# data[].attributes.body
Grupo: 3-6
Docente: María Alejandra Favila Pérez
-Jesús Adrián Alejo Luján 334136
-Bryan Iván Fernández Burciaga 341939
-Ivanna Chávez Ramírez 342048

# data[].attributes.attachment_link.readable_text
Updated on 17 March 2021 to reflect the fact that WHO has listed two versions of the AstraZeneca/Oxford COVID-19 vaccine for emergency use. A further update was made on 19 April 2021to reflect the latest WHO Global Advisory Committee on Vaccine Safety statement.
The WHO Strategic Advisory Group of Experts on Immunization (SAGE) has issued interim recommendations for use of the Oxford/AstraZeneca COVID-19 vaccine (AZD1222).

This article provides a summary of the interim recommendations; you may access the guidance document here.

Who should be vaccinated first?

While vaccine supplies are limited, it is recommended that priority be given to health workers at high risk of exposure and older people, including those aged 65 or older.

Countries can refer to the WHO Prioritization Roadmaphttps://www.who.int/publications/i/item/who-sage-roadmap-for-prioritizing-uses-of-covid-19-vaccines-in-the-context-of-limited-supply and the WHO Values Framework as guidance for their prioritization of target groups.

Who else can take the vaccine?

Vaccination is recommended for persons with comorbidities that have been identified as increasing the risk of severe COVID-19, including obesity, cardiovascular disease, respiratory disease and diabetes.

Although further studies are required for persons living with HIV or auto-immune conditions or who are immunocompromised, people in this category who are part of a group recommended for vaccination may be vaccinated after receiving information and counselling.

Vaccination can be offered to people who have had COVID-19 in the past. But individuals may wish to defer their own COVID-19 vaccination for up to six months from the time of SARS-CoV-2 infection, to allow others who may need the vaccine more urgently to go first.

Vaccination can be offered to breastfeeding women if they are part of a group prioritized for vaccination. WHO does not recommend discontinuation of breastfeeding after vaccination.

Should pregnant women be vaccinated?

While pregnancy puts women at higher risk of severe COVID-19, very little data are available to assess vaccine safety in pregnancy.

Pregnant women may receive the vaccine if the benefit of vaccinating a pregnant woman outweighs the potential vaccine risks.

For this reason, pregnant women at high risk of exposure to SARS-CoV-2 (e.g. health workers) or who have comorbidities which add to their risk of severe disease, may be vaccinated in consultation with their health care provider.

Who is the vaccine not recommended for?

People with a history of severe allergic reaction to any component of the vaccine should not take it.

The vaccine is not recommended for persons younger than 18 years of age pending the results of further studies.

What's the recommended dosage?

The recommended dosage is two doses given intramuscularly (0.5ml each) with an interval of 8 to 12 weeks.

Additional research is needed to understand longer-term potential protection after a single dose.

Is it safe?

Two versions of the vaccine - produced by AstraZeneca-SKBio (Republic of Korea) and the Serum Institute of India - have been listed for emergency use by WHO. When the vaccine underwent SAGE consideration, it had undergone review by the European Medicines Agency (EMA).

The EMA has thoroughly assessed the data on the quality, safety and efficacy of the vaccine and has recommended granting a conditional marketing authorisation for people aged 18 and above.

The Global Advisory Committee on Vaccine Safety, a group of experts that provides independent and authoritative guidance to the WHO on the topic of safe vaccine use, receives and assesses reports of suspected safety events of potentially international impact.

How efficacious is the vaccine?

The AZD1222 vaccine against COVID-19 has an efficacy of 63.09% against symptomatic SARS-CoV-2 infection.

Longer dose intervals within the 8 to 12 weeks range are associated with greater vaccine efficacy.

Does it work against new variants?

SAGE has reviewed all available data on the performance of the vaccine in the settings of variants of concern. SAGE currently recommends the use of AZD1222 vaccine according to the WHO Prioritization Roadmap, even if virus variants are present in a country. Countries should assess the risks and benefits taking into consideration their epidemiological situation.

Preliminary findings highlight the urgent need for a coordinated approach for surveillance and evaluation of variants and their potential impact on vaccine effectiveness. As new data become available, WHO will update recommendations accordingly.

Does it prevent infection and transmission?

No substantive data are available related to impact of AZD1222 on transmission or viral shedding.

In the meantime, we must maintain and strengthen public health measures that work: masking, physical distancing, handwashing, respiratory and cough hygiene, avoiding crowds, and ensuring good ventilation.

As of 19 April 2021, the AstraZeneca vaccine is safe and effective at protecting people from the extremely serious risks of COVID-19, including death, hospitalization and severe disease. Read the 16 April 2021 statement of the WHO Global Advisory Committee on Vaccine Safety on AstraZeneca COVID-19 vaccine, which covers reports of very rare side effects. The Council for International Organizations of Medical Sciences classifies rates of adverse events or medicines and vaccines as follows:

* Very common > 1/10

* Common (frequent) > 1/100 and < 1/10

* Uncommon (infrequent) >1/1000 and < 1/100

* Rare> 1/10000 and <1/1000

* Very rare < 1/10000

# data[].attributes.attachment_link.title
The Oxford/AstraZeneca COVID-19 vaccine: what you need to know

# data[].attributes.attachment_link.description
Updated on 17 March 2021 to reflect the fact that WHO has listed two versions of the AstraZeneca/Oxford COVID-19 vaccine for emergency use. A further update was made on 19 April 2021to reflect the latest WHO Global Advisory Committee on Vaccine Safety statement.

# data[].attributes.body
Desarrollada por la empresa AstraZeneca y de la Universidad de Oxford, entra en la categoría de vacunas recombinantes.
La vacuna AZD1222 contra la COVID-19 tiene una eficacia del 63,09% contra la infección sintomática por SARS-CoV-2.

# data[].attributes.body
La vacuna de AstraZeneca ha pasado por las fases de prueba de I-III en Reino Unido, Sudáfrica, Estados unidos y Brasil

# data[].attributes.body
Los síntomas notificados con más frecuencia fueron sensibilidad en el lugar de la inyección (reportada por más del 60 por ciento); dolor en el lugar de la inyección, dolor de cabeza, fatiga ( más de la mitad de los participantes); mialgia, malestar (más del 40 por ciento); pirexia, escalofríos (más del 30 por ciento); y artralgia, náuseas (más del 20 por ciento).

# data[].attributes.headline
4.-Tiene EFICACIA de 100% para casos severos, 79% de eficacia en prevenir síntomas de COVID

# data[].attributes.subject
4.-Tiene EFICACIA de 100% para casos severos, 79% de eficacia en prevenir síntomas de COVID

# data[].attributes.body
El ensayo de fase III de AstraZeneca US de AZD1222 demostró una eficacia de la vacuna estadísticamente significativa del 79% en la prevención del COVID-19 sintomático y del 100% en la prevención de enfermedades graves y hospitalizaciones.
Este análisis provisional de seguridad y eficacia se basó en 32.449 participantes que acumularon 141 casos sintomáticos de COVID-19. El ensayo tuvo una asignación al azar de 2: 1 de la vacuna al placebo.

# data[].attributes.body
Metotrexato, pednisona oral y bolos de metilprednisolona intravenosa, pero desarrolla síndrome de activación de macrófagos, elevación de ferritina sérica (14,060 ng/ml), descenso de velocidad de sedimentación globular, trombocitopenia, anemia y elevación de transaminasas, por lo que se inicia tratamiento con Tocilizumab.

# data[].attributes.body
Paciente femenino 2 años de edad.
10 kg de peso.
Fiebre de 40°C durante 3 semanas.
Rash macupapular erimatoso generalizado evanescente que excerba durante episodios febriles y cede de manera espontánea.
Adenopatías axilares, inguinales y cervicales.
Hepatoesplenomegalia.
Artritis en rodillas codos y manos.
Hipoalbumineamia, anemia microcitica hipocrómica, leucocitosis, elevación de enzimas hepáticas.

# data[].attributes.body
Pros:
-  Se creó sin ánimo de lucro.
- No tiene problemas de distribución. Se puede transportar con facilidad.
- La eficacia de la vacuna es tan alta como la de Pfizer.

Contras:
- No hay evidencia suficiente para recomendar su uso generalizado durante el embarazo
- No se dispone aún de datos consistentes de seguridad y eficacia en menores de 18 años de edad
- Se ha observado muy raramente, una combinación de trombosis y trombocitopenia (0.02%)

# data[].attributes.body
-Dolor de cabeza (56%)
-Fatiga (52%)
-Fiebre (33%)
-Nauseas (33%)
-Escalofríos (31%)
-Trombosis (0.00034%)

# data[].attributes.body
https://www.intramed.net/contenidover.asp?contenidoid=97810

https://vacunasaep.org/profesionales/noticias/vacuna-de-astrazeneca-riesgos-y-beneficios-comparados

https://www.who.int/news-room/feature-stories/detail/the-oxford-astrazeneca-covid-19-vaccine-what-you-need-to-know

https://www.analesdepediatria.org/es-desensibilizacion-rapida-tocilizumab-artritis-idiopatica-articulo-S1695403320302113

# data[].attributes.headline
10.- Caso clínico tratamiento con Tocilizumab:

# data[].attributes.subject
10.- Caso clínico tratamiento con Tocilizumab:

# data[].attributes.body
Primer ciclo sin presentar reacciones de hipersensibilidad, sigue presentando parámetros clínicos y de laboratorio que sugieren la persistencia de la enfermedad.
Durante segunda administración presenta posterior a los primeros 5 minutos: rash, edema facial, taquicardia, taquipnea, dificultad para respirar, desaturación de oxígeno a 88%, dolor abdominal fiebre y piloerección, se suspende la administración y se administra adrenalina intramuscular, corticosteroide y antihistamínicos. Se realiza prueba cutánea "prick" con Tocilizumab y sale positiva.

# data[].attributes.body
-Debido a la gravedad clínica y la falta de tratamientos, es decir SOLOS se puede usar Tocilzumab ¿Cuál sería su recomendación como médico tratante?
Iniciar un protocolo rápido de desensibilización al tocilizumab.
Se médica a la paciente con clorfenamina y metilprednisolona una hora previa, luego se le administra una disolución de tocilizumab 0,47 mg/mL con 6 ml de tocilizumab (200 mg/10ml) en 250 ml de solución fisiológica 0.9%.
La administración se hace poco a poco cada 15 minutos doblando la dosis anterior. este procedimiento se hace 8 veces cada dos semanas.

# data[].attributes.body
-Determine y justifique el tipo de hipersensibilidad:
Hipersensibilidad mediada por complemento (III).
Los síntomas como fiebre, exantemas, dolor articular y agrandamiento de ganglios linfáticos pueden explicarse por este tipo de hipersensibilidad.
Esta hipersensibilidad puede ser causada por autoantígenos lo que explicaría la artritis idiopática juvenil sistémica.