IMMUNOLOGIST JANKO N. ŽUGIĆ: 'Children fare well with corona, but are they safe from long Covid and heart, lung, and brain damage?

"Children most often fare well with the coronavirus, but the question is whether they are safe from long Covid. The long-term effects of the coronavirus are seen in as many as 25 to 70 percent of those infected and unvaccinated. It's now up to the parents to decide whether their child will take the vaccine or, following the coronavirus infection, spend the rest of their life suffering from one of these effects. And they can be quite serious – the most common damage occurs on the lungs and the heart, but also on the brain, the intestines, the liver, and the kidneys," Professor Janko Nikolić Žugić, immunologist and Head of the Immunobiology Department at Arizona University in Tucson, said in an interview with Kurir.

In this country, only the Pfizer vaccine has been approved for use on children. The vaccine being of the RNA type opens up a lot of theories…

"Whether or not they will be able to have their own children has nothing to do with the vaccine, because the vaccine has nothing to do with sterility. This sort of nonsense never ceases to amaze me. I haven't come across an account by anyone that even remotely explains how that would actually work. The mRNA molecule itself is an unstable molecule. Until about 10 years ago, mRNA vaccines couldn't be used because of this instability. It was only the recent technological modifications that managed to stabilize them and ensure they remained in place a bit longer so that they could produce the proteins targeted by the immune response. mRNA isn’t infectious and cannot be embedded into the genome (cell DNA) or, consequently, the DNA of germline cells."

Unstable here means – it comes in, does the job on the virus, and disappears?

"That's right, it fully degrades, and is gone a few days after the injection. mRNA will create virus proteins which launch the immune response, but they themselves will disintegrate after a few days, except that by that point they will have induced the immune response."

The third dose – everyone or only some people?

"In scientific terms, the third dose makes sense only in vulnerable groups, those who haven't produced a good immune response. It is fully recommended for immunocompromised people, no doubt about that. We have seen this in cancer patients receiving cytostatic treatment or treatment for B-cell lymphocytic leukaemia, where patients don't have enough B-lymphocytes and cannot create antibodies. Following the second dose of the vaccine, virus-specific T-lymphocytes can be detected in these people, and should be defending them against it, but there is too few of them. After the third dose, these T-lymphocytes, specific to SARS-CoV-2 and known as killer cells, increase sharply. With healthcare workers, there are strategic reasons for the third dose: although more potent vaccines protect most people from reinfection and severe forms of the disease, the infection does incapacitate you and renders the health system ineffective, you get quarantine again, as well as concerns over the families, etc. It is difficult for those who care for others and are the most exposed to work in fear of the disease and under pressure to remain in the workplace and take care of the patients."

Which vaccine do you recommend for the third dose?

"Experts should recommend what to take after which vaccine, because what's worst for people is lack of clarity. You cannot leave this to the personal choice of people, as if it were a marketplace. I would strongly recommend the Pfizer vaccine to those who haven't taken it. Research has shown that RNA vaccines reduce the number of infections by over 80 percent, mortality rates and severe forms of the disease as many as 25 times, and they are effective against the Delta strain. The key is that in terms of potency, they are the closest to the infection as they carry the mRNA of a similar type to the virus, except that it is considerably attenuated. It then triggers an immune response which approximates the response to the virus itself. Unfortunately, for AstraZeneca or Sinopharm, this sort of data isn't collected or is incomplete. The Chinese vaccine is 40 to 50 percent effective in disease prevention for the original, Wuhan strain, but less so against the new variants. However, it does provide protection, especially from severe forms of the disease and death, much more than if you haven't been vaccinated. It's better to take Sinopharm than nothing. The third dose of Sinopharm would probably help as well."

Most people in Serbia have taken the Chinese Sinopharm vaccine.

"For the third dose, I would definitely go for a different vaccine."

After Sputnik V, which has two different components, which vaccine would you recommend for the third dose?

"Sputnik V uses human adenoviruses act as carriers. As they cause common colds and a fairly large percentage of the human population is immune to some of them, the problem is that this immunity will virtually remove the vaccine before it manages to efficiently trigger an immune response to SARS-CoV-2. This is why for the third dose I would pick Pfizer, or even Sinopharm, rather than another Sputnik."

And for those who have taken two doses of Pfizer?

"AstraZeneca as the third dose, because it's the most different. There's a higher likelihood of immunity to the adenovirus carrier in Sputnik due to the human adenoviruses than there is to AstraZeneca, where the carrier is a chimpanzee adenovirus."

In your opinion, healthy people in Serbia shouldn't be chasing the third dose?

"That is related to availability, as it is far more important to protect as many people as possible by two doses than it is to administer the third dose to those who are already protected."

But we cannot use up the vaccines because just above 50 percent of the population have been vaccinated.

"Given how the antivaxxer lobby has operated in the past 20 years, I'm not surprised. The data on how much protection the vaccines provide is incontrovertible, and that has been shown to be the case in immunosuppressed people as well. Vaccines cause minimal side effects. There was the question of whether the vaccine would intensify the illness in people with an autoimmune condition, and that is the only group where a discussion that a patient should have with their doctor is justified. However, even there the vaccine has been shown (perhaps unexpectedly) to be safe. There is a very small percentage of those whose autoimmunity deteriorated after the administration of the vaccine. As for healthcare workers, their vaccination should be mandatory."

What do you expect in the fall, and has the situation become hopeless with such a small vaccination turnout?

"So far, Serbia has officially registered app. 740,000 infections, which makes up about 10 percent of the population. If you add those vaccinated to this, you can assume that as much as 60 percent have been exposed to the virus, although you also have those who have had Covid and taken the jab – which is legitimate, as it boosts immunity, especially against the variants, and probably against long Covid too. The remaining 40 percent means you can most certainly have another wave, which has a serious potential to jeopardize the health system and bring it to its knees. The one thing that ought to be better in this case is that (hopefully) a large number of medical workers are protected. Therefore, it isn't going to be a hopeless fall, but we ought to have plans in place for how the health system should handle it in the event of a new wave."

Should we expect new mutations?

"Objectively, I don't think that the virus has a lot of places to go. I guess that this fall will be the last to have a serious wave. After that, it's simply going to be a virus in our environment and, depending on the strain, another vaccine will probably be needed after a certain number of years, perhaps even regular vaccination every few years. However, as regards the global crisis, the vaccines have already done a good job, even with no more than 50 percent of those vaccinated. If another 20 to 25 percent of the population were to take the vaccine in Serbia, that would practically be the end of the coronavirus."

Kurir.rs/Jelena S. Spasić