Background: Coronavirus Disease 2019 (COVID-19), emerged in China at the end of 2019, became a major threat to health around the world. Breakthrough infection following COVID-19 vaccine has clinical and public health significance. The highest groups at risk of infection during the COVID-19 pandemic is health care workers; the physicians are the frontline workers. This study aimed to assess the prevalence of breakthrough COVID-19 infection and their clinical presentation, co-morbidities and outcome among physicians who were fully vaccinated, working in COVID-19 treatment centers in Myanmar. Methods: A cross-sectional descriptive study was conducted among physicians, at least 14 days after receiving second dose, working at COVID-19 treatment centers in Myanmar, during the third wave from end of May to August 2021. Data were collected by using standardized forms and analysis was done. Results: Among 410 physicians, 98.2% (221/225) received two dose of vaccination: Covaxin 90.0%, Covishield 9.5% and Sputink V 0.5%. They received first dose of vaccine in January/February 2021 and second dose in March/April 2021. In Myanmar, third wave started in end of May; the largest pandemic surge had reached its peak in July, 2021. In the third wave, most of them 72.9% (161/221) did not experience no infection. The prevalence of fully vaccinated break through infection was 27.1% (60/221); the majority 78.3% (47/60) were mild symptomatic infection. Severe infection was seen in 10% of physicians with breakthrough infection who required hospital admission and oxygen therapy. The common presenting symptoms in order of frequency were body aches and pain 62.6%, sneezing 56.6%, headache 53.5%, cough 52.5%, sore throat 45.5%, anosmia 33.3%, runny nose 23.2% and loose motion 27.3%. The uncommon symptoms were dyspnoea 9.1%, vertigo 6.1%, skin rash 5.1%, vomiting 5.1%, petechiae 3.0%, tinnitus 3.0% and silent hypoxia 3.0%, and non-per-os 1%. Most of them did not have any significant comorbidities. One out of six physicians having severe infection had diabetes mellitus and two were obese. The mean duration of hospital stay was 7 days. None of the cases was fatal. Conclusions: In this study, over 98% of physicians were fully vaccinated; majority with Covaxin. One in four physicians had breakthrough infection in third wave; mainly mild form. Nearly half of them had possible delta symptoms; aches and pain, sneezing, runny nose, headache, cough, and sore throat. Awareness of rare but important symptoms like Non-per-Os and vertigo should be highlighted both to public and health care personnel. Ten percent of physicians with breakthrough infection were severe. Mortality rate was zero.

Background: Sepsis is a common life threatening medical problem and first leading cause of death in Myanmar. This study was aimed to determine the predictive values of initial mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count for mortality in patients with sepsis and septic shock. Method: A hospital based prospective observational study done in No.(1) Defence Services General Hospital, Yangon, from January 2021 to October 2022. All patients above 18 years old admitted with sepsis and qSOFA ≥ 2 were enrolled and sample size was 121 patients. The predictors were mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count, which were assessed within 24 hour of admission and the mortality was observed for 28 days. Logistic regression was used to find out the predictive value and the predictors were compared by receiver operating characteristic curve analysis.

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Background: Patients on maintenance hemodialysis (MHD) are at high risk of contracting SARS-CoV-2 and developing severe COVID-19 infection because they have low innate immunity as well as poor antibody response to COVID-19 vaccine. This study aimed to assess the effectiveness of 4 doses of COVID-19 vaccine in preventing 5th wave of COVID-19 infections in patients on maintenance hemodialysis in Myanmar. Methods: A hospital-based descriptive study was conducted in July 2022 to November 2022 among patients on MHD who received COVID-19 vaccine 4 doses; last dose was 2 weeks ago. Data were collected by using standardized forms and analysis was done. Results: A total of 61 patients on maintenance hemodialysis ( MHD) who had 4 doses of COVID-19 vaccination more than 2 weeks were included. Nasopharyngeal swab PCR was taken twice a week to all patients (if they did not have symptoms) and it was repeated if they had symptoms suggestive of COVID-19 infection or they had history of contact with patients having COVID-19 infection. Their signs and symptoms were analyzed; chest radiograph and blood tests were taken if indicated. Then, the severity of COVID-19 infection was determined according to WHO criteria and they were given treatment according to hospital guideline. They were followed up till 28 days. The base line characteristics were as follows: mean age was 51.15 ± 12.85 years; male to female ratio was 4:6; mean BMI was 19.93 ± 2.83 kg/m2; 16.4%(10/61) had diabetic nephropathy; 9.8%(6/61) had cerebrovascular accident; 24.6%(15/61) had coronary heart disease; and one fifth of them were current smokers. Sixty six percent had past history of COVID-19 infection; duration from last infection was 404 days. Thirty three percent of cases had shortest duration of hemodialysis (6 months) and 23% were over 3 years. Mean duration from last vaccination was 39 days. Thirty six percent (22/61) had confirmed COVID-19 infection and 64% (39/61) of them were not infected till the end of 5th wave. All infected cases were mild form according to WHO criteria; none of them required oxygen therapy. One case having multiple comorbidities (lymphoma, coronary heart disease, hypertension and malignant cachexia) had sudden death due to pulmonary embolism. Conclusions: The protection rate of four doses of COVID-19 vaccine in patients on MHD was not good as 36% of them were infected in the 5th wave of epidemic in Myanmar. However, all the infected cases were mild form and they did not need oxygen therapy showing that booster vaccination prevented morbidity and mortality. Therefore, the protection rate of four doses of COVID-19 vaccine in patients on MHD was nearly 65%; it reduced the severe form of infection and death. Fifth dose of COVID-19 vaccine is necessary along with personnel protective measures.