As the epidemic becomes normalized, we must protect ourselves in this way

The new coronavirus is coming with great force and is still lingering. We must be prepared for a protracted war and get vaccinated as soon as possible if we are eligible. At the same time, we must not take the vaccination lightly.

The World Health Organization has always emphasized that vaccines in immunization programs should not have many contraindications. The benefits of routinely used vaccines are often significantly higher than the risk of adverse reactions, and every opportunity should be taken to vaccinate all eligible recipients. For special populations, it is particularly important to understand matters related to vaccination [1].

People with special diseases need to be evaluated by specialist physicians before vaccination: Currently, vaccination of people without contraindications is performed on-site by community general practitioners. The main evaluation contents include: whether there are underlying diseases and allergy history, etc., and no specialist evaluation is performed for a specific disease. Infectious disease physicians, hepatologists, and rheumatologists have unique experience in the diagnosis and treatment of their respective specialty diseases, and have also accumulated rich experience in the vaccination of such patients with other vaccines. There is a lot of accumulation of knowledge on the immune-related issues of these diseases, the organ damage that vaccines may cause, and the relationship between vaccines and drugs. In the practice of COVID-19 vaccination in my country, community physicians have encountered many confusions in deciding whether some specific populations can be vaccinated, and it is very necessary for specialist physicians to participate in the evaluation [2].

Routine prevention should not be relaxed even after vaccination: my country has vaccinated nearly half of the population, but the protective effect of the COVID-19 vaccine may not reach 100%. Therefore, wearing masks in public places, paying attention to hand hygiene and maintaining social distance are still indispensable national protection measures [3]. In addition, due to the rapid mutation of the 2019 novel coronavirus, it is still uncertain whether the inactivated vaccine prepared with the "wild strain" or the nucleic acid vaccine or recombinant protein vaccine prepared based on the gene sequence of the spike protein expression of the "wild strain" can protect against infection with the mutant virus. Combined with the recent outbreaks in many other countries outside China, as well as the intermittent imported cases and the local infections caused by them in my country, even if the vaccine is administered, individual and collective protection measures cannot be relaxed.

Treatment of the underlying disease must continue: for example, patients with chronic hepatitis B must use nucleoside drugs for long-term antiviral treatment. Patients who have not achieved "clinical cure" have a greater risk of relapse after discontinuation of medication and are more susceptible to drug resistance [4]. Therefore, nucleoside drugs should not be discontinued during vaccination. In my clinical work, I often encounter some inappropriate treatment measures. For example, when a patient uses nucleoside antiviral drugs, viral DNA is effectively suppressed and the patient's transaminase is normal, he is required to stop using nucleoside drugs for 3 days when he goes to the community to receive the new crown vaccine. This practice has neither relevant guidelines or consensus guidance nor medical basis.

Strengthen monitoring after vaccination: The 30-minute wait at the vaccination site is considered post-vaccination observation, not monitoring. Studies have shown that patients with autoimmune diseases are not only more susceptible to the 2019 novel coronavirus than the general population, but also have a higher hospitalization rate and more severe illness once infected. Therefore, although vaccination may have risks, its benefits outweigh the risks [2].

Caregivers should be vaccinated: COVID-19 is a new infectious disease. Not only is the incidence and mortality rate of severe illness after infection high, but the virus is also highly contagious and humans are generally susceptible. It is reasonable to speculate that patients with immune dysfunction (low immunity) are more susceptible than the general population. Therefore, whether in medical institutions, nursing homes, or at home, it is even more necessary for people who care for such patients to be vaccinated with the new coronavirus vaccine to minimize the spread of the virus. "Protecting yourself can protect the patient." This is the "Xiaotangshan experience" in preventing and treating severe acute respiratory syndrome (SARS) in 2003 (the corresponding author treated SARS patients in Xiaotangshan Hospital for nearly 2 months in 2003) [5].

References:

[1]. Hu Jiayu. Focus on vaccination of six special groups[J]. Jiangsu Health Care, 2020(05):22-23.

[2]. Yin Rong, Niu Yunchao, Miao Xiaohui. Interpretation of "Expert Recommendations on COVID-19 Vaccination for Special Populations (Patients with Chronic Liver Disease, Tuberculosis and Rheumatism)"[J]. Chinese Journal of Infectious Diseases, 2021, 39(10): 588-590.

[3]. Li Cheng, Zhong Yang, Wu Yi, et al. Research status and prospects of non-drug intervention measures for the novel coronavirus pneumonia epidemic [J]. Modern Preventive Medicine, 2021, 48(3): 385388.

[4]. Chinese Society of Infectious Diseases, Chinese Society of Hepatology. Guidelines for the prevention and treatment of chronic hepatitis B (2019 edition) [J]. Chinese Journal of Infectious Diseases, 2019, 37(12): 711736. DOI: 10.3760/cma.j.issn.10006680.2019.12.003.

[5]. Miao Xiaohui. Talking about personal protection against SARS based on the zero infection rate of medical staff in Xiaotangshan Hospital [J]. Journal of Second Military Medical University, 2003, 24 (7): 702703. DOI: 10.3321/j.issn:0258879X.2003.07.002.