Understanding COVID-19 Vaccination Program

Phoenix, Arizona (Dr. Noorali Bharwani)
Phoenix, Arizona (Dr. Noorali Bharwani)

Finally, COVID-19 vaccines have arrived in Alberta. The lineup has begun and the process will take a few months to complete. This is happening in phases so people most at risk get it first. We just have to be patient and wait our turn.

COVID-19 vaccines are safe, effective and save lives. The vaccine helps prevent you from getting infected and protects you from getting severely sick if you do get it.

There are at least seven different vaccines. The first mass vaccination programme started in some countries in early December 2020 and as of February 15, 2021, 175.3 million vaccine doses have been administered.

Canada has approved three vaccines: Moderna COVID-19 vaccine (efficacy rate 94 per cent – need two doses), Pfizer-BioNTech COVID-19 vaccine (efficacy rate 95 per cent – need two doses) and recently approved AstraZeneca-Oxford University COVID-19 vaccine (efficacy rate of 62 per cent – need two doses).

While AstraZeneca vaccine is less effective than the Pfizer-BioNTech and Moderna vaccines at preventing infection, the shot is 100 per cent effective in preventing the severe outcomes of COVID-19 — including serious illness, hospitalizations and death.

This is better than not having a vaccine. Same principle applies to flu vaccines. They are never 100 per cent effective. Flu vaccines, which differ each year depending on the flu strain in circulation, are typically 54 to 64 per cent effective, yet they are widely used to offer some level of protection to more people.

Other advantage of AstraZeneca vaccine is, unlike the other two vaccines which require freezing facilities, AstraZeneca does not require the same cold storage equipment necessary for the other two. The product can be stored and transported at normal refrigerated temperatures of 2 to 8 C for at least six months. This vaccine also can be easily administered in traditional health care settings, like a doctor’s office or pharmacy.

Government of Canada is expecting more supplies of vaccines and by Canada Day several million people will be vaccinated. That is the plan. The plan is to prevent serious illness, reduce hospitalizations and reduce the number of deaths.

What about the second shot of the vaccine? It will be after four to 12 weeks. Most likely 12 weeks. I don’t think the final decision is out yet but early evidence suggest it’s best to wait the full 12 weeks to deploy the second shot.

How long does the immunity last? It’s too early to know. Research is ongoing to answer this question. You should continue to use face mask and avoid close contact and practice good hygiene.

COVID-19 vaccine and other vaccines: Spacing recommendations from the National Advisory Committee on Immunization (NACI) has published the following recommendations:

  • COVID-19 vaccines should not be given simultaneously with any other vaccines.
  • Wait for a period of at least 28 days between the administration of the complete two-dose schedule of COVID-19 vaccine and the administration of another vaccine (except in the case where another vaccine is required for post-exposure prophylaxis). This includes refraining from administering other vaccines between the first and second dose of COVID-19 vaccine.
  • Wait for a period of at least 14 days after the administration of another vaccine before administering a COVID-19 vaccine.

Take care and be safe.

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Parotid Gland Abscess

Abscess over the left parotid gland area. (Dr. Noorali Bharwani)
Abscess over the left parotid gland area. (Dr. Noorali Bharwani)

46 year-old female presented with a two-week history of an abscess over the left parotid area. The patient reports an abscess in the same location 18 months prior which she had aspirated. She has a medical history of Sjögren’s syndrome.

The patient had finished a course of amoxicillin-clavulanic acid and then was started on a course of a cephalosporin. Incision and drainage was done under local anesthetic and a large amount of pus was drained. The patient healed well.

Culture: Streptococcus anginosus

Streptococcus anginosus is part of the human bacteria flora, but can cause diseases including brain and liver abscesses under certain circumstances.” (Wikipedia)

Pathology: Showed no parotid tissue. There was acute-on-chronic inflammation of subcutaneous tissues.


Salivary Gland

Infection: parotitis, sialandenitis

Symptoms – One-sided salivary gland swelling. Fever and pain will accompany the swelling.

Pathogens – Typically normal bacteria found in the mouth. Viral infections such as mumps often affect the salivary glands. Mumps most often involves parotid salivary gland. Mumps is a rare problem today because of the MMR vaccine.

Dehydration and malnutrition raise the risk of getting a bacterial infection.

Sjögren’s syndrome

This is a chronic autoimmune disease in which cells of a person’s immune system attack the salivary and other moisture-producing glands, leading to dry mouth and eyes. About half of people with Sjögren’s syndrome also have enlargement of the salivary glands on both sides of the mouth, which is usually painless.

Treatment

In some cases, no treatment is needed.

Antibiotics for fever or pus drainage, or if the infection is caused by bacteria. Antibiotics are not useful against viral infections.

Surgery or aspiration to drain abscess.

Self-care steps that can be done at home to help with recovery:

  • Practice good oral hygiene. Brush teeth and floss well at least twice a day. This may help with healing and prevent infection from spreading.
  • Rinse mouth with warm salt-water rinses (1/2 teaspoon of salt in 1 cup of water) to ease pain keep the mouth moist.
  • Stop smoking.
  • Drink lots of water and use sugar-free lemon drops to increase the flow of saliva and reduce swelling.

Prognosis

Most salivary gland infections go away on or are cured with treatment. Some infections will return. Complications are uncommon.

Complications

  • Abscess of salivary gland
  • Infection returns
  • Spread of infection (cellulitis, Ludwig’s angina)

Prevention

In many cases, salivary gland infections cannot be prevented. Good oral hygiene may prevent some cases of bacterial infection.

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Measles is a Highly Contagious Viral Infection of the Respiratory Tract

Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)
Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)

Measles is making bad news. It seems to have started in Disneyland. A place where kids go for fun. How ironic and sad. And it has spread to several states in the U.S.

According to Centers for Disease Control and Prevention (CDC) website, 50 people from six states were reported to have had measles in the first two weeks of this month. Most of these cases are part of a large, ongoing outbreak linked to Disneyland in California.

According to CBS news (January 22, 2015), at least 75 people have now been infected with measles virus. The California public health officials are urging those who haven’t been vaccinated against the disease, including children too young to be immunized, to avoid Disney theme parks.

Age of people infected ranges from seven months to 70 years old, including five Disneyland workers.

Measles spreads through the air through coughing and sneezing. It starts with a fever, runny nose, cough, red eyes, and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Complications are more common in adults and young children.

Alberta had a measles outbreak last year. On April 29, 2014, Alberta Health Services declared a measles outbreak in the Calgary, Central and Edmonton Zones of Alberta Health Services (AHS). By July, AHS declared the outbreak to be over.

The best way to prevent measles is to have Measles-Mumps-Rubella (MMR) Vaccine. All health care workers should be vaccinated with two doses of the vaccine. Health care workers are at greater risk of measles infection than the general population because they provide care for ill individuals. A recent review concluded that health care workers were 13 to 19 times more likely to develop measles than other adults.

MMR vaccine is highly effective at preventing measles. One dose is 85-95 per cent effective and the effectiveness of two doses approaches 100 per cent. Two doses provide long-lasting immunity. The vaccines are very safe.

Measles was eradicated by year 2000 because of vaccination. But the virus has made a comeback in recent years, in part because of people obtaining “personal belief exemptions” from rules that say children must get their shots to enroll in school. Others still believe in now-discredited research linking the measles vaccine to autism.

Who started the current outbreak? Should we blame people who refuse to get vaccinated because they believe it is harmful to their children? Apparently, a small number of those stricken had been fully vaccinated. It is also reported the outbreak was triggered by a measles-stricken visitor to one of the Disney parks who brought the virus from abroad last month.

Coughing and sneezing spreads the highly contagious virus. Deaths are caused by complications associated with the disease. Complications are more common in children under the age of five or adults over the age of 20.

There is no specific antiviral treatment. Mostly symptomatic treatment is provided for symptoms and complications. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. It costs approximately one U.S. dollar to immunize a child against measles. And it saves lives.

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The Controversy Around Homeopathic Vaccine for Preventing Flu

The Art of Relaxation (Dr. Noorali Bharwani)
The Art of Relaxation (Dr. Noorali Bharwani)

“Homeopathic vaccines hurt people and hurt our society. Warning labels will help but nosodes should be banned,” says Canadian Medical Association (CMA) president-elect Dr. Chris Simpson. He was expressing his thoughts on Twitter on the subject of homeopathic remedies.

According to Wikipedia, homeopathy is a system of alternative medicine created in 1796 by Samuel Hahnemann, based on his doctrine of “like cures like”, according to which a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people. Homeopathic remedies are found to be no more than a placebo, and homeopathy is widely considered a pseudoscience.

Those who believe in homeopathic therapy will not agree with what CMA or Wikipedia has to say. But I would like to summarize what their opinion is and let the readers decide what is good for them. Unfortunately, doctors cannot cure everything and people tend to go for alternative therapies. It comes down to personal choice.

According to CMA article, nosodes is advertised and sold in Canada to prevent flu and other illnesses but carry the potential for harm. Nosodes are ultra diluted forms of diseased tissue, pus, blood, or excretions of a sick person or animal that some homeopaths and naturopaths sell.

Health Canada has new guidelines for nosodes licensing. The guidelines require the packages to be labeled with a warning: “This product is not intended to be an alternative to vaccination.”

Members of the BC Medical Association and CMA have written letters to the federal government asking for stricter standards to be applied to natural health products to ensure what goes on the shelf is safe and effective, says a media report.

Health Canada says nosodes are not vaccines. It goes on to say, “Health Canada has not licensed any homeopathic medicines for the purpose of providing immunity to a communicable disease. Vaccinating yourself and your children continues to be the most effective way to prevent and control vaccine-preventable diseases.”

Get ready for the flu season. Do not forget to protect yourselves with vaccinations, healthy diet and regular exercise. Remember what Thomas La Mance said, “Life is what happens to us while we are making other plans.” I know about that quite well. Cheers. Talk to you again soon. Stay healthy.

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