COVID-19 Update #90 for 7/9/2021

COVID-19 Vaccines
 
Researchers have examined the incidence of myocarditis after mRNA COVID-19 vaccine immunization.

• Researchers at Duke examined myocarditis in seven patients. Four of the patients had received two doses of an mRNA vaccine within the past five days. All four patients recovered without further problems. There were 561,197 patients that had received an mRNA vaccine during the study time period. The authors concluded that myocarditis is extremely rare.
• Military researchers examined myocarditis in 23 patients, that presented within four days of vaccination with an mRNA vaccine. Most patients (20) developed myocarditis after the second immunization. All patients recovered or were recovering at the time of the report. There were 2.8 million patients were vaccinated during the study time period. The authors concluded the incidence of myocarditis is small, but higher than expected.​

Curevac announced that in the 40,000 patient, Phase IIb/III, HERALD trial (NCT04652102), their mRNA COVID-19 vaccine, CVnCo, demonstrated 48% efficacy after 228 cases of COVID-19 developed in the European and Latin American study population. Efficacy was 53% in patients aged 18 to 60. An analysis of COVID-19 cases found 86% were caused by Variants of Concern or Variants of Interest.
 
Researchers from NIAID and their academic partners found that while virus neutralization from antibodies from 15 persons who had received the Moderna COVID-19 vaccine and 10 persons who had received the Pfizer–BioNTech vaccine were reduced the antibodies retained 79% of activity against the B.1.617.1 (India) variant and 96% of activity against the B.1.617.2 (India, Delta) variant.
 
COVID-19 Anti-inflammatories 
 
A meta-analysis, by the World Health Organization, of 27 trials involving 10,930 patients, evaluated IL-6 inhibitors in the treatment of COVID-19.  At 28-days the mortality risk in tocilizumab or sarilumab patients was 22% compared to 25% with usual care or placebo. The mortality benefit was maintained in patients receiving corticosteroids (21% vs 25%). The data supporting tocilizumab was more robust than sarilumab due to the larger patient population and the trials being conducted later in the pandemic, when use of corticosteroids became more common. There was not enough data (one trial) to estimate the effect of using siltuximab. Based on the data, the WHO now recommends that either tocilizumab or sarilumab be added to corticosteroids for the treatment of severe or critical COVID-19 infections.