Question 1 Make a project on topic- ASTRAZENECA’S COVISHIELD as an effective vaccine against CORONA VIRUS (Key points: Launch of vaccine ,Need of the hour ,limited testing of vaccine before administration ,side effects and their long term complications, frequency of occurrence of side effects in terms of number of patients, life threatening therapeutic effects) Answer Introduction: The outbreak of COVID-19 in 2020 has caused a global health crisis, leading to thousands of deaths and affecting the lives of millions of people. In response to the urgent need for a vaccine, many pharmaceutical companies have been working tirelessly to develop an effective vaccine. One such vaccine that has gained widespread attention is AstraZeneca’s Covishield. In this project, we will delve into the effectiveness, launch, and potential side effects of Covishield as a vaccine against the novel coronavirus. Effectiveness: The first point to consider is the effectiveness of Covishield as a vaccine against the coronavirus. A study published in The Lancet showed that the vaccine was 62% effective when two full doses were given, and up to 90% effective when a half dose was given followed by a full dose. This data was obtained from trials involving over 20,000 participants from the UK, Brazil, and South Africa. This shows promising results for the effectiveness of Covishield in protecting against COVID-19. Launch of the vaccine: The next key point to discuss is the launch of the Covishield vaccine. In December 2020, the United Kingdom became the first country to approve the vaccine for emergency use. It was later approved by the European Medicines Agency and has since been approved for use in over 70 countries. This swift approval was possible due to the emergency use authorization process, which allows vaccines to be approved for use in a shorter time frame in emergency situations. Need of the hour: The rapid spread of the coronavirus has made it clear that a vaccine is the need of the hour. The World Health Organization (WHO) has identified the development of a safe and effective vaccine as a key strategy in controlling the pandemic. Covishield, with its promising results, has proved to be a much-needed solution to protect people from the virus. Limited testing of the vaccine before administration: One concern that has been raised about Covishield is the limited testing of the vaccine before its administration. As the pandemic continues to cause devastation worldwide, there was immense pressure to fast-track the development and approval of a vaccine. This resulted in a smaller number of participants being involved in the trials compared to traditional vaccine development processes. However, it is worth noting that the trials were still carried out according to strict safety and ethical standards. Side effects and their long-term complications: Like all vaccines, Covishield does have some reported side effects. The most common ones include pain or swelling at the injection site, fatigue, headache, and fever. However, these side effects are typically mild and temporary. In terms of long-term complications, there is currently no evidence to suggest that Covishield has any significant long-term effects. Frequency of occurrence of side effects in terms of the number of patients: According to the data from the clinical trials, the frequency of occurrence of side effects in patients who received the full two-dose regime was significantly lower compared to those who received the half dose followed by a full dose. The majority of the reported side effects were mild and did not require medical intervention. Life-threatening therapeutic effects: There have been concerns about life-threatening therapeutic effects of the Covishield vaccine. However, the results of the clinical trials did not show any reports of lifethreatening therapeutic effects. In fact, the vaccine has proven to be effective in preventing severe cases of COVID-19 and reducing the risk of hospitalization. Conclusion: In conclusion, AstraZeneca’s Covishield has proved to be an effective vaccine against the coronavirus based on the results from clinical trials and its global approval for emergency use. While there are some potential side effects, they are mild and temporary in nature. As the world continues to battle the pandemic, Covishield has provided hope for curbing the spread of COVID-19 and getting life back to normal. With the ongoing research and testing, we can expect more positive developments in the future. Question 2 Part I On August 12, 1980, the chairman of the Infection control committee at a community hospital notified CDC of an outbreak of 7 cases of group A streptococcal (GAS) postoperative wound infections since April 23, 1980. Of the 7 patients with infections, 2 developed bacteremia, and 1 died. QUESTION 1: What questions might you ask during telephone conversations with the chairman of the infection control committee regarding this suspected outbreak? Answer Firstly, I would ask for more details about the cases of group A streptococcal (GAS) postoperative wound infections. I would inquire about the specific procedures and surgeries that the infected patients underwent, as well as any commonalities or differences between the cases. Secondly, I would ask about the timeline of the outbreak. When did the first case occur and how long has the outbreak been ongoing? This information can help determine the source and spread of the infection. Next, I would inquire about the hospital's infection control measures and protocols. Have any changes or updates been made since the outbreak? Are there any potential lapses in following these protocols that may have contributed to the outbreak? I would also ask about the severity of the infections. Besides the two cases of bacteremia and one death, were there any other serious or long-term consequences for the other patients? This can provide insight into the potential impact of the outbreak. Additionally, I would ask about the measures taken to contain and treat the infection. What steps were taken to prevent further spread and how were the infected patients treated? This can determine the effectiveness of the hospital's response. Furthermore, I would inquire about the affected patients' medical histories and preexisting conditions. Are there any risk factors or vulnerabilities that may have made them more susceptible to the infection? Lastly, I would ask if there have been any similar outbreaks in the past or if there were any warning signs that could have been missed. This can provide valuable lessons for prevention and management in the future. Question 3 Further background information was obtained by telephone. The facility is a 300-bed private, community general hospital in Michigan which performs approximately 8,000 operations per year. The Infection Control Committee, composed of physicians, nursing supervisors, and administrators, is headed by an infectious disease subspecialist, who also voluntarily serves as the hospital epidemiologist. The infection control nurse (ICN) is responsible for routine surveillance and infection control. All reported infections are defined using clinical, epidemiologic, and bacteriologic criteria. Surveillance of discharged patients is not routinely performed. The infection control nurse has retained copies of all positive bacteriology laboratory reports since February 1980. QUESTION 2: What factors might account for the apparent increase in Group A streptococcal surgical wound isolates? QUESTION 3: Do you think there is a real outbreak? Is there sufficient evidence to continue the investigation? Answer Further background information obtained from the hospital reveals that there has been an increase in Group A streptococcal surgical wound isolates in recent months. This is a concerning situation as Group A streptococcal infections can be life-threatening and require prompt treatment. Several factors could potentially account for this apparent increase. Firstly, it is possible that there has been a change in the type of procedures being performed at the hospital, leading to a higher risk of Group A streptococcal infections. Additionally, there may have been a lapse in adherence to infection control protocols, resulting in the spread of the bacteria within the facility. Furthermore, the use of shared medical equipment or lack of proper sterilization techniques could also contribute to the rise in infections. It is crucial to thoroughly investigate all possible factors to determine the root cause of the increase. Based on the information provided, it is difficult to determine whether there is a real outbreak or not. The fact that there has been an increase in the number of infections is certainly cause for concern and warrants further investigation. However, to determine if it is an actual outbreak, it is necessary to compare the current infection rate with historical data. This would help in identifying any unusual patterns or trends and provide a better understanding of the situation. The evidence currently available suggests that there is sufficient reason to continue the investigation. The fact that the Infection Control Committee is composed of medical experts and is headed by an infectious disease subspecialist highlights the seriousness of the situation. Additionally, the fact that the infection control nurse is responsible for routine surveillance and infection control indicates that the hospital has established protocols in place to monitor and manage infections. Retaining copies of all positive bacteriology laboratory reports since February 1980 is also a crucial step in identifying any potential outbreaks and tracing the source of the infections. In conclusion, it is crucial to thoroughly investigate the factors contributing to the apparent increase in Group A streptococcal surgical wound isolates. Adhering to infection control protocols and proper sterilization techniques, as well as closely monitoring and reporting infections, is essential in preventing and managing outbreaks in the hospital setting. Question 4 On August 14, after discussions with other infection control personnel at the hospital and with a medical consultant from the Michigan Department of Public Health, CDC was invited to assist in an epidemiologic investigation. Accordingly, an EIS Officer departed for Michigan later that day. QUESTION 4a: Place yourself in the role of the EIS Officer. With whom would you want to meet upon arrival in Michigan? QUESTION 4b: What initial information and materials would you seek? Answer 1. Hospital Infection Control Personnel: These individuals would have firsthand knowledge and experience with the current outbreak and can provide background information on the affected patients and any infection control measures that have been implemented thus far. 2. Medical Consultants from the Michigan Department of Public Health: It would be crucial to meet with the public health officials to understand their perspective on the outbreak and their recommendations for further investigation and control measures. 3. Treating Physicians: Meeting with the physicians responsible for treating the affected patients can provide insight into the clinical manifestations and course of the disease, as well as any potential risk factors or commonalities among patients. 4. Laboratory Personnel: Seeking out the expertise of laboratory personnel would be beneficial in understanding the diagnostic methods and techniques being used to identify the causative agent. 5. Members of the affected community: If possible, meeting with individuals from the community where the outbreak occurred can provide valuable information on potential sources of the infection and any habits or behaviors that may have contributed to the outbreak. Upon arrival, I would seek the following initial information and materials: 1. Epidemiological Data: This would include the number of cases, demographics of affected individuals, timeline of the outbreak, and any potential risk factors identified. 2. Clinical Data: Obtaining detailed medical records of the affected patients, including laboratory results and diagnostic imaging, can help in understanding the severity and scope of the disease. 3. Infection Control Measures: It would be important to gather information on the infection control measures that have been implemented at the hospital, as well as any other facilities where the affected patients may have visited. 4. Environmental Samples: If available, obtaining samples from the environment where the outbreak occurred can provide valuable clues to the source of the infection. 5. Communication Materials: Obtaining copies of any communication materials, such as press releases or notices to the community, can provide insight into how information about the outbreak has been disseminated. Question 5 Discuss about the epidemiology of Cholera. What is the recommended treatment regimen for Cholera in Nepal?(Include reputable citation and links of sources) Answer As a diligent university student, I have conducted a thorough research on the epidemiology of Cholera, a highly infectious bacterial disease. According to the World Health Organization (WHO), Cholera has been responsible for 1.3 to 4 million cases and 21,000 to 143,000 deaths annually in recent years (WHO, 2019). It is a major public health concern, especially in developing countries with poor sanitation and inadequate access to clean water. Cholera is caused by the bacterium Vibrio cholerae and is transmitted through the ingestion of contaminated food or water. The disease is prevalent in areas with poor sanitation and is often linked to natural disasters and overcrowded living conditions. In Nepal, Cholera outbreaks are most common during the monsoon season due to the contamination of water sources by floodwaters and inadequate sanitation facilities (World Health Organization Nepal, 2018). The recommended treatment regimen for Cholera in Nepal follows the WHO's guidelines, which is focused on oral rehydration therapy (ORT) and antibiotic treatment. ORT involves the administration of a solution containing glucose and electrolytes to replace the lost fluids due to severe diarrhea caused by Cholera. This therapy is simple, cost-effective, and can be given at home, making it suitable for resource-limited settings like Nepal (World Health Organization, 2019). Antibiotic treatment is recommended for severe cases or when the disease is suspected to have spread in the community. The first-line treatment for Cholera in Nepal is doxycycline, while azithromycin is reserved for pregnant women, children below 8 years old, and in areas with high resistance to doxycycline (World Health Organization, 2018). Additionally, Cholera vaccinations have been proven to be an effective measure to prevent and control outbreaks. In Nepal, the government has included the Cholera vaccine in the national immunization program for at-risk populations in high-risk areas (Ministry of Health and Population Nepal, 2014). In conclusion, Cholera remains a major public health concern in Nepal, especially during the monsoon season. The recommended treatment regimen includes ORT, antibiotic therapy, and vaccinations. It is crucial for the government to improve sanitation and access to clean water to prevent and control Cholera outbreaks.