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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
Original article / research
Full Version
Neutralising Antibodies in Healthcare Workers after Two Doses of Covishield Vaccine at Three Months and Six Months: A Single-centre Observational Study
Correspondence Address :
Dr. Amulya Cherukumudi,
Resident, Department of Microbiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
E-mail: amulyac1@yahoo.com
Introduction: The emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) as a pandemic has put the global population at risk for its infection. It has also led to an accelerated effort to develop vaccines that can mitigate progression to severe infections at a minimum. The ambiguity about existence of antibodies in the human serum poses problem in formulating public health policies like suitable interval between doses of vaccines, appropriate time for vaccinating population, post natural infection, necessity of booster doses along with single dose.
Aim: To estimate neutralising antibody level following Covishield vaccination of Healthcare Workers (HCWs) after three months and six months, respectively.
Materials and Methods: This was a prospective observational study performed in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India after Institutional Ethics Committee (IEC) approval from January 2021 to February 2022. The study was conducted in 304 HCWs in the institute who had received two doses of Recombinant ChAdOx1 nCoV-19 Coronavirus Vaccine (Covishield). Forty one HCWs who were naturally infected with SARS-CoV-2 either before or after vaccination were also included. These participants were then subjected to IgG neutralising antibody titre estimation at three months and six months, postvaccination. The data was entered in MS excel spreadsheet 2016 and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0.
Results: The study included 304 eligible HCWs. Majority of the participants belonged to the age group of 31-40 years (35.9%). Majority of the study participants were females (51%). Of the 304 participants, 263 were uninfected and 41 participants had been infected before and after vaccination. At the six month follow-up, it was observed that all except one HCW had seroconverted with majority of the participants showing more than 60% antibody level. Participants in the age group of 31-40 years showed the highest level and this observation was found to be statistically significant.
Conclusion: Neutralising antibody response in HCWs is a key indicator of the efficacy of the vaccination program for Coronavirus Disease-2019 (COVID-19) in India.
Coronavirus disease 2019, Immunoglobulin G, Recombinant ChAdOx1 nCoV-19 coronavirus vaccine
A novel SARS-CoV-2 was detected in Wuhan, Hubei province in China in December 2019 which caused COVID-19. Following rapid and widespread transmission of this virus across the globe and absence of pre-existing immunity, World Health Organisation (WHO) declared COVID-19 a pandemic on 11th March 2020. HCWs who are the first line of defense, belong to high-risk population and can transmit the infection to patients and to other staff. Limited supply of vaccines led to prioritisation of vaccination of HCWs (1).
The pathology of COVID-19 involves immunological responses of the human body against the SARS CoV-2 virus which largely determines the disease evolution. Neutralising antibodies are those which block viral infection (2). Development of neutralising antibodies especially against the receptor binding domain on the large trimeric glycoprotein, spike (S) protein confers immunity against reinfection by inhibiting the virus host interaction (3),(4). Animal and human studies have shown that Anti Receptor Binding Domain (RBD) IgG has strong correlation with virus neutralisation as it is these antibodies that counter the interaction of RBD with Angiotensin Converting Enzyme 2 (ACE2) receptors (5),(6). The kinetics of antibody development indicates mean to median time for seroconversion for IgM to be 4-14 days post-symptom onset, for IgA 4-24 days post- symptom onset and IgG 12-15 days post-symptom onset (4). However inappropriate antibody response leading to cytokine storm, excessive neutrophil and macrophage activation causes lung damage and leads to disease progression to severe form with high morbidity and mortality (2). Protective IgG antibody persistence has been studied in some patients till five months time and is believed to be instrumental in reducing the odds ratio for reinfection and attenuating disease in case of naïve patients (7). However robust data in this regard is still lacking.
The uncertainty around persistence of protective antibodies in the human serum poses problem in formulating key public health policies like appropriate interval between doses of vaccines, appropriate time for vaccinating population post natural infection, requirement of booster dose, single dose for naturally infected population etc. There is a gap in the knowledge of disease dynamics in the Indian population hindering appropriate public health decision-making. The objective of present study was to estimate the neutralising antibody level following vaccination of HCWs after three months and six months, respectively.
This was a prospective observational study performed from January 2021 to February 2022 in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India after IEC approval was obtained (IEC Approval Ref No. SJICR/EC/2021/051).
Inclusion criteria: The study included 304 HCWs in the institute who received two doses of Recombinant ChAdOx1 nCoV-19 Coronavirus Vaccine (Covishield).
Exclusion criteria: Those that received one dose of vaccination elsewhere.
The sample size was selected using convenience sampling and participants were included after signing an informed consent. These participants were then subjected to IgG neutralising antibody titre estimation at three months and six months, postvaccination. Development of COVID-19 infection before or after vaccination was documented.
Study Procedure
The test was performed on 2 mL of serum sample drawn from the study group after informed consent was obtained. Basic demographic details and COVID-19 infection status along with the antibody level at three months and six months was recorded in a semi-structured proforma. The serological test used to detect COVID-19 neutralising antibodies of all classes was “COVID-19 Neutralising antibody Microlisa” from J Mitra and Co. Pvt. Ltd., New Delhi, India, which is an enzyme immunoassay based on the principle of blocking Enzyme Linked Immunosorbent Assay (ELSIA). The test is designed for in-vitro semi-quantitative detection of neutralising antibodies developed against SARS-CoV-2 in human plasma/serum that prevent the interaction between receptor binding domain viral spike glycoprotein RBD and cell surface receptor ACE2. The kit instruction was followed for testing. The absorbance of the sample at the end of the procedure is inversely proportional to the titre of the neutralising antibodies present. Being a semiquantitative test, more than 30% inhibition is taken as positive and indicated presence of COVID-19 neutralising antibodies in the sample tested.
Statistical analysis
The data was entered in MS excel spreadsheet 2016 and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0. The association between the age groups and antibody level was done with Chi-square test and p-value <0.05 was considered as significant.
The study included 304 eligible HCWs. Majority of the participants belonged to the age group of 31-40 years (n- 109, 35.9%) (Table/Fig 1). Majority of the study participants were females (n-155, 51%) (Table/Fig 2).
Of the 304 participants, 263 were uninfected and 41 participants had been infected before and after vaccination (Table/Fig 3).
As there was difficulty in procuring the test kit, convenience sampling was included. At the three months follow-up, a total of 138 participants were evaluated and the antibody level was more than 30% in 82.1% (n- 96) of COVID-19 negative patients, while it was more than 30% in 85.7% (n-18) of those that were COVID-19 positive. At the six months follow-up, 304 participants were evaluated. The antibody level was more than 30% in 99.6% of uninfected HCWs, while it was more than 30% in 100% of those that were COVID-19 positive (Table/Fig 4).
At the three month follow-up, when a comparison of age with the antibody level was made, it was observed that majority of the people with more than 30% antibody level belonged to the age group of 31-40 years who were uninfected. However, the association between the age groups and antibody level was not statistically significant.
At the six month follow-up, it was observed that all except one HCW had seroconverted with majority of the participants showing more than 30% antibody level. The participants in the age group of 31-40 years showed the highest level and this observation was found to be statistically significant (Table/Fig 5).
Present study was conducted to observe the persistence of neutralising antibodies after two doses of Covishield vaccine in infected and unifected HCWs in the hospital. Present study findings showed that antibody response in naturally infected HCWs was higher when compared to infection naïve vaccinated HCW. It was in accordance with findings of the study by Anichini G et al., who demonstrated that neutralising antibody level in previously infected persons spiked higher after one dose when compared to uninfected vaccinated individuals after two doses although our numbers are not statistically significant (8). The study by Sasikala M et al., showed that the memory B and T cells as well as the neutralising antibody titres were significantly higher in previously infected individuals after a single dose of vector based vaccine (9). Morales-Núñez JJ et al., studied the effect of Pfizer-BioNTech (BNT162b2) also showed similar findings and suggested the use of single dose vaccination for naturally infected persons be considered in resource limited countries (10).
Covishield (Recombinant ChAdOx1 nCoV- 19) is a recombinant vaccine with replication-deficient chimpanzee adenovirus vector encoding the SARS-CoV-2 Spike (S) glycoprotein. The efficacy of this vaccine as measured by neutralising antibodies in present study indicates that good humoral antibody response was noted and maintained in the participants at six months of observation and surpasses the levels noted in vaccine efficacy trials conducted prior to its emergency use approval (11). In infection naïve HCW, all except one participant had seroconverted at the end of six months and reiterates the efficacy of Covishield in Indian population.
The trajectory of decline in neutralising antibodies have demonstrated persistence till eight months postvaccination and present study findings show that even at six months humoral response persisted. Voysey M, et al., demonstrated that a longer prime boost interval for ChAdOx1 nCoV-19 (AZD1222) vaccine of four to twelve weeks produced strong humoral response that was consistent with similar vaccine studies on Malaria, Influenza and Ebola virus disease (11). In present study, where participants had received two doses of covishield vaccine at interval of four weeks, 82.89% of participants with and without COVID-19 infection had neutralising antibody level above 60% at six months. One explanation for this sustained and strong humoral response could be that present study participants were HCWs in a busy cardiac super specialty referral hospital in a resource limited country and may have been exposed to multiple subclinical infections which may have boosted the response postvaccination. This may also possibly explain why COVID-19 pandemic may normalise as an endemic infection in the Indian subcontinent without huge waves of periodic surge in infections from time to time as noted in the developed world. Desai A et al., showed that a single dose of ChAdOx1 nCoV-19 vaccine gave 86% additional protection against mortality and reduced ICU stay to mean of 4.47±2.3 days for vaccinated patients compared to 6.29±2.19 days for non vaccinated patients and lesser requirement for mechanical ventilation (12). Present study also correlates with the Singh AK et al., (13) which highlighted the higher seropositivity and antispike antibodies Geometric Mean Titre (GMT) of Covishield against Covaxin where 95% of uninfected recipients and COVID-19 recovered recipients of Covishield vaccine showed production of antispike antibody production after 3 weeks of receiving two doses (13). In contrast to present findings, Choudhary HR et al., showed two fold decline in vaccine induced antispike IgG antibodies in Covishield recipients and four fold decline in Covaxin recipients at six months (14). Singh AK et al., also has followed-up covishield and covaxin recipients for six months and showed 5.6 fold decline in GMT of antispike antibodies in both vaccine groups (15) which contrasts present study findings.
More analytical studies are needed to understand the natural decay of these antibodies both in general population and in HCWs to determine the ideal time for a booster dose and identify the groups which may require it. Understanding the dynamics of immune response both humoral and cell mediated will help us in formulating appropriate public health measures and present observation study serves as baseline in the Indian population in this direction. We intend to follow-up the neutralising antibody levels in our participants in the future as continuation of the study.
Limitation(s)
This was an observational study and the sample size was variable for three month and six month follow-up as we had taken convenience sampling. The kit used to estimate neutralising antibody levels was semiquantitative and provides levels of neutralising antibodies in terms of percentage of inhibition and not absolute values. The study did not perform tests to correlate the neutralising antibody levels with the antibodies against spike protein and memory B and T-cells.
Neutralising antibodies can persist well upto six months and probably beyond, of receiving two doses of Covishield vaccine. Stronger antibody response seen in COVID-19 infected recipients is encouraging to implement single dose vaccination in resource limited countries in order to optimise limited vaccine supplies.
DOI: 10.7860/JCDR/2022/56189.16758
Date of Submission: Mar 13, 2022
Date of Peer Review: Apr 26, 2022
Date of Acceptance: May 28, 2022
Date of Publishing: Aug 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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