Phuket kicks off AstraZeneca booster shots using under skin method

[GroveHillWanderer]

2 hours ago, Cake Monster said:

This report as posted basically says all that we need to know about the practice of Subcutaneous Injections of the vaccines,

That report is about the potential problems when inadvertent subcutaneous injection occurs while trying to give an intramuscular injection.

 

The Thai medical authorities are not using subcutaneous injections, they are using intradermal injection. There are significant differences between the two.

 

As mentioned in the article linked to in a previous post:

 

Quote

Vaccination through intradermal injection holds many advantages compared to other types of vaccination, such as an improved immune response to vaccine, a potential reduction of the antigen dose, and decreased anxiety and pain.

However it is also more difficult to administer and requires a lot more experience, so is used much less often.

Edited September 25, 2021 by GroveHillWanderer

[GroveHillWanderer]

2 hours ago, cclub75 said:

Indeed.

 

These thai doctors are maniacs.

 

Source : https://pmj.bmj.com/content/97/1148/400

That article deals with inadvertent subcutaneous injection - not intradermal injection, which is different. (Intradermal injection is also mentioned but it is not the subject of the piece).

[Bkk Brian]

4 minutes ago, GroveHillWanderer said:

That report is about the potential problems when inadvertent subcutaneous injection occurs while trying to give an intramuscular injection.

 

The Thai medical authorities are not using subcutaneous injections, they are using intradermal injection. There are significant differences between the two.

 

As mentioned in the article linked to above:

 

However it is also more difficult to administer and requires a lot more experience, so is used much less often.

"The manufacturers advise that the vaccine should not be injected intravascularly, subcutaneously or intradermally"

[GroveHillWanderer]

2 minutes ago, Bkk Brian said:

"The manufacturers advise that the vaccine should not be injected intravascularly, subcutaneously or intradermally"

I already mentioned that in an earlier post.

[Bkk Brian]

2 minutes ago, GroveHillWanderer said:

I already mentioned that in an earlier post.

Good just so its clear that this is being done against the manufactures recommendations and against international scientific evidence on covid vaccine administration.

Edited September 25, 2021 by Bkk Brian

[pagallim]

15 minutes ago, GroveHillWanderer said:

 

The Thai medical authorities are not using subcutaneous injections, they are using intradermal injection. There are significant differences between the two.

 

Yet the article specifically mentions the subcutaneous method, not intradermal.

 

"The subcutaneous, or under-the-skin injection is method used in this latest campaign, replaces vaccination into muscle, with only 10-15 minutes of observation needed following the jab, instead of the previous 30 minutes, as acute side effects, such as low temperature, exhaustion, and headaches are less likely than in the conventional method, with an equivalent immunity boost, based on scientific research,

 

The subcutaneous injection will allow doctors to administer approximately four times more shots of vaccine than in the conventional method, speeding up the prevention of the Delta variant,Dr. Withita says."

[PETERTHEEATER]

19 hours ago, pagallim said:

These scenes from Kantang, Trang (one of the southernmost provinces badly affected by the latest outbreak), this morning.   These people are queuing to receive their first Sinovac dose.  An absolute shambles of a national policy.

 

Excellent point from the ladies in image #1 they've spotted the 'pie in the sky'

[ThailandRyan]

20 hours ago, pagallim said:

Exactly Brian, where is the evidence and trial data to support this methodology and on who's recommendation?   I'm really surprised that there hasn't been concerns raised, particularly from the Thai medical community.

Anutin approved it, so that should be a tell all.. . 

[GroveHillWanderer]

14 minutes ago, Bkk Brian said:

Good just so its clear that this is being done against the manufactures recommendations and against international scientific evidence on covid vaccine administration.

Fine, just so it's also clear that all the potential immunological and reactogenic drawbacks mentioned in the BMJ article apply to subcutaneous injection, not intradermal injection.

 

Furthermore, it is not against all the international scientific evidence on covid vaccine administration. I already quoted from a study by Dutch scientists into administering the Moderna vaccine intradermally, and which states that:

 

Quote

trial findings reveal that the fractional dose [intradermal] regimen of the Moderna vaccine is well tolerated and safe and is capable of inducing robust antibody responses in vaccine recipients

https://www.news-medical.net/news/20210802/Intradermal-administration-of-low-dose-mRNA-COVID-19-vaccine-induces-strong-immune-response-study-finds.aspx

[pagallim]

^

 

However, it is neither Moderna nor an mRNA type vaccine being administered as a 'booster' dose, it's AstraZeneca.

[Bkk Brian]

28 minutes ago, GroveHillWanderer said:

Fine, just so it's also clear that all the potential immunological and reactogenic drawbacks mentioned in the BMJ article apply to subcutaneous injection, not intradermal injection.

 

Furthermore, it is not against all the international scientific evidence on covid vaccine administration. I already quoted from a study by Dutch scientists into administering the Moderna vaccine intradermally, and which states that:

 

https://www.news-medical.net/news/20210802/Intradermal-administration-of-low-dose-mRNA-COVID-19-vaccine-induces-strong-immune-response-study-finds.aspx

Phuket is using subcutaneous injections:

 

"The subcutaneous, or under-the-skin injection is method used in this latest campaign, replaces vaccination into muscle, with only 10-15 minutes of observation needed following the jab, instead of the previous 30 minutes, as acute side effects, such as low temperature, exhaustion, and headaches are less likely than in the conventional method, with an equivalent immunity boost, based on scientific research,

 

The subcutaneous injection will allow doctors to administer approximately four times more shots of vaccine than in the conventional method, speeding up the prevention of the Delta variant,Dr. Withita says."

 

The study you quote is using Intradermal injections and fractional dose regimen of the Moderna vaccine which has a far higher dose than any other vaccine.

 

 

Edited September 25, 2021 by Bkk Brian

[GroveHillWanderer]

52 minutes ago, Bkk Brian said:

Phuket is using subcutaneous injections:

 

"The subcutaneous, or under-the-skin injection is method used in this latest campaign, replaces vaccination into muscle, with only 10-15 minutes of observation needed following the jab, instead of the previous 30 minutes, as acute side effects, such as low temperature, exhaustion, and headaches are less likely than in the conventional method, with an equivalent immunity boost, based on scientific research,

 

The subcutaneous injection will allow doctors to administer approximately four times more shots of vaccine than in the conventional method, speeding up the prevention of the Delta variant,Dr. Withita says."

 

The study you quote is using Intradermal injections and fractional dose regimen of the Moderna vaccine which has a far higher dose than any other vaccine.

Well, if it's subcutaneous, then all bets are off.

 

However it's not subcutaneous according to the latest article in the Bangkok Post (which of course I can't quote or link to) and according to different articles about this idea (e.g. Reuters, The Nation) when it was first mooted, the whole plan was to use intradermal injection.

 

I suspect that any references to subcutaneous are because of people confusing the two terms, since they are very similar in concept.

 

The doctor proposing it even referenced the study in the Netherlands into using the Moderna vaccine intradermally.

 

Quote

He said a study in the Netherlands had showed that intradermal Moderna vaccination was as effective with one-fifth or one-tenth of the dose used for intramuscular injection.

Medical expert suggests intradermal inoculation to multiply vaccine usage

 

As for the dosage, the general principle is that whatever the amount used for intramuscular injection, a smaller dose is required when using the intradermal route, to get the same immunological effect.

 

Please note that all of this is still just being put forward as part of an academic discussion of the relative merits of different methods of vaccine administration and I'm not making any specific judgement of what the Thai authorities are currently doing.

[Bkk Brian]

7 minutes ago, GroveHillWanderer said:

Well, if it's subcutaneous, then all bets are off.

 

However it's not subcutaneous according to the latest article in the Bangkok Post (which of course I can't quote or link to) and according to different articles about this idea (e.g. Reuters, The Nation) when it was first mooted, the whole plan was to use intradermal injection.

 

I suspect that any references to subcutaneous are because of people confusing the two terms, since they are very similar in concept.

 

The doctor proposing it even referenced the study in the Netherlands into using the Moderna vaccine intradermally.

 

Medical expert suggests intradermal inoculation to multiply vaccine usage

 

As for the dosage, the general principle is that whatever the amount used for intramuscular injection, a smaller dose is required when using the intradermal route, to get the same immunological effect.

 

Please note that all of this is still just being put forward as part of an academic discussion of the relative merits of different methods of vaccine administration and I'm not making any specific judgement of what the Thai authorities are currently doing.

The overriding factor here is that there is absolutely no need to try this experiment, they did over a million jabs yesterday through traditional means, why on earth go down an unproven route that has not had any large scale trials and is advised against by AZ and WHO.

 

No other country is in the world is using this method that I know of, not even there African continent where vaccines are really scarce, its foolhardy with no peer reviewed evidence that it will work.

[Bkk Brian]

Update article published just now:

 

Phuket begins new vaccine injection method

 

PHUKET: Medical staff at the Indoor Sports Stadium at Saphan Hin yesterday (sept 24) began administering third-dose ‘booster’ injections using the subdermal method, injecting the vaccine just under the skin, instead of the intramuscular method, injecting the vaccine into muscle, as used previously.

 

Those who received subcutaneous vaccination had an average immune response of 17,662.3 AU/ml and those who received conventional vaccination had an average immune response of 17,214.1 AU/m. 840 AU/ml).

The side effects of subcutaneous vaccinations were less common than with conventional injections, such as fever or headache, the researchers noted.

“The subcutaneous injection causes more irritation and redness at the injected area, it is not worrying,” Dr Withita said.

 

https://www.thephuketnews.com/phuket-begins-new-vaccine-injection-method-81511.php

 

Article from the 15th Sept announcing results of study:

 

Dr Withita explained, “In this research, we had 242 participants who were 18-60 years old and we divided them into two groups. For the first group, of 120 participants, we injected 0.5ml of vaccine into their muscle [Intramuscular], which is normal for COVID-19 vaccine injection.

“For another 122 participants, we injected 0.1ml of vaccine under their skin [subcutaneous],” she said.

“The study found that participants who received the subcutaneous injection with 0.1ml of vaccine developed a slightly higher rate of immunity than the other group of participants,” Dr  Withita explained.

 

https://www.thephuketnews.com/phuket-study-confirms-subdermal-injections-using-less-vaccine-more-effective-as-boost-jabs-81413.php

[stevenl]

29 minutes ago, GroveHillWanderer said:

Well, if it's subcutaneous, then all bets are off.

 

However it's not subcutaneous according to the latest article in the Bangkok Post (which of course I can't quote or link to) and according to different articles about this idea (e.g. Reuters, The Nation) when it was first mooted, the whole plan was to use intradermal injection.

 

I suspect that any references to subcutaneous are because of people confusing the two terms, since they are very similar in concept.

 

The doctor proposing it even referenced the study in the Netherlands into using the Moderna vaccine intradermally.

 

Medical expert suggests intradermal inoculation to multiply vaccine usage

 

As for the dosage, the general principle is that whatever the amount used for intramuscular injection, a smaller dose is required when using the intradermal route, to get the same immunological effect.

 

Please note that all of this is still just being put forward as part of an academic discussion of the relative merits of different methods of vaccine administration and I'm not making any specific judgement of what the Thai authorities are currently doing.

There really is no point in your post on this forum, Thai government is doing it so it must be bad, and any arguments supporting, or at least not contradicting, this decision, are dismissed out of hand by all the vaccine experts on the forum.

[poohy]

This fannying around is not going to impress other  counties sadly the "red list will continue unabated with such goings on publicized

[coolcarer]

Must be a Phuket thing, fortunately no other province is using this method. The vaccine experts in Phuket must be the best in the world, only nobodies following them or have even read their study if you can call it that.

[ThailandRyan]

3 hours ago, stevenl said:

There really is no point in your post on this forum, Thai government is doing it so it must be bad, and any arguments supporting, or at least not contradicting, this decision, are dismissed out of hand by all the vaccine experts on the forum.

others have stated that "Without this income the scheme will be looked on as a pilot that did okay for a while but ultimately failed" "Sarayuth said that if the Sandbox ends that will be the death knell for Phuket, and they need Bangkok tourists and the Chinese and Europeans in large numbers to survive."

 

I guess at the end of the day if you believe that this Governments new way of giving vaccinations, which goes against the vaccine makers own recommended way for a vaccine to be injected, then the world is right in your eyes. 

 

Edited September 25, 2021 by Rimmer

[ArcticFox]

3 hours ago, Bkk Brian said:

"The manufacturers advise that the vaccine should not be injected intravascularly, subcutaneously or intradermally"

But what do they know.  Thai 'scientists' are much smarter.  Actually Thais are the smartest people on the planet.  Farang the dumbest.

[ArcticFox]

1 hour ago, Bkk Brian said:

Update article published just now:

 

Phuket begins new vaccine injection method

 

PHUKET: Medical staff at the Indoor Sports Stadium at Saphan Hin yesterday (sept 24) began administering third-dose ‘booster’ injections using the subdermal method, injecting the vaccine just under the skin, instead of the intramuscular method, injecting the vaccine into muscle, as used previously.

 

Those who received subcutaneous vaccination had an average immune response of 17,662.3 AU/ml and those who received conventional vaccination had an average immune response of 17,214.1 AU/m. 840 AU/ml).

The side effects of subcutaneous vaccinations were less common than with conventional injections, such as fever or headache, the researchers noted.

“The subcutaneous injection causes more irritation and redness at the injected area, it is not worrying,” Dr Withita said.

 

https://www.thephuketnews.com/phuket-begins-new-vaccine-injection-method-81511.php

 

Article from the 15th Sept announcing results of study:

 

Dr Withita explained, “In this research, we had 242 participants who were 18-60 years old and we divided them into two groups. For the first group, of 120 participants, we injected 0.5ml of vaccine into their muscle [Intramuscular], which is normal for COVID-19 vaccine injection.

“For another 122 participants, we injected 0.1ml of vaccine under their skin [subcutaneous],” she said.

“The study found that participants who received the subcutaneous injection with 0.1ml of vaccine developed a slightly higher rate of immunity than the other group of participants,” Dr  Withita explained.

 

https://www.thephuketnews.com/phuket-study-confirms-subdermal-injections-using-less-vaccine-more-effective-as-boost-jabs-81413.php

A scientific study published in The Phuket News Journal of Science. 

There are now 64 studies published for the "horse paste" Ivermectin.
There is one study with 242 subjects published in The Phuket News that becomes the global standard for a novel vaccine administration technique using AZ. 

It works!  Are you 'Science Deniers?" 

In the meanwhile:
"Have you been vaccinated in Thailand and plan to travel to the UK?  You may want to rethink that as they won't recognize your vaccinations as being authentic."
Wonder why mai? 

 

 

Edited September 25, 2021 by ArcticFox

[ArcticFox]

So New Normal in Thailand will be Thai Health authorities refusing to give you vaccinations in a manner approved by the vaccine's developers and manufacturers because?  Thai Knows Best.

[stevenl]

1 hour ago, ThailandRyan said:

Always the Thai apologist, and the sandbox for you is just awesome while others have stated that "Without this income the scheme will be looked on as a pilot that did okay for a while but ultimately failed" "Sarayuth said that if the Sandbox ends that will be the death knell for Phuket, and they need Bangkok tourists and the Chinese and Europeans in large numbers to survive."

 

I guess at the end of the day if you believe that this Governments new way of giving vaccinations, which goes against the vaccine makers own recommended way for a vaccine to be injected, then the world is right in your eyes.  Guess if someone offered you a half priced meal because the meat was bad and had gone rancid

it would still be just fine and you would not find fault with it either.

Lots of guessing, don't buy lottery tickets since your guesses are off.

[stevenl]

20 minutes ago, ArcticFox said:

So New Normal in Thailand will be Thai Health authorities refusing to give you vaccinations in a manner approved by the vaccine's developers and manufacturers because?  Thai Knows Best.

All the people who are receiving a vaccine this way have already received a vaccine 'in a manner approved by the vaccine's developers and manufacturers'.

[Bkk Brian]

7 minutes ago, stevenl said:

All the people who are receiving a vaccine this way have already received a vaccine 'in a manner approved by the vaccine's developers and manufacturers'.

So whats your point? Those vaccines now need boosters as they've waned, the boosters are not being administered the way not only the manufacturer recommends but also WHO

[stevenl]

1 hour ago, Bkk Brian said:

So whats your point? Those vaccines now need boosters as they've waned, the boosters are not being administered the way not only the manufacturer recommends but also WHO

The WHO is not recommending boosters. But you want to follow their advice regarding administration of boosters. Sure.

[Bkk Brian]

4 minutes ago, stevenl said:

The WHO is not recommending boosters. But you want to follow their advice regarding administration of boosters. Sure.

The WHO is currently not recommending boosters because of vaccine inequality throughout the world, ie the available supply. Thailand regardless is doing this.

 

Nothing whatsoever to do with WHO's advice on the method of vaccination as per the manufacturer.

 

WHO's advice on actual administering the vaccines which is what this is actually about, you know, the topic of the thread, is for it to be given intramuscularly. As is the advice from AZ after its extensive trials throughout the world

[bangon04]

16 hours ago, Pimoo2 said:

How can the suctaneous vac process be 4X faster than the intramuscilar injection when the dose of .5ml is the same?   The under skin method is NOT recommended by WHO or the manufacturers! So why is TH risking the lives of people for no clear or positive advantage? Seems like a recipe fo disaster!

I suppose that they save a lot of time by jabbing 10 people into the skin without wasting time changing the needle ... what could possibly go wrong?

[ThailandRyan]

Found this report by the WHO from 2009, and it is quite extensive, 94 pages to be exact.  Even though many studies were done it appears that evidence to convincingly support the concept that the dermis or epidermis are immunologically superior to the muscle or subcutaneous tissue for vaccine delivery is therefore limited.

 

https://www.who.int/immunization/programmes_systems/supply_chain/optimize/Intradermal-delivery-vaccines_report_2009-Sept.pdf

 

Many important questions remain to be answered including: • Does IDD provide the potential for greater dose sparing than can be achieved by continuing to use the IM/SC route? • This can only be addressed by conducting trials that compare equivalent doses delivered by IM/SC and IDD, and by testing a range of doses via each route. • Whenever possible, clinical trials should include devices designed specifically for IDD in order to improve the reliability and reproducibility of this route and also to provide information on the device itself. Novel IDD devices need to at least match the published or accepted reliability of the Mantoux method, which is currently the “gold-standard” method for IDD using N&S. • Will the dose-sparing phenomenon be applicable to a wide range of vaccine types and formulations? • Trials using a wider range of vaccines including protein–polysaccharide conjugate vaccines are required. • It will be important for trials to demonstrate that IDD of reduced doses of a vaccine nearing the end of its shelf-life, when its titer or potency will be lower than when it was first released, still induce non-inferior immune responses. This point is particularly important for live attenuated vaccines.

 

Newer studies have and are still being done using the Covid vaccines, and as yet have not been peer reviewed. Many of the places who would potentially use this are countries where they have little vaccines on hand and not a good supply chain.  How Thailand believes they fit into this category makes me wonder if they truly have no vaccines on-hand as they have indicated they have plenty of them, per Anutin etc..

Edited September 26, 2021 by ThailandRyan

[wensiensheng]

Apart from the obvious medical issue of this not being a recommended method of injection, there is a potential wider issue.

 

other countries do not utilize, recommend this method of injection. So they are hardly likely to accept thai residents entering their borders if they have been vaccinated in this way. Trouble is, there is no way of knowing who had the recommended injection method and who had the not recommended method. So likelihood is that no one from Thailand will be accepted. It could turn into a major issue for those wishing to travel.

[wensiensheng]

On 9/25/2021 at 3:25 PM, GroveHillWanderer said:

Well, if it's subcutaneous, then all bets are off.

 

However it's not subcutaneous according to the latest article in the Bangkok Post (which of course I can't quote or link to) and according to different articles about this idea (e.g. Reuters, The Nation) when it was first mooted, the whole plan was to use intradermal injection.

 

I suspect that any references to subcutaneous are because of people confusing the two terms, since they are very similar in concept.

 

The doctor proposing it even referenced the study in the Netherlands into using the Moderna vaccine intradermally.

 

Medical expert suggests intradermal inoculation to multiply vaccine usage

 

As for the dosage, the general principle is that whatever the amount used for intramuscular injection, a smaller dose is required when using the intradermal route, to get the same immunological effect.

 

Please note that all of this is still just being put forward as part of an academic discussion of the relative merits of different methods of vaccine administration and I'm not making any specific judgement of what the Thai authorities are currently doing.

When you say “people” are confusing the two terms, is it not correct to say that it is the term subcutaneous that is used by the Thai medical official in the OP?

 

if so, it’s somewhat concerning that a Thai “expert” is confused.

Edited September 27, 2021 by wensiensheng