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2 May, 9 tweets, 2 min read
Been answering Qs for the most part of the day, found out some misconception re: AZ vaccine or C19 vaccines in general. Would like to address these concerns/misconception.

Just to give everyone more in depth information that could help u understand more.
1. Blood disorders e.g Thalassemia, G6PD deficiency.

In general, this group mostly have no problems w receiving the vaccine. Even Haemophilia, platelet function disorders. Only consideration is if u are on treatment for these diseases, then u should consult your doctor.
2. On blood thinners.

Those on drugs like Warfarin, Aspirin, Dabigatran etc, all can take the vaccine safely. The concern is not increasing the AZ clot risk, the concern w blood thinners is after getting the shot, your arm bleeds intramuscularly.
But u need your doctor’s assessment to tweak the medication timing a little (INR reading in case of Warfarin) prior to taking the vaccine.
3. Autoimmune disorders

Again, there is no doubt u should receive the vaccine as it will protect u, like for any other person. The concern about autoimmune patients and vaccines is when the patient is on or due for immunosuppressive treatment.
If u are immunocompromised, the 1st concern is whether the vaccine will stimulate a robust immune response. Some studies show antibody levels lower in immunocompromised persons. But any level of protection is better than zero.
2nd concern is safety. Yes, trials dont include immunocomp patients. In general, we dont recommend live vaccines to immunocomp patients, for fear virus in vaccine turning pathogenic (disease causing) but none of the C19 vaccines are live vaccines.
For inactivated vaccines, it is safe for immunocomp persons. So extrapolating this evidence, in general, C19 vaccines are safe for immunocomp persons as well.

The tricky part is when the pt is on treatment. U then need your doctors assessment.
3. Pregnancy, trying to conceive, breastfeeding

The same guidelines for other vaccines r applicable for AZ vaccines. There is no evidence of harm of vaccines in this group. Barring any other medical issues, u can take it, after assessment by your obstetrician.

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More from @yoongkhean

1 May
Not going to repeat the ultra low incidence of blood clots in the AZ vaccines, think we’ve established that the benefits far outweigh the risks now.

But since tmrw is the big day, would like to offer some thoughts on other data, re: risk factors for the clots.
Most news sites will mention incidence is higher in younger age group & mostly women. However, European regulators does not mention this two groups are a risk factor, merely ‘incidence occurring higher in this 2 groups’.

Why?
1. Data is still in flux. Vaccination programs with AZ is ongoing & because of the phased nature i.e roll out in different age groups, occupation etc, means we don’t have a full set of data yet. Basically, the data is uneven.
Read 8 tweets
1 May
I’m all for getting jabs in to arms & highly recommend everyone to get any approved vaccine but funnelling all the traffic to 1 website for 260k shots will be messy.

Building a system to vaccinate the whole country is a very complicated task but there has to be a simpler way.
Some initial thoughts re: this parallel AZ track is how about those w/out internet/smartphone/laptop access?

While trying to increase no. of ppl vaccinated is the ultimate goal, the system cannot widen the inequity gap further.
Selangor/KL is highly dense & urbanised, probably why they decided to open it up there first, but doesnt address the equally wide inequality gap there.

Migrant workers, B40s, marginalised groups, etc. These groups can jostle with the rest of the M40s & above to book their appts.
Read 7 tweets
15 Feb
Some info on vaccine efficacy. We tend to make the mistake of 95% efficacy (Pfizer) being 95 out of 100 is protected from the disease while 5 out of 100 will get infected/succumb to disease.

But that’s not how vaccine efficacy works. So how did we get that 95%?
Consider these numbers. The Pfizer P3 trial had 43,661 participants.

Total was split into half, each group received the placebo or the vaccine. The placebo group had 162 symptomatic infection & the vaccine group had 8.

We then can calculate the infection risk. 0.74% vs 0.04%. Image
To get vaccine efficacy, first we get the risk difference between the two groups.

This means the vaccine reduces infection risk by 0.7 percentage point. But this is not efficacy.

Efficacy is dividing by original infection risk x 100%. Now u get the 95%. Image
Read 8 tweets
15 Jan
We shouldn’t be too fixated on vaccine efficacy. What ultimately is important (& I suspect most of us are talking about) is vaccine effectiveness (VE).

Vaccine efficacy is % of reduction of disease in a vaccinated vs unvaccinated group in a trial.

VE is the real world impact.
V.efficacy measures individual protection in a controlled environment while VE looks at how protected is a population after vaccination. There is a whole host of factors influencing it.

And not necessarily v.efficacy is directly proportional to VE. Image
Focusing on only efficacy will distract us from implementing a good vaccination plan to maximise effectiveness.

Factors like administration, cold chain, coverage (which impacts herd immunity) all can greatly increase effectiveness, which is what we want.
Read 8 tweets
3 Nov 20
Always amusing to see men (or rather boys) trying to use declining fertility of women by showing fertility rates to justify that women should marry young.

Firstly, reproduction is not the only purpose in life or partnerships/marriage.

Secondly, they are reading the data wrong.
Fertility rates (broadly) is defined as avg number of children born by a woman in her reproductive years over her lifetime. It measure a period, not the cohort’s metric.

And number of children born means u need the man as well, so the equal & opposite cohort to see is the men.
Blaming women biology for low fertility rates or high risk pregnancies in older women is lazy & ignorant.

Fertility rates drop in older women because their male partners are older too, therefore time to conception is later.
Read 9 tweets
2 Nov 20
The person interviewed is no doubt severely misinformed (or ignorant) so no need to amplify her.

But it gives us an opportunity to reexamine what is UHC for us and how effective is the index. (This thread might be #unpopularopinion 😅)
WHO defines UHC as equitable access to HC without financial hardship. Some fancy math done & the index for us & neighbours are:

Malaysia 70
Indonesia 60
Singapore, Brunei & Thailand >80
Vietnam 73
Philippines & Myanmar 50

We are somewhere in the middle amongst SEA countries.
I think the UHC missed a crucial detail, not just physical or financial accessibility. But it must be timely.

Our demography & geography is so varied that UHC index of 70 doesn’t portray the full picture.
Read 6 tweets

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