AZD1222 (Covishield) vaccination for COVID-19: Experiences, challenges, and solutions in Nepal.

Dear Editor,

The world is in desperate need of effective vaccines against the Coronavirus Disease 2019 (COVID-19) [1]. Currently, there are 78 vaccine candidates, ongoing 201 trials, and increasing. Among which 12 vaccines are approved [2], then moving the application of these vaccines progressively in different parts of the world (Fig. 1 ).

Fig. 1

World advances in COVID-19 vaccination till February 1, 2021.

In Nepal, the COVID-19 vaccination program was initiated on Jan 27th, 2021 [3]. The government of India provided a donation of ten million vaccine doses for the Nepalese population to prevent COVID-19. The government of Nepal decided to start mass vaccination, starting by immunizing health and security workers [3]. In this article, the authors share their experience regarding Oxford/AztraZeneca COVID-19 AZD1222 (Covishield) vaccination in Nepal.

All health and security workers were informed by short message service (SMS) about their vaccination slot on the day before the vaccination. On the day of the vaccination, they waited for their turn to verify their identification card. Frontline health workers were asked to fill a printed form with all demographic details, including any previous Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and allergies. The vaccine was administered in the deltoid region by the well-trained nurses with Oxford (Covishield) vaccine, containing the non-replicating chimpanzee adenovirus with SARS-CoV-2 spike protein in it.

After vaccination, people were asked to wait in the observation room for 30 min to check whether they may experience mild transient headaches, light-headedness and dizziness. After four hours of vaccination, some health workers complained about irritability in mood, six hours after vaccines, some complained of myalgia, nausea, tenderness at the injection site and feverish feeling. After 12 hours, fever with chills developed which required paracetamol to resolve.

By the second day of vaccination, fever and headache were resolved, however myalgia and tenderness at the injection site persisted. On the third day, early morning awakening and head heaviness and tenderness at the injection site persisted.

Paracetamol (NSAID) seems to be required with the Oxford vaccine compared to Pfizer or Moderna vaccines to resolve the individuals' common symptoms. Most of the health frontline persons who experience these symptoms posted in social media. As these are common symptoms or side effects observed with viral vaccines, this experience should decrease the fear of COVID-19 vaccination which appears to cause only a few general side effects observed in some vaccinated individuals in India and Europe. No one developed severe side effects or death in Nepal after the first dose of the Oxford vaccine.

It seems that such mild side effects are acceptable during COVID-19 vaccination as the body will need some time to adopt vaccination dose and to trigger the immune system to induce protective antibodies. Therefore the general people should be aware of these minor side effects which are manageable with some symptomatic treatment like paracetamol to resolve the symptoms timely or such medicine should be taken as prophylaxis to avoid developing the post-vaccination symptoms and increase the acceptance of the COVID-19 vaccine among the mass population while decreasing the psychological fear of any side effect of SARS-CoV-2 vaccination, which would certainly help to counter this pandemic disease through ongoing vaccination program successfully.

The second dose of vaccine as a booster is planned to be administered after 28 days. Though mass vaccination was done in frontline health workers and gave hope to Nepalese society, there is a challenge also. Some of the challenges are vaccine safety and efficacy. Vaccine hesitancy and literacy can be another challenge [4]. An additional challenge is that the new more infectious variants of the coronavirus, first reported in the United Kingdom, have been detected in Nepal, threatening the vaccine rollout strategy [5]. There is a need for long-term monitoring of adverse drug reactions and an urgent need for monitoring by pharmacovigilance centres within a country [6]. Randomised controlled clinical trials are required to confirm the vaccine efficacy in Nepalese populations. Pharmacogenomics study can confirm the dissimilarities in genomic sequence associated with the response of vaccine.

Funding

None.

Ethical approval

This manuscript is the consent experience shared by the authors of this paper.

Declaration of competing interest

None.