RAPID RESPONSE FROM BMJ.COM
BMJ 2002; doi: https://doi.org/10.1136/bmjusa.01060006 (Published 06 September 2002) Cite this as: BMJ 2002;:bmj;bmjusa.01060006v1All rapid responses
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Dear Editor
The global population is in great need of vaccines with high efficacy against COVID-19, and people in Nepal are no more exception. Various parts of the world have been utilizing amongst the approved 12 vaccines [1-2]. Started from 27 January 2021 with Oxford/AstraZeneca COVID-19 AZD1222 (Covishield) vaccine, Nepal has vaccinated around 5% of its total population till now. The vaccines are being administered in the deltoid region of the recipient by trained nurses, with prior history taking for identification of any serious contraindication or concern regarding morbidity or medication [2]. The most of these doses of the vaccines have been received as grant assistance from various countries.
At a time when a study has measured the incidence rates of selected adverse events associated with COVID-19 vaccines in eight countries [3], there is dearth of scientific researches quantifying gross adverse reactions due to COVID-19 vaccines in third world countries like Nepal. Further, when several countries in Europe and Thailand being the first Asian nation to have suspended administering the Covid-19 vaccine developed by the University of Oxford and AstraZeneca due to several incidences of vaccine recipients develops blood clots, there have been no reason for halting the ongoing Covishield vaccination against COVID-19 in Nepal [4]. The media coverage has not mentioned any deaths or blood clots following immunization against the COVID-19 till date. Moreover, a study conducted in a tertiary level hospital under an autonomous health sciences university in Lalitpur also reported no serious adverse reactions following first dose of Covishield vaccine. However, there have been complaints of mild symptoms from some recipients which include vomiting, urticaria, sudden rise in blood pressure, headache, fever, weakness, inflammation in the injection site, feeling dizzy, flulike symptoms feeling dizzy, loss of appetite, abdominal pain, enlarged lymph nodes, excessive sweating and itchy skin or rashes following the immunization [5-6]. As the vaccine may cause various types of reactions in the body, these symptoms are not considered to be serious. Additionally, for safety concerns against these adverse reactions, all individuals were kept under observation at the health facility for 30 minutes after immunization. Nevertheless, preparedness for handling adverse drug reactions by training healthcare workforce to strengthen system of reporting and analyzing adverse reactions to improve the safety of the vaccination should be a priority [5].
Currently, occurrence of adverse events following immunization (AEFI) is being studied nationwide to explore all the adverse events, to identify the occurrence of serious adverse events, to evaluate the socio-demographic factors, co-morbidities, and history of COVID-19 infection associated with AEFI following COVID-19 vaccination [6]. Despite this study is collecting data from whole nation, the online survey approach being utilized may exclude those who are not in the access of internet and this could miss some important cases. However, this study, being the first of its kind in Nepal regarding magnitude, is expected that the findings of this research to help prevent untoward effects of the vaccine, particularly rare events [6].
In a nutshell, although positivity and fatality rates are declining currently in Nepal, there is high chance of third and consecutive waves of the pandemic. Moreover, the current figures regarding reducing burden of this infectious diseases may be the tip of the iceberg due to fewer tests and contact tracing, greater proportion of the population developing immunity against SARS-CoV-2 after contracting it and the natural peak and fall cycle of the disease. Henceforth, to minimize the loss from ongoing wave and preventing further waves of the COVID-19, there is urgent need to continue and widen the vaccination coverage among the population, strengthen health infrastructure with more human resource, ICU/NICU/PICU beds with ventilators, and establishing oxygen plants in the hospitals for maintaining regular supply during the crisis.
References
1. NY Times Coronavirus vaccine tracker. 2021. http://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-trac... (accessed June 14, 2021).
2. Sah R, Shrestha S, Mehta R, Sah SK, Rabaan AA, Dhama K, et al. AZD1222 (Covishield) vaccination for COVID-19: Experiences, challenges, and solutions in Nepal. Travel Med Infect Dis. 2021;40:101989.
3. Li X, Ostropolets A, Makadia R, Shoaibi A, Rao G, Sena AG, et al. Characterising the background incidence rates of adverse events of special interest for covid-19 vaccines in eight countries: multinational network cohort study. BMJ. 2021;373:n1345.
4. Poudel A. March 14, 2021. Health Ministry says ongoing Covid-19 vaccination will not stop. The Kathmandu Post. 2020; published online March 14. https://tkpo.st/3csuYw7 (accessed June 14, 2021).
5. Jha N, Palaian S, Shankar PR, Dangal G. Pharmacovigilance of COVID-19 vaccines in the context of Nepal: an assessment based on early adverse drug reaction reports. Journal of Pharmaceutical Health Services Research. 2021:1–3.
6. Nepal Health Research Council. http://nhrc.gov.np/projects/adverse-events-following-the-covid-19-vaccin... (accessed June 14, 2021).
Competing Interests: No competing interests
15 June 2021
Rakesh Singh
Independent Health Researcher and Academician, Public Health Professional, Nepal Health Professional Council, Kathmandu, Nepal. Email: rakes4r@gmail.com
Sharika Mahato 2 (2 Monitoring, Evaluation and Research Section, TLMN, Anandban Hospital, Lailtpur, Nepal. Email: luckysharika@gmail.com)
Competing interests: No competing interests
Re: RAPID RESPONSE FROM BMJ.COM
Dear Editor
Grote, Izagaren and O'Brien note in their article "how to communicate with patients who are D/deaf or have hearing loss" that it is their legal right to have access to British Sign Language support during consultations. Our difficulty as GPs in York is that the CCG refuses to pay for this service unlike most other areas in England. The bill to our practice is around £50 each time we use a BSL translator. As our global sum payment for the year is only around £85, after 2 consultations we GPs are paying out of our own pockets for the BSL translator. This is a truly iniquitous position to be in. How many other professions pay to provide their professional services to a patients?
Yours sincerely
Dr David Hartley
Competing interests: No competing interests