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Monica Gandhi MD, MPH Profile picture
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Oct 30 • 5 tweets • 2 min read
INDIA: Went through BA2.75 in June-July with mild rises in cases & not severe disease; same with XBB so far because cellular immunity works against variants & lots of immunity in India (they have 8 vaccines available for their population including #covaxin- whole virus vaccine)
These subvariants are not more severe per WHO - all of them are the milder Omicron types & although antibodies from vaccines don't work as well, the T and B cell immunity from vaccines (or prior infection) work against these subvariants
www3.nhk.or.jp/nhkworld/en/ne…
If we go through how cellular immunity works, we will understand why we are in such a different place with the pandemic in 2022 than 2020 (IHME model predicts 75% of planet has been infected with COVID + vaccination rising & saved many from delta/omicron)
medscape.com/viewarticle/98…
Then finally, who is still at risk? Important to remember that immunocompromised (we treat HIV) has good responses to the COVID vaccines since they are so powerful & create redundancy. Older & comorbidities & those on immunosuppressants need boost+Paxlovid
medscape.com/viewarticle/97…
Boost of COVID vaccine will likely be needed every winter for those >65, those on immunosuppressants & those with multiple comorbidities
thelancet.com/journals/lanin…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
Oct 27
ANTIBODIES: Antibody responses to Omicron BA.4/BA.5 bivalent mRNA vaccine booster shot - Much has been made of this preprint that says antibody boost same with bivalent ancestral strain/BA4-BA5 booster vs old monovalent booster with ancestral strain biorxiv.org/content/10.110…
But we already had a study from August showing that modeling that there would be no difference in which booster was used. This really has to do with B/T cells (they stimulate with either booster or an infection) & the ability of B cells to adapt antibodies
nature.com/articles/d4158…
In macaques, Omicron specific booster vs old monovalent booster elicited same level of protection
cell.com/cell/fulltext/…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Oct 15
VACCINES WORK: Probably most ringing endorsement of vaccines (two-dose) published. 30 MILLION people in UK. Those still at risk & needed booster (& now another booster & Paxlovid): older >80, >5 comorbidities, immunosuppressants, chronic kidney disease.
thelancet.com/journals/lance…
In US, racial-ethnic disparities in vaccine uptake disappeared with good community based messaging & therefore, so did the disparities in COVID deaths for more than a year. Success story
nytimes.com/2022/10/04/bri…
Clarifying goal of our booster strategy (to prevent severe disease) & directing resources/messaging to those most at risk (older, multiple comorbidities in paper above) should increase uptake in needed populations & trust. @medpagetoday; written in March
medpagetoday.com/opinion/second…
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
Sep 30
EBOLA OUTBREAK UGANDA: With the first case identified on September 15, 2022, there is now an ongoing and deadly Ebola outbreak occurring in Uganda. With 36 suspected or confirmed cases and 23 deaths, this outbreak has a very high fatality rate of 64%. Ebola has an incubation
period of 2-21 days and is only contagious after the onset of symptoms, with spread through contact with blood or body fluids from someone who is infected. The Ebola virus is in the Filoviridae family and there are four different Ebola virus types that cause disease in humans,
Specifically Zaire ebolavirus, Sudan ebolavirus, Taï Forest ebolavirus, and Bundibugyo ebolavirus. Although there are proven vaccines for Zaire ebolavirus (which has led to many outbreaks in the neighboring Democratic Republic of Congo), these vaccines cannot combat the current
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
Sep 28
ENTEROVIRUS D68: What is this virus and what does it cause? > 100 non-polio enteroviruses; this is one identified in California in 1962. Usually causes no symptoms or very mild illness but, starting in 2014, outbreaks of more notable respiratory illness in children every 2 years
Outbreaks in 2014, 2016, 2018, less so 2020, now in 2022. Mainly in infants, children who have no prior immunity (adults/ older have been exposed). Can rarely cause acute flaccid myelitis (AFM) because - like polio (which is an enterovirus)- can rarely infect motor neurons.
Weakness in arms/legs/ "bulbar" or breathing issues. Rare (<700 cases since 2014) but serious complication rarely of enterovirus D68. ED68 like all enteroviruses more common in late summer-early fall so in season of risk. CDC reports <100 cases so far.
emergency.cdc.gov/han/2022/han00…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Sep 24
TRUST IN VACCINES
US rate of 1st COVID booster for >65 is 71% (in S. Korea 95%); flu vaccine campaigns faltering; polio & measles outbreaks. Most urgent to increase trust in vaccines. Countries which said get vaccinated for COVID & go back to normal had higher uptake.
What can we do? I admire @CDCDirector pledge in August to work on trust and transparency at the @CDCgov and putting out clear messaging; shows a great deal of commitment to increase trust in public health. 2nd - American polling shows US trust their MDs so we can have 1:1
messaging in the clinic room about importance of vaccines. Would target new & more directed Omicron specific boosters to older people - among vaccinated group, most at risk for severe breakthroughs (this large study says >=65 vax'd needs Paxlovid)
nejm.org/doi/full/10.10…
Read 10 tweets
Monica Gandhi MD, MPH Profile picture
Sep 20
ALWAYS WILL WORK ON COVID. Agreed @j_g_allen-what Biden seemed to say as did @WHO last week “end in sight” comment. Will always work on COVID w/ vaccines/therapeutics summarized in this thread. IMF ~$10 billion/year needed for endemic management worldwide

ENDEMIC MANAGEMENT IS IN NO WAY GIVING UP
But
1) COVID-19 is sadly non-eradicable virus (washingtonpost.com/outlook/2021/0…)
2) President caring about other aspects of public health (mental health, schools, loneliness, poverty) part of his job
INTERNATIONAL MONETARY FUND estimates in this April 5, 2022 paper that $10 billion a year investment needed in perpetuity to keep COVID out of the emergency phase for the planet (vaccines, boosting, therapeutics)
imf.org/en/News/Articl…
Read 5 tweets

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