For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
May 14
COVID-19 Situation Report 463
Centre for Infectious Disease Epidemiology and Research (CIDER) For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
i. Background
In December, China notified the World Health Organization (WHO) of several cases of human respiratory illness, which appeared to be linked to an open seafood and livestock market in the city of Wuhan. The infecting agent has since been identified as a novel coronavirus, previously known as 2019-nCoV and now called SAR-CoV-2; The new name of the disease has also been termed COVID-19, as of 11th February 2020. Although the virus is presumed zoonotic in origin, person-to-person spread is evident. Screening of travellers, travel bans and quarantine measures are being implemented in many countries. Despite these precautions, it is anticipated that more cases will be seen both inside China and internationally. The WHO declared the outbreak of COVID-19 constitutes a Public Health Emergency of International Concern on 30 January. On 11 March, 2020, WHO declared the coronavirus outbreak a pandemic as the global death toll rose above 4,600 and the number of confirmed cases topped 125,000. This report aims to update Global Risk Assessment, Global Epidemiology, Quarantine Orders, Travel Ban/Advisory by countries, WHO’s and CDC’s Guidance and Protocols and Scientific publication on a daily basis. New updates in the tables are bolded.
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ii. Global Risk Assessment
Table 1. Risk assessment of COVID-19 by WHO regions (Updated as of 14 May 2021, 1200H SGT) Severity of Availability of Treatment/ Overall Environmental Risk Transmissibility Disease Vaccination# Risk Global (n=198 countries) High Moderate High Limited
Globally, 189 (95.4%) countries (excluding Based on CDC Case The number of countries that have * territories ) have reported the outbreak. data, median R0 fatality rate commenced mass vaccination in each is estimated to is currently region are as follows: Combined WPRO Using an incidence >20 cases/100,000 be 5.8 (95% CI at 2.07% and SEARO (33 countries), EURO (53 people over the past 14-days as cut-off for 4.4–7.7), but globally. countries), EMRO (20 countries), a surge in cases, the number of countries the estimated Most cases Americas (33 countries), and Africa (40 reporting a surge in cases in each region effective present as countries).& are as follows: Combined WPRO and reproduction flu-like SEARO (13 countries), number in 173 illness. International clinical trials published on EURO (48 countries), countries 2 September confirm that cheap, widely EMRO (15 countries), Americas (28 ranged from available steroid drugs can help countries), and Africa (7 countries). 0.071 to 1.7.$ seriously ill patients survive Covid-19. The World Health Organization issued Only 4 (2%) countries/territories have no new treatment guidance, strongly reported restrictions on inbound arrivals, recommending steroids to treat while 144 (78%) countries/territories have severely and critically ill patients, but partially reopened their borders – require not to those with mild disease. [4] arrivals to produce a negative COVID-19 test result and/or undergo self-quarantine Researchers have found all regimens of upon arrival. 51 (28%) anticoagulants to be far superior to no countries/territories are totally closed to anticoagulants in COVID-19 patients. international arrivals. [1] More specifically, patients on both a High “therapeutic” or full dose and those on On October 7, the Centers for Disease a “prophylactic” or lower dose, showed Control and Prevention (CDC) confirmed about a 50% higher chance of survival airborne transmission of SARS-CoV-2. [2] and roughly a 30% lower chance of intubation, than those not on The U.S. CDC has revised its guidance on anticoagulants. It was observed that COVID-19 quarantine period from 14 days therapeutic and prophylactic to 7-10 days, based one's test results and subcutaneous low-molecular weight symptoms. Individuals without symptoms heparin and therapeutic oral apixaban only need quarantine for 10 days without may lead to better results. [3] testing; those tested negative can quarantine for 7 days. [14] A new strain known as B.1.525 containing the same E484K mutation The US Centers for Disease Control and found in the Brazilian and South African Prevention (CDC) on 10 Feb announced variants has been detected in Britain that fully vaccinated people did not need [18]. to quarantine if they received their last dose within three months and 14 days after their last shot, the time it takes to develop immunity. [16]
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Western Pacific Region and South-East Asia Region (n=41 countries) Moderate Moderate Moderate High
33 (80.5%) countries have reported As of May 11, Case 32 countries have commenced outbreaks; but only 13 (31.7%) countries the estimated fatality rate vaccination as of 14 May 2021. are reporting a surge in cases. effective is 1.23%. Coverage was available for the reproduction following: i) at least 1 dose was at <50% 14 (34.2%) countries have either a no. of 25 for 28 countries; 51-70% for 1 country; constant decreasing change in incidence countries >70% for 1 country ii) full vaccination or no case in the last 14 days. ranged from was at <50% for 21 countries; 51-70% & 0.58-1.3. $ for 0 country. High Highest incidence over the past 14 days Indonesia has approved Russian drug were reported from India, Malaysia, Avifavir for emergency use. [22] Maldives, Mongolia and Nepal and highest case numbers were reported from India, China has approved the use of 3 Indonesia, Japan, Nepal and Philippines. traditional chinese medicines, Qingfei Paidu Formula, Huashi Baidu Formula At least 19 countries have closed their and Xuanfei Baidu Formula, for COVID- borders, 21 countries have opened their 19 treatment. [20] borders partially conditionally, and none are allowing free travel. European Region (n=53 countries) High Moderate Moderate High
52 (98.1%) countries have reported with As of May 11, Case 53 countries have commenced outbreaks; 48 (90.6%) countries are the estimated fatality rate vaccination as of 14 May 2021. reporting a surge in cases. effective is 2.09%. Coverage was available for the following reproduction i) at least 1 dose was at <50% for 47 2 (3.8%) countries have either a constant no. of 50 countries and 51-70% for 4 countries; ii) decreasing change in incidence or no case countries full vaccination was at <50% for 48 in the last 14 days. ranged from countries; 51-70% for 1 country. & 0.17-1.2.$ Highest incidence over the past 14 days On February 28, France authorized its High were reported from Croatia, Cyprus, first ever use of synthetic monoclonal Netherlands, Sweden and Turkey and antibody, bamlanivab by Eli Lilly, for use highest case numbers were reported from on severe COVID-19 patients. [19] France, Germany, Italy, Russia and Turkey. As of February 14, Italy authorized the At least 6 countries have closed their use of the two monoclonal antibodies of borders, 46 countries have opened their companies Eli Lilly and Regeneron borders partially conditionally, and only 1 aimed mainly at more serious patients country is allowing free travel. with COVID-19 [17]. Eastern Mediterranean Region (n=22 countries) High Moderate Moderate High
22 (100%) countries have reported with As of May 11, Case 20 countries have commenced outbreak; 15 (68.2%) countries are the estimated fatality rate vaccination as of 14 May 2021. reporting a surge in cases. effective is 2.01%. Coverage was available for the reproduction following: i) at least 1 dose was at <50% High None of the countries have either a no. of 20 for 16 countries; 51-70% for 1 country constant decreasing change in incidence countries ii) full vaccination was at <50% for 13 or no case in the last 14 days. ranged from countries; 51-70% for 0 country. & 0.55-1.5.$ Highest incidence over the past 14 days As of June 25, the Abu Dhabi Stem Cell were reported from Bahrain, Iran, Kuwait, Centre has treated more than 2,000
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Oman and Qatar, and highest case COVID-19 patients using UAECell19. numbers were reported from Iran, Iraq, 1,200 have fully recovered. [6] Pakistan, Tunisia and UAE. As of April, an Israeli firm is using At least 6 countries have closed their placenta pluristem cells to treat COVID- borders, 15 countries have opened their 19 patients on a compassionate use borders partially conditionally, and only 1 basis. [5] country is allowing free travel.
Region of the Americas (n=35 countries) High Moderate High High
35 (100%) countries have reported with As of May 11, Case 33 countries have commenced outbreak; 28 (80.0%) countries are the estimated fatality rate vaccination as of 14 May 2021. reporting a surge in cases. effective is 2.44%. Coverage was available for the reproduction following: i) at least 1 dose was at <50% None of the countries have either a no. of 33 for 33 countries and 51-70% for 0 constant decreasing change in incidence countries country; ii) full vaccination was at <50% or no case in the last 14 days. ranged from for 23 countries; 51-70% for 0 country. & 0.071-1.5.$ Highest incidence over the past 14 days With the increase of multiple variants of were reported from Argentina, Chile, COVID-19, the U.S. FDA will limit the use Colombia, Costa Rica and Uruguay, and of monoclonal antibody treatments highest case numbers were reported from developed by Regeneron and Eli Lilly Argentina, Brazil, Canada, Colombia and due to concerns the medications are not USA. effective against these new strains. Eli Lilly’s bamlanivimab will not be At least 11 countries have closed their distributed to California, Arizona and borders, 22 countries have opened their Nevada, where those variants are more borders partially conditionally, and 2 common. [21] countries are allowing free travel. FDA has issued EUA to Eli Lilly’s combination antibody therapy of High bamlanivimab and etesevimab to treat mild to moderate COVID-19 patients who are at risk of serious illness or hospitalization. [15]
The Food and Drug Administration has allowed the combination use of baricitinib and Remdesivir under emergency use authorization. The EUA covers dosing of patients (above the age of two) who are on supplemental oxygen, receiving invasive mechanical ventilation or extracorporeal membrane oxygenation. [12]
Health Canada has approved bamlanvimab, for the treatment of COVID-19 in patients 12 years and older with mild to moderate symptoms who are at risk of severe disease progression. [11]
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FDA has allowed emergency use of Eli Lilly & Co’s bamlanivimab for non- hospitalized patients at risk of serious illness due to age or other conditions. [10]
FDA has issued emergency authorisation for convalescent plasma to treat COVID-19. [9]
RLF-100 (aviptadil) by NeuroRx and Relief Therapeutics was approved for emergency use in COVID-19 patients who are too ill to participate in the trial. [8]
As of October 22, remdesivir is the first and only FDA-approved COVID-19 treatment in the U.S. [7].
African Region (n=47 countries) Moderate Moderate High High
47 (100%) countries have reported with As of May 11, Case 40 countries have commenced outbreak; 7 (15.2%) countries are the estimated fatality rate vaccination as of 14 May 2021. reporting a surge in cases. effective is 2.52%. Coverage was available for the reproduction following: i) at least 1 dose was at <50% 2 (4.3%) countries have either a constant no. of 45 for 38 countries and >70% for 1 country decreasing change in incidence or no case countries ii) full vaccination was at <50% for 12 in the last 14 days. ranged from countries; 51-70% for 1 country. & 0.29-1.7.$ Highest incidence over the past 14 days Ethiopia has approved the use of High were reported from Botswana, Cabo Dexamethasone treatment for seriously Verde, Gabon, Namibia and Seychelles, ill COVID-19 patients. [13] and highest case numbers were reported from Cameroon, Ethiopia, Kenya, Madagascar and South Africa.
At least 9 countries have closed their borders, 38 countries have opened their borders partially conditionally, and no country is allowing free travel. *Only WHO member states are included. 30 territories that have reported cases (with the exception of Palestine) are excluded from the tabulation of total countries affected/imported/local cases and case fatality rate. Refer to WHO situation reports or table 4 for information. $ https://epiforecasts.io/covid/posts/global/ ^Differences between R0 and effective R can be found here https://www.coronavirustoday.com/r-number-refers- either-basic-or-effective-reproduction-number & https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/; High vaccine coverage defined as >70% population with full vaccination
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iii. Global Epidemiology
Table 2. Summary of COVID-19 cases & fatalities globally (Updated as of 14 May 2021, 1200H SGT) Case- No. of Total Cases Case- Fatality Countries/ Total Global Outside Total Fatality Rate (%) R0 Territories Cases Mainland Deaths Rate (%) [outside with Cases China [overall] China] 5.8 (95% CI 4.4– 220 161,611,787 161,520,979 3,352,950 2.07% 2.07% 7.7)^ ^Based on early release as of 10th April, 2020: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
Table 3. Comparison with other viruses Virus Incubation Period (Days) Case Fatality Rate (%) R0 Median = 5.1$ SARS-CoV-2 2.07 5.8 (95% CI 4.4–7.7) ^ (2-14) or up to 24* SARS-CoV 2-7 9.6 2.0 <1 (higher in health care MERS-CoV 5 (2-14) 34 setting) Swine Flu 1-4 0.02 1.2-1.6 *Data on 1099 patients from 552 hospitals in 31 provinces of China ^https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article $Data on 181 cases outside china
Figure 1. Growth Factor of Daily New Cases (Mainland China+ Other countries)
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Growth Factor = every day’s cases/cases on previous day. A growth factor above 1 indicates an increase, whereas one between 0 and 1 is a sign of decline, with the quantity eventually becoming zero. A growth factor below 1 (or above 1 but trending downward) is a positive sign, whereas a growth factor constantly above 1 is the sign of exponential growth. *Huge jump in cases on Feb. 12 is attributed to the change in diagnostic criteria in China.
Figure 2. Growth Factor excluding mainland China
Figure 3. Growth Factor of Novel Coronavirus Daily Deaths (Mainland China + Other Countries)
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Growth Factor = every day’s cases/cases on previous day. A growth factor above 1 indicates an increase, whereas one between 0 and 1 is a sign of decline, with the quantity eventually becoming zero. A growth factor below 1 (or above 1 but trending downward) is a positive sign, whereas a growth factor constantly above 1 is the sign of exponential growth. Source: https://www.worldometers.info/coronavirus/coronavirus-cases/
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Case Breakdown by Countries Live update of COVID-19 global cases can be found at https://storymaps.arcgis.com/stories/a1746ada9bff48c09ef76e5a788b5910
Table 4. Breakdown of COVID-19 confirmed cases and deaths (Updated as of 6 May 2021, 1230H SGT) Country Total Cases Change Total Change Total Region Deaths Recovered 1 USA 33,626,097 +34908 598,540 +669 26,667,199 Americas 2 India 24,046,809 +15079 262,350 +306 20,079,599 SEARO 3 Brazil 15,436,827 +75141 430,596 +2340 13,979,329 Americas 4 France 5,841,129 0 107,250 0 4,999,079 EURO 5 Turkey 5,083,996 0 44,059 0 4,856,763 EURO 6 Russia 4,913,439 0 114,723 0 4,527,878 EURO 7 UK 4,444,631 0 127,651 0 4,258,298 EURO 8 Italy 4,139,160 0 123,745 0 3,669,407 EURO 9 Spain 3,598,452 0 79,281 0 3,297,340 EURO 10 Germany 3,575,644 +3029 86,276 +41 3,259,000 EURO 11 Argentina 3,242,103 +26531 69,254 +447 2,891,435 Americas 12 Colombia 3,067,879 +19160 79,760 +499 2,874,656 Americas 13 Poland 2,845,762 0 71,021 0 2,584,751 EURO 14 Iran 2,722,007 0 76,231 0 2,179,890 EMRO 15 Mexico 2,375,115 +3632 219,901 +311 1,895,483 Americas 16 Ukraine 2,135,886 0 47,333 0 1,816,643 EURO 17 Peru 1,873,316 +7677 65,316 +418 1,720,665 Americas 18 Indonesia 1,731,652 0 47,716 0 1,589,079 SEARO 19 Czechia 1,649,947 0 29,825 0 1,587,457 EURO 20 South Africa 1,605,252 +3221 55,012 +44 1,520,878 Africa 21 Netherlands 1,583,767 0 17,413 0 1,346,612 EURO 22 Canada 1,312,414 +2521 24,825 +21 1,212,114 Americas 23 Chile 1,266,601 0 27,520 0 1,204,176 Americas 24 Iraq 1,132,092 0 15,883 0 1,028,627 EMRO 25 Philippines 1,124,724 0 18,821 0 1,050,643 WPRO 26 Romania 1,069,770 0 29,308 0 1,020,194 EURO 27 Sweden 1,027,934 0 14,267 0 871,072 EURO 28 Belgium 1,026,473 +2890 24,645 +15 897,904 EURO 29 Pakistan 873,220 +2517 19,384 +48 780,438 EMRO 30 Portugal 840,929 0 16,999 0 801,961 EURO 31 Israel 839,059 0 6,379 0 831,888 EURO 32 Hungary 795,200 0 28,970 0 600,461 EURO 33 Bangladesh 778,687 0 12,076 0 719,619 SEARO 34 Jordan 722,754 0 9,203 0 710,410 EMRO 35 Serbia 704,398 0 6,629 0 671,361 EURO 36 Switzerland 677,210 0 10,728 +1 612,471 EURO 37 Japan 658,629 0 11,165 0 573,913 WPRO
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38 Austria 634,893 0 10,444 0 611,254 EURO 39 UAE 542,158 0 1,623 0 522,356 EMRO 40 Lebanon 534,968 0 7,569 0 492,270 EMRO 41 Morocco 514,670 0 9,091 0 502,205 EMRO 42 Malaysia 458,077 0 1,788 0 414,707 WPRO 43 Nepal 431,191 0 4,466 0 321,518 SEARO 44 Saudi Arabia 430,505 0 7,122 0 414,139 EMRO 45 Bulgaria 413,320 +506 17,194 +44 360,002 EURO 46 Ecuador 405,783 0 19,442 0 342,878 Americas 47 Slovakia 386,868 0 12,135 0 369,609 EURO 48 Belarus 372,242 0 2,671 0 362,806 EURO 49 Greece 371,712 0 11,266 0 333,892 EURO 50 Panama 369,455 +525 6,288 +3 358,358 Americas 51 Kazakhstan 353,140 +2549 4,017 +33 310,168 EURO 52 Croatia 348,158 0 7,623 0 332,669 EURO 53 Azerbaijan 328,668 +509 4,742 +16 311,198 EURO 54 Georgia 326,441 0 4,379 0 306,264 EURO 55 Bolivia 324,868 0 13,345 0 266,512 Americas 56 Tunisia 324,823 +720 11,693 +56 284,754 EMRO 57 Paraguay 307,457 +2568 7,427 +69 254,360 Americas 58 Palestine 303,270 0 3,401 0 288,891 EMRO 59 Kuwait 289,243 0 1,674 0 274,554 EMRO 60 Costa Rica 279,926 +3039 3,514 +32 219,105 Americas 61 Dominican Republic 274,319 0 3,560 0 232,625 Americas 62 Ethiopia 264,960 0 3,951 0 215,734 Africa 63 Denmark 263,514 0 2,499 0 248,683 EURO 64 Lithuania 262,335 0 4,071 0 236,442 EURO 65 Ireland 254,450 0 4,937 0 236,747 EURO 66 Moldova 253,386 0 5,995 0 244,298 EURO 67 Slovenia 248,046 0 4,308 0 235,106 EURO 68 Egypt 242,120 +1193 14,150 +59 179,261 EMRO 69 Guatemala 238,787 +1105 7,832 +17 218,321 Americas 70 Uruguay 231,901 +3799 3,318 +66 201,367 Americas 71 Honduras 223,922 +930 5,898 +45 82,187 Americas 72 Armenia 220,217 0 4,291 0 206,752 EURO 73 Qatar 212,423 0 522 0 205,160 EMRO 74 Venezuela 211,838 +890 2,352 +15 195,380 Americas 75 Oman 202,713 0 2,148 0 186,391 EMRO 76 Bosnia and 202,003 0 8,958 0 168,145 EURO Herzegovina 77 Bahrain 196,105 +1816 715 +10 179,958 EMRO 78 Libya 181,179 +234 3,085 +3 167,629 EMRO 79 Nigeria 165,612 +53 2,066 0 156,387 Africa 80 Kenya 164,720 0 2,968 0 113,248 Africa
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81 North Macedonia 154,494 0 5,168 0 143,069 EURO 82 Myanmar 143,004 0 3,212 0 132,069 SEARO 83 Sri Lanka 135,796 0 892 +24 108,802 SEARO 84 Albania 131,890 0 2,426 0 121,122 EURO 85 S. Korea 130,380 +747 1,893 +2 120,395 WPRO 86 Latvia 126,378 0 2,240 0 114,981 EURO 87 Estonia 126,364 0 1,212 0 117,582 EURO 88 Algeria 124,889 0 3,355 0 87,003 Africa 89 Cuba 120,561 0 778 0 113,493 Americas 90 Norway 118,315 +170 774 0 88,952 EURO 91 Kyrgyzstan 99,645 0 1,681 0 92,718 EURO 92 Montenegro 98,619 0 1,551 0 95,544 EURO 93 Thailand 96,050 +2256 548 +30 62,316 SEARO 94 Uzbekistan 95,826 0 667 0 91,301 EURO 95 Ghana 93,159 +34 783 0 90,992 Africa 96 Zambia 92,262 +51 1,260 +1 90,635 Africa 97 China 90,815 +7 4,636 0 85,894 WPRO 98 Finland 89,532 0 930 0 46,000 EURO 99 Cameroon 74,946 0 1,152 0 70,497 Africa 100 El Salvador 70,915 0 2,173 0 66,418 Americas 101 Cyprus 70,571 +213 342 +1 39,061 EURO 102 Mozambique 70,315 +28 826 0 68,314 Africa 103 Luxembourg 68,899 +151 806 0 65,513 EURO 104 Afghanistan 63,349 0 2,730 0 54,619 EMRO 105 Singapore 61,453 0 31 0 61,029 WPRO 106 Namibia 50,733 0 704 0 47,776 Africa 107 Botswana 49,041 0 751 0 46,290 Africa 108 Mongolia 47,548 +515 200 +7 38,330 WPRO 109 Jamaica 47,020 0 834 0 22,761 Americas 110 Ivory Coast 46,520 +4 294 +2 45,977 Africa 111 Uganda 42,578 0 346 0 41,971 Africa 112 Maldives 41,308 +1216 87 0 27,428 SEARO 113 Senegal 40,790 +28 1,122 +1 39,501 Africa 114 Madagascar 39,759 0 745 0 37,150 Africa 115 Zimbabwe 38,491 +25 1,582 +3 36,286 Africa 116 Sudan 34,272 0 2,446 0 27,949 EMRO 117 Malawi 34,200 0 1,153 0 32,176 Africa 118 DRC 30,478 +49 775 0 26,601 Africa 119 Malta 30,473 0 417 0 29,867 EURO 120 Australia 29,957 +7 910 0 28,861 WPRO 121 Angola 29,695 +290 649 +4 25,629 Africa 122 Cabo Verde 27,386 +357 243 +5 24,289 Africa 123 Rwanda 25,934 +88 342 +2 24,486 Africa 124 Gabon 23,734 0 143 0 20,270 Africa
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125 Syria 23,595 +52 1,682 +6 19,908 EMRO 126 Guinea 22,719 0 151 0 20,341 Africa 127 Réunion 22,644 0 169 0 21,603 Non 128 Cambodia 21,499 +804 147 +11 9,867 WPRO 129 French Guiana 21,433 +327 108 0 9,995 Non 130 Mayotte 20,176 0 171 0 2,964 Non 131 French Polynesia 18,797 0 141 0 18,617 Non 132 Mauritania 18,767 +22 457 0 17,999 Africa 133 Eswatini 18,497 0 671 0 17,786 Africa 134 Guadeloupe 16,017 0 221 0 2,242 Non 135 Guyana 14,845 +186 333 +2 12,693 Americas 136 Trinidad and Tobago 14,814 +397 256 +21 9,744 Americas 137 Somalia 14,486 0 753 0 6,325 EMRO 138 Mali 14,149 0 508 +1 9,123 Africa 139 Andorra 13,470 0 127 0 13,104 EURO 140 Burkina Faso 13,387 0 164 0 13,184 Africa 141 Tajikistan 13,308 0 90 0 13,218 EURO 142 Haiti 13,268 0 269 0 12,397 Americas 143 Papua New Guinea 13,242 0 133 0 10,995 WPRO 144 Togo 13,238 +28 125 0 11,834 Africa 145 Belize 12,709 +2 323 0 12,331 Americas 146 Curaçao 12,244 +8 118 +1 12,052 Non 147 Hong Kong 11,818 0 210 0 11,511 WPRO 148 Martinique 11,736 0 90 0 98 Non 149 Suriname 11,572 +145 221 +1 10,034 Americas 150 Djibouti 11,389 0 151 0 11,221 EMRO 151 Congo 11,343 0 148 0 8,208 Africa 152 Bahamas 11,024 0 216 0 9,967 Americas 153 Aruba 10,826 +12 104 0 10,628 Non 154 Lesotho 10,778 0 320 0 6,427 Africa 155 South Sudan 10,641 0 115 0 10,462 Africa 156 Seychelles 9,184 +1012 32 +4 6,413 Africa 157 Benin 7,995 0 101 0 7,652 Africa 158 Equatorial Guinea 7,694 0 112 0 7,279 Africa 159 Nicaragua 7,086 0 184 0 4,225 Americas 160 CAR 6,866 0 95 0 5,112 Africa 161 Iceland 6,526 0 29 0 6,422 EURO 162 Yemen 6,507 +9 1,278 +1 3,003 EMRO 163 Gambia 5,934 0 175 0 5,648 Africa 164 Niger 5,326 +1 192 0 4,936 Africa 165 San Marino 5,083 0 90 0 4,968 EURO 166 Chad 4,895 +4 172 0 4,672 Africa 167 Saint Lucia 4,725 0 75 0 4,502 Americas 168 Gibraltar 4,286 0 94 0 4,189 Non
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169 Burundi 4,261 +28 6 0 773 Africa 170 Sierra Leone 4,096 +7 79 0 3,098 Africa 171 Channel Islands 4,057 0 86 0 3,956 Non 172 Barbados 3,959 +2 46 0 3,908 Americas 173 Timor-Leste 3,879 +253 8 +3 2,060 SEARO 174 Comoros 3,860 0 146 0 3,688 Africa 175 Eritrea 3,822 0 12 0 3,639 Africa 176 Guinea-Bissau 3,743 +2 67 0 3,418 Africa 177 Vietnam 3,740 +30 35 0 2,657 WPRO 178 Liechtenstein 2,980 0 58 0 2,887 Non 179 New Zealand 2,645 +1 26 0 2,601 WPRO 180 Monaco 2,490 +3 32 0 2,428 EURO 181 Bermuda 2,461 0 31 0 2,222 Non 182 Turks and Caicos 2,404 0 17 0 2,365 Non 183 Sao Tome and 2,320 0 35 0 2,270 Africa Principe 184 Sint Maarten 2,272 0 27 0 2,213 Non 185 Liberia 2,114 0 85 0 1,962 Africa 186 St. Vincent 1,928 0 12 0 1,764 Americas Grenadines 187 Saint Martin 1,773 0 12 0 1,399 Non 188 Isle of Man 1,590 0 29 0 1,555 Non 189 Caribbean 1,590 0 17 0 1,558 Non Netherlands 190 Laos 1,482 0 1 0 431 WPRO 191 Mauritius 1,274 0 17 0 1,130 Africa 192 Bhutan 1,263 0 1 0 1,121 SEARO 193 Taiwan 1,256 0 12 0 1,102 WPRO 194 Antigua and 1,240 0 32 0 1,179 Americas Barbuda 195 St. Barth 974 0 1 0 462 Non 196 Diamond Princess 712 0 13 0 699 NA 197 Faeroe Islands 669 0 1 0 663 Non 198 Cayman Islands 561 +1 2 0 546 Non 199 Tanzania 509 0 21 0 183 Africa 200 Wallis and Futuna 445 0 7 0 44 Non 201 Brunei 232 +1 3 0 220 WPRO 202 British Virgin Islands 219 0 1 0 193 Non 203 Dominica 178 0 0 0 176 Americas 204 Fiji 165 0 4 0 109 WPRO 205 Grenada 161 0 1 0 160 Americas 206 New Caledonia 124 0 0 0 58 Non 207 Anguilla 109 0 0 0 89 Non 208 Falkland Islands 63 0 0 0 63 Non 209 Macao 49 0 0 0 49 WPRO
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210 Saint Kitts and Nevis 45 0 0 0 44 Americas 211 Greenland 31 0 0 0 31 Non 212 Vatican City 27 0 0 0 15 Non 213 Saint Pierre 25 0 0 0 25 Non Miquelon 214 Montserrat 20 0 1 0 19 Non 215 Solomon Islands 20 0 0 0 20 WPRO 216 Western Sahara 10 0 1 0 8 Non 217 MS Zaandam 9 0 2 0 7 NA 218 Vanuatu 4 0 1 0 3 WPRO 219 Marshall Islands 4 0 0 0 4 WPRO 220 Samoa 3 0 0 0 2 WPRO 221 Saint Helena 2 0 0 0 2 Non 222 Micronesia 1 0 0 0 1 WPRO Total 161,838,102 +226315 3,358,711 5,761 140,692,078
Figure 4. Areas with reported confirmed cases of COVID-19 (3 May – 9 May 2021)
Source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
14 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
Table 5. COVID-19 cases and deaths reported by provinces in China (Updated as of 14 May 2021, 1200H SGT) Area Existing Change from Total Deaths Change from Recovered Active Cases previous day Diagnosed previous day (Active cases) Cases (Deaths) Shanghai 55 -3 2,026 7 0 1,964 Guangdong 54 0 2,386 8 0 2,324 Yunnan 37 -2 348 2 0 309 Sichuan 28 -1 999 3 0 968 Zhejiang 22 0 1,347 1 0 1,324 Fujian 21 0 598 1 0 576 Hainan 17 0 188 6 0 165 Shaanxi 10 0 597 3 0 584 Jiangsu 8 0 721 0 0 713 Chongqing 7 0 598 6 0 585 Shanxi 7 0 251 0 0 244 Hubei 6 0 68,158 4,512 0 63,640 Tianjin 6 -1 388 3 0 379 Guangxi 6 0 275 2 0 267 Hunan 4 0 1,046 4 0 1,038 Shandong 3 0 881 7 0 871 Inner 3 -1 383 1 0 379 Mongolia Beijing 2 0 1,057 9 0 1,046 Anhui 2 +2 996 6 0 988 Henan 1 0 1,312 22 0 1,289 Ningxia 1 0 76 0 0 75 Heilongjiang 0 0 1,610 13 0 1,597 Hebei 0 0 1,317 7 0 1,310 Xinjiang 0 0 980 3 0 977 Jiangxi 0 0 937 1 0 936 Jilin 0 0 573 3 0 570 Liaoning 0 0 408 2 0 406 Gansu 0 0 193 2 0 191 Guizhou 0 0 147 2 0 145 Qinghai 0 0 18 0 0 18 Tibet 0 0 1 0 0 1 Source: https://ncov.dxy.cn/ncovh5/view/pneumonia
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021 iv. Travel Bans/Advisories & Quarantine Orders
There are no updates from 7 May to 14 May 2021. v. Lockdowns
[1] Canada – Nova Scotia. On Friday 7 May, Premier Rankin extended school closures to the end of May and imposed tougher border restrictions. Starting Monday 10 May at 8 a.m., the border will be closed to all non-essential travel. That includes anyone intending to move to the province, or parents from outside Nova Scotia hoping to pick up or drop off students. [2] India – As of 8 May the following states are in lockdown : Maharashtra till 15 May; Tamil Nadu from 4 am on May 10 to 4 am on May 24; Punjab till 15 May; Goa from 9 May till 24 May; Rajasthan from May 10 to 24; Karnataka from from May 10 to 24; Andhra Pradesh from 6 May till 20 May; Delhi till 10 May; Uttar Pradesh till 7 am on 10 May; Kerala from 8 May till 16 May; Haryana from 3 May till 10 May; Sikkim till 16 May; Mizoram from 10 May till 17 May; Odisha till May 19; Jharkhand till 13 May; Chhattisgarh till 15 May . [3] India – The Nagaland government has today decided to impose a total lockdown in the state for a period of seven days starting May 14, restricting the movement of people unless absolutely necessary. Neiba Kronu, Minister and state government spokesperson on Covid-19, said that the High-Powered Committee on Covid-19 has decided to impose the state-wide lockdown for one week starting from 6 pm on May 14 till May 21. [4] India – Maharashtra Government extends lockdown restrictions till June 1. As per the new restrictions, negative RT-PCR test reports for those entering the state and curbs on those arriving from places of "sensitive origins" will be compulsory. [5] Malaysia – Malaysia will ban all inter-district and interstate travel from Monday (May 10) and has closed high-risk premises including major malls from Sunday 9 May. The inter-district travel ban will apply nationwide, beginning on Monday, and be in place until June 6. [6] Malaysia – All of Malaysia will be placed under a near lockdown for about a month to fight the coronavirus, but businesses will be allowed to continue to operate at reduced capacity, Prime Minister Muhyiddin Yassin announced Monday 10 May. Muhyiddin said all inter-district travel, sports and social events will be banned. He said Muslims cannot visit each other or visit family graves as is customary during the Eid festival starting Thursday 13 May to mark the end of the Muslim fasting month. All education institutions will be shut, except kindergartens and daycare centres. Dine-in service will not be allowed in restaurants, and no more than three people will be allowed in private vehicles. Religious institutions can open with limited numbers. [7] Pakistan – Pakistan on Saturday 8 May began a nine-day shutdown affecting travel and tourist hotspots in a bid to prevent a surge in Covid-19 cases during the Muslim holiday of Eid al-Fitr. Businesses, hotels, restaurants, as well as markets and parks, will be closed, while public transport between provinces and within cities has been halted. The military has been mobilised to monitor the restrictions. Mosques, however will remain open. [8] Tunisia – Tunisia decided on Friday 7 May to impose a general lockdown for a period of seven days to contain the rapid spread of COVID-19. The general lockdown in Tunisia starts from May 9 to 16. A curfew will also be imposed throughout the country from 7 p.m. to 5 a.m. local time.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021 vi. Military Surveillance
Update: COVID-19 cases in South Korea Forces [1] Five Navy sailors tested positive for the new coronavirus while on the same naval ship, bringing the total caseload from the vessel to 38, the defense ministry said Friday 7 May. In April, the Navy reported 33 COVID-19 cases among members of the Gojunbong landing ship in the first mass infection on a military vessel. Of 84 sailors aboard the ship, 51 tested negative and have been in isolation, but five of them were found to have contracted the virus in a test required to exit quarantine, the ministry said. The military also reported five more COVID-19 cases Friday 7 May-- four soldiers and a civilian worker for the Army -- across the nation.
Update: COVID-19 cases in US Forces Japan [2] On Friday 7 May, U.S. military bases in Japan reported five new cases of COVID-19, the coronavirus respiratory disease. 2 cases are from Yokosuka, homeport of the U.S. 7th Fleet, 2 cases are from Naval Air Facility Atsugi and on Okinawa, the Marine Corps reported one person at Camp Hansen had tested positive for COVID-19.
Update: COVID-19 cases in KATUSA South Korea [3] A member of the Korean Augmentation to the U.S. Army (KATUSA) has tested positive for the new coronavirus after receiving a Johnson & Johnson (J&J) vaccine shot, officials said Monday 10 May, marking the second such case.
Update: COVID-19 cases in South Korea Forces [4] On 10 May, a soldier based in the central city of Sejong was confirmed to have contracted COVID-19 after virus cases were reported at his unit, while another soldier in Dongducheon, north of Seoul, was found to be infected after coming into contact with a civilian patient while away from his base, according to the ministry.
Update: COVID-19 cases in US Forces Japan [5] Two people at Camp Hansen on Okinawa contracted COVID-19, the coronavirus respiratory disease, over the weekend, Marine Corps Installations Pacific announced on its Facebook page Monday 10 May.
Update: COVID-19 cases in South Korea Forces [6] Two Army soldiers have tested positive for the new coronavirus, the defense ministry said Tuesday 11 May. A soldier based in Yanggu, some 175 kilometers northeast of Seoul, was confirmed to have contracted COVID-19 while away from his base on vacation, and an officer in Goyang, north of the capital, was found to be infected after developing symptoms, according to the ministry.
Update: COVID-19 cases in US Forces Japan [7] U.S. military commands in Japan and South Korea reported five new cases of COVID-19, the coronavirus respiratory disease, as of 6 p.m. Tuesday 11 May. Three individuals at Marine Corps Air Station Iwakuni, 26 miles south of Hiroshima, tested positive while quarantined after their recent arrival there. At Naval Air Facility Atsugi, 26 miles southwest of central Tokyo, one individual contracted the coronavirus after close contact with a previously infected person.
Update: COVID-19 cases in South Korea Forces [8] Four Marines and three Army soldiers have tested positive for the new coronavirus, the defense
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ministry said Wednesday 12 May. The Marines, based in the southeastern city of Pohang, were confirmed to have contracted COVID-19 upon returning from vacation while under a cohort isolation, according to the ministry. The other three soldiers, each based in Seoul, the northeastern county of Inje and the southeastern city of Ulsan, were found to be infected after coming into contact with virus patients.
Update: COVID-19 cases in South Korea Forces [9] A fully vaccinated South Korean working at a U.S. military base has tested positive for the coronavirus, while an additional 10 American troops were confirmed to have the virus following their arrival here, officials said Thursday 13 May. The employee at the U.S. Army Garrison Humphreys in Pyeongtaek, some 70 kilometers south of Seoul, was confirmed to have contracted COVID-19 on Tuesday 11 May after receiving a Johnson & Johnson vaccine dose, marking the third known breakthrough case among the USFK-affiliated population. The individual last visited the base on Monday 10 May and is currently in isolation at a facility designated for coronavirus patients, according to the U.S. military.
Update: COVID-19 cases in South Korea and U.S Forces [10] Two Marines and two Army soldiers have tested positive for the new coronavirus, the defense ministry said Thursday 13 May. The Marines were confirmed to have contracted COVID-19 upon arrival in South Korea after completing their overseas education programs, according to the ministry. One soldier in the border town of Cheorwon also tested positive following his recent vacation and an Army officer in the border city of Paju was believed to have been infected after coming into close contact with a civilian who later tested positive, the ministry added.
vii. WHO Guidance & Other Protocols
The following update was published by the WHO from 7 to 14 May 2021.
• Background document on the inactivated COVID-19 vaccine BIBP developed by China National Biotec Group (CNBG), Sinopharm, 7 May 2021 Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines- SAGE_recommendation-BIBP-background-2021.1 • Interim recommendations for use of the inactivated COVID-19 vaccine BIBP developed by China National Biotec Group (CNBG), Sinopharm, 7 May 2021 Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines- SAGE_recommendation-BIBP-2021.1 • Annexes to the interim recommendations for use of the inactivated COVID-19 vaccine BIBP developed by China National Biotec Group (CNBG), Sinopharm, 7 May 2021 Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines- SAGE_recommendation-BIBP-annexes-2021.1 • COVID-19 natural immunity Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci-Brief-Immunity-passport- 2021.1 • AstraZeneca ChAdOx1-S/nCoV-19 [recombinant], COVID-19 vaccine Available at: https://www.who.int/publications/m/item/chadox1-s-recombinant-covid-19-vaccine
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
• Continuity of essential health services: Facility assessment tool Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-HCF-assessment-EHS-2021.1 • Programmatic innovations to address challenges in tuberculosis prevention and care during the COVID-19 pandemic Available at: https://www.who.int/publications/i/item/programmatic-innovations-to-address- challenges-in-tuberculosis-prevention-and-care-during-the-covid-19-pandemic • Health worker communication for COVID-19 vaccination flow diagram Available at: https://www.who.int/publications/m/item/health-worker-communication-for-covid-19- vaccination-flow-diagram
viii. CDC Guidance & Protocols
US CDC
The following update was published by the US CDC from 7 to 14 May 2021.
• Operating Childcare Programs Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance- for-childcare.html • Biosafety for Specimen Handling Available at: https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html • Safe Watering Points Guidance Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/safe-watering.html • Interim Public Health Recommendations for Fully Vaccinated People Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
EU CDC
No new update was published by the EU CDC from 7 to 14 May 2021.
ix. Vaccines/Therapeutics Development
Noteworthy reports are included to inform main developments of COVID-19 pharmaceutics. Past updates are available from situation report 211 onwards. A global map and registry of trials is also visualised & accessible at: https://www.covid-nma.com/dataviz/ and trial results are available at: https://covid- nma.com/living_data/index.php. A living systematic review of vaccine trials is also accessable at https://covid-nma.com/vaccines/ or https://covid-nma.com/ .
Vaccines
[1] Global – The World Health Organization gave emergency use authorization Friday 7 May to a COVID-19 vaccine manufactured by China’s Sinopharm. The Sinopharm vaccine will join ones made by Pfizer- BioNTech, Johnson & Johnson, Moderna, AstraZeneca, and a version of the AstraZeneca vaccine made by the Serum Institute of India, in receiving the coveted authorization from the U.N. health agency.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[2] United States– The Food and Drug Administration on Monday 10 May authorized use of the Pfizer- BioNTech Covid-19 vaccine for 12- to 15-year-olds in the United States. An advisory committee of the Centers for Disease Control and Prevention is expected to meet shortly to review the data and make recommendations for the vaccine’s use in 12- to 15-year-olds.
Therapeutics
No new updates were reported from 7 to 14 May 2021.
Vaccine Approval Status
Table 6: Number of approving countries per vaccine as of 10 May 2021 Developer Vaccine Number of countries approving Anhui Zhifei Longcom RBD-Dimer 2 Bharat Biotech Covaxin 9 CanSino Ad5-nCoV 5 Chumakov Center Kovivac 1 FBRI EpiVacCorona 2 Gamaleya Sputnik V 66 Johnson & Johnson Ad26.COV2.S 41 Kazakhstan RIBSP QazCovid-in 1 Moderna mRNA-1273 46 Oxford/AstraZeneca AZD1222 102 BioNTech/Pfizer BNT162b2 85 Serum Institute of India Covishield 40 Sinopharm BBIBP-CorV 41 Sinopharm Inactivated 2 Sinovac CoronaVac 25 Source: https://covid19.trackvaccines.org/vaccines/
Adverse Reactions & Effects
The following table documents adverse reactions reported from approved vaccines and therapeutics. New updates are bolded.
Table 7: Compilation of reports & guidance on adverse reactions Vaccine Report/Guidance Reference [Canada; Report] One person in Manitoba reportedly had an adverse reaction after receiving the first dose on December 23. [1] There were 490 more individuals vaccinated. [United Kingdom; Report] Two British healthcare workers suffered [2] Pfizer BioNTech anaphylactic shock after receiving the vaccine. [United States; Report] A healthcare worker in New York City suffered anaphylaxis after receiving Pfizer BioNTech’s vaccine. The [3] worker is currently in a stable condition. 30,000 people have been vaccinated so far.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[United States; Report] Two healthcare workers in northern Idaho and the Treasure Valley, experienced severe allergic reactions [4] after receiving the vaccine. As of the time of reporting, one has fully recovered while the other is expected to be discharged soon. [United States; Report] There have been two cases of severe allergic reaction in Alaska after receiving the COVID-19 vaccine. Symptoms of the latest case include tongue swelling, hoarse voice [5] and difficulty breathing, which kicked in about 10 mins after receving the vaccine. [United States; Report] An individual at Decatur Morgan hospital, Alabama, experienced severe allergic reaction several minutes [6] after getting the vaccine. The patient is currently in a stable condition. [United States; Report] Two healthcare workers from Essentia Health, Minnesota had non-severe allergic reactions to the [7] vaccine. About 2,500 doses of the vaccines have been administered to frontline workers at Essentia Health. [United States; Report] According to Pfizer’s data submitted to the FDA, the most common side effects were swelling and redness at the vaccine injection site. Other noted common side effects in the [8] trial included fatigue, headache and muscle pain, which had a greater chance of occurring after the second dose than the first dose. [United States; Guidance] The Centers for Disease Control and Prevention (CDC) has issued new guidance on 21 December regarding allergies and coronavirus vaccines after reports of severe [9] s allergic reactions to the jab. In the new guidance, the CDC recommends that those who have a severe reaction to the first shot of the vaccine should not receive the second jab. [United States; Guidance] Health experts have said that the side effects of COVID-19 vaccines by Pfizer BioNTech (and Moderna) are short-term and manageable. The American College of Allergy, Asthma & Immunology recently released a guideline on the risk of [10] allergic reactions to Pfizer BioNTech’s vaccine. The guideline is available at https://acaai.org/news/american-college-allergy- asthma-and-immunology-updates-guidance-risk-allergic-reactions- mrna. [Canada; Report] Of 11,930 doses of Pfizer BioNTech’s vaccine administered in British Columbia so far there have been 2 cases of [11] allergic reaction. [Israel; Report] On December 28, a 46-year-old man in Jerusalem suffered severe anaphylactic shock one hour after receiving a COVID-19 vaccination. He is the first in Israel to have such a reaction, and is reportedly allergic to penicillin. His condition has since stabilized. [12]
Separately, a 75-year old man died of heart failure at home some hours after receiving Pfizer BioNTech’s vaccine. The man was reported to have heart disease and cancer, and had suffered a number of previous heart attacks. While investigations are still
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
ongoing, preliminary findings indicated that the death did not appear to be connected to the shot. [Finland; Report] On January 2, the first adverse reaction against [13] the vaccine was reported. No further details were released. [Mexico; Report] A 32-year-old doctor in Mexico has been admitted to intensive care unit with seizures, breathing difficulties and possible encephalomyelitis. While the cause of the adverse reaction is still under investigation, preliminary diagnosis indicates encephalomyelitis. The patient condition has been stablized and is receiving treatment to reduce inflammation. [14]
[15] [Update] The doctor was allergic to sulfa drugs and has a family history of allergies. After developing allergic reaction, medication was administered to recover from the symptoms. However, she had subsequently suffered from convulsion. Diagnosis at that time was allergic reaction to the vaccine but the cause for convulsion and reduction of muscle strength is still being studied. [Bulgaria; Report] As of January 4, Bulgaria’s Medicines Agency had received four reports of adverse reactions. One case of dizziness after administration, two cases of local pain at the [16] vaccinated site, and one case of a slight temperature increase. These side effects had passed off in less than a day. [Portugal; Report] A portugese health worker had suffered a sudden death 2 days after being vaccinated on 30 Dec. She did not suffer from any adverse side-effect after vaccinated and did not has any health problem. An autopsy is expected to be conducted soon. [17] [18] [Update] In a 5 January 2020 press release, the Portuguese Ministry of Justice informed that preliminary data from the autopsy showed “no evidence of a causal relationship between the death and the vaccine that was received.” [Mexico; Report] By January 5, more than 44,000 people have received the first shot. As of January 4, about 110 people had reported allergic reaction to the vaccine but 80% were mild and only 5 people require hospitalization. Only one person was severely affected and remain in hospital.
[Update] As of 16 January 2021, 753 adverse events (729 mild and 24 serious) allegedly caused by vaccination and immunization [19] were reported since 24 December 2020. The 24 serious events [20] were reported from Coahuila (7 reports), Mexico City (4 cases), [21] Chihuahua, State of Mexico, Guanajuato, Oaxaca and Yucatan (2 reports each) and Baja California, Hidalgo and Jalisco (1 report each). Of the 24 serious events reports, 6 remain hospitalized while the remaining have been discharged.
[Update] As of 9 Feb, 6,260 negative reactions have been reported nationwide with 36 serious reaction (0.9%). Yucatan has reported 3 serious case of adverse reaction and most of them have
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
discharged. The entities with the most negative reaction cases are Mexico City (6 cases) and Coahuila and State of Mexico (4 each). [United States; Publication] Centre of Disease Control and Prevention (CDC) has reviewed on the allergric reaction to the first dose of vaccine during 14 to 23 December. Among the 1,893,360 first doses administered, 4,393 (0.2%) adverse events were reported. 21 cases of anaphylaxis (11.1 cases per million doses) were detected and 17 of them had history of allergies or allergy reaction. Of the 21 cases, 4 of them were hospitalized including 3 in intensive care and 20 of them had discharged or recovered by 23 December. There were no death reported. [22] [Update] The total number of cases of anaphylaxis has been [23] updated to 29 as on 6 January. [24] [25] [Update] CDC has roughly estimated that one in a hundred thousand people who received the Pfizer vaccine had severe allergic reactions. An average rate of 11.1 anaphylaxis cases per one million doses administered was estimated.
[Update] FDA and CDC have a total of 1,170 death between Dec. 14, 2020, and Feb. 7, 2021, among individuals who received Pfizer or Moderna Covid vaccine, accounting for 0.003% of vaccinated people. [United States; Report] A Florida doctor had died several weeks after receiving the vaccine on 18 Dec. He had suffered from hemorrhagic stroke due to a lack of platelets. It is unclear if his death was related to the vaccine while his death is being investigated. It was reported that he had dots on the skin [26] indicating internal bleeding 3 days after the injection. Pfizer and [27] BioNTech had not received any prior indication of possible connection to thrombocytopenia.
[Update] As of 12 Jan, no evidence was obtained to suggest a connection between the vaccine and the death. [Canada; Report] Nine reports of adverse medical reactions which include a total of 65 symptoms, eight of which were considered severe, have been reported as of Jan. 1 but none were considered to be unexpected side effects.
[Update] Fifteen new reports of adverse medical reactions, five of which were considered severe, have been reported as between [28] January 1 and January 8. As of January 8, 24 reports of adverse [29] effects were reported, consisting of 10 serious and 14-nonserious [30] reports. All reports were considered to be expected side effects. [31]
[Update] Sixty-six new reports of adverse medical reactions, 17 of which were considered severe, have been reported as between January 9 and January 15. As of January 15, 90 reports of adverse effects were reported, consisting of 27 serious and 63-nonserious reports. Most frequently reported adverse events were
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
vaccination site reactions, paraesthesia, pruritis, urticaria, headache, hypoaesthesia, nausea and anaphylaxis.
[Update] As of 5 Feb, a total of 371 adverse effects were reported which include 74 serious AEFI and 297 non-serious AEFI.
[Update] As of 26 March 2021, a total of 1,659 adverse effects were reported, of which 1,347 were non-serious AEFI and 312 were serious AEFI. [France; Report] Six reports of serious adverse effects with a favourable outcome were reported in France during the 3rd week of vaccination: 4 cases of allergic reactions and 2 cases of [32] tachycardia. Around 30 cases of non-serious adverse effects have been reported since 12 Jan 2021 [Norway; Report] As of 14 Jan 2021, 29 reports of side effects were reported in Norway. The 29 reports consisted of 13 deaths, 9 serious side effects and 7 less serious side effects. The deaths were all amongst frail and elderly patients in nursing homes, aged at [33] least 80 years. Serious side effects reported included allergic reactions, strong malaise and severe fever. Less serious side effects include severe pain at injection site. [United States; Report] A healthcare worker in Alaksa experienced an allergic reaction to the Moderna COVID-19 vaccine, 10 minutes [34] within receiving it on January 12. There was no information on allergy history of the healthcare worker. [Israel, Report] At least 13 cases of mild facial paralysis have been [35] reported upon receiving the vaccine. [United Kingdom, Report] A severe adverse medical reaction was reported from a medical councillor aged 42 years within minutes after receiving his vaccine on 8 January 2021. The councilor [36] experienced breathing difficulties, fever and muscle aches, and was hospitalized for 1 day before his condition stabilized and eventually recovered. [Ireland, Report] As of 11 January 2021, 81 adverse events from [37] vaccination were reported, all involving expected mild side effects. [Singapore, Report] As of 27 January 2021, a total of 432 AEFIs were reported amongst the 113,000 people who received the vaccine. All reports were mild and reported expected side effects arising from vaccination, except for 3 cases of anaphylaxis (SAE) reported. The cases were in their 20s and 30s, had a history of allergies, but no history of anaphylaxis which would have [38] precluded them from receiving the vaccine. All 3 cases have [39] recovered and were discharged from the hospital after a day’s observation or treatment.
[Update] As of February 1, 2021 all four cases of anaphylaxis following vaccination have recovered, with none requiring intensive care unit support. [Belgium, Report] As of January 26, 2021 a total of 262 AEFIs were [40] reported out of 243,412 vaccines administered, of which 37 were
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
serious AEFIs. Of the serious AEFIs reported, 14 were deaths amongst those aged over 70 years (9 deaths) or 90 years (5 years). [Croatia, Report] As of February 1, 2021 a total of 430 AEFIs were reported, of which 26 were allergic reactions and the rest were [41] mild side effects. The allergic reactions included 2 serious reactions, and 24 milder reactions. [United Kingdom; Report] A study conducted by Zoe, a British health science company had found that 37% of about 40,000 vaccinees in UK who were mostly healthcare workers had reported local side effects (e.g. swelling or pain near injection site) after first [42] dose and 45% after second dose. Systemic side effects (e.g. fatigue) were rare with 14% after first dose and 22% after second dose. The side effect reported were lower as compared to FDA trials. [Romania; Report] A doctor from Valcea county had experienced temporary facial paralysis after receiving the second dose and has since fully recovered. This is the first rare and major side effect [43] reported in Romania. Since 27 Dec, there has been more than 2,100 common and minor side effects reported with a total of 629,279 people vaccinated by 4 Feb. [United Kingdom; Report] The Medicines and Healthcare products Regulatory Agency (MHRA) had reported on the side effects of 7 million vaccine doses (5.4 million Pfizer/BioNTech & 1.5 million of the AstraZeneca) administered by 24 Jan. Yellow card system was used for vaccinated people to report side effect. There was an average of 3 yellow cards per 1,000 doses administered. There [44] were 16,756 yellow card for the Pfizer-BioNTech vaccine; 6,014 for the Oxford University-AstraZeneca vaccine and 50 for unspecified brand of the vaccine. Most reports were related to injection site or otherwise generalized symptoms (e.g. flu-like illness). These symptoms had occured shortly after vaccination and were not associated with more serious or lasting illness. [Netherland; Report] 15 elderly had died within 9 days after administered with vaccine. Most of them with fatal outcome had multiple underlying health issues or serious health problem. Half of them had symptoms identified as side effects e.g. fever after vaccination. These may have contributed to the deterioration of their health.
[45] A total of 2,812 side effects have been reported after vaccinated. 95% were administered with Pfizer/BioNTech vaccine, 113 cases were Moderna vaccine and vaccine used for 38 reports were not clear. 14 people who had epilepsy also had seizure after vaccination. Some 25 people had severe allergic reaction to Pfizer/BioNTech vaccine with 8 cases determined as anaplylactic response. Both the Pfizer and Moderna vaccines can cause lymph nodes to swell, particularly those in the armpit on the side where the shot [46] was received.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[France; Report] Between December 27 and February 18, France recorded 5,331 unwanted side effects out of 3,330,296 injections. The most common side-effects included flu-like symptoms, such as fever and muscle pain, and were more prominent after the second [47] dose. There were 75 cases of serious high blood pressure that led to symptoms like dizziness, 56 cases of cardiac issues and 10 cases of facial paralysis. [Australia, Report] The first serious AEFI in Australia involved anaphylactic reaction in a Queensland nurse following vaccination. [48] The nurse has a history of anaphylaxis and have since recovered from the reaction. [Japan, Report] The first serious AEFI in Japan involved anaphylactic reaction in a female Japanese medical worker in her 30s, following vaccination on 5 March 2021. The medical worker has a history of asthma, and whose condition have improved after taking proper medicine.
[Japan, Update] Five more anaphylaxis cases following vaccination were reported through Japan on 8 March 2021, bringing the total number of such cases to 8. The new cases occurred in women in [49] their 20s to 50s, of which four had asthma or a history of other [50] drug allergies. All cases’ condition improved after taking [51] medication. Anaphylaxis reaction was linked for vaccination for three of the cases, while the causal relationship was unclear or impossible to evaluate in the remaining 2 cases.
[Japan, Update] A total of 25 cases of anaphylaxis were reported amongst 148,000 doses administered as of 10 March 2021. The cases were primarily women (24 cases). The anaphylaxis rate in Japan is relatively higher than that reported in United States (5 cases/million doses) and Britain (20 cases/million doses) [Australia; Report] As of 16 March, 19 reports of anaphylaxis were reported nationally after vaccinated with Pfizer (14 reports) and [52] AstraZeneca (5 reports). More than 183,000 doses have been administered. [Hong Kong Report] A chronically ill 66-year-old man died on March 19, three days after receiving the BioNTech vaccine. He was the eighth person to die after getting a jab since vaccination was [53] launched. The previous seven chronically ill people died after receiving the Chinese-made Sinovac jab. But no link between the deaths and the jabs has been established so far. [Hong Kong, Report] As of March 26, there has been 1 known report of Bell’s palsy following vaccination with the Pfizer- [54] BioNTech vaccine in Hong Kong. No direct link was found between the cases and the vaccinations. [Japan, Report] As of March 21, 47 cases of anaphylaxis have been reported after 580,000 doses of Pfizer-BioNTech vaccine administered. This implies an anaphylaxis rate of 81 cases per 1 [55] million doses administered, much higher than 5 in every 1 million doses in the United States and 20 cases per million doses in
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
Britain. The rate is subject to change since Japan is further behind in the vaccination rollout. [United Kingdom, Report] A 2 reports of blood clot in the brain [56] have been reported amongst recipients as of 24 March 2021. [Australia; Report] As on 28 March 2021, 36.3% of 80,533 people receiving the vaccine reported adverse events after the first dose [57] while 60.7% reported at least one AE following their second dose since vaccination started on 22 February 2021. [Hong Kong; Report] Two pregnant women had suffered from miscarriages after administered with the BioNtech vaccine but [58] links with the vaccination has not been established. [New Zealand; Report] From 20 Feb to 13 Mar, 22,588 doses were administered with 65 new non serious and 3 new serious cases reported from the last update. Two of the serious cases were allergic reaction while the third case was a reactogenicity reaction. Previous report up to 6 Mar has identified 147 adverse reactions including 3 serious reactions.
[Update] Between 20 February and 27 March 2021, 151 new mild [59] AEFIs and 4 new serious AEFIs were reported, from the 55,143 [60] doses administered. Mild AEFIs were mostly dizziness (120 cases), headaches (111 cases), nausea (84 cases), fatigue (52 cases), fever (49 cases), muscle pain (37 cases), chills (33 cases), arm pain (31 cases), flu-like symptoms (31 cases) and fainting (25 cases). Serious AEFIs reported included allergic reactions (2 cases), a “seizure- type” event (1 case) and a reactogenicity reaction (1 case). Overall, 457 AEFI reports were made, of which 14 reports were serious, as od 27 March 2021. [Israel; Report] Herpes zoster reactivation (shingles) identified in six vaccinated patients with comorbid autoimmune/ inflammatory [61] diseases in two centers since Dec 2020 suggest new adverse event linked to the vaccine. [Saudi Arabia, Publication] A cross sectional study was conducted with 455 Saudi Arabia inhabitants. Common side-effects were injection site pain, headaches, flu-like symptoms, fever, and tiredness, less common side effects were fast heartbeat, whole body aches, difficulty breathing, joint pain, chills, and drowsiness [62] and rare side effects were Bell’s palsy and lymph nodes swelling and tenderness. There were more reports on difficulty of breathing in recipients who were previously infection as compare to not infected. Most side effects reported were consistent with the vaccine’s fact sheet for recipients and caregiver. [United Kingdom, Report] Based on the UK’s Yellow Card tool, there were 2.5 time more cases of severe side effects and related death after vaccinated with Pfizer than with AstraZeneca. As of 5 [63] April, there were 22 fatalities among 21.6 million doses of AstraZeneca and 40 fatalities among 15.4 million doses of Pfizer administered. [Croatia, Report] Out of a total of 750,000 doses of the COVID-19 [64] vaccine administered in Croatia by April 22, side effects were
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
reported in only 0.4 percent of cases. Out of a total of 2667 reports, there were 1297 side effects for Pfizer / BioNTech's vaccine, 1166 for AstraZeneca, and 202 for Moderna. Eighty-one percent were mild health problems, while 19 percent were more severe. [Estonia, Report] Seven serious side effects were reported last week after vaccination, two with the Pfizer/BioNTech Comirnaty vaccine (thrombosis), one with the Moderna vaccine (thrombosis) and four with the AstraZeneca Vaxzevria vaccine [65] (thrombocytopenia, visual impairment - retinal detachment, deep vein thrombosis and headaches and photosensitivity). Any causal link is yet to be established. [United States; Report] The FDA advisory committee has noted a special side effect of the vaccine from the clinical trials involving several patients with cosmetic facial fillers. The patients who [66] experienced side effect all had swelling and inflammation in the area that was given the filler. All reactions were resolved following treatment with steroids and antihistamines. [United States; Report] A Boston doctor experienced severe allergic reactions after receiving the Moderna COVID-19 vaccine on [67] December 24. The doctor has a history of shellfish allergy. [Canada; Report] On December 17, the US FDA reported two cases of adverse reactions in individuals who had received the Moderna vaccine. Both patients previously had dermal fillers and experienced some swelling following the vaccination. The cases were likely to have occurred in Toronto, Canada. [68] [Canada; Surveillance] As of 5 Feb, a total of 280 adverse effects [69] were reported which include 25 serious AEFI and 255 non-serious [70] AEFI. Moderna [Canada; Surveillance] As od 26 March 2021, a total of 1,165 AEFIs were reported, of which 1,106 were non-serious AEFIs and 59 were serious AEFIs. [United States; Report] A frontline worker in Robstown had experienced immediate numbness on the face after receiving the [71] vaccine a week ago but continues to have soreness and redness to her arms. [United States; Publication] Phase 3 clinical trial involving 30,420 volunteers had observed higher frequency of moderate, transient reactogenicity after vaccination in the vaccine group. Serious adverse events were rare and the incidence was similar between the placebo and vaccine groups. Hence there were no safety [72] concern, apart from the transient local and systemic reactions. [73]
[Update] The vaccine showed a 94.1% efficacy rate in its phase 3 trial, and serious adverse events occurred in just 0.6% of patients. A total of 2 deaths were reported in the vaccine group, one was due to cardiopulmonary arrest and the other was a suicide.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[United States; Report] On 31 December, the Oregon Health Authority reported a case of anaphylaxis after a healthcare worker [74] had taken the vaccine this week and is recovering in the hospital. [Guidance] A new guidance from the American Society for Dermatologic Surgery (ASDS) has been released regarding side effects from the SARS-CoV-2 mRNA vaccine on dermal fillers. FDA [75] data reports show three participants out of 15,184 who received at least one dose of Moderna’s mRNA-1273 vaccine have developed lip for facial swelling in areas of dermal filler placement. [United States; Report] A Missouri healthcare worker experienced severe allergic reaction after receiving the Moderna COVID-19 [76] vaccine on December 29. The healthcare worker has a history of severe allergy reaction to MRI contrast dye. [United States, Report] Six reports of allergy reactions requiring medical attention 24 hours from vaccination, were reported amongst healthcare workers on 14 January 2021. The healthcare workers were vaccinated with lot 41L20A from the same [77] vaccination site in San Diego. The site is temporarily closed for now and using other vaccines. California health officials recommend suspending the use of lot 41L20A, until investigation are complete. [United States, Report] A fatality was reported in a resident from a retirement home, after receiving the vaccine. Investigation on [78] whether the fatality was linked to receiving the vaccine is underway. [United States, Report] As of January 29, 2021 a total of 287 AEFIs were reported amongst 250,000 vaccines administered in Texas, of which 11 were serious AEFIs. The 11 AEFI reports included the death of an 84 years-old woman, permanent disability in another patient, and the remaining spent at most 4 days hospitalized. [79] [80] [Update] As of 5 Feb, 2021, the The Centers for Disease Control had reported that 619,452 second doses have been administered in Texas with 15 significant reports of side effect. Only 4 of them required hospital stay that had lasted less than 5 days. [Croatia, Report] As of February 1, 2021 a total of 13 AEFIs were [81] reported, all of which were mild side effects. [USA, CDC; Report] A side effect of the Moderna vaccine reported by the CDC as arm pain and redness appears to be showing up a [82] bit delayed in some people up to a week. [France; Report] Since January 22, 148 cases of unwanted side effects were reported in France. A total of 129,510 people have received at least one doses of the Moderna vaccine. The side [83] effects were mainly skin issues, muscle pain, and digestive issues. Four people had severe side effects including cardiac problems. [United States, Report] A 39-years-old female with no known health problems or comorbidities died 4 days after her second [84] vaccine shot. Investigations are in progress to determine the link of the death with the vaccine.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[United States, Report] Boston researchers report delayed skin reaction to Moderna COVID-19 vaccine which includes skin rash at [85] the injection site and the timing of it might be confusing. [Argentina; Report] Of the total 32,013 patients who had received Sputnik V the vaccine, 1% (317 patients) had reported mild adverse reaction [86] (fever and headache). [India, Report] Ninety-three reports of adverse events following immunization with Astrazeneca & Oxford Uni. ( and Bharat Biotech) vaccines were reported from Delhi (51 mild and 1 serious report), Haryana (13 mild reports), Maharashtra (14 mild reports) and Kolkata (13 mild and 1 serious report). No fatalities have been reported.
[Update] Between 16 January and 17 January, 447 reports of adverse events following immunization have been reported across India. Only 3 of the reports involved serious adverse events requiring hospitalization, of which only 1 remains hospitalized.
[Update] 82 AEFIs were reported across India on 20 January 2021. All AEFIs reported were mild cases. [87]
[88] [Update] On the 22 Jan, Day 4 of the coronavirus vaccination drive [89] in Delhi, 5,942 people were reportedly administered the shots and [90] adverse events following immunisation (AEFI) was reported in 24 [91] persons. [92]
[93] [Update] On 24 Jan, the fifth day of India’s Covid-19 vaccination Astrazeneca & [94] drive, the city of Gurugram reported 3 cases of AEFI amongst 3,055 Oxford Uni. [95] shots administed. [96]
[97] [Update] The Union Ministry of Health and Family Welfare in India
announced 23 January that over 10 lakh people had already been
immunised in the first six days (up to 21 January), but the total
number of AEFIs reported by the ministry in its daily press releases
so far adds up to 1,239 out of 15,37,190 inoculations, or 0.08 per
cent. Just 11 people have had to be hospitalised (0.0007 per cent),
while seven deaths have been reported — six of which are “not causally linked” to the vaccine, while in the seventh case, the post mortem report is awaited.
[Update] A total of 19,50,183 beneficiaries were inoculated in 35,785 sessions till 7.10 pm on Monday 25 Jan, including 3,34,679 in 7,171 sessions during the day, the ministry said. A total of 348 adverse events following immunisation (AEFIs) were reported till 7.10 pm on 25 Jan, the 10th day of the vaccination drive.
[Update] A total of 213 ARFIs were reported up till 7 pm on January 29, 2021 across India, of the 33,68,734 vaccines administered
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[Update] The Minstry of Health and Family Welfare had reported more than 40 lakh healthcare and frontline workers have been vaccinated. A total of 8,563 AEFIs (0.18%) and 34 hospitalized cases (0.0007%) have been reported. There were 19 deaths of vaccinated people but there has been no evidence on the link between vaccination and the death.
[Update] A total of 91 minor AEFIs were reported out of the 833,000 people vaccinated in the state, as of 8 March 2021 [Sweden, Report] As of 13 Feb, two regions in Sweden have temporarily stopped vaccinating health workers with the Astra [98] Zeneca vaccine, after as many as one in four reported side effects. [Germany, Report] The Herzogin-Elisabeth-Hospital in Braunschweig and Emden clinic postponed planned vaccinations with the Astrazeneca vaccine. On evening of 16 Feb, Astrazeneca vaccine was given to 88 employees of the Braunschweig clinic, 37 [99] of them called in sick temporarily due to "vaccination reactions." However, there has not been a severe course of side effects so far, and no one has had to go to a hospital with complications. [France; Report] Between February 6 and 18, 971 cases of unwanted side effects were reported in France. Of these, 93% were flu-like symptoms and 72% disappeared within 24 hours. The most common side effects were pain and inflammation at injection [100] site, digestive issues, and muscle pain. There were four serious cases – one stroke, two with loss of taste and a death. There was however, no suggestion that any death was directly caused by the vaccine. [Netherlands; Report] The side effects center Lareb, Netherlands reported that side effects like fever and chills were more likely to [101] be severe after the AstraZeneca vaccine. [South Korea; Report] South Korean authorities are probing two deaths reported days within receiving the AstraZeneca COVID-19 vaccine. One was a 63-year-old nursing home patient with cerebrovascular disease who died after showing symptoms of blood poisoning and pneumonia. The other was an individual in their 50s with a cardiac disorder and diabetes, who died after suffering multiple heart attacks. Officials are investigating the cause of the deaths.
[102] [South Korea, Update] Three more deaths following vaccination [103] were reported on 4 March 2021, raising the total number of post- [104] vaccination fatalities to 5. The 3 new deaths were all reported [105] amongst long-term care hospital patients, of which 2 of the deceased aged 52 and 58 years old had preexisting comorbidities and the remaining fatality was in her 20s. Investigations are underway to assess the association between all 5 deaths and vaccine.
[South Korea, Update] Eight of the 11 deaths following vaccination were concluded to not be linked to the vaccine, following initial investigation which did not recognize causality between adverse
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
reactions and death after vaccination. The investigation team linked the deaths to exacerbation of underlying diseases in the deceased. Investigation for the 3 remaining deaths are still underway.
[South Korea; Update] Suspended vaccination with the Astrazeneca vaccine for people younger than 60 years old, from 7 April 2021 while awaiting results from the EMA safety review regarding blood clots as a side effect from vaccination. [Austria, Report] Vaccination with a batch of the vaccine was suspended following reports of a death of a 49-year-old woman from severe coagulation disorder, and a case of pulmonary embolism in a 35-year-old woman following vaccination. Blood clotting is not a known side effect of vaccination and the [106] relationships of the 2 reports are currently under investigation. [107]
[Austria, Update] The European Medicines Agency reported no evidence linking the deaths of 2 people reported above, to the vaccination. [Denmark, Report] Vaccination of AstraZeneca will be suspended for 14 days after a 60 year old women who had received the vaccine from the same batch as Austria had formed a blood clot [108] and died. However, it is unable to conclude any link at the moment as investigation are being conducted. [Philippines, Report] As of 10 March 2021, 978 individuals administered with Sinovac (892) and AstraZeneca (86) had experienced suspected adverse event. At least 85 vaccinees administered with AstraZeneca were non-serious and 1 was serious. 872 vaccinees administered with Sinovac were non- serious and 20 were serious.
[Update] 2.21 percent of those who received Sinovac's CoronaVac [109] experienced suspected side effects, and it was 5.19 percent for [110] those inoculated with AstraZeneca's product. [111]
[Update] Among the 24,209 vaccinated individuals administered with Coronavac and AstraZeneca in Region 2 (Cagayan Valley), at least 516 had reported minor adverse effect and are in stable condition. Of the 20 individuals with serious effects, 4 deaths were reported. Three of which were co-incidental who were positive for Covid-19 with comorbidities before vaccination and were not link to the vaccine. The other death was indeterminate. [India, Report] Two senior citizens in West Bengal had died after administered with Covishield vaccine. Primary findings suggested [112] that it was due to cardiac ailments. [Norway, Report] Three health workers below 50 years old who were administered with AstraZeneca vaccine recently have been [113] treated for bleeding, blood clots and low count of blood platelet. It is uncertain if the cases are linked to the vaccine. [Spain, Report] The Community of Castilla y Leon has reported two [114] cases of possible adverse effects after administered with
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
AstraZeneca- University of Oxford vaccine in Valladolid. An individual who was diagnosed with non-infectious immunological encephalitis is in stable condition and progressing favourably. The other individual had stroke and had been treated and discharged. Specific cause-effect relationship was not able to established at the moment. [Italy, Report] The northern region of Piedmont will stop using a batch (ABV5811) of the AstraZeneca vaccine following the death of a teacher after vaccination on Saturday. Italy had also banned the [115] use of another batch (ABV2856) on 11 Mar after the deaths of two men in Sicily. No link has been established. As of 14 March, AstraZeneca has reported no evidence of increased risk of blood clots in a review of the safety data of more than 17 million people vaccinated with its vaccine in EU and UK. 15 events of deep vein thrombosis and 22 events of pulmonary [116] embolism have been reported thus far which is similar to the other licensed vaccine. AstraZeneca and the European health authorities have and are conducting additional testing and there were no cause of concern. [Sweden, Report] Vaccination of AstraZenca vaccine will be suspended for precautionary measure until EMA investigcation is done. The Swedish Medical Products Agency has noted 10 cases of [117] blood clots and one case of low levels of platelets in those vaccinated as of 15 Mar. [Denmark, Report] On 20 March, two people reported experiencing brain hemorrhages after receiving the AstraZeneca [118] Covid vaccine, one of whom died and a female civil servant in her 30s, was critically ill. [India, Report] A 62-year-old woman died on 20 March, three days after taking the Covid-19 vaccine in Karnal district. An autopsy was [119] performed and the report is awaited before a conclusion on the reason for the death can be reached. [Finland, Report] On 20 March, two cases of cerebral venous sinus thrombosis were reported within 4–10 days of receiving the AstraZeneca COVID-19 vaccine. Both patients had medical risk [120] factors for blood clots, and the analysis of the cases is still incomplete. As a precautionary measure, the use of the AstraZeneca vaccine in Finland has been suspended. [Taiwan, Report] On March 24, four reports of non-serious adverse reactions have been reported after over 3,000 medical personnel were vaccinated with AstraZeneca vaccine. Sixty-three percent [121] reported pain at the site of the injection, 55% reported muscle ache, 52,6% fatigue, 43% headache and 41.8% reported chills. [Global, Report] Drug regulators in Europe are investigating 62 cases of rare blood clotting worldwide, cerebral venous sinus thrombosis (CVST), which occurred following the use of [122] AstraZeneca’s vaccine. Forty-four cases were reported among 9.2 million vaccinees in the European Economic Area. The figure cited does not include all cases of the condition reported in Germany.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[Netherland, Report] Five reports of extensive thrombosis with low platelet counts in 7 to 10 days post-vaccination were reported in women aged between 25 and 65 years old; 3 cases had extensive [123] pulmonary embolisms, 1 case had a brain haemorrhage and one case died. The vaccine has since been temporarily suspended in use for people below 60 years old in Netherlands. [United Kingdom, Report] A total of 22 reports of blood clot in the brain accompanied by low platelet counts, and 8 reports of blood clotting problems with low platelet count have been reported [124] amongst the 18.1 million doses administered as of 24 March 2021. Of the 30 reports, 7 individuals have died. [Australia, Report] A case of serious thrombosis with low platelet count was reported in a 44-year-old man, days after receiving the [125] vaccine, on 2 April 2021. Investigation to assess the causal link with the vaccine is currently underway. [Australia; Report] Since 22 February 2021, a total of 21,378 mild AEs were reported of the 31,786 people receiving the vaccine. Fatigue was the most commonly reported AE (53.8%), followed by [126] headache (47.4%), muscle or body aches (45%) and injection site pain (44.9%). [Belgium; Update] Banned vaccination with the Astrazeneca [127] vaccine for people aged under 56, for 4 weeks from 7 April 2021. [Brunei; Update] Suspended vaccination with the Astrazeneca vaccine nationwide, from 7 April 2021 while awaiting results from [128] the EMA safety review regarding blood clots as a side effect from vaccination. [Global; Update] As of early April, 169 cases of rare brain blood clot following vaccination have been reported to the European Medicines Agency (EMA), from the 34 million doses administered in the European Economic Area. The EMA have found possible links between the vaccine and the occurrence of the brain blood clots, but reiterated on its benefits of protection.
The World Health Organisation has reviewed the latest information from EMA and the United Kingdom’s Medicines and other Health products Regulatory Agency (MHRA) and considered the causal relationship between the side effect and the vaccine [129] plausible but not confirmed, and specialized studies are needed. [130] The WHO notes that the brain blot clot event reported is very rare, [131] in low numbers reported amongst the almost 200 million individuals vaccinated with this vaccine candidate globally.
[Update, United Kingdom] As of 21 April 2021, a total of 209 cases, with 41 deaths, of the rare combination of clots with low platelet counts were reported in the United Kingdom. Figures by the MHRA showed a higher incidence of this disorder amongst younger adults, based on the age breakdown of cases when known. The overall case incidence is estimated at 9.3 per million doses, based on the estimated 22 million first doses given by 21 April 2021.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[Australia, Report] A 48 year old diabetic woman had developed blood clots and died on 15 Apr after receiving the AstraZeneca vaccine on 9 Apr but link between the death and vaccine has not been established. [132]
[133] [Update] The Australia medical regulator has ruled that the blood clot developed in the 48 year old woman is a side effect of the vaccine and would review again if test results and/or autopsy show otherwise. [Nigeria, Report] A total of 8,439 mild adverse events and 52 moderate to severe adverse events have been reported. No deaths [134] or cases of blood clots related to the vaccine has been reported. [Report] EMA is investigating on another possible side effect, capillary leak syndrome associated to the vaccine. Five cases have [135] been reported so far but link with the vaccine has not been established. [Canada, Report] A man in the 60s from Alberta has a confirmed case of blood clot linked to the AstraZeneca vaccine and is receiving treatment and recovering from it. This is the second case [136] of vaccine-induced immune thrombotic thrombocytopenia in more than 700,000 AstraZeneca or CoviSHIELD/AstraZeneca doses vaccinated in Canada. [France, Report] Nine new cases of thrombosis and four related deaths in individuals vaccinated with AstraZeneca vaccine was [137] reported for 2 to 8 April. This bring the total cases of thrombosis and blood clotting issue in France to 23 and eight total deaths. [Saudi Arabia, Report] Seven blood clots with possible association to AstraZeneca vaccine have been recorded after receiving 34 complaints of side effects. However, immunological platelet [138] deficiency and clotting syndrome associated with the vaccine have not been confirmed in the cases. [Report, Australia] Three new cases of thrombosis with thrombocytopenia syndrome (TTS), or blood clots in a 35-year-old NSW woman, a 49-year-old Queensland man and an 80-year-old Victorian man, are likely linked to the AstraZeneca vaccine bringing the total number of TTS cases to six. Symptom onset ranged from 9 to 26 days after vaccination. [139] [Update, Australia] As of 29 April 2021, a total of 6 confirmed [140] cases of TTS following vaccination, and one linked to a death of a 48-year-old female was reported by the Therapeutic Goods Administration of Australia. The latest 2 deaths occurring shortly after vaccination in 2 NSW males are still under investigation, but current evidence do not suggest the deaths were linked to the vaccine. [Philippines, Report] As of 7 March 2021, a total of 41 mild AEFIs CoronaVac were reported from 1,075 shots administered amongst health care [141] workers in Cebu city.
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
[Thailand, Report] Seven people had developed temporary partial paralysis after administered with CoronaVac. All had improved [142] after taking medicine to dissolve blood clots. [Update, Thailand] The adverse side-effects that were reported in 7 recipients. who developed “stroke-like” symptoms after receiving the first dose of the CoronaVac have recovered following [143] medical treatment. Contrary to earlier reports, no blood clots were found in any of the 7. [Hong Kong, Report] A total of 61 mild AEFIs were reported, of which 45 required hospitalisation, were reported amongst the 91,800 Sinovac doses (and 1,200 doses by Pfizer BioNTech) administered as of 6 March 2021. A death following vaccination was reported in a 71-year-old man on 8 March. The deceased [144] received his first dose on 3 March and investigation regarding the cause of death is underway. Two other deaths following vaccination, reported between 6 and 8 March were assessed to not linked with vaccination following investigation. SinoVac [Philippines, Report] Philippine health authorities on 18 Mar ruled out a COVID-19 vaccine as the cause of death of a 47-year-old [145] health care worker who died on Saturday, days after she received a jab of China's Sinovac vaccine. [Hong Kong, Report] As of March 26, there have been 11 known reports of Bell’s palsy following vaccination with the Sinovac [146] vaccine in Hong Kong. No direct link was found between the cases and the vaccinations. [Canada; Surveillance] As of 26 March 2021, there were 22 non- [147] serious AEFIs reported [Ghana; Report] A total of 1,679 adverse effects were reported from the 490,000 doses administered, of which 9 reports were serious AEs. However, only a report involving a case of febrile illness was considered related to the vaccine after investigation. [148] Covishield Remaining 1,670 reports were mild AEs, of which headache, fever, weakness, body pains, chills, pains at injection point, malaise and dizziness were most commonly reported. [Canada; Report] As of 15 April, the first case of rare blood clot was reported in Quebec and the affected person was recovering at [149] home. [United States, Report] Vaccinations with Johnson & Johnson's COVID-19 shot have been paused at a North Carolina site after 18 [150] people had adverse reactions on Thursday. Four have been taken to area hospitals. Johnson & [United States, Report] The Centers for Disease Control indicated Johnson in an alert Tuesday 13 April that the Johnson & Johnson vaccine Ad26.COV2.S could resume as soon as Wednesday 14 April. The alert came after a chaotic day when the Food and Drug Administration [151] recommended there be a "pause" for the vaccine, leading virtually every state to halt use of the single-dose shot. The CDC's Advisory Committee on Immunization Practices will convene Wednesday 14
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
April for an emergency session, with a vote scheduled on "updated recommendations for use". [Global, Report] European Medicines Agency reported a possible link between Johnson & Johnson vaccine and rare blood clot incidents but the benefit outweighed the risk. Inclusion of warning [152] on rare but fatal blood clots with low blood platelets within 3 weeks of vaccination was recommended. [USA, Report] A woman in Texas has been hospitalized with possible blood clots associated with Johnson and Johnson’s coronavirus vaccine. So far, officials are examining six reports of [153] clots, including a death, out of more than 6.8 million one-dose vaccinations that have been given. [United States; Report] A suspected case of blood clots with very low blood platelets and oxygen levels, suspected to be linked with vaccination was reported from a active and healthy 65-year old woman in Powell County. The case received the vaccine on 5 April 2021, and experienced mild adverse effects initially, until it [154] developed into more severe symptoms which required hospitalisation on 13 April 2021. One blood clot was identified in the case’s neck. The case has since recovered and been discharged. [United States; Report] As of 21 April 2021, a total of 13,526 AEFIs were reported from the 7.98 million doses administered, via the Vaccine Adverse Effects Reporting System. 97% of the reports [155] were non-serious; the most common AEFI reported were systemic reactions (76%) and reaction at the injection site (61%). [United States; Report] A death was reported from a 35-year-old female from Michigan on 19 April 2021, 11 days from her vaccination on 8 April 2021. The death was caused by acute subarachnoid hemorrhage non-traumatic, when a blood clot in a vessel burst and caused bleeding in the space between the brain [156] and surrounding membrane. It is unclear whether the death was linked to the vaccination, but the death has been reported to the VAERS system, which reported 13,725 adverse event reports, of which 97% were non-serious reports as of 4 May 2021. [China, Report] The incidence of adverse effects due to the two inactivated vaccines of Sinopharm was 1.06% based on mass-scale Sinopharm [157] emergency use in China on 519,543 people as of 1 Dec. This is lower compared to the results from phase 2 clinical trial. [India, Report] A female volunteer from a village in Andhra Pradesh had died 2 days after administered with the vaccine on 5 Feb. She was normal and there was no symptoms of fever or [158] adverse effect after the vaccination. Post-mortem will be conducted to identify the cause of death. [United States, Report] A 70 year old man had died minutes after Unspecified receiving the vaccine at NYC’s Javits Center on 7 Feb. He had collapsed about 25 minutes after vaccinated and after the [159] mandatory 15 minutes observation. He did not display any adverse reactions or effect to the vaccine. [India, Report] A 50 year old sanitation worker had suffered [160] cardiac arrest and died 24 hours after administered with the
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
vaccine in Anhra Pradesh’s Tirupati. There was no sign of adverse effect during the observation period. Autopsy will be conducted to determine the exact cause of death. [India, Report] A 72-year-old female anganwadi worker died on 6 March, after receiving the first dose on 17 February 2021 in Jiribam district, Manipur. The deceased had reportedly complained about fever and health weakness on the same day after receiving [161] the vaccine, and been receiving treatment in different hospitals since then before eventually hospitalized on 27 February after her health condition deteriorated. [India, Report] A total of 8 AEFI cases, of which 1 was a serious AEFI, were reported from the 32,714 doses given at the Brihanmumbai Municipal Corporation on 8 March 2021. The [162] serious AEFI was reported in a 65-year-old man after he received vaccination at the centre. [India, Report] A 69-year-old man collapsed on the chair within seconds, and passed away within 2 hours after receiving the [163] vaccine at a nursing home in Oshiwara. The cause of death is still under investigation. [India, Report] A 65-year-old man had died two days after being vaccinated on 10 March in Andhra Pradesh’s Eluru. No abnormality was reported during the observation after vaccinated. He had fallen ill the next day and his condition improved before passing [164] away. Primary medical reports showed that he was suffering from paralysis, diabetes, and some other serious health issues. Autopsy will be conducted to confirm the cause of death. Two suspected cases of blood clots in South Korea have been [165] reported after vaccination [India, Report] Two minor AEFis were reported from the 52,408 doses given on 3 April 2021, in New Delhi. As of mid-March 2021, 13 serious adverse events have been reported nationwide, of [166] which 6 were assessed to be attributed to vaccination, 6 were [167] assessed to be not attributable to vaccination and one case was unclassifiable. Therapeutic/Drug Report/Guidance Reference NIL NIL NIL
x. Scientific Publications with Epidemiology and Clinical Focus
Monitoring SARS-CoV-2 in municipal wastewater to evaluate the success of lockdown measures for controlling COVID-19 in the UK [503]
SARS-CoV-2 and the resulting COVID-19 pandemic represents one of the greatest recent threats to human health, wellbeing and economic growth. Wastewater-based epidemiology (WBE) of human viruses can be a useful tool for population-scale monitoring of SARS-CoV-2 prevalence and epidemiology to help prevent further spread of the disease, particularly within urban centres. Here we present a longitudinal analysis (March-July, 2020) of SARS-CoV-2 RNA prevalence in sewage across six major urban centres in the UK (total population equivalent 3 million) by q(RT-)PCR and viral genome sequencing. Our
38 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021 results demonstrate that levels of SARS-CoV-2 RNA generally correlated with the abundance of clinical cases recorded within the community in large urban centres, with a marked decline in SARS-CoV-2 RNA abundance following the implementation of lockdown measures. The strength of this association was weaker in areas with lower confirmed COVID-19 case numbers. Further sequencing analysis of SARS- CoV-2 from wastewater suggested that multiple genetically distinct clusters were co-circulating in the local populations covered by our sample sites, and that the genetic variants observed in wastewater reflected similar SNPs observed in contemporaneous samples from cases tested in clinical diagnostic laboratories. We demonstrate how WBE can be used for both community-level detection and tracking of SARS-CoV-2 and other virus’ prevalence, and can inform public health policy decisions. Although, greater understanding of the factors that affect SARS-CoV-2 RNA concentration in wastewater are needed for the full integration of WBE data into outbreak surveillance. In conclusion, our results lend support to the use of routine WBE for monitoring of SARS-CoV-2 and other human pathogenic viruses circulating in the population and assessment of the effectiveness of disease control measures.
Monitoring waves of the COVID-19 pandemic: Inferences from WWTPs of different sizes [504]
Wastewater based epidemiology was employed to track the spread of SARS-CoV-2 within the sewershed areas of 10 wastewater treatment plants (WWTPs) in Catalonia, Spain. A total of 185 WWTPs inflow samples were collected over the period consisting of both the first wave (mid-March to June) and the second wave (July to November). Concentrations of SARS-CoV-2 RNA (N1 and N2 assays) were quantified in these wastewaters as well as those of Human adenoviruses (HAdV) and JC polyomavirus (JCPyV), as indicators of human faecal contamination. SARS-CoV-2 N gene daily loads strongly correlated with the number of cases diagnosed one week after sampling i.e. wastewater levels were a good predictor of cases to be diagnosed in the immediate future. The conditions present at small WWTPs relative to larger WWTPs influence the ability to follow the pandemic. Small WWTPs (<24,000 inhabitants) had lower median loads of SARS-CoV-2 despite similar incidence of infection within the municipalities served by the different WWTP (but not lower loads of HAdV and JCPyV). The lowest incidence resulting in quantifiable SARS-CoV-2 concentration in wastewater differed between WWTP sizes, being 0.11 and 0.82 cases/1000 inhabitants for the large and small sized WWTP respectively.
39 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
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For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
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41 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
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42 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
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43 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
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45 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
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46 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
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48 | P a g e Centre for infectious di sease epidemiology and research
For citation: Centre for Infectious Disease Epidemiology and Research-NUS. COVID-19 Situation Report 463. 14 May 2021
Acknowledgement:
Dr. Pang Junxiong, Vincent
Ms Chua Ee Yong Pearleen
Ms Chua Hui Lan
Ms Gwee Xiao Wei Sylvia
Ms Koh Jiayun
Ms Shah Shimoni Urvish
Ms Wang Min Xian
Mr Lau Wai Hong Nicholas
Any queries? Email Sylvia Gwee @ [email protected]
Centre for Infectious Disease Epidemiology and Research
Saw Swee Hock School of Public Health National University of Singapore Tahir Foundation Building 12 Science Drive 2 #10-01 Singapore 117549
For more information, please visit:
Our NUS website: https://sph.nus.edu.sg/partnerships/cider/ Our blog: https://blog.nus.edu.sg/nuscider/
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