Real-World Effectiveness of COVID-19 Vaccine and Identification of SARS-CoV-2 Variants among People Living with HIV on Highly Active Antiretroviral Therapy in Central Kerala of India-An Ambi-Directional Cohort Study.

BACKGROUND: Vaccine effectiveness for first-generation coronavirus disease (COVID-19) vaccines among People Living with HIV (PLHIV) in India remains unexplored. This study entails the estimation of the real-world effectiveness of COVID-19 vaccines (AZD1222/Covishield, BBV152/Covaxin) among PLHIV and the identification of variants of SARS-CoV-2 among those infected with COVID-19. METHODS: An ambi-directional cohort study was conducted among 925 PLHIV above 18 years of age in two districts of central Kerala, India, from February 2022 to March 2023. Selected PLHIV were recruited as Participant Liaison Officers (PLOs) for the follow-up on the study participants. At enrolment, basic details, baseline CD4 count, and a Nasopharyngeal (NP) swab for RT-PCR were collected. In the follow-up phase, NP swabs were collected from subjects with COVID-19 symptoms. Positive subjects had a CD4 count and genomic sequencing performed. RESULTS: The mean age of the participants was 46.93 ± 11.00 years. The majority, 819 (93.6%), of participants had received at least one dose of any vaccine, while 56 (6.4%) were unvaccinated. A total of 649 (79.24%) participants were vaccinated with Covishield and 169 (20.63%) with Covaxin. In the vaccinated group, 158 (19.3%) reported COVID-19 infection. Vaccine Effectiveness (VE) for one dose of any vaccine was 43.2% (95% CI: 11.8-64.5), p = 0.015. The effectiveness of full vaccination with Covishied was 63.8% (95% CI: 39.3-79.2), p < 0.001, and Covaxin was 73.4% (95% CI: 44.3-87.3). VE was highest, at 60.7% (95% CI: 23.6-81.3), when the two doses of the vaccine were given at an interval of less than 6 weeks. Participants with a baseline CD4 count > 350 had greater protection from COVID-19, at 53.4% (95% CI: 19.6-75.3) p = 0.004. The incident cases were sub-variants of Omicron (BA.2, BA.2.38, BA.2.10). CONCLUSIONS: Full vaccination with Covishield and Covaxin was effective against COVID-19 infection among PLHIV on treatment; albeit, that of Covaxin was higher. A gap of 4 to 6 weeks between the two doses of COVID-19 vaccine was found to have higher VE among PLHIV.

Comparison of platelet indices in dengue fever patients based on platelet transfusion: A prospective observational study in a tertiary care center.

CONTEXT: Dengue fever is the most prevalent mosquito-borne viral disease in humans. Platelet indices (PIs) are given by the cell counters but are often not reported which is possibly due to under-recognition of the utility of these parameters. AIMS: This study aimed to compare PIs in patients with dengue fever to assess their role in the outcome such as hospital stay and platelet transfusion requirements. SETTINGS AND DESIGN: Prospective observational study in a tertiary care center, Thrissur, Kerala. SUBJECTS AND METHODS: A group of 250 dengue patients was studied over a period of 18 months. The platelet parameters (platelet count, mean platelet volume [MPV], platelet distribution width [PDW], platelet large cell ratio [PLCR], plateletcrit [PCT] and immature platelet fraction [IPF]) were measured with Sysmex XN-1000 and followed up every 24 h. The clinical features, duration of hospital stay and platelet transfusion requirements details were collected. STATISTICAL ANALYSIS USED: Independent t-test, Chi-square test, Karl Pearson correlation coefficient. RESULTS: A total of sample size was 250. The study showed normal PDW and MPV, low platelet count and PCT, and high PLCR and IPF in dengue patients. There were significant differences in PIs (lower platelet count and PCT, higher MPV, PDW, PLCR, and IPF) in comparison between dengue patients based on platelet transfusion. CONCLUSIONS: PIs may act as a predictive tool in the diagnosis and predicting outcomes in dengue fever. Low platelet count and PCT, high PDW, MPV, PLCR, and IPF in transfused dengue patients were found to be statistically significant. Clinicians need to be sensitized about the utility and limitations of these indices and rationalize the need for red cell and platelet transfusions in dengue.

Is It Time to Switch from Conventional Coombs Crossmatching to the Type and Screen Protocol?

Background: ABO grouping, Rh typing and crossmatching are routinely done as part of pre-transfusion testing. The Type and Screen (T&S) protocol has been used in developed countries to ensure the survival of transfused red cells. In this study, we compared the safety, costs and turnaround times (TATs) of the T&S protocol and the conventional pre-transfusion testing protocol for patients who had been scheduled for elective obstetrical or gynaecological procedures. Methods: This observational study was conducted in three phases at the Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Kerala, India and involved 1,800 patients from the Department of Obstetrics and Gynaecology, Jubilee Mission Medical College & Research Institute, Kerala, India over the course of 2 years. Phase I involved the traditional pre-transfusion testing and crossmatching of 150 patients. Phase II involved the use of the T&S protocol on 150 patients. Phase III involved the use of both the traditional and T&S protocols on 1,500 patients without considering the results of each protocol. The safety, costs and TATs of both protocols were compared. Results: In this study, the T&S protocol provided a safety 100% level when compared to the traditional protocol. The T&S protocol detected unexpected antibodies in 0.4% of cases, which would have gone unnoticed otherwise, demonstrating its usefulness. There was no significant difference in cost between the traditional crossmatching and T&S protocols. We discovered that using only the T&S protocol can save technologists 30% of their time. Conclusion: Implementing the T&S protocol as a pre-transfusion testing procedure can help improve hospital transfusion practices by supplying blood quickly and safely. Coombs crossmatching remains more of a tradition than a necessity.