are consistent with studies on immune protection from SARS-CoV-2 infection. Based on our study, we expect that fractional-dose vaccination could provide partial immunity against SARS-CoV-2 and its variants. Our findings provide a theoretical basis for the efficacy of fractional-dose vaccines, serving as reference evidence for implementing fractional dosing vaccine policies in areas facing vaccine shortages and thereby mitigating disease burden. Fractional-dose vaccination could be a viable vaccination strategy comparable to full-dose vaccination and deserves further exploration.

Menstrual cycle alterations in reproductive age women after anti COVID-19 vaccination. A survey in 419 Italian women and quality of life and sexual function evaluation.

Pharmacovigilance agencies did not collect data regarding menstrual changes after COVID-19 vaccination even if many women experienced it. Our aim was to evaluate whether COVID-19 vaccination is associated with secondary changes in menstrual cycle and to assess both quality of life (QoL) and sexual function (SF). This study is a retrospective analysis referred to our Department from January 2021 to December 2021. The study cohort responded to same questionnaires before the second dose of vaccination (referring to previous 3 months) and 3 months after that (referring to three menstrual cycles after full-dose vaccination). The surveys administered were FSFI, FSDS, SF-36, MEDI-Q and the VAS-scale for dysmenorrhea. Four-hundred-nineteen vaccinated women were included in the study. The survey did not show a significant change in menstrual cycle length before and after COVID-19 vaccine (5.88±3.67 vs. 4.97±2.89, P=0.21); the interval between periods was significantly higher after a full-cycle vaccination (28.32±7.34 vs. 32.38±7.45, P<0.02); 32 patients (7.6%) developed amenorrhea after the second dose; VAS Scale did not change significantly (median range 3 (3-5) vs. 4 (3-6), P=0.20). MEDI-Q did not show significant variations before and after the vaccination (43.21±11.65 vs. 40.28±9.88, P=0.35). QoL and SF did not change significantly (FSFI median 27 [24-29] vs. 28 [25-30], P=0.12, FSDS median 9 [5-11] vs. 8 [4-12], P=0.22), SF-36 median 81 [70-85] vs. 82 [72-86], P=0.43). COVID-19 vaccination is associated with a significant change in intervals between menstrual cycles without other alterations in menstrual characteristics, in QoL or SF.

Uptake of hepatitis B vaccination and associated factors among health sciences students, Mogadishu, Somalia.

Hepatitis B is a potentially fatal liver infection caused by the hepatitis B virus (HBV). It is a serious issue for global health. It considerably raises the risk of cirrhosis and liver cancer-related death and can result in chronic infection. The risk of infection is high among health sciences students due to the risk of occupational contact with fluids of infected patients and the risk of needle stick injury. The most effective way of preventing HBV infection is the vaccination of students prior to their posting to healthcare settings. There is no data available about HBV vaccination uptake among Health Sciences students in Somalia. Therefore, this study aimed to determine HBV vaccination uptake and associated factors toward HBV among health science students in Somalia. A cross-sectional study was undertaken among health sciences students from August to October 2022. Data were gathered using Kobo Toolbox using a standardized questionnaire with questions on characteristics, knowledge attitude, and HBV prevention practices. A total of 569 students were involved in the study. Stata version 15 was utilized for the analysis. Bivariate and multivariate logistic regression analysis, as well as descriptive statistics, were performed. In order to assess the existence and significance of the relationship between the outcome and risk factors, an adjusted odds ratio with a 95% confidence interval (CI) was used. Statistical significance was considered as a p-value ≤0.05. Of the 569 study participants, 33.4% (95%CI: 29.6-37.4) received a full dose of the HBV vaccine in this study. Participants had good HBV prevention knowledge, attitudes, and practices at 69.6, 37.96, and 50.6%, respectively. The lack of access and the high cost of the vaccine were the reasons for not taking the vaccine. Second-year [AOR: 0.22 (0.12-0.43)]. Positive attitude [AOR: 0.54 (0.31-0.93)], and good practice [AOR: 6.99 (3.62-13.5)]. The study indicated that 33.4% of health sciences students had received the required HBV vaccination doses, academic year, attitude, and practice were significantly associated with full-dose vaccination status. The unavailability of the vaccine and the high cost of vaccination were the most common reasons for not taking the vaccine. It is recommended that students receive vaccinations before beginning clinical rotations, and give instruction on infection prevention strategies and general precautions, particularly regarding HBV infection.

Evaluation of mpox vaccine dose-sparing strategies.

The spring-summer 2022 mpox outbreak had over 50,000 cases globally, most of them in gay, bisexual, and other men who have sex with men (MSM). In response to vaccine shortages, several countries implemented dose-sparing vaccination strategies, stretching a full-dose vaccine vial into up to five fractional-dose vaccines. Recent studies have found mixed results regarding the effectiveness of the mpox vaccine, raising the question of the utility of dose-sparing strategies. We used an age- and risk-stratified mathematical model of an urban MSM population in the United States with ∼12% high-risk MSM to evaluate potential benefits from implementing dose-sparing vaccination strategies in which a full dose is divided into 3.5 fractional doses. We found that results strongly depend on the fractional-dose vaccine effectiveness (VE) and vaccine supply. With very limited vaccines available, enough to protect with a full dose approximately one-third of the high-risk population, dose-sparing strategies are more beneficial provided that fractional doses preserved at least 40% of full-dose effectiveness (34% absolute VE), projecting 13% (34% VE) to 70% (68% absolute VE) fewer infections than full-dose strategies. In contrast, if vaccine supply is enough to cover the majority of the high-risk population, dose-sparing strategies can be outperformed by full-dose strategies. Scenarios in which fractional dosing was 34% efficacious resulted in almost three times more infections than full dosing. Our analysis suggests that when mpox vaccine supply is limited and fractional-dose vaccination retains moderate effectiveness, there are meaningful health benefits from providing a smaller dose to a larger number of people in the high-risk population. These findings should inform the public-health response to future mpox outbreaks.

Anti-SARS-CoV-2 spike receptor binding domain (S-RBD) IgG antibodies following CoronaVac administration: a longitudinal study. Anti-SARS-CoV-2 S-RBD IgG antibodies

Reports on antibody titers following CoronaVac administration are still scarce, particularly when it comes to the post-vaccination effectiveness of CoronaVac in the Indonesian population. The purpose of this study is to determine the efficacy of COVID-19 vaccination by comparing the IgG levels against the S1 subunit of SARS-CoV-2 RBD after the first and second vaccinations. The researchers collected venous blood samples from participants after they received the CoronaVac 600 SU/0.5 mL vaccine at two different intervals (14 days and 28 days). Blood was drawn twice (after the first and second vaccinations) and tested for antibodies (positive antibody detection value of 50 AU/mL). Paired data were analyzed by using either the Wilcoxon test (numerical) or the McNemar test (categorical). The median IgG1 levels in the 14-day interval between vaccine doses were 64.40 AU/mL and IgG2 levels were 886.10 AU/mL. Meanwhile, the median IgG1 level was 146.10, and IgG2 level was 688.00.AU/mL in the group with a 28-day interval between vaccine doses. After the first vaccination, 60.00 % of study subjects had positive IgG levels, which increased to 98.57% after the second vaccination. Following the full-dose vaccination, all participants had higher antibody levels, and considered significant. The effect was stronger in the group that received the vaccine at 14-day intervals. CoronaVac has also been shown to increase the prevalence of detectable antibody positivity in study participants.

A flexible age-dependent, spatially-stratified predictive model for the spread of COVID-19, accounting for multiple viral variants and vaccines.

After COVID-19 vaccines received approval, vaccination campaigns were launched worldwide. Initially, these were characterized by a shortage of vaccine supply, and specific risk groups were prioritized. Once supply was guaranteed and vaccination coverage saturated, the focus shifted from risk groups to anti-vaxxers, the under-aged population, and regions of low coverage. At the same time, hopes to reach herd immunity by vaccination campaigns were put into perspective by the emergence and spread of more contagious and aggressive viral variants. Particularly, concerns were raised that not all vaccines protect against the new-emerging variants. The objective of this study is to introduce a predictive model to quantify the effect of vaccination campaigns on the spread of SARS-CoV-2 viral variants. The predictive model introduced here is a comprehensive extension of the one underlying the pandemic preparedness tool CovidSim 2.0 (http://covidsim.eu/). The model is age and spatially stratified, incorporates a finite (but arbitrary) number of different viral variants, and incorporates different vaccine products. The vaccines are allowed to differ in their vaccination schedule, vaccination rates, the onset of vaccination campaigns, and their effectiveness. These factors are also age and/or location dependent. Moreover, the effectiveness and the immunizing effect of vaccines are assumed to depend on the interaction of a given vaccine and viral variant. Importantly, vaccines are not assumed to immunize perfectly. Individuals can be immunized completely, only partially, or fail to be immunized against one or many viral variants. Not all individuals in the population are vaccinable. The model is formulated as a high-dimensional system of differential equations, which is implemented efficiently in the programming language Julia. As an example, the model was parameterized to reflect the epidemic situation in Germany until November 2021 and future dynamics of the epidemic under different interventions were predicted. In particular, without tightening contact reductions, a strong epidemic wave is predicted during December 2021 and January 2022. Provided the dynamics of the epidemic in Germany, in late 2021 administration of full-dose vaccination to all eligible individuals (e.g. by mandatory vaccination) would be too late to have a strong effect on reducing the number of infections in the fourth wave in Germany. However, it would reduce mortality. An emergency brake, i.e., an incidence-based stepwise lockdown, would be efficient to reduce the number of infections and mortality. Furthermore, to specifically account for mobility between regions, the model was applied to two German provinces of particular interest: Saxony, which currently has the lowest vaccine rollout in Germany and high incidence, and Schleswig-Holstein, which has high vaccine rollout and low incidence. A highly sophisticated and flexible but easy-to-parameterize model for the ongoing COVID-19 pandemic is introduced. The model is capable of providing useful predictions for the COVID-19 pandemic, and hence provides a relevant tool for epidemic decision-making. The model can be adjusted to any country, and the predictions can be used to derive the demand for hospital or ICU capacities.

COVID-19 Full-Dose Vaccination Across Uninsured Populations: Evidence Across Counties in the United States

COVID-19 Full-Dose Vaccination Across Uninsured Populations: Evidence Across Counties in the United States

Lingering SARS-CoV-2 in Gastric and Gallbladder Tissues of Patients with Previous COVID-19 Infection Undergoing Bariatric Surgery

BackgroundLingering severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gut tissue might be a source of infection during bariatric surgery. This study aimed to confirm the presence of SARS-CoV-2 nucleocapsid in gastric and gallbladder tissues removed during bariatric surgery in individuals previously infected with coronavirus disease 2019 (COVID-19) who had negative polymerase chain reaction results prior to the surgery.MethodsGastric and gallbladder specimens from 80 patients who underwent bariatric surgery between November 2021 and May 2022 and had a history of COVID-19 infection with gastrointestinal symptoms were examined for the presence of lingering SARS-CoV-2 nucleocapsid proteins using immunohistochemistry.ResultsGastric specimens from 26 (32.5%) patients and 4 (100%) cholecystectomy specimens showed positive cytoplasmic staining for the anti-SARS-CoV-2 nucleocapsid protein in surface mucosal epithelial cells. The mean age was 37.8 ± 10.3 years. The average body mass index was 44.2 ± 7.0 kg/m2; most of the patients were females (71.3%). The positive staining group was significantly younger than the negative staining group (p = 0.007). The full-dose vaccination rate was 58.8%, with a median of 91 days after the last vaccine dose. A positive serological anti-spike IgG response was observed in 99% of the patients. The median time between initial COVID-19 infection and surgery was 274 and 380 days in the positive and negative staining groups, respectively (p = 0.371).ConclusionGastric and gallbladder tissues can retain SARS-CoV-2 particles for a long time after COVID-19 infection, handling stomach specimens from patients during an operation must be done with care, as we usually do, but now with the knowledge that in 1/3 of patients they can be present. Performing LSG on post-COVID patients did not seem to increase perioperative morbidity.Graphical

Two-Dose Vaccination Significantly Prolongs the Duration from Symptom Onset to Death: A Retrospective Study Based on 173,894 SARS-CoV-2 Cases in Khyber Pakhtunkhwa, Pakistan.

This research was carried out to quantify the duration from symptom onset to recovery/death (SOR/SOD) during the first four waves and the Alpha/Delta period of the epidemic in Khyber Pakhtunkhwa, Pakistan, and identify the associated factors. A total of 173,894 COVID-19 cases were admitted between 16 March 2020 and 30 November 2021, including 458 intensive care unit (ICU) cases. The results showed that the case fatality rate (CFR) increased with age, and females had a higher CFR. The median SOR of ICU cases was longer than that of non-ICU cases (27.6 vs. 17.0 days), while the median SOD was much shorter (6.9 vs. 8.4 days). The SOR and SOD in the Delta period were slightly shortened than the Alpha period. Age, cardiovascular diseases, chronic lung disease, diabetes, fever, breathing issues, and ICU admission were risk factors that were significantly associated with SOD (p < 0.001). A control measure, in-home quarantine, was found to be significantly associated with longer SOD (odds ratio = 9.49, p < 0.001). Infected vaccinated individuals had longer SOD than unvaccinated individuals, especially for cases that had received two vaccine doses (p < 0.001). Finally, an advice on getting full-dose vaccination is given specifically to individuals aged 20–59 years.

Pre-emptive oral cholera vaccine (OCV) mass vaccination campaign in Cuamba District, Niassa Province, Mozambique: feasibility, vaccination coverage and delivery costs using CholTool

IntroductionMozambique suffers from regular floods along its principal river basins and periodic cyclones that resulted in several cholera epidemics during the last decades. Cholera outbreaks in the recent 5 years...

Incidence of COVID-19 after vaccination in people with multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM

The objective of the study was to evaluate the incidence of COVID-19 after complete vaccination in people with multiple sclerosis (PwMS) included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177). Methodscohort study conducted between May 2021 and December 2021. The primary outcome was the appearance of infection during the follow-up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (date, symptoms, need for hospitalization, ventilatory assistance, treatment, and evolution). The contact was made every 30 days during the period of 3 months after the full dose vaccination. A positive COVID-19 case was defined according to the definition established by the Ministry of Health in Argentina. Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. ResultsA total of 576 PwMS were included, mean age 45.2 ± 13 years, 432 (75%) RRMS, 403 (70%) were female. The mean and median time of follow-up after the second dose was 91 ± 17 and 94 ± 21 days respectively. Most frequent first and second dose received was Astra-Zeneca vaccine, followed by Sputnik V vaccine. During follow-up a total of twenty COVID-19 cases were observed for a total exposure time of 39,557 days. The overall cumulative incidence for the observed period was 3.4% (SE 0.4%) with an overall incidence density of 5 × 10.000 patients/day (95%CI 0.7–12). We observed more cases in woman than men with an incidence density of 6 × 10.000 patients/day (95%CI 0.9–9) vs. 3 × 10.000 patients/day (95%CI 0.2–6) respectively, but not significantly different (IRR 1.7 95% CI 0.56–7.37 p = 0.15). Conclusionwe found an incidence density of breakthrough COVID-19 infection of 5 × 10.000 patients/day (95%CI 0.7–12) after vaccination in Argentina.

COVID-19 Double-Decrement Model Forecasting for South Korean Population

Since the first case in November 2019, COVID-19 has spread fast, infected many people, and taken many lives. Once COVID-19 cases are confirmed, and hospital treatments are required, they will need high costs yet still be at risk of death. Therefore, insurance companies and social service providers need a reliable model to estimate the expenses and ensure their financial health. This study discusses the modeling of time-until-release and time-until-death since cases are confirmed, using the South Korean data. Double-decrement model is assumed to follow Weibull and log-logistic hazard for time-until-release and time-until-death, respectively. Considered risk factors are sex, symptoms, age group, and the month when the case is confirmed. The nonlinear survival regression model is proposed, with the Solver function in Microsoft Excel for parameter estimation. The results suggest that virus lifespan and mortality risk get lower over time. Time-until-death is also lower, implying that we have less time to save lives from mortality risk. More frequent testing with faster results and not waiting for the symptoms to occur is needed for people under thirty years old due to shorter time-until-death and those at sixty and above due to higher case fatality rates. Full dose vaccination must be prioritized for ages sixty and above to save as many lives as possible.

Evidence of Maternal Antibodies Elicited by COVID-19 Vaccination in Amniotic Fluid: Report of Two Cases in Italy

With SARS-CoV-2 infection, pregnant women may be at a high risk of severe disease and adverse perinatal outcomes. A COVID-19 vaccination campaign represents the key strategy to combat the pandemic; however, public acceptance of maternal immunization has to be improved, which may be achieved by highlighting the promising mechanism of passive immunity as a strategy for protecting newborns against SARS-CoV-2 infection. We tested the anti-SARS-CoV-2 antibody response following COVID-19 full-dose vaccination in the serum and amniotic fluid of two pregnant women who presented between April and June 2021, at the Center for the Treatment and Prevention of Infections in Pregnancy of the National Institute for Infectious Diseases “L. Spallanzani”, for antenatal consultancy. Anti-SARS-CoV-2 IgG was found in residual samples of amniotic fluid collected from both women at the 18th week of gestation (63 and 131 days after the second dose’s administration). Titers in amniotic fluid mirrored the levels detected in serum and were inversely linked to the time from vaccination. Our results suggest that antibodies elicited by COVID-19 vaccination can cross the placenta and reach the fetus; therefore, they may offer passive immunity at birth. It is critical to fully understand the kinetics of the maternal response to vaccination, the efficiency of IgG transfer, and the persistence of antibodies in infants to optimize maternal immunization regimens.

Analysis of 65 Years Old and Over Patients with Full Dose Vaccination by Inactive Vaccine and without Vaccination Admitted to Hospital with SARS-CoV-2 PCR Positivity

Analysis of 65 Years Old and Over Patients with Full Dose Vaccination by Inactive Vaccine and without Vaccination Admitted to Hospital with SARS-CoV-2 PCR Positivity

Graded coronavirus disease 2019 vaccine administration: A safe alternative to vaccine avoidance

Graded coronavirus disease 2019 vaccine administration: A safe alternative to vaccine avoidance

Modeling comparative cost-effectiveness of SARS-CoV-2 vaccine dose fractionation in India

Given global Coronavirus Disease 2019 (COVID-19) vaccine shortages and inequity of vaccine distributions, fractionation of vaccine doses might be an effective strategy for reducing public health and economic burden, notwithstanding the emergence of new variants of concern. In this study, we developed a multi-scale model incorporating population-level transmission and individual-level vaccination to estimate the costs of hospitalization and vaccination and the economic benefits of reducing COVID-19 deaths due to dose-fractionation strategies in India. We used large-scale survey data of the willingness to pay together with data of vaccine and hospital admission costs to build the model. We found that fractional doses of vaccines could be an economically viable vaccination strategy compared to alternatives of either full-dose vaccination or no vaccination. Dose-sparing strategies could save a large number of lives, even with the emergence of new variants with higher transmissibility.

The impact and effectiveness of new coronavirus vaccine on disease outcome worldwide

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is spreading rapidly around the world caused serious respiratory disease leading to death, therefore vaccine is the effective way to control this pandemic. Scientists tried to produce safe and effective SARS-CoV-2 vaccines in record time and vaccination program started in December 2020. The aim of this study to determine the impact of SARS-CoV-2 vaccine on COVID-19 disease. Materials and methods: The COVID-19 cases data of post-vaccination and pre-vaccination were collected from Worldmeter website, and the percentage of vaccinated people data obtained from Statistics and Research Coronavirus Vaccinations. The statistical analyses performed with SPSS software version 16.0. Results: The results showed countries with higher percentage of full dose vaccinated people correlated strongly with decrease of death and the severity of the disease among their infected population. This study showed that different vaccine mechanism against SARS-CoV-2 virus of more than 23.5% of vaccination people with full dose vaccine is effective to decrease death and serious symptoms of COVID-19 disease and increasing the recovery rate. Conclusions: Different mechanism type of full dose vaccine against SARS-CoV-2 is effective to decrease death and serious symptoms of COVID-19 disease with increasing recovery rate. It was difficult to assess the effect of single dose alone, therefore more studies are recommended to assess the effect of single dose vaccine with COVID-19 disease outcome and to determine if the vaccine will accelerate the period of recovery rate and reduce the infectious period time in each country.

Acute Limb Ischemia in One Dose Vaccination of COVID-19

Introduction: The extraordinary thrombotic manifestations of Corona virus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome CoV-2 (SARS-CoV-2) virus, presenting as venous and arterial thrombosis have been reported in several literatures, but in this report, we presented a special case of acute limb ischemia in a patient that has been vaccinated by COVID-19 vaccine. Acute limb ischemia (ALI) is defined as decreasing in arterial perfusion of a limb with a threat to viability of the limb and mortality. COVID-19 has been declared as a global pandemic by the WHO. Patients with COVID-19 have abnormalities in blood coagulation parameters and are prone to thromboembolic events. This hypercoagulable state caused by COVID-19 mainly manifests as venous thromboembolism while peripheral arterial involvement is less frequent. Case: A 54-year diabetic and smoker male has already got one dose COVID-19 vaccination came to our emergency unit with severe acute respiratory syndrome and pain, pale and paresthesia of his left leg. There was pneumonia pattern according to chest X-ray and a ground glass opacity in chest CT-scan, he was confirmed infected by COVID-19 according to RT-PCR test. From CT-Angiography we found multiple thrombosis in the distal aorta, superficial femoral artery (SFA), anterior tibial artery (ATA), and posterior tibial artery (PTA) of left lower extremity. Initial treatment we started with unfractionated heparin, oxygenation, intravenous fluid and analgesia. We managed the patient in isolation ward special for COVID-19. We did thrombectomy to save the limb, nevertheless in few days after we performed amputation at the level of talonavicular joint to the distal part of left foot caused by gangrene. Conclusion: Vaccination can protect from COVID-19 if we vaccinated with full dose and our immune system able to create antibody. The condition will be different in immunocompromised condition and we get not full dose vaccination. Covid-19 Patient with Diabetes and smoker could have higher risk to develop acute limb ischemia because of hypercoagulable state. Management of a COVID-19 patient with cute limb ischemia is more complicated and challenging. Although we have already vaccinated life style modification like wearing a mask, social distancing and using hand sanitizer can give us more protection from Covid 19. Keywords: acute limb ischemia, COVID-19 vaccination, heparinization, thrombectomy

Antibody response to the inactivated SARS-CoV-2 vaccine among healthcare workers, Indonesia

BackgroundAs healthcare workers (HCWs) are at high risk for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), they have priority for receipt of the coronavirus disease 2019 (COVID-19) vaccine. The inactivated SARS-CoV-2 vaccine has been used in Indonesia to induce an antibody response against SARS-CoV-2 infection in HCWs. However, information regarding the kinetics of antibodies induced by this vaccine remains scarce.ObjectiveTo investigate the magnitude and durability of antibodies against the spike (S) protein (anti-S) in fully-vaccinated HCWs using an electrochemiluminescence immunoassay.ResultsSeroconversion of anti-S antibodies was observed among 159 (99.4%) of 160 HCWs without prior SARS-CoV-2 infection 14 days after full-dose vaccination. The level of anti-S antibodies decreased significantly by day 42 post-vaccination compared with day 14 post-vaccination, but persisted for up to 98 days post-vaccination. In contrast, vaccinated HCWs with prior SARS-CoV-2 infection had significantly higher, stable levels of anti-S antibodies compared with vaccinated HCWs without prior SARS-CoV-2 infection.ConclusionThe remarkable decline and lower level of anti-S antibodies among HCWs without prior SARS-CoV-2 infection may indicate the need for an additional booster dose of SARS-CoV-2 vaccine for protection against COVID-19. This study of antibody responses induced by the inactivated SARS-CoV-2 vaccine among HCWs may contribute to future policy decisions regarding vaccination.