Educating Your Patients About the Pfizer and Moderna Vaccines
Since February 2020, United States oral health professionals and patients have been addressing the health implications of SARS-CoV-2, a novel coronavirus that manifests as COVID-19 disease. While most individuals are aware of safety measures—such as frequent hand washing, social distancing, and wearing masks—cases of COVID-19 continue to rise at an alarming rate. Oral health professionals can use guidance from the US Centers for Disease Control and Prevention (CDC), American Dental Association (ADA), American Dental Hygienists’ Association (ADHA), Occupational Safety and Health Administration, and the Organization for Safety Asepsis and Prevention to continue providing safe care and control infectious transmission.
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Vaccines using mRNA technology have been studied for use against other diseases, including the flu, Zika, rabies, and cytomegalovirus. With this technology, material from the SARS-CoV-2 virus issues instructions for cells to make a harmless protein that is unique to the virus, known as a spike (S) protein. Once cells make copies, the genetic material from the spike protein is destroyed from the vaccine. The immune system will recognize this protein as foreign, and T-lymphocytes and B-lymphocytes will build an immune response to fight the virus should an infection occur. The S protein is the most likely target antigen for long-term immune response and vaccine design for COVID-19. The rapid pace of vaccine development is attributed to prior knowledge of the S protein and its role in immunity and coronavirus pathogenesis.
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In partnership with the National Institute of Allergy and Infectious Diseases, Moderna has developed a vaccine that uses the stabilized SARS-CoV-2 spike immunogen (or S-2P), which mediates attachment and entry of the virus into host cells. Research suggests mRNA-1273 generates a robust immune response to the SARS-CoV-2 S protein. The clinical trial for mRNA-1273 enrolled 30,000 subjects, who were assigned to a single blind randomized 1:1 trial (meaning, participants had a 50% chance of receiving mRNA-1273 or the placebo). Both were delivered intramuscularly to the upper arm on Day 1 and Day 29 of the trial. An independent data and safety monitoring board evaluated 95 cases of COVID-19 among study participants. Of these, 90 infections were in subjects who had received the placebo, while five were in participants who had received mRNA-1273. These results demonstrate the vaccine has a 94.5% efficacy.
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Developed by BioNTech and Pfizer, BNT162b2 was the first COVID-19 vaccine to receive an EUA for use in the US. This vaccine uses mRNA embedded with the SARS-CoV-2 full-length spike, modified by two proline mutations to lock it in the prefusion conformation and more closely mimic the intact virus, with which the elicited virus-neutralizing antibodies must interact.” Participants in the study for BNT162b2 received two injections into the upper arm 21 days apart. Preliminary results for this vaccine demonstrated over 95% immunogenicity for COVID-19. The partnership expects to distribute 50 million doses of BNT162b2 by the end of 2020, and up to 1.3 billion doses by the end of 2021. Unlike the other vaccines, it requires specialized storage for maximum efficacy. The concentrated vaccine must be stored and transported at -70° Celsius (-94 Fahrenheit). When ready for use, the undiluted concentrate will be thawed and diluted. Once dilution occurs, BNT162b2 has a shelf life of only 6 hours.
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Creating a Robust Immune Response
Ideally, all vaccines that come to market should be capable of inducing a robust response involving both neutralizing antibodies and T-cells that will provide a significant level of protection against COVID-19. The typical vaccine development timeframe is 10 years to 15 years and involves multiple preclinical and clinical trials. Yet due to the accelerated need associated with this pandemic, the development process and ongoing clinical trials have occurred in less than a year in some cases. As various vaccines advance through the EUA process, the CDC will provide guidance for states to decide how to prioritize immunization. The CDC has suggested healthcare workers and long-term care residents should be among the first to be vaccinated, but, ultimately, it is up to each state to decide how to allocate their immunization resources.
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What This Means for Oral Health Professionals
Among the implications of vaccine development is a call by the ADA, ADHA, and American Dental Education Association (ADEA) to recognize dental providers—including laboratory technicians and oral health students—as high-risk workers who should be among the first to receive the vaccine. In addition, dentists, dental hygienists, and dental therapists can play a pivotal role in mitigating COVID-19 by being part of the vaccination response. As highly trained professionals who regularly administer local anesthesia, these oral health professionals can expand the medical team’s capacity to administer vaccines and thus reduce the occurrence of COVID-19.
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Dentists, dental hygienists, and dental therapists play an important role in educating patients about the importance of vaccination in controlling this pandemic. As healthcare providers, oral health professionals must remain current and deliver accurate information about COVID-19, vaccination availability, the benefits of immunization, and anticipated side effects.