Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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

Important Notice

Case Series
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : LR01 - LR03 Full Version

Breakthrough Cases of COVID-19 among Healthcare Workers: A Case Series


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52421.15894
Anuradha Mohapatra, Gajanan D Velhal, Uma R Nair, Nived G Sudarson

1. Assistant Professor, Department of Community Medicine, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India. 2. Professor and Head, Department of Community Medicine, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India. 3. Junior Resident, Department of Community Medicine, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India. 4. Junior Resident, Department of Community Medicine, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India

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

Abstract

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.

Keywords

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.

Case Report

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.

Discussion

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.

Conclusion

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.

References

1.
Keehner J, Horton LE, Pfeffer MA, Longhurst CA, Schooley RT, Currier JS, et al. SARS-CoV-2 Infection after Vaccination in Health Care Workers in California. N Engl J Med. 2021;384:1774-75. Published online March 23, 2021:NEJMc2101927. Doi:10.1056/NEJMc2101927. [crossref] [PubMed]
2.
Amit S, Beni SA, Biber A, Grinberg A, Leshem E, Regev-Yochay G. Postvaccination COVID-19 among Healthcare Workers, Israel. Emerg Infect Dis. 2021;27(4):1220-22. Doi: 10.3201/eid2704.210016. [crossref] [PubMed]
3.
Serum Institute Of India - ChAdOx1 nCoV- 19 Corona Virus Vaccine (Recombinant)- COVISHIELD. Accessed April 19, 2021. https://www.seruminstitute.com/product_covishield.php. [crossref] [PubMed]
4.
Biotech B, Council I, Ella K. Bharat Biotech Announces Phase 3 Results of COVAXIN ®: India's First COVID-19 Vaccine Demonstrates Interim Clinical Efficacy of 81%.
5.
Shah AK, Velhal GD, Raul MU. Dilemma and implication of COVID-19 recurrences among healthcare workers. Int J Community Med Public Heal. 2021;8(3):1498. Doi: 10.18203/2394-6040.ijcmph20210851. [crossref]
6.
Das P, Satter SM, Ross AG, Abdullah Z, Nazneen A, Sultana R, et al. A case series describing the recurrence of covid-19 in patients who recovered from initial Illness in Bangladesh. Trop Med Infect Dis. 2021;6(2):41. Doi: 10.3390/TROPICALMED6020041/S1. [crossref] [PubMed]
7.
COVID-19 Breakthrough Case Investigations and Reporting|CDC.
8.
Bergwerk M, Gonen T, Lustig Y, Amit S, Lipsitch M, Cohen C, et al. Covid-19 breakthrough infections in vaccinated health care workers. N Engl J Med. 2021;385(16):1474-84. Doi: 10.1056/NEJMOA2109072/SUPPL_FILE/NEJMOA2109072_DATA-SHARING.PDF. [crossref] [PubMed]
9.
Voysey M, Costa Clemens SA, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: A pooled analysis of four randomised trials. Lancet. 2021;397(10277):881-91. Doi: 10.1016/S0140-6736(21)00432-3. [crossref]
10.
Amit S, Regev-Yochay G, Afek A, Kreiss Y, Leshem E. Early rate reductions of SARS-CoV-2 infection and COVID-19 in BNT162b2 vaccine recipients. Lancet. 2021;397(10277):875-77. Doi: 10.1016/S0140-6736(21)00448-7. [crossref]
11.
Klompas M. Understanding breakthrough infections following mRNA SARS-CoV-2 vaccination. JAMA. 2021;326(20):2018-20. Doi: 10.1001/JAMA.2021.19063. [crossref] [PubMed]
12.
Wang SY, Juthani PV, Borges KA, Shallow MK, Gupta A, Price C, et al. Severe breakthrough COVID-19 cases in the SARS-CoV-2 delta (B.1.617.2) variant era. The Lancet Microbe. 2021;0(0). Doi: 10.1016/S2666-5247(21)00306-2. [crossref]
13.
Trogen B, Caplan A. Risk compensation and COVID-19 vaccines. Ann Intern Med. Published online March 2, 2021. Doi: 10.7326/m20-8251. [crossref] [PubMed]

Tables and Figures
[Table / Fig - 1]
DOI and Others

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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