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For citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
Apr 28
COVID-19
Situation Report 454
Centre for Infectious Disease Epidemiology and Research (CIDER)For citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
i. Background
In December, China notified the World Health Organization (WHO) of several cases of human respiratory
illness, which appeared to be linked to an open seafood and livestock market in the city of Wuhan. The
infecting agent has since been identified as a novel coronavirus, previously known as 2019-nCoV and now
called SAR-CoV-2; The new name of the disease has also been termed COVID-19, as of 11th February 2020.
Although the virus is presumed zoonotic in origin, person-to-person spread is evident. Screening of
travellers, travel bans and quarantine measures are being implemented in many countries. Despite these
precautions, it is anticipated that more cases will be seen both inside China and internationally. The WHO
declared the outbreak of COVID-19 constitutes a Public Health Emergency of International Concern on 30
January. On 11 March, 2020, WHO declared the coronavirus outbreak a pandemic as the global death toll
rose above 4,600 and the number of confirmed cases topped 125,000. This report aims to update Global
Risk Assessment, Global Epidemiology, Quarantine Orders, Travel Ban/Advisory by countries, WHO’s and
CDC’s Guidance and Protocols and Scientific publication on a daily basis. New updates in the tables are
bolded.
1|Page Centre for infectious disease epidemiology and researchFor citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
ii. Global Risk Assessment
Table 1. Risk assessment of COVID-19 by WHO regions (Updated as of 28 Apr 2021, 11:00 SGT)
Severity of Availability of Treatment/ Overall
Environmental Risk Transmissibility
Disease Vaccination# Risk
Global (n=198 countries)
High Moderate High Limited
Globally, 189 (95.4%) countries (excluding Based on CDC Case The number of countries that have
territories*) have reported the outbreak. data, median R0 fatality rate commenced mass vaccination in each
is estimated to is currently region are as follows: Combined WPRO
Using an incidence >20 cases/100,000 be 5.8 (95% CI at 2.11% and SEARO (31 countries), EURO (52
people over the past 14-days as cut-off for 4.4–7.7), but globally. countries), EMRO (18 countries),
a surge in cases, the number of countries the estimated Most cases Americas (33 countries), and Africa (39
reporting a surge in cases in each region effective present as countries).&
are as follows: Combined WPRO and reproduction flu-like
SEARO (14 countries), number in 171 illness. International clinical trials published on
EURO (49 countries), countries 2 September confirm that cheap, widely
EMRO (15 countries), Americas (30 ranged from available steroid drugs can help
countries), and Africa (9 countries). 0.42 to 4.1.$ seriously ill patients survive Covid-19.
The World Health Organization issued
Only 4 (2%) countries/territories have no new treatment guidance, strongly
reported restrictions on inbound arrivals, recommending steroids to treat
while 144 (78%) countries/territories have severely and critically ill patients, but
partially reopened their borders – require not to those with mild disease. [4]
arrivals to produce a negative COVID-19
test result and/or undergo self-quarantine Researchers have found all regimens of
upon arrival. 51 (28%) anticoagulants to be far superior to no
countries/territories are totally closed to anticoagulants in COVID-19 patients.
international arrivals. [1] More specifically, patients on both a High
“therapeutic” or full dose and those on
On October 7, the Centers for Disease a “prophylactic” or lower dose, showed
Control and Prevention (CDC) confirmed about a 50% higher chance of survival
airborne transmission of SARS-CoV-2. [2] and roughly a 30% lower chance of
intubation, than those not on
The U.S. CDC has revised its guidance on anticoagulants. It was observed that
COVID-19 quarantine period from 14 days therapeutic and prophylactic
to 7-10 days, based one's test results and subcutaneous low-molecular weight
symptoms. Individuals without symptoms heparin and therapeutic oral apixaban
only need quarantine for 10 days without may lead to better results. [3]
testing; those tested negative can
quarantine for 7 days. [14] A new strain known as B.1.525
containing the same E484K mutation
The US Centers for Disease Control and found in the Brazilian and South African
Prevention (CDC) on 10 Feb announced variants has been detected in Britain
that fully vaccinated people did not need [18].
to quarantine if they received their last
dose within three months and 14 days
after their last shot, the time it takes to
develop immunity. [16]
2|Page Centre for infectious disease epidemiology and researchFor citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
Western Pacific Region and South-East Asia Region (n=41 countries)
Moderate Moderate Moderate High
33 (80.5%) countries have reported As of Apr 26, Case 31 countries have commenced
outbreaks; but only 14 (34.2%) countries the estimated fatality rate vaccination as of 28 April 2021.
are reporting a surge in cases. effective is 1.29%. Coverage was available for the
reproduction following: i) at least 1 dose was at 70% for 1 country ii) full vaccination
or no case in the last 14 days. ranged from was atFor citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
Highest incidence over the past 14 days As of June 25, the Abu Dhabi Stem Cell
were reported from Bahrain, Kuwait, Centre has treated more than 2,000
Oman, Palestine and Qatar, and highest COVID-19 patients using UAECell19.
case numbers were reported from Iran, 1,200 have fully recovered. [6]
Iraq, Jordan, Pakistan and Tunisia.
As of April, an Israeli firm is using
At least 5 countries have closed their placenta pluristem cells to treat COVID-
borders, 16 countries have opened their 19 patients on a compassionate use
borders partially conditionally, and only 1 basis. [5]
country is allowing free travel.
Region of the Americas (n=35 countries)
High Moderate High High
35 (100%) countries have reported with As of Apr 26, Case 33 countries have commenced
outbreak; 30 (85.7%) countries are the estimated fatality rate vaccination as of 28 April 2021.
reporting a surge in cases. effective is 2.43%. Coverage was available for the
reproduction following: i) at least 1 dose was atFor citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
FDA has allowed emergency use of Eli
Lilly & Co’s bamlanivimab for non-
hospitalized patients at risk of serious
illness due to age or other conditions.
[10]
FDA has issued emergency
authorisation for convalescent plasma
to treat COVID-19. [9]
RLF-100 (aviptadil) by NeuroRx and
Relief Therapeutics was approved for
emergency use in COVID-19 patients
who are too ill to participate in the trial.
[8]
As of October 22, remdesivir is the first
and only FDA-approved COVID-19
treatment in the U.S. [7].
African Region (n=47 countries)
Moderate Moderate High High
47 (100%) countries have reported with As of Apr 26, Case 39 countries have commenced
outbreak; 9 (19.6%) countries are the estimated fatality rate vaccination as of 28 April 2021.
reporting a surge in cases. effective is 2.52%. Coverage was available for the
reproduction following: i) at least 1 dose was atFor citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
iii. Global Epidemiology
Table 2. Summary of COVID-19 cases & fatalities globally (Updated as of 28 Apr 2021, 11:00 SGT)
Case-
No. of Total Cases Case-
Fatality
Countries/ Total Global Outside Total Fatality
Rate (%) R0
Territories Cases Mainland Deaths Rate (%)
[outside
with Cases China [overall]
China]
5.8 (95% CI 4.4–
220 149,328,858 149,238,236 3,148,781 2.11% 2.11%
7.7)^
^Based on early release as of 10th April, 2020: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
Table 3. Comparison with other viruses
Virus Incubation Period (Days) Case Fatality Rate (%) R0
Median = 5.1$
SARS-CoV-2 2.11 5.8 (95% CI 4.4–7.7) ^
(2-14) or up to 24*
SARS-CoV 2-7 9.6 2.0For citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
Figure 2. Growth Factor excluding mainland China
Figure 3. Growth Factor of Novel Coronavirus Daily Deaths (Mainland China + Other Countries)
Growth Factor = every day’s cases/cases on previous day. A growth factor above 1 indicates an increase, whereas one between 0 and 1 is a sign
of decline, with the quantity eventually becoming zero. A growth factor below 1 (or above 1 but trending downward) is a positive sign, whereas
a growth factor constantly above 1 is the sign of exponential growth.
Source: https://www.worldometers.info/coronavirus/coronavirus-cases/
7|Page Centre for infectious disease epidemiology and researchFor citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
Case Breakdown by Countries
Live update of COVID-19 global cases can be found at
https://storymaps.arcgis.com/stories/a1746ada9bff48c09ef76e5a788b5910
Table 4. Breakdown of COVID-19 confirmed cases and deaths (Updated as of 28 Apr 2021, 11:00 SGT)
Country Total Cases Change Total Deaths Change Total Recovered Region
1 USA 32,927,091 +52046 587,384 +773 25,521,913 Americas
2 India 17,988,637 +352330 201,165 +3271 14,807,704 SEARO
3 Brazil 14,446,541 +76085 395,324 +3120 12,992,442 Americas
4 France 5,534,313 +30317 103,603 +347 4,441,986 EURO
5 Russia 4,779,425 +8053 108,980 +392 4,402,678 EURO
6 Turkey 4,710,582 +43301 39,057 +346 4,167,263 EURO
7 UK 4,409,631 +2685 127,451 +17 4,202,311 EURO
8 Italy 3,981,512 +10398 119,912 +373 3,413,451 EURO
9 Spain 3,496,134 +7665 77,855 +117 3,186,967 EURO
10 Germany 3,326,778 +19009 82,698 +354 2,931,400 EURO
11 Argentina 2,905,172 +25495 62,599 +512 2,563,223 Americas
12 Colombia 2,804,881 +17578 72,235 +436 2,616,821 Americas
13 Poland 2,768,034 +5711 65,897 +460 2,467,036 EURO
14 Iran 2,438,193 +20963 70,532 +462 1,907,190 EMRO
15 Mexico 2,333,126 +3592 215,547 +434 1,856,543 Americas
16 Ukraine 2,038,248 +7915 42,950 +432 1,596,829 EURO
17 Peru 1,775,062 +6876 60,416 +403 1,688,091 Americas
18 Indonesia 1,651,794 +4656 44,939 +169 1,506,599 SEARO
19 Czechia 1,622,777 +2571 29,075 +73 1,541,963 EURO
20 South Africa 1,577,200 +880 54,237 +51 1,502,986 Africa
21 Netherlands 1,472,674 +5337 17,093 +31 1,235,344 EURO
22 Canada 1,194,989 +7071 24,065 +41 1,086,611 Americas
23 Chile 1,179,772 +4158 26,020 +45 1,113,463 Americas
24 Romania 1,049,539 +2019 27,683 +172 979,445 EURO
25 Iraq 1,045,010 +7152 15,348 +45 920,523 EMRO
26 Philippines 1,013,618 +7190 16,916 +63 925,027 WPRO
27 Belgium 976,088 0 24,065 0 841,998 EURO
28 Sweden 953,254 +14911 13,968 +45 779,472 EURO
29 Israel 838,217 +110 6,359 +6 830,205 EURO
30 Portugal 834,991 +353 16,970 +5 794,205 EURO
31 Pakistan 810,231 +5292 17,530 +201 704,494 EMRO
32 Hungary 772,707 +1253 26,984 +183 491,620 EURO
33 Bangladesh 751,659 +3031 11,228 +78 666,927 SEARO
34 Jordan 706,355 +1815 8,707 +47 675,212 EMRO
35 Serbia 683,799 +2145 6,286 +29 626,756 EURO
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COVID-19 Situation Report 454. 28 April 2021
36 Switzerland 653,957 +2135 10,587 +4 581,714 EURO
37 Austria 612,170 +1625 10,126 +28 577,977 EURO
38 Japan 571,040 +4177 10,004 +32 508,388 WPRO
39 Lebanon 522,763 +1182 7,197 +26 453,865 EMRO
40 UAE 514,591 +2094 1,578 +5 495,589 EMRO
41 Morocco 509,972 +507 9,005 +6 496,031 EMRO
42 Saudi Arabia 414,219 +1045 6,922 +9 397,587 EMRO
43 Bulgaria 401,109 +1850 16,182 +81 332,418 EURO
44 Malaysia 398,451 +2733 1,462 +13 371,575 WPRO
45 Slovakia 380,498 +488 11,572 +41 360,466 EURO
46 Ecuador 375,329 +554 18,389 +89 318,598 Americas
47 Panama 363,533 +368 6,216 +4 353,503 Americas
48 Belarus 354,669 +823 2,512 +10 344,950 EURO
49 Greece 337,723 +3287 10,179 +92 291,153 EURO
50 Croatia 324,833 +1797 6,957 +52 304,546 EURO
51 Azerbaijan 315,119 +1307 4,429 +27 282,786 EURO
52 Kazakhstan 311,400 0 3,599 0 265,940 EURO
53 Nepal 307,925 +4364 3,194 +18 278,506 SEARO
54 Georgia 305,850 +1578 4,060 +17 287,938 EURO
55 Tunisia 303,584 +1957 10,444 +92 253,058 EMRO
56 Bolivia 298,778 0 12,861 0 246,673 Americas
57 Palestine 293,466 +1414 3,201 +17 267,346 EMRO
58 Paraguay 271,814 +2461 6,094 +92 223,606 Americas
59 Kuwait 269,681 +1446 1,535 +8 252,888 EMRO
60 Dominican Republic 265,481 +78 3,462 +3 222,466 Americas
61 Ethiopia 254,044 +924 3,605 +35 195,547 Africa
62 Moldova 249,714 +329 5,762 +17 238,423 EURO
63 Denmark 248,950 +624 2,479 +2 236,925 EURO
64 Ireland 247,489 +420 4,884 +10 229,657 EURO
65 Costa Rica 243,167 +1927 3,186 +18 201,784 Americas
66 Lithuania 242,926 +1054 3,877 +20 219,678 EURO
67 Slovenia 238,023 +804 4,221 +7 223,686 EURO
68 Egypt 224,517 +1003 13,168 +61 168,665 EMRO
69 Guatemala 223,025 +1086 7,453 +25 199,005 Americas
70 Armenia 214,064 +595 4,058 +18 195,701 EURO
71 Honduras 207,320 0 5,193 0 77,814 Americas
72 Qatar 203,599 +695 441 +4 184,712 EMRO
73 Bosnia and Herzegovina 196,732 +761 8,418 +68 157,095 EURO
74 Venezuela 193,721 +1223 2,082 +17 176,058 Americas
75 Oman 191,398 +1128 1,992 +9 170,929 EMRO
76 Uruguay 190,096 +2747 2,452 +61 160,632 Americas
77 Libya 176,254 +501 3,010 +5 161,676 EMRO
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COVID-19 Situation Report 454. 28 April 2021
78 Bahrain 173,548 +972 626 +1 162,537 EMRO
79 Nigeria 164,912 +156 2,063 +1 155,012 Africa
80 Kenya 157,492 +511 2,665 +22 106,836 Africa
81 North Macedonia 151,122 +450 4,742 +28 130,910 EURO
82 Myanmar 142,740 +18 3,207 0 131,945 SEARO
83 Albania 130,736 +130 2,383 +4 107,163 EURO
84 Algeria 121,344 +232 3,225 +8 84,598 Africa
85 Estonia 120,836 +458 1,148 +3 108,968 EURO
86 S. Korea 120,673 +775 1,821 +1 110,248 WPRO
87 Latvia 116,132 +596 2,110 +4 105,828 EURO
88 Norway 111,686 +524 736 0 88,952 EURO
89 Cuba 103,524 +1083 604 +7 97,462 Americas
90 Sri Lanka 103,487 +1111 647 0 94,856 SEARO
91 Montenegro 96,930 +151 1,478 +5 92,975 EURO
92 Kyrgyzstan 94,277 +247 1,589 +5 88,415 EURO
93 Ghana 92,464 +211 779 +2 90,103 Africa
94 Zambia 91,418 +40 1,249 +1 89,717 Africa
95 China 90,622 +12 4,636 0 85,669 WPRO
96 Uzbekistan 89,630 +275 646 +1 86,180 EURO
97 Finland 86,161 +224 908 +2 46,000 EURO
98 Mozambique 69,762 +47 814 +5 64,448 Africa
99 El Salvador 68,922 +454 2,111 +5 64,667 Americas
100 Luxembourg 66,594 +220 791 0 62,989 EURO
101 Cameroon 65,998 0 991 0 57,821 Africa
102 Cyprus 63,720 +760 303 +2 39,061 EURO
103 Singapore 61,063 +12 30 0 60,704 WPRO
104 Thailand 59,687 0 163 0 33,551 SEARO
105 Afghanistan 59,370 +145 2,611 +13 52,794 EMRO
106 Namibia 48,011 +70 634 +6 45,740 Africa
107 Botswana 46,600 +745 702 +11 44,740 Africa
108 Ivory Coast 45,885 +22 285 +2 45,451 Africa
109 Jamaica 45,212 +67 767 +6 20,729 Americas
110 Uganda 41,737 +22 341 0 40,898 Africa
111 Senegal 40,193 +27 1,106 +2 38,953 Africa
112 Zimbabwe 38,164 +62 1,565 +5 35,480 Africa
113 Madagascar 36,190 +145 614 +9 29,370 Africa
114 Malawi 34,031 +10 1,147 0 31,953 Africa
115 Sudan 33,104 +242 2,349 +9 26,795 EMRO
116 Mongolia 32,437 0 88 0 17,543 WPRO
117 Malta 30,234 +45 413 0 29,421 EURO
118 Australia 29,745 +28 910 0 28,558 WPRO
119 DRC 29,701 +90 760 +4 26,156 Africa
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COVID-19 Situation Report 454. 28 April 2021
120 Maldives 28,588 +386 71 0 24,499 SEARO
121 Angola 25,942 +232 587 +4 23,341 Africa
122 Rwanda 24,814 +137 331 +1 23,089 Africa
123 Cabo Verde 22,772 +186 211 +3 19,715 Africa
124 Gabon 22,568 0 138 0 19,173 Africa
125 Syria 22,389 +124 1,559 +11 16,283 EMRO
126 Guinea 22,046 +61 141 0 19,466 Africa
127 Réunion 20,381 +1038 148 +7 18,659 Non
128 Mayotte 19,849 0 169 0 2,964 Non
129 French Guiana 19,099 +95 100 0 9,995 Non
130 French Polynesia 18,744 +5 141 0 4,842 Non
131 Eswatini 18,448 +5 671 0 17,741 Africa
132 Mauritania 18,314 +32 455 0 17,620 Africa
133 Somalia 13,915 +103 713 +11 5,847 EMRO
134 Mali 13,722 +64 476 +2 8,313 Africa
135 Guadeloupe 13,669 0 185 0 2,242 Non
136 Tajikistan 13,308 0 90 0 13,218 EURO
137 Burkina Faso 13,263 0 156 0 12,937 Africa
138 Andorra 13,121 +38 124 0 12,561 EURO
139 Haiti 13,017 +18 254 +1 12,143 Americas
140 Togo 12,884 +57 122 0 10,927 Africa
141 Guyana 12,826 +72 291 +4 10,944 Americas
142 Belize 12,631 +7 322 0 12,193 Americas
143 Curaçao 12,146 +17 107 +2 11,339 Non
144 Hong Kong 11,749 +8 209 0 11,379 WPRO
145 Martinique 11,253 +642 75 +7 98 Non
146 Cambodia 11,063 +508 82 +3 3,704 WPRO
147 Djibouti 10,931 +46 142 +4 10,510 EMRO
148 Papua New Guinea 10,835 0 105 0 8,561 WPRO
149 Lesotho 10,728 0 316 0 6,267 Africa
150 Congo 10,678 0 144 0 8,208 Africa
151 Aruba 10,570 +15 98 0 10,245 Non
152 South Sudan 10,553 +15 114 0 10,312 Africa
153 Bahamas 10,220 0 198 0 9,326 Americas
154 Suriname 10,157 +76 201 0 9,193 Americas
155 Trinidad and Tobago 9,947 +151 161 +2 8,281 Americas
156 Benin 7,720 0 97 0 7,510 Africa
157 Equatorial Guinea 7,559 0 107 0 7,097 Africa
158 Nicaragua 6,898 +63 182 +1 4,225 Americas
159 Iceland 6,447 +18 29 0 6,240 EURO
160 CAR 6,359 +135 87 +2 5,112 Africa
161 Yemen 6,220 +37 1,207 +2 2,674 EMRO
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COVID-19 Situation Report 454. 28 April 2021
162 Gambia 5,882 +25 174 +1 5,309 Africa
163 Seychelles 5,354 0 26 0 4,675 Africa
164 Niger 5,220 +16 191 0 4,843 Africa
165 San Marino 5,058 +3 90 0 4,880 EURO
166 Chad 4,779 +7 170 +1 4,406 Africa
167 Saint Lucia 4,508 +6 74 +1 4,344 Americas
168 Gibraltar 4,283 0 94 0 4,183 Non
169 Channel Islands 4,111 0 86 0 3,956 Non
170 Sierra Leone 4,046 0 79 0 3,045 Africa
171 Burundi 3,884 +10 6 0 773 Africa
172 Comoros 3,829 0 146 0 3,650 Africa
173 Barbados 3,828 +3 44 0 3,746 Americas
174 Guinea-Bissau 3,731 +5 67 0 3,267 Africa
175 Eritrea 3,640 0 10 0 3,455 Africa
176 Liechtenstein 2,903 +18 57 0 2,766 Non
177 Vietnam 2,857 +5 35 0 2,516 WPRO
178 New Zealand 2,609 0 26 0 2,547 WPRO
179 Monaco 2,442 +3 32 0 2,338 EURO
180 Turks and Caicos 2,379 +3 17 0 2,328 Non
181 Bermuda 2,362 +5 24 0 1,737 Non
182 Sao Tome and Principe 2,299 0 35 0 2,239 Africa
183 Sint Maarten 2,220 0 27 0 2,181 Non
184 Liberia 2,098 0 85 0 1,942 Africa
185 Timor-Leste 2,048 +99 3 0 972 SEARO
186 St. Vincent Grenadines 1,844 +5 11 +1 1,711 Americas
187 Saint Martin 1,720 0 12 0 1,399 Non
188 Isle of Man 1,587 0 29 0 1,545 Non
189 Caribbean Netherlands 1,556 +2 15 0 1,465 Non
190 Antigua and Barbuda 1,232 +4 32 0 1,014 Americas
191 Mauritius 1,206 0 17 0 1,055 Africa
192 Taiwan 1,110 +6 12 0 1,050 WPRO
193 Bhutan 1,053 +27 1 0 951 SEARO
194 St. Barth 958 0 1 0 462 Non
195 Diamond Princess 712 0 13 0 699 NA
196 Faeroe Islands 663 0 1 0 661 Non
197 Cayman Islands 541 0 2 0 521 Non
198 Laos 511 +75 0 0 49 WPRO
199 Tanzania 509 0 21 0 183 Africa
200 Wallis and Futuna 443 +1 5 0 44 Non
201 Brunei 223 0 3 0 212 WPRO
202 British Virgin Islands 194 0 1 0 183 Non
203 Dominica 173 0 0 0 171 Americas
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COVID-19 Situation Report 454. 28 April 2021
204 Grenada 159 0 1 0 155 Americas
205 New Caledonia 124 0 0 0 58 Non
206 Fiji 109 +6 2 0 65 WPRO
207 Anguilla 84 +4 0 0 29 Non
208 Falkland Islands 63 0 0 0 62 Non
209 Macao 49 0 0 0 49 WPRO
210 Saint Kitts and Nevis 44 0 0 0 44 Americas
211 Greenland 31 0 0 0 31 Non
212 Vatican City 27 0 0 0 15 Non
213 Saint Pierre Miquelon 25 0 0 0 24 Non
214 Montserrat 20 0 1 0 19 Non
215 Solomon Islands 20 0 0 0 19 WPRO
216 Western Sahara 10 0 1 0 8 Non
217 MS Zaandam 9 0 2 0 7 NA
218 Vanuatu 4 0 1 0 3 WPRO
219 Marshall Islands 4 0 0 0 4 WPRO
220 Samoa 3 0 0 0 2 WPRO
221 Saint Helena 2 0 0 0 2 Non
222 Micronesia 1 0 0 0 1 WPRO
Total 149,328,858 +831172 3,148,781 14,921 127,465,511
Figure 4. Areas with reported confirmed cases of COVID-19 (19 April – 25 April 2021)
Source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
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COVID-19 Situation Report 454. 28 April 2021
Table 5. COVID-19 cases and deaths reported by provinces in China (Updated as of 28 Apr 2021, 11:00
SGT)
Area Existing Change from Total Deaths Change from Recovered
Active previous day Diagnosed previous day
Cases (Active cases) Cases (Deaths)
Shanghai 62 -1 1,972 7 0 1,903
Yunnan 59 0 342 2 0 281
Guangdong 44 +2 2,334 8 0 2,282
Fujian 26 -1 590 1 0 563
Sichuan 24 +1 978 3 0 951
Shaanxi 18 +1 590 3 0 569
Hainan 16 0 187 6 0 165
Zhejiang 11 0 1,332 1 0 1,320
Beijing 9 0 1,057 9 0 1,039
Jiangsu 9 0 718 0 0 709
Tianjin 9 0 385 3 0 373
Shanxi 6 0 249 0 0 243
Hubei 5 0 68,157 4,512 0 63,640
Shandong 5 0 876 7 0 864
Chongqing 5 +1 596 6 0 585
Henan 4 -1 1,312 22 0 1,286
Hunan 3 0 1,044 4 0 1,037
Inner Mongolia 3 0 380 1 0 376
Guangxi 3 0 270 2 0 265
Gansu 1 0 193 2 0 190
Heilongjiang 0 0 1,610 13 0 1,597
Hebei 0 0 1,317 7 0 1,310
Anhui 0 0 994 6 0 988
Xinjiang 0 0 980 3 0 977
Jiangxi 0 0 937 1 0 936
Jilin 0 0 573 3 0 570
Liaoning 0 0 408 2 0 406
Guizhou 0 0 147 2 0 145
Ningxia 0 0 75 0 0 75
Qinghai 0 0 18 0 0 18
Tibet 0 0 1 0 0 1
Source: https://ncov.dxy.cn/ncovh5/view/pneumonia
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COVID-19 Situation Report 454. 28 April 2021
iv. Travel Bans/Advisories & Quarantine Orders
[1] Australia – As of 28 April, all flights from India will be suspended until at least May 15.
[2] Belgium – All passenger traveling by air, train, boat, and bus, including transit traffic, from India,
Brazil and South Africa to Belgium will be banned. Belgian nationals and those who have their
main residence in Belgium can return from these countries.
[3] Czech Republic – As of 27 April, all travels to India has been banned while tightening the
measures for those that are arriving from India. Only Czechs citizens and residents will be
allowed to return and will have to undergo a PCR test on the day of arrival, in 24 hours upon
returning and between the tenth and the fourteenth day after arrival, while staying in
quarantine for the entire period.
[4] Malawi – With immediate effect, all travels to and from Bangladesh, Brazil, India and Pakistan
has been banned. Any essential travel shall be required to undergo mandatory institutional
quarantine, negative PCR-based COVID-19 test result or certificate conducted no more than 72
hours before arrival.
[5] Pakistan – From May 8 to May 16, a blanket ban on tourism and inter-provincial transport and
closure of all tourist resorts, hotels, restaurants, shopping centers, parks, beaches, and other
public places will be in effect.
[6] Philippines - From April 29 to May 14, entry of travelers from India as well as those with recent
travel history will be banned.
[7] Qatar – As of 28 April, a compulsory hotel quarantine has been imposed on all arrivals including
transit and vaccinated passengers from India, Nepal, Bangladesh, Pakistan, Sri Lanka and the
Philippines. Arrivals must undergo 10-14 days quarantine based on the facility. Passengers are
also required to take a mandatory Covid-19 PCR test done 48 hours before departure and a
repeat test within a day of arriving.
v. Lockdowns
[1] Cambodia – Lockdown in Phnom Penh and Takmao town has been extended until May 5. From
April 29, lockdown areas will be designated as Red Zone, Dark Yellow Zone, and Yellow Zone
depending on the severity of the outbreak and restrictions will be set accordingly.
[2] India (Chhattisgarh) – Lockdown in 14 districts: Raipur, Balod, Mahasamund, Durg,
Rajnandgaon, Dhamtari, Korba, Bemetra, Jashpur, Surajpur, Surguja, Balrampur, Kanker and
Kondagaon has been extended until May 5.
[3] India (Nagaland) – As of 30 April, two-week lockdown will be implemented in the state with
consolidated guidelines. While educational institutions including vocational and training
institutes, hostels, will remain shut, restaurants and shopping malls can remain open with strict
adherence to COVID-19 protocols and no restrictions will be placed on essential commodities.
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vi. Military Surveillance
Petawawa military base in Ontario hit with COVID outbreak [1]
As of 27 April, a small outbreak of COVID-19 was confirmed at Garrison Petawawa and contact tracing
and isolation of affected personnel has occurred. As of April 19, there have been 1,525 confirmed cases
of coronavirus in the Canadian military, 99 of them active and the rest have been resolved.
South Korea - COVID-19 cases in USFK [2]
As of 27 April, a soldier at U.S. Army Garrison Humphreys was confirmed to have contracted COVID-19.
The American service member was stationed at a U.S. military base in Pyeongtaek and is currently in
isolation at a designated facility. The latest case raised the total number of infections reported among
the USFK-affiliated population to 840.
vii. WHO Guidance & Other Protocols
No new update was published by the WHO on 27 April 2021.
viii. CDC Guidance & Protocols
US CDC
The following update was published by the US CDC on 27 April 2021:
COVID-19 Vaccination Program Provider Enrollment: Guidance for Providers
Available at: https://www.cdc.gov/vaccines/covid-19/reporting/requirements/support-for-
providers.html
EU CDC
No new update was published by the EU CDC on 27 April 2021.
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ix. Vaccines/Therapeutics Development
Noteworthy reports are included to inform main developments of COVID-19 pharmaceutics. Past updates
are available from situation report 211 onwards. A global map and registry of trials is also visualised &
accessible at: https://www.covid-nma.com/dataviz/ and trial results are available at: https://covid-
nma.com/living_data/index.php. A living systematic review of vaccine trials is also accessable at
https://covid-nma.com/vaccines/ or https://covid-nma.com/ .
Vaccines
[1] China - A clinical study of the Covid-19 inactivated vaccine combined with Zadaxin (thymalfasin)
has begun in China by the Chinese company SciClone Pharmaceuticals.
[2] UK - The National Institute for Health Research (NIHR)-supported Valneva Phase 2/3 study has
been initiated for healthy adults who have not been previously vaccinated for COVID-19. All
participants will receive two active vaccine doses, administered in a four-week interval; above
30 years will receive either the Valneva vaccine, or the approved Oxford/AstraZeneca vaccine
and those between 18 – 29 years will only receive the Valneva vaccine.
Therapeutics
[3] Africa - The ANTICOV study includes a consortium of 26 African and global research and
development organizations and will take place in 13 African countries. The trial will examine the
combination of antiparasitic nitazoxanide and inhaled corticosteroid ciclesonide.
[4] USA - A combination of remdesivir and repurposed drugs for hepatitis C virus (HCV): simeprevir,
vaniprevir, paritaprevir, and grazoprevir has shown 10 times more effectiveness at inhibiting
SARS-CoV-2.
Vaccine Approval Status
Table 6: Number of approving countries per vaccine as of 27 April 2021
Developer Vaccine Number of countries approving
Anhui Zhifei Longcom RBD-Dimer 2
Bharat Biotech Covaxin 9
CanSino Ad5-nCoV 5
Chumakov Center Kovivac 1
FBRI EpiVacCorona 2
Gamaleya Sputnik V 63
Johnson & Johnson Ad26.COV2.S 41
Moderna mRNA-1273 46
Oxford/AstraZeneca AZD1222 92
BioNTech/Pfizer BNT162b2 83
Serum Institute of India Covishield 33
Sinopharm BBIBP-CorV 35
Sinopharm Inactivated 2
Sinovac CoronaVac 22
Source: https://covid19.trackvaccines.org/vaccines/
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Adverse Reactions & Effects
The following table documents adverse reactions reported from approved vaccines and therapeutics.
New updates are bolded.
Table 7: Compilation of reports & guidance on adverse reactions
Vaccine Report/Guidance Reference
[Canada; Report] One person in Manitoba reportedly had an
adverse reaction after receiving the first dose on December 23. [1]
There were 490 more individuals vaccinated.
[United Kingdom; Report] Two British healthcare workers suffered
[2]
anaphylactic shock after receiving the vaccine.
[United States; Report] A healthcare worker in New York City
suffered anaphylaxis after receiving Pfizer BioNTech’s vaccine. The
[3]
worker is currently in a stable condition. 30,000 people have been
vaccinated so far.
[United States; Report] Two healthcare workers in northern Idaho
and the Treasure Valley, experienced severe allergic reactions
[4]
after receiving the vaccine. As of the time of reporting, one has
fully recovered while the other is expected to be discharged soon.
[United States; Report] There have been two cases of severe
allergic reaction in Alaska after receiving the COVID-19 vaccine.
Symptoms of the latest case include tongue swelling, hoarse voice [5]
and difficulty breathing, which kicked in about 10 mins after
receving the vaccine.
[United States; Report] An individual at Decatur Morgan hospital,
Alabama, experienced severe allergic reaction several minutes
[6]
after getting the vaccine. The patient is currently in a stable
condition.
Pfizer BioNTech
[United States; Report] Two healthcare workers from Essentia
Health, Minnesota had non-severe allergic reactions to the
[7]
vaccine. About 2,500 doses of the vaccines have been
administered to frontline workers at Essentia Health.
[United States; Report] According to Pfizer’s data submitted to the
FDA, the most common side effects were swelling and redness at
the vaccine injection site. Other noted common side effects in the
[8]
trial included fatigue, headache and muscle pain, which had a
greater chance of occurring after the second dose than the first
dose.
[United States; Guidance] The Centers for Disease Control and
Prevention (CDC) has issued new guidance on 21 December
regarding allergies and coronavirus vaccines after reports of severe
[9] s
allergic reactions to the jab. In the new guidance, the CDC
recommends that those who have a severe reaction to the first
shot of the vaccine should not receive the second jab.
[United States; Guidance] Health experts have said that the side
effects of COVID-19 vaccines by Pfizer BioNTech (and Moderna)
are short-term and manageable. The American College of Allergy,
[10]
Asthma & Immunology recently released a guideline on the risk of
allergic reactions to Pfizer BioNTech’s vaccine. The guideline is
available at https://acaai.org/news/american-college-allergy-
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asthma-and-immunology-updates-guidance-risk-allergic-reactions-
mrna.
[Canada; Report] Of 11,930 doses of Pfizer BioNTech’s vaccine
administered in British Columbia so far there have been 2 cases of [11]
allergic reaction.
[Israel; Report] On December 28, a 46-year-old man in Jerusalem
suffered severe anaphylactic shock one hour after receiving a
COVID-19 vaccination. He is the first in Israel to have such a
reaction, and is reportedly allergic to penicillin. His condition has
since stabilized.
[12]
Separately, a 75-year old man died of heart failure at home some
hours after receiving Pfizer BioNTech’s vaccine. The man was
reported to have heart disease and cancer, and had suffered a
number of previous heart attacks. While investigations are still
ongoing, preliminary findings indicated that the death did not
appear to be connected to the shot.
[Finland; Report] On January 2, the first adverse reaction against
[13]
the vaccine was reported. No further details were released.
[Mexico; Report] A 32-year-old doctor in Mexico has been
admitted to intensive care unit with seizures, breathing difficulties
and possible encephalomyelitis. While the cause of the adverse
reaction is still under investigation, preliminary diagnosis indicates
encephalomyelitis. The patient condition has been stablized and is
receiving treatment to reduce inflammation.
[14]
[15]
[Update] The doctor was allergic to sulfa drugs and has a family
history of allergies. After developing allergic reaction, medication
was administered to recover from the symptoms. However, she
had subsequently suffered from convulsion. Diagnosis at that time
was allergic reaction to the vaccine but the cause for convulsion
and reduction of muscle strength is still being studied.
[Bulgaria; Report] As of January 4, Bulgaria’s Medicines Agency
had received four reports of adverse reactions. One case of
dizziness after administration, two cases of local pain at the [16]
vaccinated site, and one case of a slight temperature increase.
These side effects had passed off in less than a day.
[Portugal; Report] A portugese health worker had suffered a
sudden death 2 days after being vaccinated on 30 Dec. She did not
suffer from any adverse side-effect after vaccinated and did not
has any health problem. An autopsy is expected to be conducted
soon. [17]
[18]
[Update] In a 5 January 2020 press release, the Portuguese
Ministry of Justice informed that preliminary data from the
autopsy showed “no evidence of a causal relationship between the
death and the vaccine that was received.”
[Mexico; Report] By January 5, more than 44,000 people have [19]
received the first shot. As of January 4, about 110 people had [20]
reported allergic reaction to the vaccine but 80% were mild and [21]
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only 5 people require hospitalization. Only one person was
severely affected and remain in hospital.
[Update] As of 16 January 2021, 753 adverse events (729 mild and
24 serious) allegedly caused by vaccination and immunization
were reported since 24 December 2020. The 24 serious events
were reported from Coahuila (7 reports), Mexico City (4 cases),
Chihuahua, State of Mexico, Guanajuato, Oaxaca and Yucatan (2
reports each) and Baja California, Hidalgo and Jalisco (1 report
each). Of the 24 serious events reports, 6 remain hospitalized
while the remaining have been discharged.
[Update] As of 9 Feb, 6,260 negative reactions have been reported
nationwide with 36 serious reaction (0.9%). Yucatan has reported
3 serious case of adverse reaction and most of them have
discharged. The entities with the most negative reaction cases are
Mexico City (6 cases) and Coahuila and State of Mexico (4 each).
[United States; Publication] Centre of Disease Control and
Prevention (CDC) has reviewed on the allergric reaction to the first
dose of vaccine during 14 to 23 December. Among the 1,893,360
first doses administered, 4,393 (0.2%) adverse events were
reported. 21 cases of anaphylaxis (11.1 cases per million doses)
were detected and 17 of them had history of allergies or allergy
reaction. Of the 21 cases, 4 of them were hospitalized including 3
in intensive care and 20 of them had discharged or recovered by
23 December. There were no death reported.
[22]
[Update] The total number of cases of anaphylaxis has been [23]
updated to 29 as on 6 January. [24]
[25]
[Update] CDC has roughly estimated that one in a hundred
thousand people who received the Pfizer vaccine had severe
allergic reactions. An average rate of 11.1 anaphylaxis cases per
one million doses administered was estimated.
[Update] FDA and CDC have a total of 1,170 death between Dec.
14, 2020, and Feb. 7, 2021, among individuals who received Pfizer
or Moderna Covid vaccine, accounting for 0.003% of vaccinated
people.
[United States; Report] A Florida doctor had died several weeks
after receiving the vaccine on 18 Dec. He had suffered from
hemorrhagic stroke due to a lack of platelets. It is unclear if his
death was related to the vaccine while his death is being
investigated. It was reported that he had dots on the skin
[26]
indicating internal bleeding 3 days after the injection. Pfizer and
[27]
BioNTech had not received any prior indication of possible
connection to thrombocytopenia.
[Update] As of 12 Jan, no evidence was obtained to suggest a
connection between the vaccine and the death.
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[Canada; Report] Nine reports of adverse medical reactions which
include a total of 65 symptoms, eight of which were considered
severe, have been reported as of Jan. 1 but none were considered
to be unexpected side effects.
[Update] Fifteen new reports of adverse medical reactions, five of
which were considered severe, have been reported as between
January 1 and January 8. As of January 8, 24 reports of adverse
effects were reported, consisting of 10 serious and 14-nonserious
reports. All reports were considered to be expected side effects.
[28]
[Update] Sixty-six new reports of adverse medical reactions, 17 of
[29]
which were considered severe, have been reported as between
[30]
January 9 and January 15. As of January 15, 90 reports of adverse
[31]
effects were reported, consisting of 27 serious and 63-nonserious
reports. Most frequently reported adverse events were
vaccination site reactions, paraesthesia, pruritis, urticaria,
headache, hypoaesthesia, nausea and anaphylaxis.
[Update] As of 5 Feb, a total of 371 adverse effects were reported
which include 74 serious AEFI and 297 non-serious AEFI.
[Update] As of 26 March 2021, a total of 1,659 adverse effects
were reported, of which 1,347 were non-serious AEFI and 312
were serious AEFI.
[France; Report] Six reports of serious adverse effects with a
favourable outcome were reported in France during the 3rd week
of vaccination: 4 cases of allergic reactions and 2 cases of [32]
tachycardia. Around 30 cases of non-serious adverse effects have
been reported since 12 Jan 2021
[Norway; Report] As of 14 Jan 2021, 29 reports of side effects were
reported in Norway. The 29 reports consisted of 13 deaths, 9
serious side effects and 7 less serious side effects. The deaths were
all amongst frail and elderly patients in nursing homes, aged at [33]
least 80 years. Serious side effects reported included allergic
reactions, strong malaise and severe fever. Less serious side
effects include severe pain at injection site.
[United States; Report] A healthcare worker in Alaksa experienced
an allergic reaction to the Moderna COVID-19 vaccine, 10 minutes
[34]
within receiving it on January 12. There was no information on
allergy history of the healthcare worker.
[Israel, Report] At least 13 cases of mild facial paralysis have been
[35]
reported upon receiving the vaccine.
[United Kingdom, Report] A severe adverse medical reaction was
reported from a medical councillor aged 42 years within minutes
after receiving his vaccine on 8 January 2021. The councilor
[36]
experienced breathing difficulties, fever and muscle aches, and
was hospitalized for 1 day before his condition stabilized and
eventually recovered.
[Ireland, Report] As of 11 January 2021, 81 adverse events from
[37]
vaccination were reported, all involving expected mild side effects.
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[Singapore, Report] As of 27 January 2021, a total of 432 AEFIs
were reported amongst the 113,000 people who received the
vaccine. All reports were mild and reported expected side effects
arising from vaccination, except for 3 cases of anaphylaxis (SAE)
reported. The cases were in their 20s and 30s, had a history of
allergies, but no history of anaphylaxis which would have
[38]
precluded them from receiving the vaccine. All 3 cases have
[39]
recovered and were discharged from the hospital after a day’s
observation or treatment.
[Update] As of February 1, 2021 all four cases of anaphylaxis
following vaccination have recovered, with none requiring
intensive care unit support.
[Belgium, Report] As of January 26, 2021 a total of 262 AEFIs were
reported out of 243,412 vaccines administered, of which 37 were
[40]
serious AEFIs. Of the serious AEFIs reported, 14 were deaths
amongst those aged over 70 years (9 deaths) or 90 years (5 years).
[Croatia, Report] As of February 1, 2021 a total of 430 AEFIs were
reported, of which 26 were allergic reactions and the rest were
[41]
mild side effects. The allergic reactions included 2 serious
reactions, and 24 milder reactions.
[United Kingdom; Report] A study conducted by Zoe, a British
health science company had found that 37% of about 40,000
vaccinees in UK who were mostly healthcare workers had reported
local side effects (e.g. swelling or pain near injection site) after first
[42]
dose and 45% after second dose. Systemic side effects (e.g.
fatigue) were rare with 14% after first dose and 22% after second
dose. The side effect reported were lower as compared to FDA
trials.
[Romania; Report] A doctor from Valcea county had experienced
temporary facial paralysis after receiving the second dose and has
since fully recovered. This is the first rare and major side effect
[43]
reported in Romania. Since 27 Dec, there has been more than
2,100 common and minor side effects reported with a total of
629,279 people vaccinated by 4 Feb.
[United Kingdom; Report] The Medicines and Healthcare products
Regulatory Agency (MHRA) had reported on the side effects of 7
million vaccine doses (5.4 million Pfizer/BioNTech & 1.5 million of
the AstraZeneca) administered by 24 Jan. Yellow card system was
used for vaccinated people to report side effect. There was an
average of 3 yellow cards per 1,000 doses administered. There
[44]
were 16,756 yellow card for the Pfizer-BioNTech vaccine; 6,014 for
the Oxford University-AstraZeneca vaccine and 50 for unspecified
brand of the vaccine. Most reports were related to injection site or
otherwise generalized symptoms (e.g. flu-like illness). These
symptoms had occured shortly after vaccination and were not
associated with more serious or lasting illness.
[Netherland; Report] 15 elderly had died within 9 days after
administered with vaccine. Most of them with fatal outcome had
[45]
multiple underlying health issues or serious health problem. Half
of them had symptoms identified as side effects e.g. fever after
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vaccination. These may have contributed to the deterioration of
their health.
A total of 2,812 side effects have been reported after vaccinated.
95% were administered with Pfizer/BioNTech vaccine, 113 cases
were Moderna vaccine and vaccine used for 38 reports were not
clear. 14 people who had epilepsy also had seizure after
vaccination. Some 25 people had severe allergic reaction to
Pfizer/BioNTech vaccine with 8 cases determined as anaplylactic
response.
Both the Pfizer and Moderna vaccines can cause lymph nodes to
swell, particularly those in the armpit on the side where the shot [46]
was received.
[France; Report] Between December 27 and February 18, France
recorded 5,331 unwanted side effects out of 3,330,296 injections.
The most common side-effects included flu-like symptoms, such as
fever and muscle pain, and were more prominent after the second [47]
dose. There were 75 cases of serious high blood pressure that led
to symptoms like dizziness, 56 cases of cardiac issues and 10 cases
of facial paralysis.
[Australia, Report] The first serious AEFI in Australia involved
anaphylactic reaction in a Queensland nurse following vaccination.
[48]
The nurse has a history of anaphylaxis and have since recovered
from the reaction.
[Japan, Report] The first serious AEFI in Japan involved
anaphylactic reaction in a female Japanese medical worker in her
30s, following vaccination on 5 March 2021. The medical worker
has a history of asthma, and whose condition have improved after
taking proper medicine.
[Japan, Update] Five more anaphylaxis cases following vaccination
were reported through Japan on 8 March 2021, bringing the total
number of such cases to 8. The new cases occurred in women in
[49]
their 20s to 50s, of which four had asthma or a history of other
[50]
drug allergies. All cases’ condition improved after taking
[51]
medication. Anaphylaxis reaction was linked for vaccination for
three of the cases, while the causal relationship was unclear or
impossible to evaluate in the remaining 2 cases.
[Japan, Update] A total of 25 cases of anaphylaxis were reported
amongst 148,000 doses administered as of 10 March 2021. The
cases were primarily women (24 cases). The anaphylaxis rate in
Japan is relatively higher than that reported in United States (5
cases/million doses) and Britain (20 cases/million doses)
[Australia; Report] As of 16 March, 19 reports of anaphylaxis were
reported nationally after vaccinated with Pfizer (14 reports) and
[52]
AstraZeneca (5 reports). More than 183,000 doses have been
administered.
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[Hong Kong Report] A chronically ill 66-year-old man died on
March 19, three days after receiving the BioNTech vaccine. He was
the eighth person to die after getting a jab since vaccination was
[53]
launched. The previous seven chronically ill people died after
receiving the Chinese-made Sinovac jab. But no link between the
deaths and the jabs has been established so far.
[Hong Kong, Report] As of March 26, there has been 1 known
report of Bell’s palsy following vaccination with the Pfizer-
[54]
BioNTech vaccine in Hong Kong. No direct link was found between
the cases and the vaccinations.
[Japan, Report] As of March 21, 47 cases of anaphylaxis have been
reported after 580,000 doses of Pfizer-BioNTech vaccine
administered. This implies an anaphylaxis rate of 81 cases per 1
million doses administered, much higher than 5 in every 1 million [55]
doses in the United States and 20 cases per million doses in
Britain. The rate is subject to change since Japan is further behind
in the vaccination rollout.
[United Kingdom, Report] A 2 reports of blood clot in the brain
[56]
have been reported amongst recipients as of 24 March 2021.
[Australia; Report] As on 28 March 2021, 36.3% of 80,533 people
receiving the vaccine reported adverse events after the first dose
[57]
while 60.7% reported at least one AE following their second dose
since vaccination started on 22 February 2021.
[Hong Kong; Report] Two pregnant women had suffered from
miscarriages after administered with the BioNtech vaccine but [58]
links with the vaccination has not been established.
[New Zealand; Report] From 20 Feb to 13 Mar, 22,588 doses were
administered with 65 new non serious and 3 new serious cases
reported from the last update. Two of the serious cases were
[59]
allergic reaction while the third case was a reactogenicity reaction.
Previous report up to 6 Mar has identified 147 adverse reactions
including 3 serious reactions.
[Israel; Report] Herpes zoster reactivation (shingles) identified in
six vaccinated patients with comorbid autoimmune/ inflammatory
[60]
diseases in two centers since Dec 2020 suggest new adverse event
linked to the vaccine.
[Saudi Arabia, Publication] A cross sectional study was conducted
with 455 Saudi Arabia inhabitants. Common side-effects were
injection site pain, headaches, flu-like symptoms, fever, and
tiredness, less common side effects were fast heartbeat, whole
body aches, difficulty breathing, joint pain, chills, and drowsiness
[61]
and rare side effects were Bell’s palsy and lymph nodes swelling
and tenderness. There were more reports on difficulty of
breathing in recipients who were previously infection as compare
to not infected. Most side effects reported were consistent with
the vaccine’s fact sheet for recipients and caregiver.
[United Kingdom, Report] Based on the UK’s Yellow Card tool,
there were 2.5 time more cases of severe side effects and related
[62]
death after vaccinated with Pfizer than with AstraZeneca. As of 5
April, there were 22 fatalities among 21.6 million doses of
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AstraZeneca and 40 fatalities among 15.4 million doses of Pfizer
administered.
[Croatia, Report] Out of a total of 750,000 doses of the COVID-19
vaccine administered in Croatia by April 22, side effects were
reported in only 0.4 percent of cases. Out of a total of 2667
reports, there were 1297 side effects for Pfizer / BioNTech's [63]
vaccine, 1166 for AstraZeneca, and 202 for Moderna. Eighty-one
percent were mild health problems, while 19 percent were more
severe.
[Estonia, Report] Seven serious side effects were reported last
week after vaccination, two with the Pfizer/BioNTech Comirnaty
vaccine (thrombosis), one with the Moderna vaccine
(thrombosis) and four with the AstraZeneca Vaxzevria vaccine [64]
(thrombocytopenia, visual impairment - retinal detachment,
deep vein thrombosis and headaches and photosensitivity). Any
causal link is yet to be established.
[United States; Report] The FDA advisory committee has noted a
special side effect of the vaccine from the clinical trials involving
several patients with cosmetic facial fillers. The patients who
[65]
experienced side effect all had swelling and inflammation in the
area that was given the filler. All reactions were resolved following
treatment with steroids and antihistamines.
[United States; Report] A Boston doctor experienced severe
allergic reactions after receiving the Moderna COVID-19 vaccine on [66]
December 24. The doctor has a history of shellfish allergy.
[Canada; Report] On December 17, the US FDA reported two cases
of adverse reactions in individuals who had received the Moderna
vaccine. Both patients previously had dermal fillers and
experienced some swelling following the vaccination. The cases
were likely to have occurred in Toronto, Canada.
[67]
[Canada; Surveillance] As of 5 Feb, a total of 280 adverse effects [68]
were reported which include 25 serious AEFI and 255 non-serious [69]
Moderna AEFI.
[Canada; Surveillance] As od 26 March 2021, a total of 1,165 AEFIs
were reported, of which 1,106 were non-serious AEFIs and 59
were serious AEFIs.
[United States; Report] A frontline worker in Robstown had
experienced immediate numbness on the face after receiving the
[70]
vaccine a week ago but continues to have soreness and redness to
her arms.
[United States; Publication] Phase 3 clinical trial involving 30,420
volunteers had observed higher frequency of moderate, transient
reactogenicity after vaccination in the vaccine group. Serious
adverse events were rare and the incidence was similar between
[71]
the placebo and vaccine groups. Hence there were no safety
[72]
concern, apart from the transient local and systemic reactions.
[Update] The vaccine showed a 94.1% efficacy rate in its phase 3
trial, and serious adverse events occurred in just 0.6% of patients.
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A total of 2 deaths were reported in the vaccine group, one was
due to cardiopulmonary arrest and the other was a suicide.
[United States; Report] On 31 December, the Oregon Health
Authority reported a case of anaphylaxis after a healthcare worker [73]
had taken the vaccine this week and is recovering in the hospital.
[Guidance] A new guidance from the American Society for
Dermatologic Surgery (ASDS) has been released regarding side
effects from the SARS-CoV-2 mRNA vaccine on dermal fillers. FDA
[74]
data reports show three participants out of 15,184 who received
at least one dose of Moderna’s mRNA-1273 vaccine have
developed lip for facial swelling in areas of dermal filler placement.
[United States; Report] A Missouri healthcare worker experienced
severe allergic reaction after receiving the Moderna COVID-19
[75]
vaccine on December 29. The healthcare worker has a history of
severe allergy reaction to MRI contrast dye.
[United States, Report] Six reports of allergy reactions requiring
medical attention 24 hours from vaccination, were reported
amongst healthcare workers on 14 January 2021. The healthcare
workers were vaccinated with lot 41L20A from the same
[76]
vaccination site in San Diego. The site is temporarily closed for
now and using other vaccines. California health officials
recommend suspending the use of lot 41L20A, until investigation
are complete.
[United States, Report] A fatality was reported in a resident from a
retirement home, after receiving the vaccine. Investigation on
[77]
whether the fatality was linked to receiving the vaccine is
underway.
[United States, Report] As of January 29, 2021 a total of 287 AEFIs
were reported amongst 250,000 vaccines administered in Texas, of
which 11 were serious AEFIs. The 11 AEFI reports included the
death of an 84 years-old woman, permanent disability in another
patient, and the remaining spent at most 4 days hospitalized. [78]
[79]
[Update] As of 5 Feb, 2021, the The Centers for Disease Control
had reported that 619,452 second doses have been administered
in Texas with 15 significant reports of side effect. Only 4 of them
required hospital stay that had lasted less than 5 days.
[Croatia, Report] As of February 1, 2021 a total of 13 AEFIs were
[80]
reported, all of which were mild side effects.
[USA, CDC; Report] A side effect of the Moderna vaccine reported
by the CDC as arm pain and redness appears to be showing up a [81]
bit delayed in some people up to a week.
[France; Report] Since January 22, 148 cases of unwanted side
effects were reported in France. A total of 129,510 people have
received at least one doses of the Moderna vaccine. The side [82]
effects were mainly skin issues, muscle pain, and digestive issues.
Four people had severe side effects including cardiac problems.
[United States, Report] A 39-years-old female with no known
health problems or comorbidities died 4 days after her second
[83]
vaccine shot. Investigations are in progress to determine the link
of the death with the vaccine.
26 | P a g e Centre for infectious disease epidemiology and researchFor citation: Centre for Infectious Disease Epidemiology and Research-NUS.
COVID-19 Situation Report 454. 28 April 2021
[United States, Report] Boston researchers report delayed skin
reaction to Moderna COVID-19 vaccine which includes skin rash at [84]
the injection site and the timing of it might be confusing.
[Argentina; Report] Of the total 32,013 patients who had received
Sputnik V the vaccine, 1% (317 patients) had reported mild adverse reaction [85]
(fever and headache).
[India, Report] Ninety-three reports of adverse events following
immunization with Astrazeneca & Oxford Uni. ( and Bharat
Biotech) vaccines were reported from Delhi (51 mild and 1 serious
report), Haryana (13 mild reports), Maharashtra (14 mild reports)
and Kolkata (13 mild and 1 serious report). No fatalities have been
reported.
[Update] Between 16 January and 17 January, 447 reports of
adverse events following immunization have been reported across
India. Only 3 of the reports involved serious adverse events
requiring hospitalization, of which only 1 remains hospitalized.
[Update] 82 AEFIs were reported across India on 20 January 2021.
All AEFIs reported were mild cases.
[86]
[87]
[Update] On the 22 Jan, Day 4 of the coronavirus vaccination drive
[88]
in Delhi, 5,942 people were reportedly administered the shots and
[89]
adverse events following immunisation (AEFI) was reported in 24
[90]
persons.
[91]
[92]
[Update] On 24 Jan, the fifth day of India’s Covid-19 vaccination
Astrazeneca & [93]
drive, the city of Gurugram reported 3 cases of AEFI amongst 3,055
Oxford Uni. [94]
shots administed.
[95]
[96]
[Update] The Union Ministry of Health and Family Welfare in India
announced 23 January that over 10 lakh people had already been
immunised in the first six days (up to 21 January), but the total
number of AEFIs reported by the ministry in its daily press releases
so far adds up to 1,239 out of 15,37,190 inoculations, or 0.08 per
cent. Just 11 people have had to be hospitalised (0.0007 per cent),
while seven deaths have been reported — six of which are “not
causally linked” to the vaccine, while in the seventh case, the post
mortem report is awaited.
[Update] A total of 19,50,183 beneficiaries were inoculated in
35,785 sessions till 7.10 pm on Monday 25 Jan, including 3,34,679
in 7,171 sessions during the day, the ministry said. A total of 348
adverse events following immunisation (AEFIs) were reported till
7.10 pm on 25 Jan, the 10th day of the vaccination drive.
[Update] A total of 213 ARFIs were reported up till 7 pm on
January 29, 2021 across India, of the 33,68,734 vaccines
administered
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