Know ur covid vaccine

 

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by corona virus (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. It has since spread worldwide, leading to an ongoing pandemic. (1)

COVID-19 vaccines have been developed at an unprecedented speed. Currently, there are 18 vaccines who have received EUA whereas 184 candidate vaccines are in preclinical development and 104 in clinical stages of development. (2, 3)

The Vaccines approved by Drugs Controller General of India (DCGI) have been listed in table no. 1 below (4)-

Table-1 : COVID-19 vaccines approved for Restricted Use in Emergency Situation by DCGI

S.N	Vaccine	Firm & Date of EUA	Dosing Schedule	Approved for age group	Route
1.	ChAdOx1 nCoV-19 Corona Virus vaccine Recombinant) [Chimpanzee Adeno vector] (Covishield vaccine)	M/s Serum Institute of India Pvt. Ltd. 03.01.2021	Two doses, 4 to 6 weeks apart (Overseas Data available for 12 weeks)	For ≥ 18 years age	IM
2.	Whole-Virion Inactivated SARS CoV-2 Vaccine (Covaxin vaccine)	M/s Bharat Biotech 03.01.2021	Two doses, Day 0 & 28	For ≥ 18 years age	IM
3.	Recombinant Adenovirus vector based SARS-CoV-2 liquid vaccine Gam COVID Vac (component I & II) (SPUTNIK-V)	M/s Dr. Reddy’s Lab. Ltd. (Importer) 12.04.2021	Two doses, Day 0 (comp I) & Day 21 (comp II)	For ≥ 18 years age	IM
4.	mRNA-1273 COVID-19 vaccine (Moderna vaccine)	M/s Cipla Ltd. (Importer) 29.06.2021	Two doses, Day 0 & 28	For ≥ 18 years age	IM
5.	Recombinant Adenovirus vector based SARS-CoV-2 liquid vaccine Gam COVID Vac (component I & II) (SPUTNIK-V)	M/s Panacea Biotec Ltd 02.07.2021	Two doses, Day 0 (comp I) & Day 21 (comp II)	For ≥ 18 years age	IM
6.	COVID-19 vaccine (Ad26.COV2-S) [recombinant] (Janssen Vaccine)	M/s Johnson & Johnson Pvt. Ltd. (Importer) 07.08.2021	Single dose	For ≥ 18 years age	IM
7.	COVID-19 vaccine (Ad26.COV2-S) [recombinant] (Janssen Vaccine)	Biological E Limited 18.08.2021	Single dose	For ≥ 18 years age	IM
8.	Novel Corona Virus-2019-nCov vaccine (recombinant DNA) (2 mg) (ZyCoV-D Vaccine)	Cadila Healthcare Limited 20.08.2021	Three doses (Day 0, 28 and 56)	For ≥ 12 years age	Id

IM = Intramuscular,   Id: Intradermal

Types of vaccine-

Many types of Covid vaccines have been developed as depicted in Table 2 below:

Table 2: Composition of various types of covid vaccines

	Live Attenuated Vaccine	Inactivated Vaccine	Replicating Viral Vector Vaccine	Non-Replicating Viral Vector Vaccine	DNA Vaccine	RNA vaccine	Subunit Vaccine
Composition	live virus particles weakened to keep them from causing disease	whole virus particles, that have been killed or inactivated so that they do not cause disease	Harmless low pathogenic viruses used as viral vectors – so  when introduced in host will induce production of same proteins as disease causing virus	Similar to replicating viral vector vaccines except that they cannot replicate inside the body as the key viral replication genes is deleted from the low pathogenic vector virus.	DNA plasmids containing a gene for SARSCOV-2 along with additional genetic elements that will produce some of the same antigenic proteins as the disease-causing virus	Piece of mRNA that will produce some of the same antigenic proteins as the disease-causing virus	Antigenic protein from the disease causing virus without any genetic material
Immunogenicity	Strong	Less immunogenic than live viral vaccines	Strong	Require high doses to confer immunity	Poor	Poor	Not Very immunogenic
Shortcomings	Might not be suitable for people with compromised immune systems	Require booster doses as the immunity conferred by these vaccines is weaker than live vaccines	May not work for people already immune to the low pathogenic virus.	Improved efficacy and safety	Infection risk nil but there is a possibility that the immune system does not fight against the antigen (tolerance to the antigen).	Risk of being integrated to the host genome is averted but, sometimes the RNA molecules may trigger an unintended immune response in the body	These vaccines require multiple doses for long term immunity. They require adjuvants which are ingredients that help create a stronger immune response
Covid vaccines	Codagenix, Indian Immunologicals Ltd	Sinovac; Sinopharma; Bharat Biotech	Themis Bioscience; University of Pisttsburg	University of Oxford and & AstraZeneca	Inovio, Genexine, Zydus cadila	Moderna;CureVac;Pfizer, BioNTech, Fosun Pharma	Novavax; AdaptVac
Safety	Highly effective and safe	Safe and well tolerated	Safe and effective.	Improved efficacy and safety	Safe and very well tolerated	Safe and effective	Subunit vaccines are considered very safe.

 

 

 

 

 

 

Figure 1: Covid 19 vaccine development-

VACCINES- The various types of vaccines are compared in Table 3.

1.     COVAXIN Vaccine-

COVAXIN^TM, India's indigenous COVID-19 vaccine developed by Bharat Biotech  in collaboration with the Indian Council of Medical Research (ICMR) - National Institute of Virology (NIV).

The vaccine is developed using Whole-Virion Inactivated Vero Cell derived platform technology.

Inactivated vaccines do not replicate and are therefore unlikely to revert and cause pathological effects.  COVAXIN^® is included along with immune-potentiators (vaccine adjuvants).

No reconstitution requirement, and ready to use liquid presentation in multi-dose vials.

Site of vaccination          

Vaccine is to be injected into the deltoid muscle of the upper arm.

Side effects that have been are expected by the manufacturers include:-

Injection site pain/ Swelling / Redness/ Itching

Headache

Fever

Malaise / bodyache

Nausea

Vomiting

Rashes

A severe allergic reaction may very rarely occur after getting a dose of COVAXIN®

Contraindications-

1.     Had a severe allergic reaction to any ingredients of the vaccine.

2.     Had a severe allergic reaction after a previous dose of this vaccine.

3.     Currently have an acute infection or fever.

 

2.     COVISHIELD Vaccine—

 

It is a recombinant, replication-deficient chimpanzee adenovirus vector encoding the SARS-CoV-2 Spike (S) glycoprotein.  Following administration, the genetic material of part of corona virus is expressed which stimulates an immune response.

Contraindication-

Hypersensitivity to the active substance or to any of the excipients listed below:

L-Histidine

L-Histidine hydrochloride monohydrate

Magnesium chloride hexahydrate

Polysorbate 80

Ethanol

Sucrose

Sodium chloride

Disodium edetate dihydrate (EDTA)

 

Patients who have experienced major blood clotting (venous and/or arterial thrombosis) in combination with low platelet count (thrombocytopenia) following any COVID-19 vaccine.

Severe allergic reaction after a previous dose of this vaccine

Side effects as mentioned by the manufacturers:-

Very common (may affect more than 1 in 10 people) - tenderness, pain, warmth, or itching where the injection is given, generally feeling unwell, feeling tired (fatigue), chills or feeling feverish, headache, feeling sick (nausea), joint pain or muscle ache

Common (may affect more than 1 in 10 people) - swelling or redness where the injection is given, fever, being sick (vomiting) or diarrhoea, pain in legs or arms, flu-like symptoms, such as high temperature sore throat, runny nose, cough and chills

Uncommon (may affect up to 1 in 100 people) – sleepiness or feeling dizzy, abdominal pain, enlarged lymph nodes, excessive sweating, itchy skin, rash or hives

Not known (the frequency cannot be determined from the available data) -severe allergic reaction (anaphylaxis), severe swelling of the lips, mouth, throat (which may cause difficulty in swallowing or breathing)

Rarest: Major blood clotting (venous and/or arterial thrombosis) in combination with low platelet count (thrombocytopenia) have been observed very rarely (with a frequency less than 1 in 100,000 vaccinated individuals)

As per the present guidelines of GOI, the vaccine is safe to use for pregnant and lactating mothers.

3.     ZyCoV-D Vaccine-

It is Novel Corona Virus-2019-nCov vaccine (recombinant DNA) vaccine launched by Cadila Healthcare Limited.

Schedule-

Three doses at Day 0, 28 and 56 for ≥ 12 years age group by intradermal route.

 

The vaccine is given as an intradermal injection using a spring-powered jet injector.

4.     Sputnik V Vaccine-

Sputnik V is the world's first registered vaccine based on a well-studied human adenovirus vector platform. It has been approved for use in 70 countries with a total population of 4 billion people.

Side effects-

·       Pain, redness, or swelling at the site of injection

·       Asthenia (lack of energy / abnormal physical weakness)

·       Fatigue (feeling tired)

·       Body and muscle pain

·       Cough and Sore throat

·       Runny nose

·       Fever and Chills

·       Nausea and Vomiting

·       Diarrhea

·       Headache

 

5.     Biological E’s novel Covid-19 vaccine-

Corbevax, which is a RBD protein sub-unit vaccine, is currently undergoing Phase 2 and Phase 3 trials on adults and children.

6.     COVOVAX Vaccine-

Indian Council of Medical Research and Serum Institute of India jointly performing a phase 2/3, observer-blind, randomized, controlled study to determine the safety and immunogenicity of COVOVAX [SARS-CoV-2 recombinant spike protein nanoparticle vaccine (SARS-CoV-2 rS) with Matrix-M1™ adjuvant] in Indian adults

7.     mRNA based vaccine (HGCO19) Vaccine-

Gennova Biopharmaceuticals Limited is working on safety, tolerability and immunogenicity of the candidate HGCO19 (COVID-19 vaccine)

8.     BBV154 Vaccine-

A novel adenovirus vectored, intranasal vaccine for COVID-19 that stimulates a broad immune response – neutralizing IgG, mucosal IgA, and T cell responses.

Immune responses at the site of infection (in the nasal mucosa) – essential for blocking both infection and transmission of COVID-19.

 The nasal route has excellent potential for vaccination due to the organized immune systems of the nasal mucosa.

 Non-invasive, needle-free hence easy to administer, eliminates needle associated risks, associated with high compliance and can be given by untrained workers

9.     Oravax Vaccine-

Efforts are on to develop an oral vaccine for Covid. The Oravax technology seamlessly integrates a novel approach to vaccines from Premas Biotech based on their D-Crypt^TM technology with an oral delivery platform Oramed Pharmaceuticals based on their proprietary POD^TM delivery technology.

Table 3: Comparison of various Covid vaccines

Name of Vaccine and developer	Developed by	Type of vaccine	Storage temp requirement	Efficacy
Covishield	AstraZeneca-Oxford Serum Institute of India (SII)	Adenovector vaccine	2-8 oC	63%
Covaxin	Bharat Biotech & ICMR & NIV	Inactivated vaccine	2 to 8°C	93.4%
BNT162 B1/B2	Pfizer/BioNTech +Fosun Pharma	mRNA	-60 to -80 °C	95%
Moderna	Moderna + National Institute of Allergy and Infectious Diseases (NIAID)	mRNA	2 to 8 °C for up to 30 days; -15 to 25 °C for long-term storage	94%
Sputnik V	Gamaleya Research Institute; Health Ministry of the Russian Federation	Adenovirus vector	Lyophilised formulation requires 2 to 8 °C; frozen formulation requires -18 °C	91.4%
CoronaVac	Sinovac Research and Development Co., Ltd	Inactivated virus	2 to 8°C	50%
WUHAN/ SINOPHARM VACCINE	Sinopharm + China National Biotec Group Co + Wuhan Institute of Biological Products	Inactivated virus	2 to 8°C	78.1%
BBIBP-CorV	Sinopharm + China National Biotec Group Co + Beijing Institute of Biological Products	Inactivated virus	2 to 8°C	86%
QAZCOVID-IN	Research Institute for Biological Safety Problems, Rep of Kazakhstan	Inactivated virus	2 to 8°C	70 to 96%
NVX-COV2373	Novavax	Protein subunit	2 to 8°C	89.7%
mRNA-1273	Moderna + National Institute of Allergy and Infectious Diseases (NIAID)	RNA based vaccine	2 to 8 °C for up to 30 days; -15 to 25 °C for long-term storage	94.1%
AD26.COV2.S	Janssen Pharmaceutical (Johnson & Johnson)	Viral vector (Non- replicating	2 to 8	66.9%
CAMS VACCINE	Institute of Medical Biology + Chinese Academy of Medical Sciences	Inactivated virus	2 to 8 °C	95%
INO-4800	Inovio Pharmaceuticals, International Vaccine Institution, Ad vaccine (Suzhou) Biopharmaceutical Co., Ltd	DNA based vaccine	Room temp.	NA
CVnCoV	CureVac AG	RNA based vaccine	2 to 8 °C	47%
Ad5-nCoV	CanSino Biological Inc./ Beijing Institute of Bio technology	Viral Vector (Non-replicating)	2 to 8 °C or -15 to 25 °C is typical for vectored vaccines	94%
Novel Corona Virus-2019-nCov vaccine (recombinant DNA)	Cadila Healthcare Limited	Recombinant DNA	2-8°C	NA

 

CONCLUSION-

Advances in COVID-19 vaccines are encouraging because this is the first time that vaccine development has accelerated at this speed. Research advances incorporating vaccinology have ensured that the most critical public health intervention is developed timely. Points to consider for future COVID-19 vaccines include the development of heat stable vaccines, which can be administered easily in low resource tropical settings.