At the moment, frontrunners in the coronavirus vaccine race include Moderna, Pfizer BioNTech, Sinovac Biotech and Oxford AstraZeneca.

Source of information: AKADEMI SAINS MALAYSIA

The vaccines protect against symptomatic forms of COVID-19, but it is still unclear whether they will stop the spread of the SARS-CoV-2 virus, the cause of COVID-19. Therefore, you should still continue to take appropriate precautions in protecting yourself and others around you even after receiving the COVID-19 vaccine.

Both the Moderna and Pfizer BioNTech’s vaccines use mRNA (messenger RNA) technology and it is interesting to note that the mRNA vaccines have never been approved for use in any disease. It has however received emergency use authorisation from the FDA.

mRNA vaccines work by injecting pieces of the virus’ genetic code into the body to stimulate an immune system reaction which enables the body to defend itself against the coronavirus.

The mRNA in the body breaks down fully within 48 hours. As it doesn’t enter the human nucleus, it does not affect human DNA. Both Moderna and Pfizer’s mRNA vaccines require 2 doses for adequate protection, and the doses are administered between 3 and 4 weeks apart.

Oxford AstraZeneca and Sinovac Biotech’s vaccines employ a modified delivery virus (that usually causes symptoms such as the common cold) to introduce SARS-CoV-2 viral proteins to the immune system, which then mounts a defence against it. The delivery virus is attenuated or modified so the person won’t develop the common cold when administered with this vaccine.

Why is COVID-19 vaccination important?
The national COVID-19 immunisation programme by the Malaysian government is an important step to stop the pandemic. Benefits from the immunisation programme include:
• Preventing someone from COVID-19 infection or becoming seriously ill due to COVID-19.
• Curb the spread of COVID-19 to others.
• To achieve herd immunity where a significant amount of the population is protected through vaccination against the virus, making it difficult for the disease to spread.
• Infectious Disease Prevention and Control Act (Act 342)

COVID-19 vaccination – safe for pregnant women and breastfeeding mothers?

Update: Recent announcement by the Ministry of Health, Malaysia on 25 May 2021 indicated that only the Pfizer vaccine is allowed for pregnant women between week 14 and 33, or they should defer vaccination till after their delivery. The AstraZeneca and Sinovac vaccines are not recommended at the moment. As for breastfeeding mothers, both the Pfizer and AstraZeneca vaccines are suitable for them. For Sinovac vaccine, it is currently not recommended for pregnant women due to the limited clinical data. Breastfeeding mothers who would like to opt for Sinovac vaccine are required to consult their specialists prior to vaccination.


 

Vaccine	Pregnant Mothers	Breastfeeding Mothers
Pfizer	Suitable for pregnant mothers between 14 – 33 weeks of pregnancy. For pregnancies above 34 weeks, vaccination can be considered in consultation with your O&G specialist.	Vaccine is suitable for breastfeeding mothers.
Astra Zeneca	Suitable for pregnant mothers between 14 – 33 weeks of pregnancy. For pregnancies above 34 weeks, vaccination can be considered in consultation with your O&G specialist.	Vaccine is suitable for breastfeeding mothers.
Sinovac	Suitable for pregnant mothers between 14 – 33 weeks of pregnancy. For pregnancies above 34 weeks, vaccination can be considered in consultation with your O&G specialist.	Vaccine is suitable for breastfeeding mothers.




Source of information: Kementerian Kesihatan Malaysia





Government bodies and health authorities around world are encouraging eligible members of the general public to get vaccinated. This is because as more people get vaccinated it reduces the chances of transmission. Which means it becomes more difficult for the virus to spread, hence making it safer for the society if more people get vaccinated.

But, what if you are pregnant or breastfeeding? Is it (really) safe to get vaccinated for COVID-19?

Is it safe to get vaccinated if you are pregnant?

There is currently very little data available to assess the safety of COVID -19 vaccines on pregnant women and breastfeeding mothers because of the lack of clinical testing during the development of the COVID-19 vaccine. Having said that, based on the safety and efficacy data of the current vaccines in the market, the World Health Organization (WHO) states they do not have any reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women. In fact, findings of a few studies did not indicate any adverse effects on fetal development.

Additionally, pregnant women and breastfeeding mothers have also taken other vaccines such as tetanus toxoid, influenza and pertussis for example. However, If you are still unsure, we highly recommend that you speak to your OB-GYN to seek advice and discuss about your eligibility for COVID -19 vaccination.

Is it safe to get vaccinated if you are breastfeeding?

While there is currently very little data to suggest the safety and efficacy of the COVID -19 vaccines on pregnant women or breastfeeding mothers, there are also no known risks of the COVID-19 vaccine to breastfeeding mothers.

This is because the vaccines currently available in the market are non-replicating vaccines. Non-replicating vaccines can create an immune response but do not reproduce inside host cells – meaning that there is no possible way by which the vaccine can pass to your baby through breast milk.

So, is it (really) safe for pregnant women and breastfeeding mother to be vaccinated?

• It is encouraged for pregnant woman and breastfeeding mother to consider getting vaccinated against COVID -19 especially if you are in the frontline e.g. a healthcare worker or have known medical conditions. However, the decision should be made as a mutual agreement between the mother and her consultant. She should get clearance from her consultant prior to considering getting vaccinated for COVID-19.


• Despite insufficient data on the potential effects of the Covid-19 vaccines in expecting and nursing mothers, the Health Ministry will allow them to be inoculated if the benefits outweigh the risks. However, the decision to either allow or advise these mothers against receiving their vaccine shots must come from a specialist after assessing their potential risk




One of the key considerations to note is that women who are pregnant and part of a group recommended to receive the Covid-19 vaccine, such as healthcare personnel, may choose to be vaccinated after thorough discussions with their doctor.


References

Source: Ministry of Health Malaysia (Updated February 2021) World Health Organization (WHO) (Updated February 2021)

“Panduan Vaksinasi Untuk Ibu Mengandung dan Ibu Menyusukan Bayi”. Kementerian Kesihatan Malaysia.
Accessed from http://covid-19.moh.gov.my/vaksin-covid-19/panduan/panduan-vaksinasi-untuk-ibu-mengandung-dan-ibu-menyusukan-bayi

COVID-19 Vaccine – Safe for those with heart conditions?

Can those with cardiovascular conditions or heart problems take the COVID-19 vaccine?


In short, yes. In fact, heart patients are highly encouraged to take the COVID-19 vaccine as it can help to protect them from contracting the virus. Here’s why.

According to studies, heart patients have a higher risk of developing health complications from COVID-19 compared to those without history of heart problems. That is why, heart patients fall under a group of people who have been prioritized to get the COVID-19 vaccine alongside other patients with chronic diseases such as diabetes, hypertension, and high cholesterol etc.

Therefore, if you are an individual that have heart conditions, or if your family member is a heart patient, you should take or advice your family member to get vaccinated against COVID-19 – by taking this action, not only are you protecting yourself but you are also protecting your loved ones from COVID-19.

However, it is understood that you may have some concerns over the safety of the COVID-19 vaccine, especially since you or your loved ones have pre-existing medical conditions. Would it worsen the condition or will the side-effects be more severe?

Will those with cardiovascular disease or heart problems experience any side effects?


The current mRNA COVID-19 vaccines available in the market have been shown to be safe for use for heart patients. This is because people with pre-existing medical conditions such as diabetes, heart problems, hypertension and high cholesterols were included in the early clinical trials.Which means that the vaccines have been tried and tested by people who have the same medical conditions as you and they were found to benefit from the vaccine.

When it comes to side effects, most vaccine can have side effects. It is important to note that both the mRNA vaccines PfizerBioNTech and Moderna do carry the risk of some common side effects such as pain, redness or swelling in the shoulder muscle area where the injections were administered, as well as fatigue, headaches, muscle pain, chills, fever, and nausea. These symptoms will most likely resolve within one or two days. If the symptoms persist, please consult a healthcare professional for medical advice.

However, if you history of allergic reaction to any component (active ingredients or excipients or any material used in process) of the vaccine or similar vaccines, it is advisable for you not to get the vaccine – not at least until more safety data become available.

Should you get vaccinated if you have cardiovascular disease or heart problems?

Yes, you should. As advised by the Ministry of Health, everyone who is medically eligible should get vaccinated. This is because as more people get vaccinated, the slower the virus would spread, and as a result, our community will be safer.

However, if you are still concerned about the safety of these vaccinations, we encouraged you to seek consultation with your doctor. Click here to speak with our doctors. Our doctors will be able to assess your medical and allergy history to determine your eligibility for COVID-19 vaccines.

However, if you still have concerns, you may well get advice from your consultant.


References

1. “Should heart patients take the COVID-19 vaccine?”. Singapore Heart Foundation. Accessed from https://www.myheart.org.sg/press-and-media/heart-news/heart-patient-and-covid19-vaccine/

2. “The effects of virus variants on COVID-19 vaccines”. World Health Organization (1 March 2021). Accessed from https://www.who.int/news-room/feature-stories/detail/the-effects-of-virus-variants-on-COVID-19-vaccines

3. Merschel, M. “What heart and stroke patients should know about COVID-19 vaccines”. The American Heart Association. Accessed from https://www.heart.org/en/news/2021/01/15/what-heart-and-stroke-patients-should-know-about-COVID-19-vaccines

4. “COVID-19 VACCINATION”. Ministry of Health Singapore (n.d). Accessed from https://www.moh.gov.sg/COVID-19/vaccination

None of us ever expected that our lives would change indefinitely when the COVID-19 pandemic took over the entire world by storm. We are now left to embrace the ‘new normal’ of living. Something that still needs getting used to. Some light did come to show early this year when some pharmaceutical companies begun rolling out the much-awaited COVID-19 vaccine. Even so, they are increasing the production of these vaccines as we progress daily.

This is a step in the right direction as it prepares us to return to normal life by achieving herd immunity – a term used to describe a huge population that is immune to a virus. Through herd immunity, the risk of large-scale outbreaks – like we have seen over the past year – is significantly reduced1. However, two important questions remain – can you still get infected with COVID-19 after taking the vaccine, and are you eligible for the vaccine if you have previously tested positive for the virus? Let’s find out together.





Can those who get vaccinated still contract COVID-19?

Let us first understand that the COVID-19 vaccines that were developed have been found to be effective at preventing a COVID-19 infection. However, there is still a minor possibility that you can contract COVID-19 despite being vaccinated. Rest assured, that it is a very slim chance and with vaccination already taking place at break speed, the risk of COVID-19 infections becomes even lower.

It’s also important to be aware that the coronavirus vaccine might not have enough time to provide complete protection - not that it is ineffective against COVID-19. This is why mRNA vaccinations need to be given in two dosages and require approximately two weeks to fully activate our immune system response.

So even if an individual has received the vaccination, practicing cautions in social or physical distancing as well as basic hygiene is crucial.





Can those who have been previously diagnosed with COVID-19 be vaccinated?

A person can take the vaccine until the person has recovered from the acute illness (if the person had symptoms) and they have met criteria to discontinue isolation. Why? Getting vaccinated can offer a stronger and more reliable immune system response to a past COVID-19 infection as compared to the natural immunity developed by the body.
As a matter of fact, those who have recovered from COVID-19 were found to have antibodies that were up to 10 times higher than vaccinated individuals who did not previously test positive for COVID-19. But those with pre-existing immunity experienced systemic side effects such as fatigue, headache, chills, fever, and muscle or joint pains with considerably higher frequency This is why those who fall in this category are also encouraged to sign-up for vaccination as soon as possible.





Will life return to normal for those who have been vaccinated?

Hopefully, it will. The most important thing is to do your duty as a good citizen by signing up for the vaccination. However, getting vaccinated against COVID-19 should not be considered a substitute for basic precautionary measures. We should always remember to do our part by practicing good hygiene habits like regular handwashing, masking up when outdoors, and adhering to social distancing measures. By doing this, we are one step closer to beating the pandemic once and for all.



References

1. “Coronavirus disease (COVID-19): Vaccines”. World Health Organization (28 October 2020).
Accessed from https://www.who.int/news-room/q-a-detail/coronavirus-disease-(covid-19)-vaccines

2. “Information about the Pfizer-BioNTech COVID-19 Vaccine”. Centers for Disease Control and Prevention (4 March 2021).
Accessed from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html

3. “Information about the Moderna COVID-19 Vaccine”. Centers for Disease Control and Prevention (4 March 2021).
Accessed from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html

4. “Key Things to Know About COVID-19 Vaccines”. Centers for Disease Control and Prevention (13 March 2021).
Accessed from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/keythingstoknow.html

5. Wise, J. “Covid-19: People who have had infection might only need one dose of mRNA vaccine”. thebmj (2 February 2021).
Accessed from https://www.bmj.com/content/372/bmj.n308

Studies have shown that it is natural for any type of virus to evolve into newer variants. It simply means that viruses can mutate after some time. This doesn’t mean that they are a new form of a virus, but rather a different kind of the same virus.

The best way to describe this is to think of them as being part of the same family. Now, these new strains may cause some changes that are a little different from how we understand the original virus to be. While many would panic especially when we keep hearing about the COVID-19 new variants, it's best we first understand how this mutation works.

It’s true, new strains can either increase or decrease the risk of a virus being contagious. These strains may also affect the severity or level of an infection. So, in the case of COVID-19, how exactly do new strains affect the level of symptoms? Does it impact the effectiveness of the different vaccines that are already available? Let’s take a closer look at how these happens.




Can a new virus strain cause COVID-19 symptoms that are more severe?

Before we dive in a little deeper, it’s important to note that virus strains exist because of differences in geographic location. What does that mean, you ask? It means that different countries or regions may have the same primary virus, but new and different virus strains may appear in these places simply because of geographical reasons Let’s look at the virus strain that was originally detected in the UK for example. This virus strain, also known as B117, was found to increase the risk of being contagious by up to 50% compared to the original COVID-19 virus. Whoa!

The South African strain - B1351 - on the other hand, was found to be 50% more contagious than the original COVID-19 virus3. Similarly, the P1 virus strain that was first detected in Brazil was found to be up to 2.2 times more contagious than the B117 variant. Pretty intense we would say, but does a higher risk of being contagious mean that there are more severe COVID-19 symptoms?

Meanwhile, B117 (UK) and B1351 (South Africa) have not been found to affect the level of COVID-19 symptoms experienced. However, more data is required to understand the level of COVID-19 symptoms experienced by those infected with the P1 (Brazil) strain.

More recently is the strain discovered out of India (B.1.617) which has caused global record numbers in daily infections within the country over the past weeks. It’s still too early to say if this strain is the cause of rapid spread in India, but experts are treating it as such. It’s also being called a “super mutation” that will make its way around to the rest of the world. Oh no! This strain has already been detected in countries like Germany, Belgium and even in the U.K.

This is why it’s important to continue practicing basic precautionary measures and get vaccinated as soon as possible. Through this, you are doing your civic duty as a responsible citizen to prevent further widespread of these new strains.




Can a new virus strain affect the effectiveness of the different vaccines available?

According to the World Health Organisation (WHO), there is no reason to believe that these COVID-19 virus strains can cause any vaccine to be ineffective We can totally breathe easy now! This is because COVID-19 vaccinations give our bodies some sort of protection by working with our immune system, which is the body’s natural defense against viral infections. Through this, our bodies’ natural defenses cover a wide range of COVID-19 infections, even the new variants.

On a brighter note, it’s also possible to make changes to existing vaccines so that they offer better protection against different COVID-19 virus strains. This will be especially important if data ever shows that these new strains cause the COVID-19 vaccines to be not effective, however, there is no such news yet. We know, what a relief!




What can you do to prevent COVID-19 virus strains?

Ultimately, it’s important for you to get vaccinated as soon as possible to prevent a COVID-19 infection. And by keeping the spread of the primary virus low, you help to reduce the risk of creating new virus strains in your country or region. Pretty simple, no? At the same time, it’s recommended that you carry on practicing basic measures such as regular handwashing, masking up, and maintaining social distancing in public areas. By doing this, you can help to reduce the contagiousness of the main COVID-19 virus, whilst reducing the risk of COVID-19 virus strains altogether. You’ve got this, people!


References

1. “The effects of virus variants on COVID-19 vaccines”. World Health Organization (01 March 2021).
Accessed from https://www.who.int/news-room/feature-stories/detail/the-effects-of-virus-variants-on-covid-19-vaccines

2. “Pfizer-BioNTech COVID-19 Vaccine Overview and Safety”. Centers for Disease Control and Prevention (21 May 2021).
Accessed from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html

3. CJuan C. Salazar, MD, MPH, FAAP.“What Are the New COVID-19 Strains, and Do They Infect Kids More Easily?”. (01 February 2021).
Accessed from https://www.connecticutchildrens.org/coronavirus/what-is-the-new-b117-strain-of-covid-19-and-does-it-more-easily-infect-kids/

4. Simon Clarke.“Brazil coronavirus variant: what is it and why is it a concern? An expert explains”. (03 March 2021).
Accessed from https://theconversation.com/brazil-coronavirus-variant-what-is-it-and-why-is-it-a-concern-an-expert-explains-156234

5. “New COVID variant with 5 mutations identified in California”. Center for Infectious Disease Research and Policy (12 February 2021).
Accessed from https://www.cidrap.umn.edu/news-perspective/2021/02/new-covid-variant-5-mutations-identified-california

6. David Kennedy.“What you need to know about the new COVID-19 variants”. (16 January 2021).
Accessed from https://theconversation.com/what-you-need-to-know-about-the-new-covid-19-variants-153366

7. “SARS-CoV-2 Variant Classifications and Definitions”. Center for Infectious Disease Research and Policy (25 May 2021).
Accessed from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html

8. Gayathri Vaidyanathan. “Coronavirus variants are spreading in India — what scientists know so far”. (11 May 2021).
Accessed from https://www.nature.com/articles/d41586-021-01274-7

A visit to the doctor’s for orthopaedic problems (joints, ligaments, tendons, muscles, and nerves) during a pandemic can be an uneasy experience. But it sure can be rewarding if you’re heading there for a COVID-19 shot. Why, you ask? If you have any type of pre-existing health condition, you may be at higher risk of getting COVID-19 than someone else without them. Simple equation!

Therefore, it's important to consider getting vaccinated immediately if you are eligible. But one question could be on your mind: is it safe to give the COVID-19 vaccine to someone who is going for orthopaedic surgery? Let’s deep dive together to answer this question, shall we?

Is it safe for those undergoing orthopaedic surgery to take the COVID-19 vaccine?

It's generally safe for you to take the COVID-19 vaccine if you are considered eligible. However, if you are undergoing surgery, you should first consult a doctor before getting vaccinated. Chances are that the doctor will advise you not to take it before surgery.

This is because any side effect from the vaccine may impact the outcome of the surgery. For example, any common side effect such as fever or muscle ache may slow down the rehabilitation or prolong the duration of hospitalisation. On the other hand, patients who have experienced physical trauma (fractures, broken or dislocated bones) due to a car accident, fall or sports injury, may be asked upon arrival at the Emergency department if they already have received the COVID-19 vaccination.

Those who have bone or blood-related diseases (bone cancer, osteoporosis, and leukaemia) that are severe and can cause terminal illness should also seek consultation with a doctor before getting the COVID-19 vaccine. Better to be safe than sorry, people.

Is it safe to take the COVID-19 vaccine alongside pain management medicine prior to surgery?

Yes, it is safe for someone who has been given pain management medicine such as steroids for joint pain or inflammation to get the COVID-19 vaccine. Also, it’s recommended to consult with the clinician in charge for medical advice.

This piece of good news will make no one happier than the elderly. Why the elderly, you may ask? Well, for one, old age can put a person at a bigger risk of injury or developing orthopaedic conditions³. For example, arthritis, which requires medicine to manage the pain caused by swollen or tender joints. Ouch!

At the same time, old age can also lower immune system function (your body’s natural defences) and increase the risk of infectious diseases like COVID-19⁴. This is why it’s important for the elderly to prioritise getting vaccinated, as it can help to protect them against the harmful effects of COVID-19⁴.

If you’re not sure about taking the COVID-19 vaccine while on steroid treatment, we encourage you to speak to our orthopaedic specialists and come to a decision that works best for you.

Should you get vaccinated prior to orthopaedic surgery?

Yes. But before you do, we recommend that you speak to any of our doctors. They are best qualified to decide if you are eligible for the COVID-19 vaccine, or if you are at risk of having health problems due to vaccination. The doctor’s decision to not allow you to take the vaccine relies on things like a weakened immune system, a platelet count that is less than 50,000, and a history of experiencing a severe allergic reaction (also known as anaphylaxis) to venom, certain foods or medication.

In parting, just remember, it takes a joint (pun intended) effort by everyone to achieve complete immunity within our communities. This starts with prioritising vaccination and other preventive measures such as regular handwashing, masking up in public places, and maintaining social distancing.

References

1. Blouhos, K, et al. “Understanding Surgical Risk During COVID-19 Pandemic: The Rationale Behind the Decisions”. Frontiers in Surgery.
Accessed from https://www.frontiersin.org/articles/10.3389/fsurg.2020.00033/full
2. Chakarvarty, K, et al. “Recommendations and Guidance for Steroid Injection Therapy and COVID-19 Vaccine Administration from the American Society of Pain and Neuroscience (ASPN)”. Dovepress (5 March 2021). Centers for Disease Control and Prevention (21 May 2021).
Accessed from https://www.dovepress.com/recommendations-and-guidance-for-steroid-injection-therapy-and-covid-1-peer-reviewed-fulltext-article-JPR
3. Anderson, A. S, MD and Loeser, F. R, MD. “Why is Osteoarthritis an Age-Related Disease?”. US National Library of Medicine (24 February 2010).
Accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818253/
4. “Aging changes in immunity”. MedlinePlus.
Accessed from https://medlineplus.gov/ency/article/004008.htm
5. “COVID-19 VACCINATION”. Ministry of Health Singapore (n.d).
Accessed from https://www.moh.gov.sg/covid-19/vaccination
6. “Thrombocytopenia following Pfizer and Moderna SARS-CoV-2 vaccination”. The National Center for Biotechnology Information.
Accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014568/