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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case Series
Full Version
Breakthrough Cases of COVID-19 among Healthcare Workers: A Case Series
Correspondence Address :
Dr. Nived G Sudarson,
Room Number 508, Anant Niketan KEM Doctors Hostel, Dr. M Samant Marg, Dighe Nagar, Prabhadevi, Mumbai-400013, Maharashtra, India.
E-mail: nivedgsudarson@gmail.com
Breakthrough infections after Coronavirus Disease-2019 (COVID-19) vaccinations are an expected phenomenon as no vaccine is 100% effective. Healthcare Workers (HCW) are at a higher risk of contracting the infection owing to the exposure at the workplace. This case series describes clinical profile of 27 breakthrough infections after two weeks of second dose of vaccination. Of the total HCWs with the COVID-19 infection during the study period, 21.77% were breakthrough infections. The mean age of these HCWs was 36±12.02 years. The mean interval between the second dose of vaccine and being detected COVID-19 positive was 24.41±7.69 days. Majority of them were doctors (66.67%) and nurses (14.81%). All of them suffered from mild disease and recovered fully. Availability of vaccines coupled with pandemic fatigue has led to false reassurance among population. Hence, COVID-19 Appropriate Behaviour (CAB) before and after vaccination should be followed rigorously to prevent such infections.
Coronavirus disease-2019, Pandemic, Postvaccination infection, Vaccination
A nationwide vaccination campaign has been one of the foremost steps implemented to tackle the coronavirus infection in several countries across the world. The Coronavirus Disease-2019 (COVID-19) vaccination campaign started in India on January 16th 2021. Two vaccines used for this drive were Oxford-AstraZeneca’s Covishield and Bharat Biotech’s Covaxin. Healthcare Workers (HCWs) were given the first priority to receive the vaccination. Vaccinated people are contracting COVID-19 infection following complete vaccination (1),(2).These breakthrough cases are expected phenomena as no vaccine is 100% effective in preventing illness. Covishield is estimated to have an efficacy of 62-90% whereas, Covaxin is estimated to have 81% efficacy (3),(4). HCWs are at a higher risk of contracting the infection owing to the exposure at the workplace. Cases of recurrences have also been reported among them (5),(6). Reporting breakthrough cases provides vital information regarding clinical profile and CAB following vaccination. Through this case series, authors report 27 vaccine breakthrough cases of COVID-19 amongst HCWs of a tertiary care Institute in Mumbai.
All HCWs in the Institute were offered the Covishield-ChAdOx1 nCoV-19 Corona vaccine from 16th January 2021, and the second dose was offered after a gap of four weeks. The data regarding HCWs has been obtained from contact tracing records maintained by the Department of Community Medicine for all the HCWs during the pandemic of COVID-19. A breakthrough case of COVID-19 is someone who tested positive ≥14 days after receiving both doses of vaccine (7). Among the total 124 HCWs who were positive during the study period, i.e., 26th February (14 days after starting second dose) to 31st March 2021, 17 HCWs (13.71%) had received only the first dose of vaccination, and 38 (30.65%) had received the second dose. Rest were not vaccinated. Of these 38 HCWs, 27 cases were breakthrough infections. All of these HCWs were in service of COVID-19 patients in rotation since the beginning of pandemic. The clinical epidemiological profile of 27 breakthrough cases of COVID-19 among HCWs in the institute has been presented in (Table/Fig 1).
Vaccination history: After receiving the first dose, 15 (55.56%) cases had minor symptoms like fever, sore throat, headache, myalgia, local arm pain. The mean duration of these symptoms was 15.11 hours (1-48 hours). After receiving the second dose, three of these cases had symptoms like headache, fever, and local arm pain. Twelve (44.44%) cases did not have any symptoms after receiving vaccination. This was based on contact tracing records. It does not contain the data regarding symptoms/adverse events following vaccination. Hence, these could not be assessed.
Clinical history: The mean interval between the second dose of vaccine and HCW being detected COVID-19 positive was 24.41±7.69 days (14-42 days). All the cases had contracted COVID-19 for the first time except for one female doctor, for whom this was the second episode. She was previously positive 10 months back and had completely recovered. The most common symptoms were fever (12 cases), followed by sore throat (8 cases), cough (7 cases), and myalgia (6 cases).The mean duration of symptoms was 3.52±2.83 days (1-11 days). Total 14 HCW (51.85%) were home isolated and the rest were admitted to the hospital. The reason for hospital admission was non availability of a home isolation facility (10 cases) and co-morbidities (3 cases). All the cases are stable and have completed their period of isolation of 17 days. All of them have tested negative at the end of isolation.
An unmitigated pandemic with uncertain treatment guidelines and variable prognosis triggered the innovation to produce vaccines at an unforeseen pace to tackle the virus.
In the present case series, of the total numbers of HCWs who were infected during the study period, the proportion of breakthrough cases was 21.77%. Due to the unavailability of the total number vaccinated at the institute, it is difficult to comment on the incidence of breakthrough infections. Also, 11 cases were infected between 1-14 days of taking the second dose hence, cannot be called vaccine breakthrough infections. The mean age of the breakthrough cases was 36±12.02 years. A prospective cohort study done in Israel, conducted from January to April 2021, reported 2.6% (39/1497) breakthrough infections among fully vaccinated HCWs (8). Amit S et al., reported that the proportion of postvaccination COVID-19 among HCWs of Israel was 0.54% (22 cases). However, none of the cases were breakthrough infections. The mean age of these HCWs was 45.3±9.85 years and the median duration between vaccination and onset of symptoms was 3.5 days (range 0-11 days) (2). In another study by Keehner J et al., it was reported that, of the 37 HCWs who tested positive after complete vaccination, only seven HCWs had tested positive ≥15 days after the second vaccination (1). Pre-existing exposure/early exposure after vaccination, risk compensation behaviour, pandemic fatigue, mutations in the viral genome, insufficient immune response could have contributed to acquiring COVID-19 infection after vaccination. HCWs have increased exposure to the virus in their work environment too.
In the present study, majority (22 cases) tested because they were symptomatic. Similar to the present study findings, Amit S et al., also reported that, of the 22 HCWs who had developed infection postvaccination, majority (13 cases) tested due to symptoms, two cases tested as they reported symptoms upon questioning and rest tested due to well-defined exposure to a positive patient (2). Therefore, even in breakthrough infections, mild symptoms are possible and COVID-19 testing should be done immediately.
All cases of breakthrough infection in this series experienced no symptoms to only mild symptoms. The mean duration of symptoms was also less (3.52 days). A recent study published in Lancet shows 66.7% percent overall efficacy of Covishield vaccine after 14 days of vaccination against symptomatic COVID-19 and 76% efficacy against COVID-19 in the first 90 days after vaccination (9). Trials have also suggested similar findings with the absence of severe symptoms in breakthrough cases as well as a decrease in the incidence of COVID-19 in the vaccinated group as compared to the control group (10). A recent study conducted among hospitalised patients with symptomatic COVID-19 found out that, as compared to unvaccinated patients, vaccinated patients are less likely to require intensive care (25% vs 40%), mechanical ventilation (7.7% vs 23%) and less likely to die (6.3% vs 8.6%) (11). Similar findings were reported in a study by Wang SY et al., wherein a shorter mean duration of hospitalisation (10.8 days vs 13.1 days), lower risk of advanced oxygen or ventilatory support (32% vs 51%) and lower in-hospital mortality (10% vs 12%) was observed among breakthrough COVID-19 infections as compared to unvaccinated (12).
The “Peltzman effect” results in risk compensation and its effects leading to increased violation of CAB have been found after vaccination too (13). In the present series too, 30% of the cases admitted to having a lapse in CAB.
Breakthrough cases of COVID-19 although rare do occur. Along with a decline in compliance to CAB and false sense of reassurance due to availability of vaccines, breakthrough cases could facilitate further spread of COVID-19 infection. To prevent further infections, morbidity and mortality due to COVID-19, compliance to CAB prior to as well as postvaccination should be ensured in conjunction with continuous testing and contact tracing of symptomatic people.
DOI: 10.7860/JCDR/2022/52421.15894
Date of Submission: Sep 21, 2021
Date of Peer Review: Nov 10, 2021
Date of Acceptance: Dec 13, 2021
Date of Publishing: Jan 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 22, 2021
• Manual Googling: Dec 06, 2021
• iThenticate Software: Dec 13, 2021 (4%)
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