Category: Corona Virus Vaccine

GENEVA, Aug 31 (AP) The World Health Organization (WHO) said on Wednesday that new cases of the novel coronavirus and deaths due to the infection have been steadily declining worldwide, a welcome decline.

The United Nations health agency said in front of the media that 4.5 million new cases of Covid-19 were reported last week, which is 16 percent less than its previous week. He said that last week, the death toll from the infection decreased by 13 percent to 13500 compared to the previous week.

He said that deaths due to corona virus infection have decreased worldwide except in Southeast Asia and the Western Pacific. According to him, deaths due to infection in Southeast Asia and the Western Pacific have increased by 15 and three percent respectively.

WHO Director-General Tedros Adhanom Ghebreyesus warned that experts fear an increase in the number of hospitalized patients and deaths as winter begins in the Northern Hemisphere and a more dangerous form of Covid-19 is likely to emerge.

He said that even in wealthy countries, vaccination rates are very low and 30 per cent of health workers and 20 per cent of the elderly have not been vaccinated. This vaccination gap is dangerous for us. So if you havent vaccinated, take it. Youve had the vaccine and if its recommended, get a booster.

AP Rajkumar Santosh

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New cases of Covid-19 are declining everywhere in the world, deaths continue to decline: WHO - News Day Express

Post Name: COVID 19 Corona Virus vaccine registration in India 2022

Post Date: 19 April 2022

Post Information: Indian Government has launched online registration for covid 19 Vaccination. if you want to take covid 19 Vaccine then you first read the full article. in this article full process described in short language. All Indian citizens who are eligible in this phase for Vaccination can register online. in the first phase who are above 60 years of age can register for the covid vaccine registration in India. Please read the complete advertisement before you registering online.

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This is a new generation of corona vaccine, says Matti Sllberg, professor at the Department of Laboratory Medicine, Karolinska Institutet, and the studys joint last author with Ali Mirazimi, adjunct professor at the same department. The idea is that it will give broader protection that more resembles that gained after an actual infection and will be a bit more future-proof than the vaccines currently in use.

Different types of vaccine have been highly instrumental in impeding the pandemic caused by the coronavirus SARS-CoV-2. One challenge is the viruss mutability, which is to say its ability to change to avoid the human defence response.

Most current vaccines are based on using parts of the coronaviruss so-called spike protein to trigger the bodys immune response to the virus. It is a good vaccine protein to use, but unfortunately it is the spike protein where frequent mutations occur, which can impact the vaccines effectiveness.

The researchers at Karolinska Institutet are therefore developing a vaccine containing more parts of the virus, including ones that do not mutate at the same rate as the spike protein.

The vaccine is a DNA vaccine, which means that it comprises DNA sequences which when injected into the body make the cells produce the proteins that the DNA sequences contain instructions for. In this case, it concerns DNA for parts of the spike protein from three different coronavirus variants and DNA for another two virus proteins, called M and N, where mutations are less common.

In this newly published study, the researchers show that the vaccine protects mice against serious infection from the beta variant of SARS-CoV-2, a variant that can evade the immune response, and activates immune cells (T cells) that recognise the coronavirus found in bats.

The researchers hope that the vaccine can one day be used as a booster to be given as a top-up after a basic vaccination with other vaccines.

The next step is to test it on humans in a small safety study, whats known as a phase I study, and weve submitted permit applications for this, says Matti Sllberg.

The vaccine has been designed and tested at Karolinska Institutet in collaboration with the Karolinska University Hospital and the KTH Royal Institute of Technology in Sweden. Infection studies and toxicological studies have been conducted with the Swedish Public Health Agency and Adlego Biomedical, a company based in Solna (Sweden). Northx Biologics in Matfors (Sweden) have produced the vaccine.

The vaccine is administered with a newly developed instrument for DNA vaccination produced by the Italian company IGEA Biomedical. The project also involves researchers from Germanys Justus Liebig University, which has studied how the innate immune response is affected by the vaccine.

The research was financed through the EUs Horizon 2020 (Opencorona) and ERINHA programmes, by the Swedish Research Council, the Swedish Cancer Society, Vinnova, the Knut and Alice Wallenberg Foundation and CIMED, and with ALF grants from Region Stockholm and support from private donors.

Matti Sllberg and co-author Lars Frelin are founders of and shareholders in Svenska Vaccinfabriken Produktion, which owns patent applications for the vaccine.

A universal SARS-CoV DNA vaccine inducing highly crossreactive neutralizing antibodies and T cells, Sofia Appelberg, Gustaf Ahln, Jingyi Yan, Negin Nikouyan, Sofie Weber, Olivia Larsson, Urban Hglund, Soo Aleman, Friedemann Weber, Emma Perlhamre, Johanna Apro, Eva-Karin Gidlund, Ola Tuvesson, Simona Salati, Matteo Cadossi, Hanna Tegel, Sophia Hober, Lars Frelin, Ali Mirazimi och Matti Sallberg. EMBO Molecular Medicine, published online 19 August 2022, doi:10.15252/emmm.202215821.

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New generation of corona vaccine shows promising results

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Corona - Wikipedia

Introduction

Coronavirus Disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread in many countries and regions around the world since 2019. At present, more than 250 million people have been infected and millions have died. Although vaccination and isolation of patients have been implemented in various countries, more than 100,000 new patients are added daily. Previous studies have shown that about 19% of COVID-19 patients develop into severe or critical diseases,1 and the mortality rate is more than 15%.2 In addition to severe lung injury and functional changes, patients will also lead to complications such as liver, nervous system and gastrointestinal tract. Single drug may not achieve therapeutic effect. At the same time, the combined use of multiple drugs will increase the risk of drug interactions, resulting in reduced or increased drug exposure, affecting the efficacy and safety of treatment. Therefore, drug selection and diagnosis and treatment plan determination have great challenges.3 Treatment of COVID-19 has not yet been defined. Early antiviral therapy is based on the experience of fighting SARS and MARS, and a large number of clinical trials are carried out to verify the efficacy of drugs.4 China National Health Commission has issued eight editions of new coronavirus pneumonia diagnosis and treatment programs. Interferon, lopinavir/ritonavir, ribavirin, chloroch and abidol are among the recommended drugs for the treatment programme.5 Currently, according to various versions of our pneumonia treatment protocols and studies for novel coronavirus infections,6 antiviral drugs such as ribavirin, abirater and lopinavir are included in the treatment of COVID-19 in China. Redsivir is currently in clinical trials and has not been put into use on its own, but only as an adjuvant drug in conjunction with it. NIH guidelines indicate that the antiviral drugs currently available as therapeutic agents in the US are Redsivir, Paxlovid and Monupivir. Meanwhile, after two years of clinical research and practice, more relevant results have been published. Although there are many reviews that have done the same work we have done, searching for and summarising the effectiveness and safety of antiviral drugs, the main drugs analysed and the focus of each review varies and does not provide a detailed summary of the effectiveness and safety of all drugs, and over time, new characteristics of the physicochemical properties of some drugs are identified. In order to obtain a more comprehensive and higher level of research evidence, this article systematically evaluates the efficacy and safety of antiviral drugs for the treatment of COVID-19 based on published clinical findings. This review adds to certain aspects of drugs and medications not summarised in other reviews and is helpful in how antiviral drugs are used to treat neocrown pneumonia.

All the research literatures on antiviral drug treatment COVID-19 from December 2019 to December 2021 in CNKI, PubMed, Embase, Wanfang and VIP databases were searched by computer. Chinese search terms include: novel coronavirus, novel coronavirus pneumonia, novel coronavirus, novel coronavirus pneumonia, COVID-19, antiviral, antiviral therapy, treatment, research, trials, clinical trials. Keywords: COVID-19 (Mesh), 2019-nCo V, SARS-CoV-2, treatment, treatment, clinical observation, antiviral therapy, antiviral.

Inclusion criteria: (1) Confirmed cases according to the ninth edition of the Guidelines for the Diagnosis and Treatment of New Coronavirus Pneumonia: suspected cases also have one of the following etiological or serological basis: 1) positive nucleic acid detection of new coronavirus; 2) positive specific IgM antibody and IgG antibody of new coronavirus in those who are not vaccinated with new coronavirus vaccine.

(2) Use antiviral therapy, and describe the clinical outcome; (3) A complete description of the treatment plan with major efficacy or safety outcomes; (4) It is a prospective or retrospective Chinese or English study published in public. The research types include randomized controlled trials (RCT), non-randomized controlled trials (N-RCT), case-control studies, and cohort studies.

Exclusion criteria: (1) Traditional Chinese medicine, immunotherapy as the main treatment; (2) Summary, case report; (3) Patients are diagnosed as suspected cases; (4) Selective reporting results; (5) Studies describing clinical features.

The literature retrieved by two researchers independently read and evaluated, and the literature was screened according to the inclusion and exclusion criteria, such as the controversial introduction of the third researcher to discuss and decide.

Extract the final information included in the literature. The contents included: (1) Basic information: research area, time, author; (2) Baseline special diagnosis of the subjects: age, disease type, number of cases, number of shedding cases; (3) Research program: research type, research program, course of treatment; (4) Outcome indicators: treatment efficacy, death, adverse reactions.

A total of 1508 articles were retrieved, 273 articles with similar contents were excluded, 1059 articles were excluded after reading topics and abstracts, and 155 articles were excluded after further reading. A total of 21 articles were included.725 The results of literature retrieval included 12 Chinese and 9 English, including 5 randomized controlled studies (RCT), 5 non-randomized controlled studies (N-RCT), 3 retrospective cohort studies, 6 retrospective case series studies, 2 observational studies, and a total of 2118 cases. The results are shown in Table 1.

Table 1 Characteristics of the Included Studies

Two RCTs evaluated the efficacy of lopinavir/ritonavir on COVID-19 with inconsistent results.7,8 Both lopinavir/ritonavir and control were administered at 400mg/100mg, po, bid. Lopinavir/ritonavir did not show obvious advantages in severe patients, and the median clinical improvement time was similar to that in the conventional treatment group (16d vs 16d, P>0.05). The 28d mortality rate was 5.8% lower than that in the conventional treatment group.7 However, RCTs conducted in ordinary patients showed that the addition of Lopinavir/ritonavir on the basis of interferon- and lianhuaqingwen capsule could improve the treatment efficiency (76.67% vs 46.67%, P< 0.05), but the sample size of this study was small.8 Another N-RCT compared the efficacy of lopinavir/ritonavir versus fapiravir in the treatment of mild and common COVID-19. There were 35 patients in the FPV group and 45 patients in the control group, and the drug was administered as falopir 1600 mg, po, bid on day 1, 600 mg, po, bid on day 214, and lopinavir/ritonavir 400 mg/100 mg, po, bid. Changes in chest computed tomography (CT), viral clearance and drug safety were compared between the two groups, with 32 in the FPV group and 28 in the control group. Fapiravir was superior to lopinavir/ritonavir in median virus clearance time (4d vs 11d, P<0.001) and lung CT improvement at 14d (91.43% vs 62.22%, P=0.004).9 Lopinavir/ritonavir was used in four case series studies.1012 There were 83 cases in total. No patient died, only 1 case developed into severe disease, and 3 cases were transferred to hospital.

In one RCT, subjects were treated with 1200 mg/d for 1 to 3 days followed by 800 mg/d for 23 weeks. The RCT showed that there was no significant difference in virus negative conversion rate between hydroxychloroquine group and standard nursing group on day 28 (85.4% vs 81.30%, P=0.314), but the use of hydroxychloroquine could significantly improve clinical symptoms such as fever and cough.13 The efficacy of hydroxychloroquine for COVID-19 in a small sample of N-RCT at 400 mg, po, qd, was similar to that in the conventional treatment group, and the median time of virus negative conversion was longer than that in the control group (4d vs 2d, P>0.05). One case in the hydroxychloroquine group developed into severe disease.12 Another N-RCT compared the clinical outcomes of patients with COVID-19 who were treated with hydroxychloroquine plus azithromycin, hydroxychloroquine alone and untreated. Hydroxychloroquine is administered as 200 mg, po, bid, with azithromycin added as clinically indicated, 500 mg on day 1 and 250 mg daily for the next 4 days, with virus negative conversion rates of the three groups on the sixth day were 100%, 57.1% and 12.5%, respectively (P<0.001). The use of azithromycin could significantly improve the clearance effect of hydroxychloroquine on viruses, and the two had synergistic effects.12 In view of the results of this study, another retrospective cohort study based on the data of the U.S. Veterans Health Management Center included 368 patients with COVID-19, and also compared the mortality and mechanical ventilation ratio of patients with COVID-19 who were treated with azithromycin, with or without hydroxychloroquine. The results showed that hydroxychloroquine did not reduce the mechanical ventilation ratio (6.9% vs 13.3% vs 14.10%, P=0.547), but increased the mortality (22.1% vs 27.8% vs 11.40%, P=0.03).14 The use of azithromycin can reduce the proportion of mechanical ventilation and mortality.

In an RCT comparing the efficacy of abirater and lopinavir/ritonavir in the treatment of mild to moderate COVID-19, lopinavir/ritonavir was administered at 400mg/100mg, po, bid and abirater at 0.2g, po, tid. The RCT showed no significant difference in viral clearance time and viral clearance rates on days 7 and 14.15 A small sample retrospective cohort study showed that the virus clearance rate on the 7 th and 14 th day and chest CT performance on the 7 th day were significantly improved in the combination of Abidol and Lopinavir/Litonavir compared with Lopinavir or Litonavir alone (P<0.05).16 Another RCT compared the efficacy of abidol with that of fapravi. A total of 240 patients were randomly assigned in a 1:1 ratio to receive treatment. In the trial, fapravi was administered at 1600 mg, po, bid on day 1 and 600 mg, po, bid on day 210, while abidol was administered at 0.2 g, po, tid. There was no difference in the recovery rate and time to viral regression in the Arbidol group, with 71 recoveries out of 116 in the Favipiravir group and 62 recoveries out of 120 in the Arbidol group, but fapravi had obvious advantages in relieving clinical symptoms such as fever and cough, and the improvement time was 1.7 days shorter than that of abidol (P<0.001).17

A retrospective analysis of 224 patients with COVID-19 showed that there were no significant differences in the negative conversion time of viral nucleic acids in respiratory tract specimens, the negative conversion rate of viral nucleic acids within 14 days, the proportion of progression to severe disease after admission and the overall incidence of adverse reactions between multiple treatment regimens (interferon- alone, interferon- + lopinavir/ritonavir, interferon- + ribavirin, interferon- + lopinavir/ritonavir + ribavirin, other solutions) (P>0.05).18 A N-RCT study included 62 patients with COVID-19, and the results showed that there was no significant difference in fever clearance time, symptom relief time, nucleic acid negative conversion time and hospitalization time between the treatment group and the control group (P>0.05). In the severe group, the nucleic acid negative conversion time in the treatment group was significantly longer than that in the control group [(23.62 2.12)d vs (9.25 0.95)d], and the difference was statistically significant (P<0.05).19

A retrospective analysis examined the efficacy of favipiravir (FPV) in the treatment of COVID-19.20 Experimental group was famipiravir at 1600 mg, twice a day, then 600 mg, twice a day, for 9 days and control group was herbal medicine, nutrition and oxygenation. The results showed that there was no significant difference in hospitalization time between the treatment group (29 (24, 39)d) and the control group (32 (22, 44)d)(=0.575). The median time of novel coronavirus nucleic acid negative conversion was 25 (18, 33) d in the treatment group and 25 (13, 40) d in the control group (P=0.982). The incidence of severe disease in the treatment group was significantly lower than that in the control group (6.12% vs 21.77%), and the difference was statistically significant (P=0.000). The chest CT remission time of the treatment group (9.38 4.94) d was shorter than that of the control group (13.44 4.67)d, and the difference between the two groups was statistically significant (P= 0.033).

An observational study that included only 11 patients with COVID-19 common type showed that the combination of danorrvir and ritonavir had better curative effect.21 The median time of virus negative conversion was 2 days, and the median time of lung CT obvious absorption was 3 days. All 11 patients were cured and discharged.

In a national multicentre randomised double-blind placebo-controlled trial, patients were randomly allocated in a 2:1 ratio to either intravenous raltegravir (200 mg on day 1, followed by 100 mg on days 210 as a single daily infusion) or the same volume of placebo for 10 days. A total of 237 patients were enrolled, 158 receiving raltegravir and 79 receiving placebo. The results showed that there was no significant difference in the clinical improvement time of patients with severe diseases between Redsivir and placebo, which were 21 d and 23 d, respectively. The mortality rates of the two groups were also close, which were 14% and 13%,22 respectively. Another observational study of international multicenter patients with severe COVID-19 sympathizing with the use of Redsivir showed that 68% of 53 patients had clinical improvements, 57% had extubation, 47% were discharged and 13% died.23

Thirteen studies described adverse events.7,1113,1519,2224 Among the three RCTs, the incidence of adverse events in the lopinavir/ritonavir group was 35.3%, 48.4% and 55.56%,6,15,24 respectively, mainly gastrointestinal reactions. Another retrospective cohort study using lopinavir/ritonavir also reported gastrointestinal dysfunction in 43.7% of patients.16 Severe gastrointestinal adverse reactions caused by lopinavir/ritonavir led to withdrawal of 13% of patients in one study. In a case series of only 10 patients, 30% of patients stopped taking lopinavir because of gastrointestinal discomfort.11

There was no significant difference in the overall incidence of adverse reactions among different antiviral regimens in the comparison of one antiviral treatment for COVID-19 (P=0.080), but there was significant difference in the incidence of nausea/vomiting, diarrhea and dyslipidemia among different regimens (P < 0.05).18 The incidence of gastrointestinal adverse reactions and dyslipidemia in patients receiving three antiviral drugs were significantly higher than those receiving 12 antiviral drugs (P<0.05). Another study also showed that Lopinavir/Rituximab combined with interferon- antiviral therapy could cause higher incidence of diarrhea.19

In addition to Lopinavir/Ritalinavir, the safety of Redsivir needs to be paid attention to. The total incidence of adverse events in the two studies was 66% and 60%, respectively, and the incidence of severe adverse events was 18% and 12%, respectively, including multiple organ dysfunction, septic shock, acute kidney injury and hypotension, which led to the withdrawal of 18 patients (12%) and 4 patients (7.5%),22,23 respectively. Other reported adverse events included nausea caused by light chlorine chirp (one patient was discontinued), diarrhea, and elevation of transaminase, elevation of serum uric acid caused by fapravi, and elevation of bilirubin caused by abidol.

At present, the epidemic of COVID-19 is globalized, but there is no evidence-based medical evidence to support antiviral drugs for new coronaviruses. Therefore, it is extremely important to explore effective treatment regimens as soon as possible to control the epidemic.

Lopinavir/ritonavir is one of the earliest recommended antiviral drugs. Multiple controlled trials showed that the clinical efficacy of lopinavir/ritonavir on COVID-19 was poor, but it caused serious gastrointestinal adverse reactions, so the proportion of withdrawal could reach 13%. The adverse reactions of lopinavir/ritonavir mostly occurred in the early stage of medication, and the recommended course of treatment for COVID-19 was 10 days. The risk of adverse reactions at this stage was high, and medication safety should be closely monitored. Ritonavir is a potent CYP3A4 inhibitor and also inhibits P-glycoprotein transporters. Lopinavir is also a substrate of CYP3A and P-glycoprotein, which can interact with many drugs and cause adverse reactions.9 For COVID-19 patients with more complications, drug interactions should be examined before starting the use of lopinavir/ritonavir to avoid serious adverse reactions.

Chloroquine is also used in the treatment of COVID-19 as an old antimalarial drug. In addition to the recommended treatment plan in China, the FDA also approved that chloroquine and hydroxychloroquine can be used in adult and adolescent COVID-19 inpatients with body weight greater than 50 kg in emergency situations.25 Based on published research data, whether chloroquine or light chloroquine has curative effect on COVID-19 and whether use increases mortality remains unclear. The synergistic effect of azithromycin and hydroxychloroquine also needs further clinical trials to verify. The American Society of Infectious Diseases recommended the application of chloroquine and hydroxychloroquine in clinical trials in the COVID-19 Guidelines for Treatment and Management, while the addition of azithromycin can only be used in clinical trials, and it is not recommended as a conventional treatment.26 The safety of chloroquine and hydroxychloroquine in clinical use is also concerned, which can often cause gastrointestinal reactions, skin allergy, and serious liver and kidney function and cardiac dysfunction. Conditional medical institutions can monitor the plasma concentration. When the plasma trough concentration is greater than 0.8 g/mL, the risk of adverse reactions increases, and it is recommended to reduce the dose. Clinical trial data showed that hydroxychloroquine 600 mg daily, taken three times, the plasma concentration was (0.46 0.2) g/mL, the dose was relatively safe.12

The rapid recovery of the first confirmed patient in the United States was benefited from the treatment of adefovir, making adefovir one of the most concerned drugs that may have special effects on COVID-19. However, the randomized double-blind placebo-controlled trial in critically ill patients in China did not find that Ridzevir had a stronger scavenging effect on SARS-CoV-2 than placebo.22 The curative effect was more obvious after taking adefovir within 10 days of diagnosis, and the average clearance time of the virus was 5 days shorter than that of the placebo group. The results suggested that adefovir was suitable for early viral infection. If the diagnosis had been confirmed for more than 10 days, it would not only benefit little, but also face the high risk of serious adverse reactions and further aggravate the disease. Due to the effective control of the epidemic in China, the study failed to include the target number of subjects, reducing the statistical effectiveness of the data to some extent. The existing evidence can be supplemented when the results of randomized controlled trials (RCTs) ofvir abroad are published.

Based on the limited clinical trial results, the efficacy of fapravi, abidol and danorrvir on COVID-19 is not clear, and it needs to be further verified by high-quality, large-sample randomized controlled trials. In addition, when the three antiviral drugs are used in combination, they are most prominent in nausea, vomiting, diarrhea and other aspects. Considering that they are related to the combination of the three antiviral drugs, according to the new coronavirus pneumonia diagnosis and treatment plan (eighth edition) promulgated by the National Health and Health Commission of China, it is not recommended to use the three drugs in combination, and the more drugs are, the heavier the gastrointestinal burden is. The proportion of dyslipidemia in patients with interferon- + lopinavir/ritonavir treatment was higher, which was considered to be related to the adverse reactions of lopinavir/ritonavir.24 It is worth noting that there are many drugs in the treatment of (critically) severe patients, so the adverse reactions need to be considered due to other drugs except antiviral drugs, and the incidence of adverse reactions may be higher. However, some studies have found that compared with Mild and Moderate patients, the incidence of adverse reactions in (critically) severe patients has no significant increase, indicating that most of the adverse reactions may come from antiviral drugs.18 Fortunately, most patients had mild clinical manifestations of adverse reactions.

The drugs discussed in this paper, such as abidol, pitavir, chloroquine, lopinavir/ritonavir, and interferon, have been marketed in China and approved for the treatment of new coronary pneumonia, and the currently carried out clinical trial for the treatment of COVID-19 is its new indication.26 Abidol has currently registered five clinical trials of Abidol for the treatment of COVID-19 in five hospitals including the Second Affiliated Hospital of Chongqing Medical University.27 The trial status of efaprevir is that the Clinical Study on the Safety and Efficacy of Faprevir in the Treatment of Patients with CO V1D-19 currently cooperated by the National Emergency Prevention and Control Drug Engineering Technology Research Center and the Third Peoples Hospital of Shenzhen has been completed, and Hisun Pharmaceutical has obtained the marketing approval letter of efaprevir tablets approved by the China Food and Drug Administration based on the results of this clinical trial. A Phase II clinical study to explore the dose of fapiravir tablets in patients with usual COVID- 1 9 has been completed, but results have not been published.26 Hydroxychloroquine At present, 19 clinical trials of chloroquine/hydroxychloroquine for the treatment of COVID-19 have been registered in 14 hospitals including Peking University First Hospital and the Second Affiliated Hospital of Chongqing Medical University. Lopinavir/ritonavir has been registered in 11 clinical trials using lopinavir/ritonavir for the treatment of COVID-19 in 9 hospitals including the Second Affiliated Hospital of Chongqing Medical University and the Fifth Affiliated Hospital, Sun Yat-sen University. At present, West China Hospital of Sichuan University and Wuhan Jinyintan Hospital have registered two clinical trials of interferon-alpha for the treatment of COVID-19 in the Chinese Clinical Trial Registry.27 Ruidexivir has been marketed and used in the United States, European Union, Japan and other places, but in China, it is still in clinical trials. At present, Wuhan Jinyintan Hospital and China-Japan Friendship Hospital have registered two clinical trials on the use of repaglinide for the treatment of COVID-19.27 Danorevir is mainly used for the treatment of hepatitis C. The highest study phase of the trial of danorevir in the treatment of new crowns is now the fourth phase,28 and the Department of Infectious Diseases of the Ninth Hospital of Nanchang published a clinical study on the medRxiv preprint platform to investigate the therapeutic effect of danorevir combined with ritonavir in the treatment of COVID-19 pneumonia.29

In summary, there is no specific drug for COVID-19. Patients with mild and common types have greater benefits in treatment, and antiviral drugs combined with Chinese patent medicine have better curative effect and prognosis. The treatment of severe patients is difficult, and lopinavir/ritonavir may be ineffective. Ridzevir shows initial effect in the early stage of infection, but it still needs higher quality clinical trials to provide evidence. Fapiravir can significantly improve the clinical symptoms of mild to moderate patients such as fever and cough, which can further investigate the curative effect of severe patients.

All data generated or analyzed during this study are included in this published article.

An ethics statement was not required for this study type, no human or animal subjects or materials were used.

Zhenwang Nie and Tao Sun are co-first authors of this article.

There is no funding to report.

All of the authors had no any personal, financial, commercial, or academic conflicts of interest separately.

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21. Tiandi GZ, Qian F, Zhang TY, et al. Clinical observation on the incidence of severe cases of new coronavirus pneumonia treated with favelavir. Chin J Pharmacov. 2021;18(10):901904 + 909.

22. Chen H, Zhang Z, Wang L, et al. First clinical study using HCV protease inhibitor danoprevir to treat COVID-19 patients. Medicine. 2020;99(48):e23357. doi:10.1097/MD.0000000000023357

23. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020;395(10236):15691578. doi:10.1016/S0140-6736(20)31022-9

24. Grein J, Ohmagari N, Shin D, et al. Compassionate use of remdesivir for patients with severe Covid-19. N Engl J Med. 2020;382(24):23272336. doi:10.1056/NEJMoa2007016

25. Puech R, Gagnieu MC, Planus C, et al. Extreme bradycardia due to multiple drug-drug interactions in a patient with HIV post-exposure prophylaxis containing lopinavir-ritonavir. Br J Clin Pharmacol. 2011;71(4):621623. doi:10.1111/j.1365-2125.2010.03849.x

26. Ning L, Xiaohong H. Research progress in clinical trials of COVID-19. Chin J New Drugs. 2020;15:17381745.

27. Sicong L, Xiaoyan N, Sheng H, Luwen S. Advances in researches of anti novel coronavirus drugs. Drug Eval. 2020;17(4):1924.

28. Xiaoxu W, Xinyi W, Hao L, Cheng C, Dongyang L. Progress in drug development for treatment of coronavirus disease 2019(COVID-19). Chin J Pharmacol Toxicol. 2021;35(08):561574.

29. Hui L, Xinwei W, Chaohui B. Current research status of antiviral drugs in the treatment of novel coronavirus pneumonia[J]. Clin J Med Officer. 2020;48(09):11081110.

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Antiviral drugs in the treatment of COVID-19 | IDR - Dove Medical Press

This is the weekly edition of CNNs coronavirus newsletter. Look out for your roundup every Wednesday. If you havent subscribed yet, sign up here.

CNN

If weve learned anything over the past two and a half years, its that Covid-19 is one strange disease. The latest case in point: the coronavirus rebound.

The condition grabbed international attention last week when US President Joe Biden tested positive for the virus six days after testing negative following his first bout of the illness.

The White House said Biden, who is back in isolation, was experiencing a bit of a loose cough but did not have a fever and his lungs were clear.

The President tested positive again after being treated with the antiviral Paxlovid. White House officials had previously suggested a rebound case of Covid was unlikely, based on reports of cases around the country, but Bidens doctors continued to monitor his health and test him.

Dr. Ashish Jha, the White House Covid response coordinator, said clinical data shows the rate of rebound infections is low and noted that even those who suffer them are still generally protected from serious illness.

Biden is not the only high-profile patient to develop the condition. National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci also experienced rebound Covid-19. Unlike Bidens, his symptoms got worse when they returned after treatment with Paxlovid, and his doctors prescribed another course of the drug.

Experts have been calling for more systematic research into the instances of rebound to understand who is most at risk and whether the standard five-day course of Paxlovid should be lengthened to prevent it.

Studies have shown that people can pass the infection to others during a rebound, which is another reason to try to understand it better.

The United States Centers for Disease Control and Prevention (CDC) issued a health alert to doctors in May about the potential for Covid-19 rebound, saying symptoms sometimes come back, and that may just be how the infection plays out in some people, regardless of whether theyre vaccinated or treated with medications like Paxlovid.

The CDC said most cases of rebound involve mild disease and that Paxlovid continues to be recommended for early-stage treatment of mild to moderate COVID-19 among persons at high risk for progression to severe disease.

Pfizer, the company that makes Paxlovid, has said its studies showed rebounds were rare, and that they happened in both people who took the drug and those who took a placebo pill. Because investigators noted the phenomenon in both groups, the company doesnt believe it is tied to the medication.

Q: How does Paxlovid work?

A: Considered a game-changer when it was authorized in December because of its strong performance in lowering the risk of severe Covid-19, Paxlovid in combination with vaccines and boosters is thought to be one of the best ways to protect people at high risk for severe illness.

The drug suppresses the coronavirus, blocking an enzyme that helps it reproduce inside the body.

As with all antivirals, the treatment is thought to work best if started within five days of the first symptoms appearing.

Clinical trials of Paxlovid showed that it reduced the risk of hospitalization and death by 88% when given within five days of the start of symptoms.

Send your questions here. Are you a health care worker fighting Covid-19? Message us on WhatsApp about the challenges youre facing: +1 347-322-0415.

Most US public schools plan to keep masks optional for start of classes

Students are heading to another school year amid the Covid-19 pandemic, but this time, there seem to be fewer discussions and less fretting about masks and other mitigation measures despite a rise in infections across the country.

Most of the largest public school districts in the US are not requiring masks for the new school year, making masking optional as students return to classes and the highly transmissible BA.5 subvariant spreads.

Dr. Sanjay Gupta: Are we making the same mistakes?

The pandemic, which has held the US and almost every other country in its grip, should have taught us valuable lessons about how to manage a public health emergency. But it seems we are making some of the same mistakes with the monkeypox virus that we made not even three years ago when the SARS-CoV-2 virus started to spread.

Testing for monkeypox, once very limited, is now more available, but underused. The demand for vaccines is outpacing the supply. There are nearly 2 million courses of the highly effective TPOXX antiviral sitting in the Strategic National Stockpile, but many health care providers are still having a hard time getting the medication for their patients.

At this time, only 336,710 doses have been shipped to states. Ordering only just began for about 800,000 more doses. This scarcity has created long lines in monkeypox hotspots like New York City, which has the highest number of cases in the country.

Updated Covid-19 booster shots could be available in September

Moderna and Pfizer booster shots updated to target Omicron coronavirus subvariants could be available in the US in the early fall, pending signoff by federal health agencies, the US Department of Health and Human Services said Friday.

The US Food and Drug Administration advised vaccine makers in June to update the boosters to add an Omicron BA.4/5 component and create a bivalent booster that would work for two different strains.

Pfizer and Moderna have indicated that they anticipate the modified vaccines being available as early as September, an FDA spokesperson said.

Many children will soon be returning to schools while coronavirus cases are still high.

Parents and caregivers have a lot of questions about what precautions they should take. Do kids need to wear masks again? How often should families test kids? What happens if their kids contract Covid-19? How long should they stay out of school? CNN Medical Analyst Dr. Leana Wen answers the most pressing questions.

Read more:

The curious case of the Covid-19 rebound - CNN

By Nyima Sillah

As misconceptions continue around the covid-19 vaccine, Gibril Gando Baldeh, a senior health communications officer at the Ministry of Health highlighted the importance of the vaccine, saying it prevents people from the severe effects of coronavirus.

However, health officials say that the number of females that have taken the vaccines is more than males.

The vaccine can also prevent you from the signs and symptoms of the virus. Also, anyone that takes the vaccine within The Gambia and abroad is given a card as a reference and this card now is more important than the passport, Mr. Baldeh claimed.

Because the card is called a vaccine pass and if you dont have it, even Guinea-Conakry, and Mali they will not allow you to enter their countries, talk less of Saudi Arabia and Europe. So, everyone needs to be vaccinated.

He, therefore, urged those who have taken a half dose of the vaccine to take another injection as it will contribute to helping their body system to become strong and active to fight the virus.

Everyone knows that vaccines have contributed immensely towards the eradication of several viruses in The Gambia and therefore I urge the entire public to take the opportunity of this nationwide vaccination campaign seriously and get vaccinated.

However, from the updates received from Aja Kandeh of the Ministry of Health Communications Department, the vaccination data for persons who received at least one dose is 451, 778, whilst persons who received two doses is 32, 216 and the booster dose is 9,586.

The National Covid-19 vaccination coverage stands at 18.5%.

She likewise said the number of females that are vaccinated is more than the number of males and therefore urged the entire public be it male or female to go and get vaccinated.

Meanwhile, Dr Musa Marena, Obstetrician and Gynecologist at Edward Francis Small Teaching hospital, highlighted the importance of vaccination for women and children.

If more women and children are vaccinated then the increases in herd immunity among the population will reduce. Also, the spread of the virus Vaccinations helps build immunity hence when we are exposed to the virus our strong immunity will fight it.

More so, he said, the vaccine is important because it prevents severe illness, protects high risk of one dying from COVID 19, and also prevents the rapid spread of the virus.

Sireh Drammeh, a nurse, explained that since the beginning of the pandemic, they did a lot of counseling, trying to make people understand how the virus spread, the mode of transmission, and the benefits involved in taking the vaccine.

The Government should render more sensitisation exercise and let people know the benefits involved in taking the vaccines and also provide means of making it easy for people to get access to these vaccines by making it readily available in all health facilities.

Fatima Jabbie Touray, a nurse, said she has seen patients who did not take the vaccine.

We talked to them about the importance of the vaccine; how the vaccines minimize symptoms even when you are exposed to coronavirus.

We explain to them that vaccines dont stop one from having covid-19, but even when you have it, your chances of recovery will be higher than the one who has not taken the vaccine.

Halimatou Ceesay, a concerned citizen who is yet to be vaccinated said since the pandemic emerged, a lot of misinformation is going around on social media which has given her doubts about getting vaccinated.

I am scared that the vaccine might cause infertility and I am recently married and want to build a family. So, I cant take a vaccine that can prevent me from having a child, she said with dismay.

Another concerned citizen, Louis Mendy, even said I dont feel comfortable about the injection considering all these stories around it. I dont feel the need to take it and I dont think I will take it soon.

Also, I dont have confidence in the vaccine because I dont believe that this corona(virus) is as serious as they are portraying it. To me, its more like the flu, he talked ignorantly.

This story was produced with support from Journalists for Human Rights (JHR), through its Mobilizing Media in the Fight Against COVID-19 in partnership with Mai-Media and The Voice Newspaper.

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Gambia's Health Ministry poised to defeat misconceptions around covid-19 vaccines - - Voice Gambia Newspaper

Introduction

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the novel coronavirus (SARS-CoV-2) and was first identified in December 2019 in Wuhan, China.1 The World Health Organization (WHO) declared COVID-19 as a global pandemic on 11 March 2020.2 The virus infects millions of people and kills millions since its inception.3 Vaccines effectively reduce the risk of serious illness and death from COVID-19. The COVID-19 vaccine is also safe and has a low risk of serious adverse events.46

Vaccines provide great protection in terms of public health, however, to be successful, the vaccine level must be high.7 Especially relevant in the context of the current COVID-19 epidemic, high vaccination coverage rates are needed to provide indirect protection to society as a whole, bring society back to a normal way of life, and to re-open the world economy to the general population.8 High vaccination rates are also important in achieving herd immunity to reduce the spread of COVID-19 and to create a lower risk of infection in the general population and those most susceptible to transmission.810

The success of the COVID-19 vaccination program depends on the proportion of people who prefer to be vaccinated, and recent estimates suggest that up to 70% of the population may need to be vaccinated to end the current epidemic.11 COVID-19 vaccines need to be released as quickly as possible to bring the public back to normal as soon as possible. However, vaccine hesitancy poses a major threat to the effectiveness of the vaccine in preventing disease and death from COVID-19.12,13 Studies conducted in 2021 show that between 40% and 50% of respondents worldwide are reluctant to receive the COVID-19 vaccine with wide variations across countries.14,15 In Ethiopia, a survey found that only 31% of the general population was willing to receive the COVID-19 vaccine.16

The WHO defines vaccine hesitancy as delay in acceptance or rejection of safe vaccines despite the availability of vaccine services.17 COVID-19 vaccine hesitancy is thought to be a multi-factor event influenced by a range of factors. It includes cognitive, psychological, socio-demographic, political, and cultural factors and varies among different populations.18 Numerous studies have shown that public concern about the safety and/or side effects of COVID-19 vaccines, widespread misinformation about COVID-19 vaccines, and distrust in governments are the factors contributing to the growing hesitancy toward COVID-19 vaccines.1922 Overcoming vaccine hesitancy is complex, so no single intervention can be completely resolved, especially in the case of COVID-19 where the evidence for effective strategies to address it is currently limited.23 Hence, a multi-component approach tailored to the local population is required to effectively address vaccine hesitancy.23 Accordingly, it is essential to understand the proportion and determinants of the COVID-19 vaccine hesitancy to inform policymakers and formulate direct intervention measures that can successfully combat the COVID-19 pandemic.

Despite the growing literature, examining the prevalence and determinants of the COVID-19 vaccine in Ethiopia, limited comprehensive evidence has been presented to provide an in-depth and systematic summary of important factors driving vaccine hesitancy specific to the Ethiopian population. This systematic review aimed to examine the proportion of COVID-19 vaccine hesitancy and its associated factors among the Ethiopian population. This review provides valuable insights for policymakers to design and implement targeted and holistic interventions to combat the COVID-19 epidemic in Ethiopia. It helps and facilitates the planning of vaccination campaigns to improve the uptake of the COVID-19 vaccine. Furthermore, our result can not only increase COVID-19 vaccine coverage but also improve the readiness of the existing health system for routine and emergency vaccination.

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.24 By using these guidelines, we have developed a search strategy and eligibility criteria before review. Then, the search was conducted through a two-step selection process based on the pre-defined eligibility criteria and evaluated the returned articles. After identifying studies relevant to this review, relevant data were collected from each study. Details of the review process are provided below.

PubMed, EBSCO, Google Scholar, and Semantic Scholar were searched by using the following search strategy: (COVID-19 OR SARS-CoV-2 OR corona virus disease 2019 OR nCOV OR 2019-nCOV) AND (vaccine OR vaccination) AND (acceptance OR willingness OR intention OR hesitancy) AND (associated factors OR determinant factors) AND (Ethiopia).

The inclusion criteria for this systematic review were peer-reviewed journal articles, survey studies done among the Ethiopian population (general population, health care workers, teachers, students, drivers, lactating mothers, adults, bankers, pregnant women, and patients), studies that investigated the prevalence and/or determinants of COVID-19 vaccine hesitancy/acceptance/willingness, and studies published in English until January 18, 2022. Unpublished manuscripts (preprints), non-empirical studies, articles studying vaccine hesitancy other than COVID-19 disease, studies conducted in other countries, and articles that did not report the outcome of interest were excluded from the present systematic review.

The identified articles were selected in two stages. The first step involves screening all article titles and abstracts based on eligibility criteria, followed by reviewing the full text of articles with similar criteria. Initially, two independent reviewers examined all titles and abstracts for eligible articles. Disputes regarding exclusions between the two reviewers were resolved through discussions. Finally, all the reviewers individually evaluated the full text of each article and made a final selection of articles to be included.

In this systematic review, the primary outcome was the prevalence of the COVID-19 vaccine hesitancy, which was reported in the included studies. The secondary outcome was determinants of COVID-19 vaccine hesitancy, which has been reported in included studies.

Studies that met the inclusion criteria were further analyzed and the following items were extracted from each study: authors, year of publication, study period, data collection method, target population, study design, sample size, prevalence, and determinants of COVID-19 vaccine hesitancy. The Strategic Advisory Group of Experts (SAGE) determinants of vaccine hesitancy model25 was used to categorize the determinants. Using this model, the determinants of COVID-19 vaccine hesitancy were categorized into three groups: contextual factors, individual/group factors, and vaccine/vaccination-related factors. Finally, the factors were analyzed according to the frequency of occurrences in the studies.

Quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Study.26 There are nine criteria in the checklist to assess the quality of cross-sectional studies. Each item in the evaluation criterion is represented by yes,no, unclear or not available. The score is one (1) for yes and zero (0) for the rest. A quality score is calculated for each article by dividing the total score by the total possible score. Each article is classified as low quality (<50%), medium quality (5069%), or high quality (7 0%).

The selection process and relevant eligibility criteria are presented in Figure 1. A total of 1801 articles were identified for initial screening. Of this, 903 articles were excluded due to duplication. Following the removal of the duplicates, the titles and abstracts of 898 articles were evaluated for eligibility. Leaving 824 articles based on title and abstract screening, 74 articles were retained for full-text screening. Subsequently, 54 studies were excluded after the full-text screening. Finally, 20 articles have been included in the present systematic review.

Figure 1 PRISMA flow chart of study selection process for systematic review of the prevalence and determinants of COVID-19 vaccine hesitancy among the Ethiopian population.

Notes: Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.24 Creative Commons Attribution (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/legalcode).

A total of 20 cross-sectional studies published up to January 18, 2022, were analyzed in this review. Most studies have been conducted on health workers. The paper questionnaire is a commonly used data collection tool in the included studies. The largest sample size was 1184 and the smallest sample size was 323. More than half of the studies were conducted in the SNNPR (n = 7) and Amhara regions (n = 6) in Ethiopia. Further details of the included studies are shown in Table 1.

Table 1 Characteristics of Studies Included in the Systematic Review of Prevalence and Determinants of COVID-19 Vaccine Hesitancy in Ethiopia, 2022

The proportion of COVID-19 vaccine hesitancy from different parts of Ethiopia is presented in Table 1. The highest level of COVID-19 vaccine hesitancy was reported among pregnant women in SNNPR (68.7%)27 and the lowest level of COVID-19 vaccine hesitancy was recorded among cancer patients in Addis Ababa (14.1%).28

A total of 12 factors were identified under contextual determinants of COVID-19 vaccine hesitancy (Table 2). Among the contextual factors being young appeared in seven of the 20 studies (35%).2935 Lower educational status appeared in six of the 20 studies (30%).16,27,3639 Lack of adequate information on COVID-19 vaccination appeared in four of the 20 studies (20%).28,32,39,40 Being females,16,39,41 living in rural areas,16,27,38 and religious beliefs,16,30,37 each appeared in three of the 20 studies (15%). Lack of trust in government33,40 and being only academic staff in university hospitals34,36 appeared in two of the 20 studies (10%). Four factors, namely: being married,16 not having health insurance,42 being a non-health science student,35 and unclear information by public health authorities,29 each appeared in one of the 20 articles (5%).

Table 2 Contextual Determinants of COVID-19 Vaccine Hesitancy in Ethiopia

Ten factors were identified for the individual determinants of COVID-19 vaccine hesitancy (Table 3). Among the ten factors under this category poor knowledge about the COVID-19 vaccine27,30,35,36,38,41,42 and low perceived risk of being infected with COVID-192830,32,37,43,44 appeared in seven of the 20 studies (35%). Poor compliance with COVID-19 prevention measures27,29,35,38,44 and negative attitude towards COVID-19 vaccine30,40,4244 appeared in five of the 20 studies (25%). Not having a history of chronic illness appeared in three of the 20 studies (15%).36,41,44 Not having close relatives or friends diagnosed with COVID-1939,42 and not having COVID-19 infection experience28,34 appeared in two of the 20 studies (10%). Three factors, namely: believing that other non-vaccine preventive mechanisms are sufficient to prevent COVID-19 infection,45 belief in having adequate natural immunity,45 and lesser trust in science,33 each appeared in one of the 20 articles (5%).

Table 3 Individual/Group Related Determinants of COVID-19 Vaccine Hesitancy in Ethiopia

A total of 3 factors were identified under vaccine-related determinants of COVID-19 vaccine hesitancy (Table 4). Among the three factors under this category concern about the safety and/or side effect of the vaccine appeared in six of the 20 studies (30%).29,33,37,39,40,45 Doubts about the effectiveness of the vaccine appeared in four of the 20 studies (20%).32,37,40,45 Lack of advocacy for COVID-19 vaccination from health professionals appeared in one of the 20 studies (5%).38

Table 4 Vaccine/Vaccination-Related Determinants of COVID-19 Vaccine Hesitancy in Ethiopia

The JBI critical appraisal checklist for analytical cross-sectional studies included the following eight criteria. (#1) Was the criteria for inclusion in the sample clearly defined? (#2) Were the study subjects and the setting described in detail? (#3) Was the exposure measured validly and reliably? (#4) Were objective, standard criteria used for measurement of the condition? (#5) Were confounding factors identified? (#6) Were strategies to deal with confounding factors stated? (#7) Were the outcomes measured validly and reliably? (#8) Was appropriate statistical analysis used? Based on the above criteria, the quality score of included studies is given in (Table 5). Of the included studies, 15 were rated as high quality, five as moderate quality, and no studies were rated as poor quality.

Table 5 Quality Assessment Results of the Included Studies Using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies

In this review, we examined the proportion and determinants of COVID-19 vaccine hesitancy in Ethiopia. The overall proportion of COVID-19 vaccine hesitancy ranged from 14.1% to 68.7%, as reported in Addis Ababa and SNNPR, respectively. This finding suggests that vaccine hesitancy poses a serious challenge to COVID-19 pandemic management and control. Many countries are developing vaccines to protect their populations from the current COVID-19 pandemic.46 The widespread use of the COVID-19 vaccine is believed to boost herd immunity and protect the population from COVID-19.47 However, with this high level of COVID-19 vaccine resistance, the current COVID-19 pandemic is becoming increasingly difficult to manage and control. Therefore, the establishment of educational resources should be implemented to improve the use of the COVID-19 vaccine to make the population aware of its safety, the importance of the vaccine, and the adverse effects of vaccine rejection.

In this study, the proportion of the COVID-19 vaccine hesitancy in the general population in Ethiopia ranged from 35% to 68%. Similarly, previous studies show that between 40% and 50% of the worlds population are reluctant to receive the COVID-19 vaccine, with variations in different countries.14,15 In addition, our results were similar to another study conducted in Germany, with 42.5% of the participants reporting that they were hesitant to vaccinate against COVID-19.48 On the contrary, the acceptance rate of the COVID-19 vaccine was observed to be high in the USA (81%)49 and the Chinese population (91.3).50 This can be attributed to differences in the spread and burden of the COVID-19 pandemic between countries. In addition, the variation can be explained by differences in awareness of the severity of COVID-19 and access to healthcare. This discrepancy may also be due to differences in respondents local traditions, cultures, and beliefs about the benefits and risks of the COVID-19 vaccine. For example, the Chinese population had strong beliefs about the effectiveness of the COVID-19 vaccine, as 89.5% thought the vaccine was an effective way to prevent and control COVID-19.50 This positive attitude towards COVID-19 vaccination and the perceived major pandemic impact may explain the high acceptance of the COVID-19 vaccine among the Chinese population compared to the Ethiopian population.

Our review also indicated that the proportion of COVID-19 vaccine hesitancy among healthcare workers in Ethiopia ranged from 36% to 60.3%. The result of this study was in line with a previous systematic review which reported the proportion of COVID-19 vaccine hesitancy as 49%.51 This implies that a considerable proportion of healthcare workers were hesitant towards the COVID-19 vaccine, which hinder their recommendation of vaccination to their patients. Evidence shows that the attitude of the healthcare workers toward the COVID-19 vaccine was found to influence their intention to suggest the vaccine to their patients and the general population.52 This problem is alarming due to the position of health care workers at the forefront in combating the spread and impact of the COVID-19 epidemic, which puts them at risk of infection.5355 Therefore, health workers need to be involved in future priority education so that they can influence the use of vaccines and be approved by the population.

The widespread prevalence of COVID-19 vaccine hesitancy observed in our study is due to the following factors: contextual factors, individual factors, and vaccine-specific factors. Younger age, being females, living in rural areas, lack of adequate information, and lower education were common contextual factors associated with COVID-19 vaccine hesitancy. Poor knowledge about the COVID-19 vaccine, lower self-perceived risk of infection with COVID-19, poor adherence to COVID-19 prevention rules, and negative attitude towards COVID-19 vaccine were most frequently mentioned individual and group related factors associated with increased COVID-19 vaccine hesitancy. Common vaccine/vaccination-specific determinants included concerns about the safety and/or side effects of the vaccine and worries about the effectiveness of the vaccine.

Being young was the most frequently mentioned determinant of COVID-19 vaccine hesitancy. This is in line with previous systematic reviews of COVID-19 vaccine hesitancy.5660 This increase in the hesitancy of the COVID-19 vaccine among young people may be due to the WHO announcement about groups at high risk of COVID-19 infection and death. The WHO has declared that the COVID-19 pandemic is more prevalent and worse for older people than for younger ones. This leads to younger participants being more hesitant than older participants.61 This finding also means that older people may have more responsibility and accountability towards themselves and their families. Therefore, an in-depth understanding of the potential factors influencing adolescents hesitancy to take the COVID-19 vaccine and their vaccine intent will contribute to the development and implementation of effective methods to promote the COVID-19 vaccine in this group.

Our review also confirmed that females were more hesitant to the COVID-19 vaccine. This is consistent with the findings of various systematic reviews,5660 which identified being females as one of the most frequently reported factors associated with increased COVID-19 vaccine hesitancy. Studies conducted in Bangladesh and Vietnam also reported higher COVID-19 vaccine hesitancy among female respondents.62,63 The main reasons may be the apparent low-risk perception of COVID-19, high beliefs of conspiracy-related theories about the pandemic in women than men,64 and concerns about the safety of vaccination during pregnancy and lactation.65

The current study also identified a low level of education as a major determinant of COVID-19 vaccine hesitancy. This is in line with the findings of some systematic reviews,57,58,66 which identified a low level of education among commonly cited determinants of COVID-19 vaccine hesitancy. In a US study, high levels of hesitancy against the COVID-19 vaccine were shown in people with limited education.67 This may be because more educated people have better access to vaccine information and can understand information about the benefits and safety of the COVID-19 vaccine; on the contrary, the uneducated are more likely to be misinformed about the vaccine. Thus, individuals should be aware of herd immunity, vaccine safety, and how vaccines can help people return to their daily lives.

Consistent with the findings in many systematic reviews;5759,66,68 living in rural areas was one of the most frequently reported determinants of COVID-19 vaccine hesitancy. Further, a study from Bangladesh reported that rural residents were more reluctant to vaccinate than those living in urban areas.62 The high prevalence of vaccination among urban dwellers can be explained as people living in urban areas have improved access to health care and are more exposed to different media than the rural population. In addition, compared with the urban community, rural communities may be reluctant to vaccinate because of certain cultural practices and religious beliefs that prevent vaccination.69

Poor knowledge of the COVID-19 vaccine was also an important factor associated with the growing hesitancy against the COVID-19 vaccine. This result is consistent with previous studies conducted in Southeast Asia and England.70,71 These findings are explained by having good knowledge of the COVID-19 vaccine will help people to know the benefits of the COVID-19 vaccine. Hence, improving public awareness of the benefits, efficacy, and safety of the COVID-19 vaccine is one of the strategies to achieve targeted vaccine coverage. To increase public awareness about the COVID-19 vaccination, there need to be frequent social campaigns that highlight the vaccines usefulness.

Poor adherence to COVID-19 prevention measures was one of the most frequently stated factors influencing COVID-19 vaccine hesitancy. Consistent with this, a high hesitancy of the COVID-19 vaccine was found among people who showed poor adherence to COVID-19 protection measures such as social isolation, face masking, and frequent hand washing.72 Our study found that low trust in the government and the actions they took, the health care response, and the information provided by health officials were associated with the rejection of the COVID-19 vaccine. Other studies have also reported a lack of trust in government/health officials as a factor in the COVID-19 vaccine reluctance.73,74 Evidence suggests that people who trust the governments message are more likely to adhere to disease prevention practices. Therefore, the Ethiopian government and health authorities should work to build public trust and explicitly state the effectiveness of the vaccine, adverse effects, and safety through traditional media and other means.

The perception of a low risk of being infected with COVID-19 was found to be associated with COVID-19 vaccine hesitancy. This is consistent with studies conducted in Vietnam and South Italy.75,76 This is because people who find themselves at low risk are less concerned about getting infected with COVID-19. As a result, they will not fully participate in COVID-19 prevention strategies, including vaccination.77 Therefore, interventions with different communication methods should be implemented to explain the risk of COVID-19 to the population.

Concerns about the safety and side effects of the vaccines were recognized as a major determinant of COVID-19 vaccine hesitancy. This is in line with a study conducted among healthcare workers in Egypt.78 Another systematic review found that the main reasons for vaccine rejection were concerns about vaccine safety and efficacy.21 This is because hesitancy is largely caused by concerns about the safety, efficiency, and side effects of the vaccine. People who are unsure whether the side effects of the COVID-19 vaccine are tolerable or not are very reluctant to take this vaccine.79,80 Therefore, the provision of clear and scientifically valid information about the safety of the COVID-19 vaccine and its adverse outcomes should be a priority task for public health authorities. Since willingness to take the COVID-19 vaccine and its perceived safety and efficacy are strongly linked, it is important to build confidence in the vaccine. The high efficacy and safety of COVID-19 vaccines increase public confidence in the vaccines, thus reducing vaccine hesitancy. The government should continue to educate the public about the safety and side effects to boost confidence in vaccines. It is also important to understand how the implementation of public health measures affects vaccination hesitancy.

Overall, this review has briefly summarized the level of COVID-19 vaccine hesitancy among the Ethiopian population and associated factors. These findings will make a significant contribution to health policymakers, health authorities, researchers, health care providers, and the entire population. All relevant organs should be actively involved to overcome the COVID-19 vaccine hesitancy that can minimize the morbidity and mortality associated with this pandemic and halt this period of the pandemic. Identifying factors based on their frequency of occurrence in the literature can help policymakers prioritize effort levels for maximum effectiveness, and the results of this review should enable future studies to explore the significance and order of importance. In addition, public health authorities should encourage the uptake of the COVID-19 vaccine by providing reliable information about the COVID-19 vaccine. The population needs to be educated about the efficacy, benefits, and safety of the COVID-19 vaccine to increase acceptance rates of this vaccine. It is also imperative to disseminate better public health messages to raise awareness and change the negative attitudes of the population towards the COVID-19 vaccine. Furthermore, future studies may use our findings to explore strategies to address COVID-19 vaccine hesitancy in Ethiopia.

To our knowledge, our study is the first to bring together key factors of COVID-19 vaccine hesitancy across contextual, individual, and vaccine-specific effects among the Ethiopian population to shed light on the design of targeted intervention programs. Another strength of this review lies in the analysis of factors based on the frequency of occurrence in the literature, which facilitates the understanding of the most important factors causing COVID-19 vaccine hesitancy in Ethiopia. Despite its strength, our review has some limitations. Some of the studies included in this review were subject to selection bias because people required internet access to participate in the study and complete the survey. Moreover, the protocol for this review has not been prospectively registered in PROSPERO.

Overall, COVID-19 vaccine hesitancy is quite common and differs in different parts of Ethiopia. Younger age, being female, living in a rural area, lack of adequate information, and low education were the most common contextual determinants of COVID-19 vaccine hesitancy. Insufficient knowledge about the COVID-19 vaccine, low self-perceived risk of contracting COVID-19, poor adherence to COVID-19 prevention measures, and negative attitude toward the COVID-19 vaccine were the most frequently studied individual factors. Common vaccine-specific determinants included concerns about vaccine safety and side effects, and doubts about vaccine efficacy.

Healthcare managers should acknowledge the widespread prevalence of COVID-19 vaccine hesitancy in Ethiopian regions and be aware of the factors we identified when formulating policies regarding the COVID-19 vaccine. Although we present our identified factors as separate factors, each factor alone does not affect COVID-19 vaccine hesitancy. Therefore, understanding the relationships between our identified factors and knowing how our factors affect each population group is crucial to improving COVID-19 vaccine uptake and addressing vaccine hesitancy among the Ethiopian population.

The data used to support the findings of this study are included in the manuscript.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

The authors declare no conflicts of interest in this work.

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Prevalence and Determinants of COVID-19 Vaccine | RMHP - Dove Medical Press

CAIRO - 28 July 2022: Hossam Hosni, head of the Supreme Committee for Combating Corona at the Ministry of Health and Population, revealed that the rates of COVID infection among children under 12 years old do not exceed 1 percent, indicating that children from 12 to 15 years old are currently vaccinated with Pfizer vaccine.

Dr. Hossam Hosni said in press statements, that the benefit of the vaccine is that it prevents complications during infection, and also reduce the symptoms to be mild and moderate, which is easy to treat and recover from quickly.

"Citizens will receive booster doses every 6 months for people under 60 years old who do not suffer from chronic diseases, and 3 months for those over 60 who suffer from chronic diseases," adding that if the epidemic turns into a seasonal flu, the vaccine will be taken annually.

He added, it is expected that there will be a 5th dose of the Corona vaccine if the infections continue to increase, which means that the epidemic has not become a seasonal epidemic.

Dr. Hosni further explained that the drugs for the therapeutic protocol for Corona and its variants are available at all hospitals and are dispensed free of charge, and continued: "The therapeutic protocol will be updated in its seventh version within hours, and new drugs will be added."

He continued: There is a new mutant from "Omicron" that has led to an increase in the number of infections during the past period, and this mutant is called "B4-B5".

"The new Omicron mutant "B4-B5" is characterized by an increase in proliferation and reproduction, but on the other hand, it attacks the upper respiratory tract, and attacks the lungs only at a very slow rate," he added.

Regarding the most prominent symptoms of the new mutant, he said the symptoms are a rise in body temperature for a period of 24 to 48 hours, up to above 37.6 degrees Celsius, with sore throat, and this is enough to diagnose the case as suspected of being infected with the new mutant.

He continued: We do not wait for the rest of the symptoms to appear, such as body pain, excessive sleep, persistent cough and runny nose, but the necessary precautions must be taken immediately, home isolation, and health follow-up with a specialized doctor.

The Ministry of Health and Population continues to raise its preparations in all governorates of the country, follow up on the situation first-hand regarding the emerging corona virus, and take all necessary preventive measures against any viruses or infectious diseases.

The ministry has also allocated a number of means of communication to receive citizens inquiries about the emerging corona virus and infectious diseases, including: the hotline 105, 15335 and the WhatsApp number 01553105105, in addition to the Health Egypt application available on phones.

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5th vaccine dose is expected as COVID infection rates still high: Health Official - Egypt Today

Introduction

In December 2019, a pneumonia outbreak that started in Wuhan, China had spread rapidly to the entire world.14 In response, the WHO had declared it a Corona Virus Disease (COVID-19) pandemic on March 11, 2020.5,6 The second wave of the pandemic peaked all over the world in the mid-summer of 2020 due to the relaxation of precautionary measures by the local governments.7 It reached a plateau and then gradually declined as a result of social distancing, mandatory use of face masks in public areas, the use of sanitizers, and tracing, testing, and isolation of the close contacts of identified cases. Then, several new variants of concern with higher transmissible and more severe disease emerged in the UK, South Africa, USA, and Japan/Brazil and were cautioned by the CDC of the US.8,9 The following third wave turned out to be more deadly but by then vaccination programs have rolled out.10 The COVID-19 pandemic, which has entered the third wave in most countries by May 2021, has affected the lives of all walks of people globally.

COVID-19 can affect all levels of society. Health-care workers (HCW) have been the predominant front-line defense workforce during the pandemic; they have a greater risk of getting infected at the workplace through contact with COVID-19 positive patients who seek treatment at clinics and hospitals. The Italian National Institute of Health11 reported 13,000 cases and the International Council of Nurses (ICN)12 claimed that more than 90, 000 cases of OHCW have been infected across the globe during the first wave when the protective equipment was scarce. OHCW also experienced burnout due to additional workload while attending the COVID-19 patients.13 The pandemic also causes psychological distress among the HCW as a result of overwork, lack of rest, anxiety related to fear of getting infected and infecting others; thus, a timely assessment and proper interventions are important.14,15 Although there are voluminous studies on the psychological effect on HWCs, few studies involved the oral health-care workers (OHCWs) who are equally vulnerable to the disease and under unprecedented pressure because of the nature of the profession.5 The reports suggested that OHCWs experience distress and anxiety during the pandemic psychological distress the picture is less than clear. This review was aimed to determine the understanding about the potential factors influencing psychological distress of OHCW during the pandemic.

Oral health-care workers (OHCW) are equally vulnerable to the disease and under unprecedented pressure because of the nature of the profession.5 Dentists have been reported to be in a state of fear and suffered from psychological distress while at work during the pandemic.16 Dentists in the UK, USA, and Ireland are reported to close their practices temporarily or permanently and suffer large financial losses due to suspension of care.17,18 The recommendation to limit services to emergency procedures only has increased the anxiety and insecurity levels and financial issues among oral health practitioners. It has been suggested that mental instability among the HCWs, including OHCWs, might precipitate Post Traumatic Stress Disorder, anxiety, and depression.1922 There is currently a dearth of review on the psychological impact of the COVID-19 pandemic on OHCWs. Therefore, this scoping review aimed to describe the psychological health of oral health-care workers during the COVID-19 pandemic and identify the interventions and strategies that can improve the mental health status of OHCWs.

The participants, context, and concept mentioned in the study are explained below:

OHCW includes dental surgeons, dental assistants, dental technicians, individual professionals, representatives of professional bodies and dental academics (lecturers/Assistant professors/Professors, etc).

This review considered only the psychological health of OHCWs related to COVID-19 pandemic and the interventions are training and counselling sessions for those who have been psychologically affected by the pandemic.

Outcomes related to dental practices of OHCWs and the adverse effects of this pandemic on their practices will be identified.

The setting is the work premises of the OHCW which included dental hospitals and clinics and teaching dental hospitals and dental colleges.

The search for articles was carried out in the PubMed, Web of Science and Science Direct databases and gray literature in Google scholar but limited to original research reports in English Language published between January 2020 and February 2021. The keywords and terms used in the online search were derived by two primary investigators (A.F. and F.A.C.) and had been reviewed by other co-authors and included oral health-care workers, COVID-19, pandemic, dentistry, and dental practice. Reports in other languages, case reports, book chapters and short communications were excluded.

All records were merged into a single file and duplicate reports were removed. The titles and abstracts of the records were then screened to identify the relevant reports by two investigators (A. F. and F. A. C.). In case of disagreement, the record was referred to the third investigator (M.H.) to arrive at a decision. Then, the full text of only the relevant studies were retrieved and screened based on eligibility criteria by the same two investigators. Pre-screening was done by recording the results from different search bases.

Data extracted from reviewed OHCWs centred care framework and model were included in data extraction records and synthesized in summary format. Data extraction was carried out using a charting form in Microsoft Excel and had included the information on authorship, article type, year, population, and OHCW-centered care approach. The charted data was used to identify themes relating to psychological status, and potential causes of psychological distress in OHCWs.

The search process to identify the relevant articles is presented in the Flow Diagram in Figure 1. Only 16 full-text reports were retrieved, seven studies were excluded due to incomplete information (n = 965), and short communication (n = 3). The remaining nine studies were screened based on eligibility criteria, and after which only eight studies were found to be relevant to the current study.

Figure 1 PRISMA 2009 flow diagram showing study characteristics.

This study had identified five themes in research on OHCW during the pandemic: psychological impacts, preparedness, concerns, epidemiological factors, and future of practice.

Three studies had assessed the psychological impact of the pandemic on OHCW. One study reported that 11.5% of dentists experienced anxiety, based on assessment using Kesslers K6. In the same study, lower psychological distress was found to be in relation with being in a committed relationship (p = 0.021) and having higher self-efficacy (p = 0.005).

Three main sub-themes identified were: financial, concern of infection, work (sub: workload, intervention/training).

Four studies had linked the impact of the pandemic to financial issues, since the dentists are unable to practice, which affected their financial status.

Dentists being a high-risk population among the front-line workers showed greater concerns regarding the current pandemic. However, fear of being in contact with COVID-19 infected people was found to be more among those people with some chronic illnesses, psychological distress, or those with the greater workload, since existing comorbidities make them a better candidate to get the disease.23,24

Increased workload had been a reason to worry for the dentists during this pandemic. Lack of training and equipment created an unsettled state among the dentists. One study reported that only 12.6% dental staff was being trained for this pandemic.23

The preparedness of dentists can be explained in two sub-themes: knowledge about COVID-19 among dentists, and guidelines.

Arora et al explained that the majority of dentists had enough knowledge about COVID-19 and were worried about the adverse effects caused by this pandemic.

The feedback was received from 26 countries. The overall response rate from United States and Indonesia was 14.3%. The rate of response being higher in Indonesia. 92% of the dentists were aware about the transmission of COVID-19. Nearly all the participants recognized breathing problems as an alarming sign of COVID 19. A few dentists had a limited knowledge about breathing issues being an alarming symptom. 91% of the subjects knew that there is no vaccine for COVID-19. The knowledge about the diagnosis of COVID-19 was higher among the respondents, while it was significantly low about the transmission, symptom, treatment and protection methods. The level of knowledge was low among the undergrads as compared to specialists and PHD holders. Clinicians who saw more number of patients had higher scores. Countries that were affected the most and had highest number of COVID-19 cases had more knowledge.25

Dentists were recommended to follow CDC and WHO guidelines during this pandemic.26

Four studies included that dentist were concerned about this alarming situation of pandemic, adversely affecting the dental practice. Chaudhary et al stated that although dentists were concerned about the current situation, they responded that their institutions were not well prepared to cater to this pandemic situation.27 The academics were found to be worrisome about the professional responsibilities and restricted mobility. There was direct dose-dependent association found between the worries and fear of the dental academics and the spread of pandemic. Greater fear and worries were found to be associated with frequent hand washing among the participants during this pandemic.

Only 12.6% of the population responded that infection control sessions have been conducted in their institutions. Overall, the dental community was concerned regarding the future of dentistry.28,29

The epidemiological aspects include epidemiology, and epidemiological investigations.

89.6% of dentists showed concerns about the future of dentistry. This increased number is thus an alarming situation for the dentists.

Meng et al summed up that provision of emergency dental procedures along with using advanced PPE is found to prevent the spread of COVID-19 infection. Although maintaining a balance between the provision of dental care and COVID-19 infection control is required.30

Ugo et al expressed that during the current pandemic, either complete closure of dental clinics or only restricted dental practice was observed following standard operating procedures (SOPs) strictly. The dental practice has been compromised severely due to this pandemic.

Albeit guidelines for dental practice during the pandemic have been regulated throughout the world, and financial constraints had been observed among dentists from various regions of the world. These include America, China, Saudi Arabia, the United Kingdom, and Spain. It has been concluded that governments should address ways to overcome this issue by making changes in the policies.18 Another study explained that during this pandemic, guidelines issued by CDC and WHO need to be followed.26

Themes and sub-themes formed by concluding this scoping review are given in Table 1. The summary of the included studies is mentioned in Table 2.

Table 1 Themes and Sub- Themes

Table 2 Summary of Studies Included in the Scoping Review

In this study, we reviewed the impact of COVID-19 on the dental practice of oral health-care workers (OHCWs), and how it has affected their psychological health. The majority of OHCWs showed greater concern regarding the risk of being infected, as they are most exposed to the infection. Similar findings were found in a study conducted in Singapore during the SARS outbreak.31 Same results were also found while considering long-term psychological and occupational effects on HCWs those provided hospital health care during the SARS outbreak in Toronto, Canada during SARS outbreak.32

In this study, Arora et al26 concluded that about 80.8% of the participants had fair knowledge (4070%) about the disease. In contrast to this, Kamate et al showed a higher percentage of respondents (92.7%) with fair knowledge among females and post-graduate residents. This difference of knowledge might have appeared due to the choice of areas where the studies have been conducted; since the former study is of developing country India, and the latter is of developed countries like America and Australia.33 This study varied from the other one conducted by Putrino et al in which males dentist were found to be more aware of this disease than females.34 However, it showed similar results to the study conducted by Quadri et al in which specialists showed higher levels of knowledge than the graduates.35 In the current study, OHCWs did not suggest quarantine in the absence of symptoms, which is contrary to the study of the SARS outbreak in 2002 where people were asked to quarantine even if they were asymptomatic.36

Overall, the dental community was found to be endangered to practice in the current situation, which might be an influence of vast media coverage, lack of technical equipment and shortage of personal protective equipment (PPE), extended working hours, and many other reasons.37,38 Moreover, in this study, it was concluded that dental staff exhibited greater psychological stress problems amid this pandemic because of greater exposure to risk. This finding is relevant to the study that showed unwillingness by dentists to treat patients diagnosed with some infectious diseases like HIV39,40 and tuberculosis.41

Regarding self-efficacy, higher self-efficacy reflects lower psychological distress levels. Self-efficacy plays the most important role since improved self-efficacy levels can enhance personal performance in different tasks and other related behaviours.42 While considering the stress levels with dental staff with some other comorbidities, they were found to exhibit greater psychological distress possibly because they were going through the distress caused by already existing comorbidities.43 Albeit dentists showed concerns regarding the future of dentistry, only a few among the dental population looked to change their profession and the majority continued with dental practice amid this pandemic. This finding was found to be consistent with the findings of other studies carried out in Singapore and the USA during the SARS and influenza outbreak, where HCWs continued to practice their profession.31,44 However, in contrast to these findings, HCWs were unwilling to work during infection outbreaks in Taiwan, Hong Kong, and the UK. They preferred other jobs over working in health-care settings.4547

This pandemic had severe adverse effects on dental practice. Partial to complete closure of the dental clinics/hospitals has been implemented due to the COVID-19 pandemic, which has led to major economic setbacks to the dentists.48 Only a small proportion (12.6%) of OHCWs had attended sessions in their institutions, which in comparison to the study in Singapore is much lower (88%) during the SARS outbreak. This is the need of the hour that OHCWs should get proper training sessions to cater to this current pandemic situation.29,49 This pandemic has been a major setback for dental students too. Dental education has been affected adversely during this time since dental practice plays a major role in learning dentistry, which cannot be achieved by online learning.50

Focus on the provision of preventive dental care with minimal aerosol production procedures is required to be practised. Check on patients who have had dental treatment from the dental clinics should be kept under observation to check if they get the infection due to treatment. Advanced teledentistry should be made practical during this pandemic.5154 Many countries including Pakistan have recommended guidelines for dental practice during COVID-19 which needs to be implemented on the ground to stop the spread of this pandemic. This study highlights the importance of precautionary measures required to be taken by the OHCWs amid COVID-19 since the world has hit the third wave of this infectious disease. Focusing on the mental health of OHCWs in the current situation is the need of the hour. This would be beneficial to cope with the future challenges faced during implications regarding training sessions on infection control for the dentists and dental staff.5557 The imitations of this study were, since this is a new virus, more research is required to be done to see its impact and due to limited access to the search engines, a restricted number of studies could be accessed.

Overall, this study shed light on the psychological effects on OHCWs amid the COVID-19 pandemic, and how this pandemic has affected their lives. Our results show that OHCWs are fully aware with knowledge regarding COVID-19 and showed concerns for dentistry and dental health-care workers during this pandemic. Complete or partial closure of dental clinics has had adverse effects on the future of dentistry, economically as well as psychologically. Institutions need to upgrade their strengthening systems to cater to any such situation efficiently. Focus from diagnosis and treatment needs to be shifted towards preventive oral care to reduce the burden of outpatient departments. All the oral health-care workers/providers should be readily vaccinated following all the standard operating procedures to minimize the chance of cross-infection. Along with these, proper counselling sessions should be conducted for the OHCWs to monitor, identify and treat the cases found. However, policy and decision-makers need to make policy in this regard followed by its implementation.

The authors report no conflicts of interest in this work.

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