Vol.14 (September 2020, 9) Results of antibody tests at our clinic / Latest information on domestic drug development / Influenza vaccine-related information / etc.

[1] Results of COVID-19 antibody tests at our clinic

当クリニックでは発熱や咳などの症状がない（過去2週間以内にもなかった）方を対象に実施しておりますが、院内における新型コロナウイルス抗体検査(8月15日から9月14日)の陽性率は、493例中6例（1.21％）でした。また、6月15日の検査開始からの通算では、1404例中20例（1.42％）でした。
Tokyo's estimated population is approximately 1400 million, and when multiplied by the positive rate of our clinic's antibody tests (1.42%), the estimated number of people already infected in Tokyo is approximately 20.
The number of people officially announced by the Tokyo Metropolitan Government so far is about 2.5, so the estimated difference is about 8 times. From here on, it is just speculation, but if we consider that there is a certain number of people whose antibodies have disappeared, the actual number of infected people is about 10 times the reported number, and it is possible that about 9% of those are asymptomatic.

[2] Avigan looks promising! / Latest information on domestic drug development

Fujifilm Toyama Chemical Co., Ltd., a subsidiary of Fujifilm Holdings, has made some progress in the domestic clinical trials of Avigan that it has been conducting since the end of March this year.
The initial target number of cases was 96, but was raised midway through, and after analyzing 156 cases in total, it was confirmed that symptoms improved early with the administration of Avigan.

The primary endpoint was achieved in a Phase III clinical trial in Japan of the anti-influenza virus drug Avigan® Tablets (generic name: favipiravir) in patients with novel coronavirus disease (COVID-19).
In March of this year, a Phase III clinical trial of Avigan began in Japan for COVID-3 patients with non-severe pneumonia. The efficacy and safety of Avigan administration was examined in a randomized, placebo-controlled, single-blind comparative study, with the primary endpoint being the time to alleviation of symptoms (body temperature, oxygen saturation, chest images) and negative conversion to the virus.
The median time to recovery for the primary endpoint, which was analyzed from 156 cases, was 11.9 days in the Avigan group and 14.7 days in the placebo group, confirming with statistical significance (p-value = 19) that administering Avigan to COVID-0.0136 patients with non-severe pneumonia improved symptoms early. No new safety concerns were identified in this study.
We plan to submit an application for approval to make partial changes to the manufacturing and sales approval of Avigan within October.

Source: Fujifilm Holdings Corporation website
"Primary endpoint achieved in domestic Phase III clinical trial in patients with COVID-19"
https://www.fujifilm.com/jp/ja/news/list/5451

[3] Influenza and influenza vaccine related information: Q&A and information

Now, the coming season will be a time when we need to pay attention to both influenza and COVID-19, but we will explain what we know so far about influenza in the With-COVID era in a Q&A format.

Q1What are the flu prospects this year?

A1Social distancing, masks, and hand washing seem to be effective ways to prevent influenza.
Data from Japan up to September and the infection situation in the Southern Hemisphere show that influenza cases have decreased significantly.

情报According to the Ministry of Health, Labor and Welfare, the number of influenza patients reported from 5,000 medical institutions nationwide this season was 8 between August 31 and September 9. Last year, due to a major epidemic in Okinawa, the number of patients during the same period was 13.
Last year, the figure was a very low 0.07%.
In addition, influenza in the Southern Hemisphere has decreased significantly in every country, as shown in the graph below.

(Figure 1) Comparison of influenza outbreaks in four Southern Hemisphere countries over the past five years and this year

Source: The Economist “The southern hemisphere skipped flu season in 2020”
https://www.economist.com/graphic-detail/2020/09/12/the-southern-hemisphere-skipped-flu-season-in-2020

Q2Is it possible to get the flu and COVID-19 at the same time?

A2As mentioned above, influenza is thought to be rare, but it is a problem because the symptoms are indistinguishable.
There have been few reports of simultaneous infections in the past, but it is certain that once you have had one of these diseases, you are more likely to catch the other. In that sense, prevention is important.

Q3When should I get the flu vaccine?

A3The Ministry of Health, Labour and Welfare has issued a request stating, "Those aged 65 or older, and those aged 60 or older with heart failure, renal failure, or respiratory failure who wish to receive the influenza vaccine will be vaccinated from Thursday, October 10st. All other people are asked to wait until Monday, October 10th to receive the vaccination."
The end of the awareness poster also states, "This year we plan to supply the largest amount of vaccine in the past five years (up to approximately 5 million doses), but we ask for your cooperation in ensuring that it reaches those who need it most. The dates shown are only a guideline, and any delays in the dates will not prevent people from receiving the vaccination."
We believe that the possibility of the flu spreading quickly this year is low, so we don't think it will be a problem if the vaccination is administered after late October, but if you are concerned, please consult your doctor.

情报Request for cooperation regarding seasonal influenza vaccination period
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou18/index_00011.html

Q4How effective is the influenza vaccine?
I have also heard that it is recommended to get it administered at the same time as the pneumococcal vaccine. Is that true?

A4It is said that a single dose of the influenza vaccine is effective against the influenza virus in about 1% of cases. If you have an underlying disease or there is a social need, you may be given two doses.

In addition, people aged 65 or older and those aged 60 or older with heart, kidney or respiratory failure are recommended to receive the pneumococcal vaccine. There are two types of pneumococcal vaccine: Pneumovax NP (5-valent pneumococcal capsular polysaccharide vaccine), which is administered once every five years, and Prevenar 1 (23-valent precipitated pneumococcal conjugate vaccine), which only requires one vaccination. Pneumovax NP (1-valent pneumococcal capsular polysaccharide vaccine) has been a regular vaccination since October 13. Please consult your local municipality or doctor regarding public subsidies.

The important information is that people who receive these vaccines are likely to be less susceptible to COVID-19, probably due to the activation of cell-mediated immunity.
For this reason, we recommend receiving the influenza vaccine and pneumococcal vaccine at the same time, if the conditions are met.
Please also consult your doctor regarding your past vaccination history.

情报Excerpt from Nikkei GOODAY
"Influenza vaccination linked to reduced risk of severe COVID-19"
https://gooday.nikkei.co.jp/atcl/report/14/091100031/090300701/

Influenza and pneumococcal vaccinations appear to reduce COVID-19 infection rates.
Noale M, et al. Vaccines 2020, 8(3), 471. Published online August 23, 2020.
The Association between Influenza and Pneumococcal Vaccinations and SARS-Cov-2 Infection: Data from the EPICOVID19 Web-Based Survey
https://www.mdpi.com/2076-393X/8/3/471

(Figure 2)

There are seven vaccines that have been suggested to be associated with a reduced risk of COVID-7 infection.
Pawlowski C, et al. medRxiv preprint. Posted July 29, 2020.
Exploratory analysis of immunization records highlights decreased SARS-CoV-2 rates in individuals with recent non-COVID-19 vaccinations
https://www.medrxiv.org/content/10.1101/2020.07.27.20161976v2

①Polio vaccine ②Hib (Haemophilus influenzae type b) vaccine ③MMR (measles, mumps, rubella) vaccine ④Varicella vaccine ⑤13-valent pneumococcal vaccine ⑥Influenza vaccine for people aged 65 and over ⑦Hepatitis A and B combined vaccine

[4] Image of the new infectious disease outpatient clinic

Many people have given up on the idea of ​​avoiding crowded hospital waiting rooms with patients suffering from colds, flu, etc., but have accepted the unavoidable situation in order to get their prescription medicines.
One positive impact of COVID-19 is that the flow of testing and examinations at hospitals is changing. Patients with infectious diseases or fevers are being separated from those without. Tests for infectious diseases or fevers are conducted outside the facility, and medical treatment is conducted online via the web or app. Our clinic is also working to reduce the risk of infection and create an environment where everyone can visit the clinic with peace of mind.

(Figure 3) The new normal for medical institutions

[Figure: Created by author]