AAION was treated with high-dose oral corticosteroids and tocilizumab therapy[22] , while the NA-AION resolved without treatment[23]. 2021;40(12):1629-1632. doi:10.1097/ICO.0000000000002844, Patel SN, Yonekawa Y. These large percentage changes show increasing uncertainty amongst patients about how their glaucoma is managed during the crisis. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. By Amy Norton, HealthDay News. Cornea. Internet Explorer). Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6years, following anti-SARS-CoV-2 vaccination. It should be noted that there are no peer-reviewed cases of adverse COVID-19 vaccination effects in glaucoma patients[9]. Murray PHN on LinkedIn: This World Glaucoma Week, GPs and primary Then in May, Myra's right eye started to feel "somewhat gummy," and she noticed her night vision was almost gone. "These surgeries have to be done in a timely manner," he explains, as the initial cancer removal often "leaves the patient susceptible to infection, scarring and disfigurement.". COVID-19 Vaccines - WebMD Accessed March 12, 2022. https://covid19.who.int, Baden LR, El Sahly HM, Essink B, et al. Glaucoma Care During the Coronavirus (COVID-19) - BrightFocus While COVID-19 vaccines havent been tied to serious vision issues, researchers have detected eye problems in a number of children with the disease itself. Common side effects from the chickenpox vaccine include: Soreness and a mild rash at the injection spot. Bottom line. "Any new or substantial change in vision should be a warning sign," he says, such as blurry vision, eye pain or a sudden decrease in sight. 2022;240:79-98. doi:10.1016/j.ajo.2022.02.011. The Pfizer-BioNTech vaccine was the first COVID-19 shot to be authorized for use in the European Union. NIH begins large clinical trial to test immune modulators for treatment Central retinal vein occlusion after mRNA SARS-CoV-2 vaccination: A case report. Her doctors had to perform surgery to treat the condition, and tests of her eye tissue showed evidence of SARS-CoV-2. And it was a Chinese ophthalmologist who, in December 2019, warned the world about what came to be known as COVID-19; the disease wound up causing his death. Glaucoma | Johns Hopkins Medicine Many of the concerns stem from perceived harms of receiving the vaccination. Somner JEA, Sii F, Bourne RR, Cross V, Burr JM, Shah P. Moving from PROMs to POEMs for glaucoma care: a qualitative scoping exercise. . Many of these patients lacked medical comorbidities that may have predisposed them to these conditions, although hormone-based birth control was noted in a few patients[40][41]. Jayaram H, Strouthidis NG, Gazzard G. The COVID-19 pandemic will redefine the future delivery of glaucoma care. The patient was a 64-year-old woman who was hospitalized for COVID-19 on Jan 31. Glaucoma Clinics where the Candidate should be able to work independently and formulate treatment plans for Ophthalmology patients and list for surgery. 2). COVID-19 Vaccine Is Safe for People With Autoimmune Rheumatic Diseases Iridotomy to slow progression of visual field loss in angle-closure glaucoma. Fear of side effects, vision problems included, is the biggest reason why some people are hesitant to get a COVID-19 vaccine. 2022;29:e01536. In rare cases, some patients whove received the flu vaccine experienced mild symptoms like eye redness, eye pain and blurred vision. "We know that delays to get patients in for treatment did impact their vision in a measurable way," says Dr. Timothy Murray, a retina specialist and ocular oncologist in Miami and president of the American Society of Retina Specialists. Although some patients had a previous history of uveitis-related diseases that may have predisposed them to this phenomenon, many notably did not[11]. Purpose: To report two cases; bilateral arteritic anterior ischemic optic neuropathy (AAION) and bilateral acute zonal occult outer retinopathy (AZOOR) after COVID-19 mRNA vaccination. Glaucoma Clinical Trial Analysis by Trial Phase, Trial Status, Trial Safety of COVID-19 vaccines | European Medicines Agency Population estimates from 2019 US Census Bureau. What You Should Know as a Glaucoma Patient during COVID-19 Her family decided not to bring her in for treatment during the shutdown. COVID-19 vaccine myths debunked - Mayo Clinic News Network The impacts of COVID-19 on glaucoma patient outcomes as - Nature The coronavirus tidal wave has made Dr. Ruth Williams rethink what she considers essential and elective care in her field of ophthalmology which cases constitute an emergency, and which count as routine. Advertisement. We hope you will find the following tips and information helpful as we all deal with the national and global . An official website of the United States government. He adds that eye scans, called OCTs, clearly show that the longer treatment is delayed, the more a patient's vision declines. To examine whether anti-VEGF drug injections increase risk of glaucoma, the researchers reviewed the cases of more than 800 people in British Columbia who received bevacizumab injections to treat . 2 X. ZHOU ET AL. This enables the detection of any rare side effects that may emerge once many millions of people are vaccinated. Ocular adverse events following COVID-19 vaccines, although exceedingly rare, have also been documented[8][9]. COVID-19 Vaccines | HHS.gov Keywords: Investig Ophthalmol Vis Sci. Following the latest guidelines for preventing disease transmission through safe hygiene and social distancing is expected to slow and ultimately end the spread of COVID-19. The vaccines are not safe, because they were developed so fast. During the shutdown, the patient developed an infection of an oil-producing gland in the eyelid. Across most medical specialties, doctors have noted a sharp drop in care during the pandemic, as nonessential visits and procedures were curbed and people feared a medical appointment could lead to coronavirus infection. Ocular Adverse Events After COVID-19 Vaccination. All About Vision does not provide medical advice, diagnosis or treatment. Retina: Retinal microvascular changes have been noted on ocular imaging in people with COVID-19. While that may be enough in most cases, people caring for someone with COVID-19 at home may want to be extra cautious. Glaucoma actually refers to a group of progressive eye diseases where the optic nerve slowly dies over time, and is usually related to pressure . Pain, redness and/or swelling in the arm where you got the injection. Methods: Data of patients with positive PCR result for COVID 19 infection and concurrent findings of acute angle-closure glaucoma were analysed retrospectively. It is used when the eyes have been irritated by allergies, irritation, or infection. The COVID-19 vaccines with reported ophthalmic reactions included the mRNA vaccine (BNT162b2, Pfizer, Brooklyn, NY, USA . Foot B, MacEwen C. Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome. CDC issues new COVID-19 vaccine guidance for people with allergies A severe allergic reaction would usually occur within a few minutes to one hour after getting a dose of the Janssen COVID-19 Vaccine. Careers. Responses to Q4 demonstrate that patients are increasingly less confident that the progression of their glaucoma remains stable. Maaz A. Khan1, Bryan L. C. Loh1, Gopija Nanthagopan1, Arun James Thirunavukarasu1, Aaron P. L. Fleming1, Suraya Yusuf1, Xiu Sheng Tan1, Shravan V. Gowrishankar1, Mrudula Utukuri1, Gabriella C. A. Gilks1, Marie-Julie Anna Maria Cnudde1, Sajan Rajani1, Lionel Dufour1, Reema Pujari1, Rynda Nitiahpapand1, Paolo Scollo1, Rupert Bourne1, Geoffrey Chan1, Sharon Springdal1, Daniel Kelly1, Amy Page1, Cambridge Eye Research Centre, Department of Ophthalmology, Addenbrookes Hospital, Cambridge University Hospital NHS, Cambridge, UK, Rathin Pujari,Geoffrey Chan,Ian Tapply,Maaz A. Khan,Bryan L. C. Loh,Gopija Nanthagopan,Arun James Thirunavukarasu,Aaron P. L. Fleming,Suraya Yusuf,Xiu Sheng Tan,Shravan V. Gowrishankar,Mrudula Utukuri,Gabriella C. A. Gilks,Marie-Julie Anna Maria Cnudde,Sajan Rajani,Lionel Dufour,Reema Pujari,Rynda Nitiahpapand,Paolo Scollo,Rupert Bourne,Geoffrey Chan,Sharon Springdal,Daniel Kelly,Amy Page&Rupert R. Bourne, Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia, School of Medicine, Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK, You can also search for this author in Contact your state health department to find . The link between COVID-19 and episcleritis may include vasculo-immunological factors and coagulation disorders. Experts have reserved judgement about whether this is the result of COVID-19 infection. Migraine After COVID-19 Vaccine: About Headache Side Effects - Healthline Blue eyes: Is everyone with blue eyes related? A number of biopharmaceutical companies have applied for U.S. Food and Drug Administration (FDA) emergency use authorization for a new COVID-19 vaccine and a limited number of vaccines will be available before the end of the year. Central retinal vein occlusion post-COVID-19 vaccination. All About Vision and AllAboutVision.com are registered trademarks of AAV Media, LLC. Does the COVID-19 vaccine affect your vision? - FeelGoodContacts COVID-19 Vaccines and People with HIV. Dr. William Culbertson, professor of ophthalmology at the Bascom Palmer Eye Institute in Miami, United States, told Ophthalmology Times that ophthalmologists and staff at the institute started receiving vaccinations Dec. 15, 2020. BMJ Case Rep. 2022;15(5):e247159. Guillain-Barre syndrome can cause eye-related symptoms such as double vision and problems moving the eyes, in addition to other neurological symptoms. Other potential vision issues associated with measles include: Red and watery eyes triggered by pink eye (conjunctivitis). The vaccine should slow the spread of COVID-19 around the world. [17]. doi: 10.1097/IJG.0000000000001864. urinary calculi, adrenal nodule, and glaucoma. Published literature to date demonstrates very few post-COVID-vaccination cases of optic neuritis[18][19][20][21] and ischemic optic neuropathy[22][23]. Now when you get sick, the same thing happens and actually a lot of the symptoms from illnesses that we get like influenza and COVID, are actually caused not by . Intraocular pressures (IOP) of the first, second, and third cases were 35 mmHg, 44 mmHg, and 40 mm Hg, respectively. The POEM questionnaire highlights that this situation has been exacerbated by COVID. Further, corneal graft rejections were also associated with COVID-19 vaccines[23][24]. He, as have most of his colleagues across the country, has resumed operating. 2021;69(10):2865-2866. doi:10.4103/ijo.IJO_1477_21, Sonawane NJ, Yadav D, Kota AR, Singh HV. Ocular Adverse Reactions after Receiving COVID-19 Vaccine Rare side effects include short-term seizures and low platelet count. Suspected patients should be referred to the ophthalmology department. Cases of Herpes zoster ophthalmicus have been reported after both the first and second doses of COVID-19 vaccines[18][19]. Presented by Vision 20/20 Australia in Cataract surgery led to glaucoma -related adverse events (AEs) in children, according to study findings published in JAMA Ophthalmology, and among patients younger than 3 months, there was an . "The body's immune response is so robust to this new pathogen, there are protein markers inside of your . Data of patients with positive PCR result for COVID 19 infection and concurrent findings of acute angle-closure glaucoma were analysed retrospectively. The Iris: Anatomy, Function, and Treatment - Verywell Health Bilateral Acute Macular Neuroretinopathy After Vaccination Against SARS-CoV-2. Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233 to find COVID-19 vaccine locations near you. Indiadotcom Digital Private Limited, Essel Studio,FC-19, Sector 16-A,Noida - 201301, India, COVID-19 Live Updates: China May See Over 36,000 Deaths Daily This Month, Experts Predict Future of COVID, Coronavirus Live Updates: COVID-19 XBB.1.5 Variant Cases Rising In India, INSACOG Warns, Coronavirus Live Updates| Omicron XBB.1.5 Accounts For More Than 40% Of COVID-19 Cases In The US. One is whether the virus present in the eye tissue is actually infectious. 9 June 2021. Ophthalmic Plast Reconstr Surg. Dr. William Culbertson, professor of ophthalmology at the Bascom Palmer Eye Institute in Miami, told Ophthalmology Times that ophthalmologists and staff at the institute started receiving vaccinations Dec. 15, 2020. 2022;76(2):146-148. doi:10.5455/medarh.2022.76.146-148, Farrell DA, Deacon S, Mauger T. Marginal keratitis following COVID 19 vaccination. IDCases. Disclaimer. Find an eyecare professional and book online in minutes! Acute macular neuroretinopathy[39][40][41], central retinal artery occlusion40[42], central retinal vein occlusion[43][44], central serous chorioretinopathy[45], paracentral acute middle maculopathy[46], and retinal hemorrhage[47] have all been reported in the peer-reviewed literature following COVID-19 vaccination. Kozarsky insists the new practice environment is even better for patients and staff now than it was before the pandemic. This will reduce the chance of any virus, including cold and flu bugs, from coming into contact with the eyes. 2021;113:116-118. doi:10.1016/j.ijid.2021.09.075, Fowler N, Mendez Martinez NR, Pallares BV, Maldonado RS. Results: The common characteristic of all cases was positive PCR test for COVID 19 infection . JAMA Ophthalmology. Cataracts, Glaucoma Part of COVID-19's Collateral Damage Taking Care of Your Glaucoma During COVID-19 - BrightFocus But it wasn't just the more dramatic specialties where medical professionals witnessed the collateral damage from COVID, and ophthalmology has been hit particularly hard. Neuroretinitis after the second injection of a SARS-CoV-2-vaccine: A case report. Three million people in the United States and 80 million people worldwide have glaucoma. Angle-closure glaucoma; COVID 19 infection; hyponatremia. But the UK's Joint Committee on Vaccination and Immunisation (JCVI) has recommended . Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. SEE RELATED: 5 ways measles can affect eyesight. Photo: Dave Reid. COVID-19 Vaccine - Michigan I Got Glaucoma After COVID and I'm One of the Lucky Ones "It is safe for people to receive immune checkpoint inhibitors and COVID-19 vaccines," said Adam . N Engl J Med. Experts say the benefits of being vaccinated against COVID-19 outweigh the potential side effects. While it's not clear how the virus got into the patient's eyes, the experts agreed that the case underscores the importance of eye protection. Presentation of this work and link to additional material: While conducting this research, we also used conversations with four patients to brief an actress who prepared a monologue that highlights these key areas, accessible via the following link, https://player.vimeo.com/video/488126493. PMID: 35323144; PMCID: PMC9093224. More than 3 million people in the U.S. have glaucoma, and most are 40 and older. https://doi.org/10.1038/s41433-021-01425-0, DOI: https://doi.org/10.1038/s41433-021-01425-0. What You Should Know as a Glaucoma Patient during COVID-19. Data and anecdotal reports from earlier in the pandemic pointed to plummeting hospital admissions for serious issues such as heart attack and stroke. Glaucoma Surgery and Laser . Largest study of COVID-19 vaccine skin reactions shows a wide range of Ng XL, Betzler BK, Ng S, Chee SP, Rajamani L, Singhal A, Rousselot A, Pavesio CE, Gupta V, de Smet MD, Agrawal R. The Eye of the Storm: COVID-19 Vaccination and the Eye. This virus is a coronavirus called SARS-CoV-2. Color blind tests: Do you see colors as they really are? 5 have been reported).1,2 This reported risk emphasises how important it is that these patients develop protective immunity via COVID-19 vaccinations, but, unfortunately . The https:// ensures that you are connecting to the Retinal hemorrhage of late post-COVID-19 and post-vaccine-related pathogenic mechanisms: A new challenge for ophthalmologist in COVID era. Progressive lenses: No-line multifocals for a younger you, Reading glasses: What to know before buying, Glasses that suit your personality and lifestyle, The best glasses for your face shape and skin tone, Cheap glasses: How to find a bargain on eyeglasses, Buying eyeglasses online or in person: Your choice, Performance sports sunglasses: See better, play better, Polarized sunglasses: Best for reducing glare, Prescription sunglasses: Clear, comfortable vision, Designer sunglasses: Look like a celebrity, Nonprescription sunglasses: What to know before buying, Guide to buying the best sunglasses for kids, Understanding your contact lens prescription, Bladeless LASIK: Femtosecond laser eases LASIK fears, Custom LASIK: Personalized vision correction, 8 tips to speed your cataract surgery recovery. According to GlobalData, Phase II drugs for Open-Angle Glaucoma have a 40% phase transition success rate (PTSR) indication benchmark for progressing into Phase III. In guidelines published by the College of Optometrists in the United Kingdom, the organization states, Optical staff would be treated as frontline health and social care workers, listed as the second-highest priority group in the vaccination programme.. 2012;53:59407. Accessibility She previously lost one eye and suffers from wet macular degeneration a particularly severe from of the disease in the other. Candidates should have a MD degree and be board certified or board eligible in ophthalmology, fellowship-trained in glaucoma, and be eligible for medical licensure in the state of Texas. Many eye doctors just like dental providers and ear, nose and throat specialists are wearing N95 respirators, goggles or face shields. A case of arteritic anterior ischemic optic neuropathy (AAION)[22] and a case of non-arteritic anterior ischemic optic neuropathy (NA-AION)[23] were reported after the second and first mRNA vaccine doses, respectively. According to the American Academy of Pediatrics, Pfizer has enrolled children down to age . Medicaid: Eligibility and Vision Benefits. COVID-19 vaccines are widely recommended to the general public for prevention of severe disease courses. Three vaccines are currently being used in the United States: Pfizer-BioNTech, now fully approved by the FDA under the brand name Comirnaty. One study found rare instances of corneal inflammation in children (chickenpox) and adults (shingles) after they received the zoster virus vaccine for both conditions. Face Masks COVID-19 Test Kits COVID-19 Medication Immune Support Book your COVID-19 Vaccine COVID-19 Vaccine Digital Record. "And from there, it could have become a systemic infection" with a potentially deadly outcome. It is a known fact that some anatomical features of the eye make some people vulnerable to acute angle-closure glaucoma. As of July 31, 2022, there have been over 570 million confirmed cases of COVID-19 and over 6 million deaths worldwide[1]. Acute-onset central serous retinopathy after immunization with COVID-19 mRNA vaccine. A WHO report on the Moderna COVID-19 vaccine reported similar side effects. Bookshelf Impaired antibody response to inactivated COVID-19 vaccines in hospitalized patients with type 2 diabetes Xiaoying . Before One hundred and twenty-six consecutive patients attending a tertiary centre glaucoma clinic over a 2-week period in September 2020 were surveyed. Pujari, R., Chan, G., Tapply, I. et al. The CDC has updated its guidance about the COVID-19 vaccine for people with certain pre-existing medical conditions. One case of bilateral immune-mediated keratolysis was associated with vaccination, which was treated with tectonic penetrating keratoplasty and post-operative steroid antibiotics[38]. Hyponatremia may cause an angle-closure attack in patients with shallow anterior chamber angles.Therefore, one should be aware of the possibility of angle-closure glaucoma in patients who develop hyponatremia due to COVID 19 disease. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. "Some orbital fractures must be dealt with urgently," he says. For the shingles vaccine, common side effects are sore arm, redness and swelling at the injection site, tiredness, muscle pain, headache, shivering, fever, stomach pain and nausea. Although we are not frontline health care providers, we all see patients face to face at the slit lamp and in surgery, so we have all been at substantial risk until we get vaccinated, Culbertson said. Her doctors had to perform surgery to treat the condition, and . 2022;41(2):257-259. doi:10.1097/ICO.0000000000002886, Simo MF, Kwitko S. Corneal Graft Rejection After Inactivated SARS-CoV-2 Vaccine: Case Report. Some patients may have conjunctivitis, which could cause red and watery eyes and irritation. Steroids can reduce some types of irritation, swelling, and redness by decreasing inflammation that's mediated by your immune system. Impaired confidence in the glaucoma team may not only cause unnecessary concern but cause issues with compliance that could contribute to disease progression. HIV and COVID-19: What You Should Know | HIV.gov "Adults of any age with certain underlying medical conditions are at increased . Who should, and should not get the Covid-19 vaccine | CNN COVID-19 vaccinations for individuals with certain medical conditions N Engl J Med. 1). ; These vaccines are given as a shot in the muscle of the upper arm or in the . Patients were treated with steroids and most were able to reach their baseline BCVA[14][15][16] . The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. HHS Vulnerability Disclosure, Help According to the CDC, the vast majority of vaccine side effects are mild, and are "normal signs that your body is building protection." Other symptoms such as headache and nausea. One study showed nearly one-fourth of children at a Chinese hospital who were treated in January, February and March 2020 for COVID-19 had developed mild eye problems. Indian J Ophthalmol. Hyponatremia is the most common electrolyte disorder in COVID 19 infection. Glaucoma is often referred to as "the silent killer of vision" because patients have few symptoms as the disease progresses. American Journal of Ophthalmology. Other side effects caused by the Pfizer/BioNTech vaccine are mostly mild to moderate, according to a report published by the World Health Organization (WHO). All About Vision and AllAboutVision.com are registered trademarks of AAV Media, LLC. BMJ Case Rep. 2021;14(9):e245792. Tara Haelle. A case series of 3 cases with orbital inflammation following mRNA vaccines were described and all cases were successfully treated with oral prednisolone. sharing sensitive information, make sure youre on a federal Introduction: To report three cases that developed acute angle-closure glaucoma on the background of hyponatremia due to COVID 19 infection. Cancelations of clinic visits, deemed non-urgent, were compounded by social distancing measures and potential fear of COVID-19 infection. doi:10.1136/bjophthalmol-2021-319338, Abousy M, Bohm K, Prescott C, Bonsack JM, Rowhani-Farid A, Eghrari AO. Copyright 2022 Indiadotcom Digital Private Limited. Ophthalmologists in the U.S. also are engaged in the fight against COVID-19. Neufeld also performed some reconstructive procedures during the pandemic for patients who had previous skin cancer surgery around the eyes. Am J Ophthalmol Case Rep. 2021;23:101136. doi:10.1016/j.ajoc.2021.101136. Encounters for glaucoma, which can cause blindness, were down 88%. Unbound in its middle to allow the pupil to change size, this structure is connected to the ciliary bodythe part of the eye that produces the eye's fluid (aqueous humor) and regulates contraction and constriction . 2021;2021:5126254. doi:10.1155/2021/5126254, Lee YK, Huang YH. doi: 10.1002/14651858.CD012270.pub2. Further studies investigating delays in patient appointments with impacts on visual acuity deterioration as well as true glaucomatous progression will further elucidate the psychological and physiological impacts that COVID has had. doi:10.1136/bcr-2021-245792, Khan TA, Sidhu N, Khan L, et al. Acute Corneal Transplant Rejection After COVID-19 Vaccination. Unauthorized use of these marks is strictly prohibited. 2022;45(6):597-602. doi:10.1016/j.jfo.2022.01.006, Malerbi FK, Schoeps VA, T F Matos K. Paracentral acute middle maculopathy in Susac syndrome after dual exposure to SARS-CoV-2 antigen. But Kozarsky's patient developed an abscess in his eyelid, and the physician had to bring the man in to drain the abscess. 2018 Jun 13;6(6):CD012270. "My immune system is weak, and I was terrified to contract COVID," she says. Once she went back to see her specialist in mid-July, he confirmed what she'd suspected: Her vision had decreased. For children aged 6 months-4 years who completed the Moderna primary series. The AAO recommends that people 50 and over get the shingles vaccine to prevent an extremely painful and disfiguring complication called herpes zoster ophthalmicus, which can cause blindness. Researchers confirm coronavirus can infect the eye. 2021;24:101200. doi:10.1016/j.ajoc.2021.101200, Lee S, Sankhala KK, Bose S, Gallemore RP. Opthalmology is among the medical specialties hit hardest by restrictions and fears tied to the coronavirus pandemic. Kozarsky has a patient who suffers from an inflammatory neurological disorder that requires strong medications. In extremely rare cases, the MMR vaccine can cause deafness, long-term seizures, coma or brain damage. When side effects occurred among participants, the most common reactions were: Injection-site symptoms, including pain, swelling, and redness. The most common sign of glaucoma is high eye pressure that over time damages the optic nerve and leads to a loss of peripheral vision. If you notice any of the symptoms of TTS or Guillain-Barre in the days or weeks after a J&J vaccine, get medical help right away. Eye. Getting vaccinated is the best way to help protect people from COVID-19. If the shingles virus infects the nerves of the eye, the AAO says it can lead to: Swelling of the optic nerve behind the eye, Corneal breakdown requiring a cornea transplant, SEE RELATED: Shingles in the eye (ocular shingles). Johnson & Johnson Statement on COVID-19 Vaccine (7/12)
