JCVI statement on use of the AstraZeneca COVID-19 vaccine: 7 April 2021
Balance of benefit:risk still in favour of vaccination. Under-30s to be offered alternative vaccines instead if available, as a precaution.
Cerebral venous sinus thrombosis (CVST) is rare.

Background rate 2-5 cases per million per year. Linked with cancers, autoimmune disease & blood clotting disorders, pregnancy, contraceptives, infections etc

Possibly 2-3 CVST per million vaccinations.
Let's put the risk in context.

In the past year, <4.4M people infected, ~127,000 deaths.

If all 4.4M were immunized, extrapolate ~22 CVSTs, but we would save >100,000 lives.

Compared to risk of CVST after vaccination,
~6 times more likely to be struck by lightning in your lifetime,
~11 times more likely to die in a car accident each year
~100 times more likely to get a blood clot if you're using an oral contraceptive,

Risk of CVST may be ⬆️in younger groups, but far from certain. We're still learning about the efficacy & safety of ALL new vaccines. We know more about Oxford-AstraZeneca simply because we have used it more. That said, precautionary approach taken by MHRA/JCVI makes sense.

Finally, no such thing as zero risk for any drug or vaccine or medical intervention. Around 1 in 10 of us have an antibiotic allergy, some do die from it, but doesn't stop us using them vs infections. Same with vaccines. Need to help put risks in perspective for the public.

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More from @andrewleedr

5 Apr
OpenSAFELY: Risks of COVID-19 hospital admission and death for people with learning disabilities - a cohort study

HT: @apsmunro @DFTBubbles

Some concerning trends...

Cohort study of data from primary care linked to secondary care & mortality records in England.
89% of adults with Down Syndrome & 38% with cerebral palsy on the learning disability register.
For under-16s: only 34% with Down Syndrome & 11% with cerebral palsy on LD register.
It matters that persons with learning disabilities are correctly identified & recorded on primary care registers. How else can reasonable adjustments be made, or they are identified correctly for immunisations, annual health checks, care plans, etc...?
Read 5 tweets
27 Mar
An intriguing preprint (modelling study by LSHTM) just out: "Within and between classroom transmission patterns of seasonal influenza and implications for pandemic management strategies at schools"
Simulations suggest⬇️class sizes may not be effective in⬇️risk of major school outbreaks, possibly due to contact behaviour between students i.e. students may have certain no. of ‘close friends’ with whom they have more interactions that could facilitate transmission.
They suggest 2 approaches. Pre-emptive approach eg symptom screening, regular tests, ⬇️outside-class interactions & intermittent schooling. Or Responsive approach - single class closure where there's a case, but need to detect outbreak early before spreads outside the class.
Read 4 tweets
19 Feb
On a lighter note this weekend, let me tell you the story of a (not so secret) service dedicated to protecting the human population from aliens.

(They don't usually dress like that btw with exception of maybe @antmikeg & @Smithkjj )
And by aliens I mean the bug kind...

(Sometimes real biology looks worse than our imagined extra-terrestrial invaders)

If you've not guessed yet I'm referring to Health Protection teams across the UK who deal with communicable diseases & environmental health threats.

HP teams are made up of a diverse lot of professionals: communicable disease control consultants, nurses, practitioners, scientists, epidemiologists, microbiologists, analysts, emergency planners, etc.... that reflect the skill mix required.

Read 13 tweets
18 Feb
Normally I enjoy the high standards of journalism in @guardian . Not today as disappointed with misleading headline that suggest infections are spreading fastest in children. It'll worry parents/teachers & I doubt most readers will unpick the headline.
The latest REACT1 report shows prevalence of infection in ALL age groups has fallen, including children aged 5-12 from 1.59% in Round 8 to 0.86% in Round 9a. The authors of REACT1 report also (wisely) didn't try to interpret the prevalence figures.
If this were a research trial you wouldn't place much weight on the age differences in % prevalence because of the wide confidence intervals, i.e. differences weren't statistically significant.
Read 16 tweets
3 Feb
In the past 15+ yrs I've worked as a GP in some of the poorest parts of Sheffield with all the social ills of poverty: debts, joblessness/job insecurity, crime, abuse, domestic violence, mental ill health, disrupted lives, chronic diseases, alcoholism, early deaths, etc... 1/
For many of my patients, poverty isn't an abstract concept you read about. It's their lived experience. It's real. It's pervasive. It wears you down. It kills your hopes & dreams. And they're trapped in a repeating cycle across generations. 2/
COVID has been really bad for them. Difficult to lockdown in rubbish housing, little greenspace, nowhere to go, nothing to do. Having debts & insecure work forces you to work. I feel most for the kids, many who went to school with my kids, but lack the opportunities mine have. 3/
Read 6 tweets
3 Feb
Our @ScHARRSheffield MPH disaster management class recently looked at the topic of post-disaster recovery. Several key points that will be relevant as we look ahead to the coming months. (I know we are in the thick of pandemic response, but never too early to look ahead!) 1/
It needs to be a managed process that starts the moment an incident has occurred. Not just about rebuilding and recovery, but also has to incorporate prevention/risk reduction measures & preparedness for potential further crisis. 2/
Key to this will be the need for multi-sectoral rapid needs assessments. The population's needs will have changed considerably between pre-disaster and post-disaster. So NHS/LA need to start thinking about doing these RNAs to guide next steps. 3/
Read 11 tweets

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