601
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Szarpak L, Pruc M, Koda M, Chirico F. Heart inflammation risk after COVID-19 vaccine. Cardiol J 2021; 28:1001-1002. [PMID: 34897637 PMCID: PMC8747813 DOI: 10.5603/cj.a2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/04/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Lukasz Szarpak
- Institute of Research Outcomes, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland.
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Mariusz Koda
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Francesco Chirico
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Health Service Department, Italian State Police, Milan, Italy
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602
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Milano G, Gal J, Creisson A, Chamorey E. Myocarditis and COVID-19 mRNA vaccines: a mechanistic hypothesis involving dsRNA. Future Virol 2021. [PMID: 34887937 PMCID: PMC8647997 DOI: 10.2217/fvl-2021-0280] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/24/2021] [Indexed: 12/18/2022]
Abstract
While tolerance to COVID-19 vaccination is considered satisfactory, a phenomenon of myocarditis, although rare, is becoming a safety concern in mRNA COVID-19 vaccination. The presence of low residual levels of double-strand RNA (dsRNA) has been reported in mRNA COVID-19 vaccine preparations. dsRNA is a known inducer of immune-inflammatory reactions. dsRNA present in vaccine nanoparticles may be suspected to be at the origin of the still unexplained cases of myocarditis.
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Affiliation(s)
- Gerard Milano
- Centre Antoine Lacassagne, Unité Propre de Recherche 7497, Université Côte d'Azur, 06100, Nice, France.,Centre Antoine Lacassagne, UNS EA 7497 Nice University, 33 Avenue de Valombrose, 06189, Nice, France
| | - Jocelyn Gal
- Centre Antoine Lacassagne, UNS EA 7497 Nice University, 33 Avenue de Valombrose, 06189, Nice, France.,Epidemiology & Biostatistics Department, Centre Antoine Lacassagne, University Côte d'Azur, 33 Avenue de Valombrose, 06189, Nice, France
| | - Anne Creisson
- Medical oncology Department, Centre Antoine Lacassagne, University Côte d'Azur, 33 Avenue de Valombrose, 06189, Nice, France
| | - Emmanuel Chamorey
- Centre Antoine Lacassagne, UNS EA 7497 Nice University, 33 Avenue de Valombrose, 06189, Nice, France.,Epidemiology & Biostatistics Department, Centre Antoine Lacassagne, University Côte d'Azur, 33 Avenue de Valombrose, 06189, Nice, France
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603
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Barda N, Dagan N. The role of observational studies based on secondary data in studying SARS-CoV-2 vaccines. Clin Microbiol Infect 2021; 28:313-314. [PMID: 34906720 PMCID: PMC8665840 DOI: 10.1016/j.cmi.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Noam Barda
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
| | - Noa Dagan
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel; The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
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604
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Pageaud S, Pothier C, Rigotti C, Eyraud-Loisel A, Bertoglio JP, Bienvenüe A, Leboisne N, Ponthus N, Gauchon R, Gueyffier F, Vanhems P, Iwaz J, Loisel S, Roy P. Expected Evolution of COVID-19 Epidemic in France for Several Combinations of Vaccination Strategies and Barrier Measures. Vaccines (Basel) 2021; 9:1462. [PMID: 34960207 PMCID: PMC8708137 DOI: 10.3390/vaccines9121462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
The outbreak of the SARS-CoV-2 virus, enhanced by rapid spreads of variants, has caused a major international health crisis, with serious public health and economic consequences. An agent-based model was designed to simulate the evolution of the epidemic in France over 2021 and the first six months of 2022. The study compares the efficiencies of four theoretical vaccination campaigns (over 6, 9, 12, and 18 months), combined with various non-pharmaceutical interventions. In France, with the emergence of the Alpha variant, without vaccination and despite strict barrier measures, more than 600,000 deaths would be observed. An efficient vaccination campaign (i.e., total coverage of the French population) over six months would divide the death toll by 10. A vaccination campaign of 12, instead of 6, months would slightly increase the disease-related mortality (+6%) but require a 77% increase in ICU bed-days. A campaign over 18 months would increase the disease-related mortality by 17% and require a 244% increase in ICU bed-days. Thus, it seems mandatory to vaccinate the highest possible percentage of the population within 12, or better yet, 9 months. The race against the epidemic and virus variants is really a matter of vaccination strategy.
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Affiliation(s)
- Simon Pageaud
- Université de Lyon, F-69000 Lyon, France; (S.P.); (F.G.); (J.I.)
- Université Claude Bernard Lyon 1, F-69100 Villeurbanne, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, F-69100 Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, F-69003 Lyon, France
- Laboratoire de Sciences Actuarielle et Financière (LSAF), Institut de Science Financière et d’Assurances (ISFA), Université Claude Bernard Lyon 1, F-69007 Lyon, France; (A.E.-L.); (A.B.); (N.L.); (R.G.); (S.L.)
- Fondation du Risque, Groupe Louis Bachelier, F-75002 Paris, France
| | - Catherine Pothier
- CNRS UMR 5205, Laboratoire d’InfoRmatique en Image et Systèmes d’Information (LIRIS), F-69621 Villeurbanne, France; (C.P.); (C.R.)
- Institut National des Sciences Appliquées de Lyon (INSA), F-69621 Villeurbanne, France
| | - Christophe Rigotti
- CNRS UMR 5205, Laboratoire d’InfoRmatique en Image et Systèmes d’Information (LIRIS), F-69621 Villeurbanne, France; (C.P.); (C.R.)
- Institut National des Sciences Appliquées de Lyon (INSA), F-69621 Villeurbanne, France
- INRIA Grenoble-Rhône-Alpes, F-38334 Montbonnot, France
| | - Anne Eyraud-Loisel
- Laboratoire de Sciences Actuarielle et Financière (LSAF), Institut de Science Financière et d’Assurances (ISFA), Université Claude Bernard Lyon 1, F-69007 Lyon, France; (A.E.-L.); (A.B.); (N.L.); (R.G.); (S.L.)
| | - Jean-Pierre Bertoglio
- CNRS UMR 5509, Laboratoire de Mécanique des Fluides et d’Acoustique (LMFA), F-69130 Ecully, France;
- École Centrale de Lyon, F-69130 Lyon, France;
| | - Alexis Bienvenüe
- Laboratoire de Sciences Actuarielle et Financière (LSAF), Institut de Science Financière et d’Assurances (ISFA), Université Claude Bernard Lyon 1, F-69007 Lyon, France; (A.E.-L.); (A.B.); (N.L.); (R.G.); (S.L.)
| | - Nicolas Leboisne
- Laboratoire de Sciences Actuarielle et Financière (LSAF), Institut de Science Financière et d’Assurances (ISFA), Université Claude Bernard Lyon 1, F-69007 Lyon, France; (A.E.-L.); (A.B.); (N.L.); (R.G.); (S.L.)
| | - Nicolas Ponthus
- École Centrale de Lyon, F-69130 Lyon, France;
- CNRS UMR 5513, Laboratoire de Tribologie et Dynamique des Systèmes (LTDS), F-69130 Ecully, France
- École Nationale des Travaux Publics de l’État (ENTPE), F-69120 Vaulx-en-Velin, France
| | - Romain Gauchon
- Laboratoire de Sciences Actuarielle et Financière (LSAF), Institut de Science Financière et d’Assurances (ISFA), Université Claude Bernard Lyon 1, F-69007 Lyon, France; (A.E.-L.); (A.B.); (N.L.); (R.G.); (S.L.)
| | - François Gueyffier
- Université de Lyon, F-69000 Lyon, France; (S.P.); (F.G.); (J.I.)
- Université Claude Bernard Lyon 1, F-69100 Villeurbanne, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, F-69100 Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Philippe Vanhems
- Service d’Hygiène, Épidémiologie, Infectiovigilance et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France;
- Centre International de Recherche en Infectiologie (CIRI: Inserm U1111, CNRS UMR 5308, École Nationale Supérieure de Lyon), F-69007 Lyon, France
| | - Jean Iwaz
- Université de Lyon, F-69000 Lyon, France; (S.P.); (F.G.); (J.I.)
- Université Claude Bernard Lyon 1, F-69100 Villeurbanne, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, F-69100 Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Stéphane Loisel
- Laboratoire de Sciences Actuarielle et Financière (LSAF), Institut de Science Financière et d’Assurances (ISFA), Université Claude Bernard Lyon 1, F-69007 Lyon, France; (A.E.-L.); (A.B.); (N.L.); (R.G.); (S.L.)
| | - Pascal Roy
- Université de Lyon, F-69000 Lyon, France; (S.P.); (F.G.); (J.I.)
- Université Claude Bernard Lyon 1, F-69100 Villeurbanne, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, F-69100 Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, F-69003 Lyon, France
- CNRS UMR 5513, Laboratoire de Tribologie et Dynamique des Systèmes (LTDS), F-69130 Ecully, France
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605
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Dagan N, Barda N, Balicer RD. Adverse Effects after BNT162b2 Vaccine and SARS-CoV-2 Infection, According to Age and Sex. N Engl J Med 2021; 385:2299. [PMID: 34706169 PMCID: PMC8609601 DOI: 10.1056/nejmc2115045] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Noa Dagan
- Clalit Research Institute, Tel Aviv, Israel
| | - Noam Barda
- Clalit Research Institute, Tel Aviv, Israel
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606
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Lee TJ, Lu CH, Hsieh SC. Herpes zoster reactivation after mRNA-1273 vaccination in patients with rheumatic diseases. Ann Rheum Dis 2021; 81:595-597. [PMID: 34876461 DOI: 10.1136/annrheumdis-2021-221688] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/26/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Tai-Ju Lee
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Hsun Lu
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Song-Chou Hsieh
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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607
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Witberg G, Barda N, Hoss S, Richter I, Wiessman M, Aviv Y, Grinberg T, Auster O, Dagan N, Balicer RD, Kornowski R. Myocarditis after Covid-19 Vaccination in a Large Health Care Organization. N Engl J Med 2021; 385:2132-2139. [PMID: 34614329 PMCID: PMC8531986 DOI: 10.1056/nejmoa2110737] [Citation(s) in RCA: 399] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Reports have suggested an association between the development of myocarditis and the receipt of messenger RNA (mRNA) vaccines against coronavirus disease 2019 (Covid-19), but the frequency and severity of myocarditis after vaccination have not been extensively explored. METHODS We searched the database of Clalit Health Services, the largest health care organization (HCO) in Israel, for diagnoses of myocarditis in patients who had received at least one dose of the BNT162b2 mRNA vaccine (Pfizer-BioNTech). The diagnosis of myocarditis was adjudicated by cardiologists using the case definition used by the Centers for Disease Control and Prevention. We abstracted the presentation, clinical course, and outcome from the patient's electronic health record. We performed a Kaplan-Meier analysis of the incidence of myocarditis up to 42 days after the first vaccine dose. RESULTS Among more than 2.5 million vaccinated HCO members who were 16 years of age or older, 54 cases met the criteria for myocarditis. The estimated incidence per 100,000 persons who had received at least one dose of vaccine was 2.13 cases (95% confidence interval [CI], 1.56 to 2.70). The highest incidence of myocarditis (10.69 cases per 100,000 persons; 95% CI, 6.93 to 14.46) was reported in male patients between the ages of 16 and 29 years. A total of 76% of cases of myocarditis were described as mild and 22% as intermediate; 1 case was associated with cardiogenic shock. After a median follow-up of 83 days after the onset of myocarditis, 1 patient had been readmitted to the hospital, and 1 had died of an unknown cause after discharge. Of 14 patients who had left ventricular dysfunction on echocardiography during admission, 10 still had such dysfunction at the time of hospital discharge. Of these patients, 5 underwent subsequent testing that revealed normal heart function. CONCLUSIONS Among patients in a large Israeli health care system who had received at least one dose of the BNT162b2 mRNA vaccine, the estimated incidence of myocarditis was 2.13 cases per 100,000 persons; the highest incidence was among male patients between the ages of 16 and 29 years. Most cases of myocarditis were mild or moderate in severity. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.).
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Affiliation(s)
- Guy Witberg
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Noam Barda
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Sara Hoss
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Ilan Richter
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Maya Wiessman
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Yaron Aviv
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Tzlil Grinberg
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Oren Auster
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Noa Dagan
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Ran D Balicer
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Ran Kornowski
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
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608
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Mevorach D, Anis E, Cedar N, Bromberg M, Haas EJ, Nadir E, Olsha-Castell S, Arad D, Hasin T, Levi N, Asleh R, Amir O, Meir K, Cohen D, Dichtiar R, Novick D, Hershkovitz Y, Dagan R, Leitersdorf I, Ben-Ami R, Miskin I, Saliba W, Muhsen K, Levi Y, Green MS, Keinan-Boker L, Alroy-Preis S. Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel. N Engl J Med 2021; 385:2140-2149. [PMID: 34614328 PMCID: PMC8531987 DOI: 10.1056/nejmoa2109730] [Citation(s) in RCA: 396] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Approximately 5.1 million Israelis had been fully immunized against coronavirus disease 2019 (Covid-19) after receiving two doses of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) by May 31, 2021. After early reports of myocarditis during adverse events monitoring, the Israeli Ministry of Health initiated active surveillance. METHODS We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorized the information using the Brighton Collaboration definition. We analyzed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart); by calculating the standardized incidence ratio of the observed-to-expected incidence within 21 days after the first dose and 30 days after the second dose, independent of certainty of diagnosis; and by calculating the rate ratio 30 days after the second dose as compared with unvaccinated persons. RESULTS Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardized incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637. CONCLUSIONS The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.
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Affiliation(s)
- Dror Mevorach
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Emilia Anis
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Noa Cedar
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Michal Bromberg
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Eric J Haas
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Eyal Nadir
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Sharon Olsha-Castell
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Dana Arad
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Tal Hasin
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Nir Levi
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Rabea Asleh
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Offer Amir
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Karen Meir
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Dotan Cohen
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Rita Dichtiar
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Deborah Novick
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Yael Hershkovitz
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Ron Dagan
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Iris Leitersdorf
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Ronen Ben-Ami
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Ian Miskin
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Walid Saliba
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Khitam Muhsen
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Yehezkel Levi
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Manfred S Green
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Lital Keinan-Boker
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Sharon Alroy-Preis
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
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609
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Niculescu AG, Bîrcă AC, Grumezescu AM. New Applications of Lipid and Polymer-Based Nanoparticles for Nucleic Acids Delivery. Pharmaceutics 2021; 13:2053. [PMID: 34959335 PMCID: PMC8708541 DOI: 10.3390/pharmaceutics13122053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023] Open
Abstract
Nucleic acids represent a promising lead for engineering the immune system. However, naked DNA, mRNA, siRNA, and other nucleic acids are prone to enzymatic degradation and face challenges crossing the cell membrane. Therefore, increasing research has been recently focused on developing novel delivery systems that are able to overcome these drawbacks. Particular attention has been drawn to designing lipid and polymer-based nanoparticles that protect nucleic acids and ensure their targeted delivery, controlled release, and enhanced cellular uptake. In this respect, this review aims to present the recent advances in the field, highlighting the possibility of using these nanosystems for therapeutic and prophylactic purposes towards combatting a broad range of infectious, chronic, and genetic disorders.
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Affiliation(s)
- Adelina-Gabriela Niculescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, 011061 Bucharest, Romania; (A.-G.N.); (A.C.B.)
| | - Alexandra Cătălina Bîrcă
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, 011061 Bucharest, Romania; (A.-G.N.); (A.C.B.)
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, 011061 Bucharest, Romania; (A.-G.N.); (A.C.B.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 50044 Bucharest, Romania
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610
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Cummins NW. Yes, It Does. Mayo Clin Proc 2021; 96:2934-2935. [PMID: 34863388 PMCID: PMC8633938 DOI: 10.1016/j.mayocp.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022]
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611
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Jaffal K, Mascitti H. Grippe et Covid-19. Infect Dis Now 2021. [PMCID: PMC8704829 DOI: 10.1016/s2666-9919(21)00555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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612
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Sanchez Tijmes F, Thavendiranathan P, Udell JA, Seidman MA, Hanneman K. Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 Vaccination. Radiol Cardiothorac Imaging 2021; 3:e210252. [PMID: 34934954 PMCID: PMC8686006 DOI: 10.1148/ryct.210252] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/12/2021] [Accepted: 11/04/2021] [Indexed: 12/29/2022]
Abstract
Myocarditis is a nonischemic inflammatory disease of the myocardium that can be triggered by a multitude of events, including viral infection and toxins. Recently, there has been heightened interest in myocarditis given its association with COVID-19 vaccination. Timely identification of myocarditis can affect patient management and prognosis. Therefore, it is crucial for radiologists and cardiac imagers to understand the role of cardiac imaging to establish a diagnosis and inform treatment decisions. Cardiac MRI is the most important noninvasive imaging modality for evaluation of myocarditis, with typical findings of focal or diffuse myocardial edema and myocardial damage, including presence of late gadolinium enhancement. There are currently limited data available to indicate that the pattern of myocardial injury following COVID-19 vaccination is similar to other causes of myocarditis, although the severity of disease may be relatively mild. A description of the role of imaging and typical imaging features will be reviewed here, with a focus on emerging data in the setting of myocarditis after COVID-19 vaccination. Keywords: MRI, Heart, Inflammation © RSNA, 2021.
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Affiliation(s)
- Felipe Sanchez Tijmes
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
| | - Jacob A. Udell
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
| | - Michael A. Seidman
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
| | - Kate Hanneman
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
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613
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Weng Y, Lu D, Bollyky J, Jain V, Desai M, Lindan C, Boothroyd D, Judson T, Doernberg SB, Holubar M, Sample H, Huang B, Maldonado Y, Rutherford GW, Grumbach K. Race-ethnicity and COVID-19 Vaccination Beliefs and Intentions: A Cross-Sectional Study among the General Population in the San Francisco Bay Area. Vaccines (Basel) 2021; 9:1406. [PMID: 34960152 PMCID: PMC8705240 DOI: 10.3390/vaccines9121406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The study was designed to compare intentions to receive COVID-19 vaccination by race-ethnicity, to identify beliefs that may mediate the association between race-ethnicity and intention to receive the vaccine and to identify the demographic factors and beliefs most strongly predictive of intention to receive a vaccine. DESIGN Cross-sectional survey conducted from November 2020 to January 2021, nested within a longitudinal cohort study of the prevalence and incidence of SARS-CoV-2 among a general population-based sample of adults in six San Francisco Bay Area counties (called TrackCOVID). Study Cohort: In total, 3161 participants among the 3935 in the TrackCOVID parent cohort responded. RESULTS Rates of high vaccine willingness were significantly lower among Black (41%), Latinx (55%), Asian (58%), Multi-racial (59%), and Other race (58%) respondents than among White respondents (72%). Black, Latinx, and Asian respondents were significantly more likely than White respondents to endorse lack of trust of government and health agencies as a reason not to get vaccinated. Participants' motivations and concerns about COVID-19 vaccination only partially explained racial-ethnic differences in vaccination willingness. Concerns about a rushed government vaccine approval process and potential bad reactions to the vaccine were the two most important factors predicting vaccination intention. CONCLUSIONS Vaccine outreach campaigns must ensure that the disproportionate toll of COVID-19 on historically marginalized racial-ethnic communities is not compounded by inequities in vaccination. Efforts must emphasize messages that speak to the motivations and concerns of groups suffering most from health inequities to earn their trust to support informed decision making.
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Affiliation(s)
- Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA; (D.L.); (M.D.); (D.B.)
| | - Di Lu
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA; (D.L.); (M.D.); (D.B.)
| | - Jenna Bollyky
- Division of Primary Care & Population Health, School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Vivek Jain
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital, San Francisco, CA 94110, USA;
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA; (D.L.); (M.D.); (D.B.)
| | - Christina Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94134, USA; (C.L.); (G.W.R.)
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA 94134, USA
| | - Derek Boothroyd
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA; (D.L.); (M.D.); (D.B.)
| | - Timothy Judson
- Division of Hospital Medicine, Department of Medicine, University of California,
San Francisco, CA 94117, USA;
| | - Sarah B. Doernberg
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco CA 94117, USA;
| | - Marisa Holubar
- Division of Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Hannah Sample
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco CA 94134, USA;
| | - Beatrice Huang
- Department of Family and Community Medicine, University of California, San Francisco, CA 94110, USA; (B.H.); (K.G.)
| | - Yvonne Maldonado
- Division of Pediatric Infectious Diseases, Stanford University School of Medicine , Stanford, CA 94305, USA;
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94134, USA; (C.L.); (G.W.R.)
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA 94134, USA
| | - Kevin Grumbach
- Department of Family and Community Medicine, University of California, San Francisco, CA 94110, USA; (B.H.); (K.G.)
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614
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Shiravi AA, Ardekani A, Sheikhbahaei E, Heshmat-Ghahdarijani K. Cardiovascular Complications of SARS-CoV-2 Vaccines: An Overview. Cardiol Ther 2021; 11:13-21. [PMID: 34845662 PMCID: PMC8629102 DOI: 10.1007/s40119-021-00248-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 12/19/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the deadly disease known as coronavirus disease 2019 (COVID-19) that has reached pandemic proportions. Currently, there is no definitive treatment for COVID-19, although many vaccines have been developed. The World Health Organization has approved the safety and efficacy of the AstraZeneca/Oxford, Johnson and Johnson/Janssen (JnJ), Moderna, Pfizer/BioNTech, Sinopharm, and Sinovac vaccines so far. The approved formulations of AstraZeneca, JnJ, and Gam-COVID-vac (Sputnik V) contain DNA delivered within non-replicating recombinant adenovirus vector-based systems, while the Pfizer and Moderna vaccines utilize mRNA technology and lipid nanoparticle delivery systems. All of these vaccines encode production of the SARS-CoV-2 spike (S) protein, ultimately triggering immunity in the human body. COVID-19 causes several cardiovascular complications, such as arrhythmias, myocarditis, pericarditis, and venous thromboembolism. SARS-CoV-2 vaccines have been associated with rare, but sometimes fatal, cardiovascular side effects, which are the topics of this review. SARS-CoV-2 vaccines in general may cause thromboembolic events, such as cerebral vein thrombosis, and mRNA-based vaccines in particular may cause myocarditis/pericarditis, with the latter more likely to occur in younger adults after the second vaccination dose. Nevertheless, the advantages of these vaccines for ending the pandemic and/or decreasing the mortality rate outweigh any risk for the rare cardiovascular complications.
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Affiliation(s)
- Amir Abbas Shiravi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Esfahān, Iran
| | - Ali Ardekani
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Sheikhbahaei
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Esfahān, Iran.,Cardiovascular Research Institute, Isfahan Cardiovascular Research Center, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Blvd., Azadi Sq., Esfahān, Iran
| | - Kiyan Heshmat-Ghahdarijani
- Cardiovascular Research Institute, Isfahan Cardiovascular Research Center, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Blvd., Azadi Sq., Esfahān, Iran.
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615
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Lim J, Lee SA, Khil EK, Byeon SJ, Kang HJ, Choi JA. COVID-19 vaccine-related axillary lymphadenopathy in breast cancer patients: Case series with a review of literature. Semin Oncol 2021; 48:283-291. [PMID: 34836672 PMCID: PMC8547943 DOI: 10.1053/j.seminoncol.2021.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 02/08/2023]
Abstract
Purpose Lymphadenopathy (LAP) after COVID-19 vaccination in patients with a diagnosis of cancer has been challenging. We analyzed imaging and clinical features from early cases of axillary LAP in six COVID-19 vaccine recipients with a history of breast cancer. Method Among the patients with a history of breast cancer and recent COVID-19 vaccine administration, six patients who showed isolated axillary LAP were gathered. Radiologic features were reviewed from breast ultrasound, chest computed tomography, and breast magnetic resonance imaging. Clinical and pathological information were obtained for analysis. Results The interval between ultrasound detection of LAP and last COVID-19 vaccine administration ranged from 14 to 28 days (mean 21.67 days). Round shape of the lymph node and irregular cortex were noted in 2 and 0 cases, respectively. Mean maximum cortical thickness, length to width ratio and interval aggravation in maximum cortical thickening were 4.2 mm, 1.34, and 2.81-fold with cut-off value of 3 mm, 1.5, 2.0-fold, respectively. Conclusion We observed axillary LAP ipsilateral to a recent vaccine administration persisting longer than what the Centers for Disease Control and Prevention announced. In our patients, COVID-19 vaccine-related LAP tended to show increased cortical thickness without cortical irregularity. Oncologist as well as radiologist should be familiar with the fact that COVID-19 vaccines, regardless of vaccine type or dosage, can frequently cause ipsilateral axillary LAP, showing some suspicious features more often than others, and can persist longer than anticipated so that both over- and underdiagnosis can be avoided. We report our observations in six patients and provide an exhaustive review of the published literature
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Affiliation(s)
- Jihe Lim
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea.
| | - Seun Ah Lee
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Sun-Ju Byeon
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Hee Joon Kang
- Department of General Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
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616
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Ursini F, Ruscitti P, Raimondo V, De Angelis R, Cacciapaglia F, Pigatto E, Olivo D, Di Cola I, Galluccio F, Francioso F, Foti R, Tavoni A, D'Angelo S, Campochiaro C, Motta F, De Santis M, Bilia S, Bruno C, De Luca G, Visentini M, Ciaffi J, Mancarella L, Brusi V, D'Onghia M, Cuomo G, Fusaro E, Dagna L, Guiducci S, Meliconi R, Iannone F, Iagnocco A, Giacomelli R, Ferri C. Spectrum of short-term inflammatory musculoskeletal manifestations after COVID-19 vaccine administration: a report of 66 cases. Ann Rheum Dis 2021; 81:440-441. [PMID: 34836886 DOI: 10.1136/annrheumdis-2021-221587] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/04/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Francesco Ursini
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Vincenzo Raimondo
- Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy
| | | | - Fabio Cacciapaglia
- Rheumatology Unit, Department of Emergence Medicine and Transplantation, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Erika Pigatto
- Rheumatology Outpatient Clinic, Villa Salus Hospital, Mestre, Italy
| | - Domenico Olivo
- Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy
| | - Ilenia Di Cola
- Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Felice Galluccio
- Department of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Rosario Foti
- Rheumatology Unit, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
| | - Antonio Tavoni
- Department of Clinical Immunology, University of Pisa, Pisa, Italy
| | - Salvatore D'Angelo
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, Regional Hospital San Carlo, Potenza, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele, Milano, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Silvia Bilia
- Department of Clinical Immunology, University of Pisa, Pisa, Italy
| | - Caterina Bruno
- Rheumatology Outpatient Clinic, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele, Milano, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, University of Rome La Sapienza, Rome, Italy
| | - Jacopo Ciaffi
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luana Mancarella
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Brusi
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Martina D'Onghia
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanna Cuomo
- Clinical Immunology Outpatient Clinic, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele, Milano, Italy
| | - Serena Guiducci
- Department of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Riccardo Meliconi
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergence Medicine and Transplantation (DETO), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, MFRU and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Roberto Giacomelli
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Campus Bio-Medico University Hospital, Roma, Italy
| | - Clodoveo Ferri
- Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy .,Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
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617
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Abičić A, Adamec I, Habek M. Miller Fisher syndrome following Pfizer COVID-19 vaccine. Neurol Sci 2021; 43:1495-1497. [PMID: 34817727 PMCID: PMC8611397 DOI: 10.1007/s10072-021-05776-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022]
Abstract
Introduction Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome characterized by ataxia, areflexia, and ophthalmoplegia. We present a case of MFS following Pfizer COVID-19 vaccine. Case presentation A previously healthy 24-year-old female presented with binocular horizontal diplopia 18 days after receiving the first dose of Pfizer COVID-19 vaccine (Comirnaty®). Anti-ganglioside testing revealed positive anti-GQ1b antibodies. Intravenous immunoglobulins were administered, in a dose of 2 g per kg of body weight over 5 days. On a follow-up exam 3 weeks after the treatment, clinical improvement was noted with normal bulbomotor examination. Conclusion Patients with acute ophthalmoplegia occurring after COVID-19 vaccination should be screened for the presence of anti-GQ1b antibody. If the antibody is present, intravenous immunoglobulin should be administered as it may hasten clinical improvement. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05776-0.
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Affiliation(s)
| | - Ivan Adamec
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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618
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Abstract
Introduction Inflammatory conditions affecting the heart and surrounding tissues have been recently reported following mRNA vaccination. Evaluating trends in the epidemiology of these events and possible mechanisms related to vaccination will enhance vaccine safety surveillance and inform best practices for future vaccine campaigns. Areas covered Epidemiology of the burden of vaccine-associated myocarditis are reviewed. Key summaries of available data from public health advisory bodies and vaccine safety surveillance databases are critically reviewed. The possible biological pathways for vaccine-associated heart inflammations are introduced. A critical synthesis of available information to inform vaccine recommendations and best practices is provided. The citations were selected by the authors based on PubMed searches of the literature, national vaccine safety surveillance databases and summaries from national public health bodies. Expert opinion Myocarditis may be associated with vaccination, through several biological mechanisms. Studies have shown that live viral vaccinations can act as a trigger for hypersensitivity inflammatory reactions, but further work is required to examine how the mRNA formulation may induce these autoimmune responses. Given that the risk of these adverse events is low, and the benefit of protection against disease is so great, the receipt of mRNA vaccines is recommended.
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Affiliation(s)
- Charlotte Switzer
- Department of Health Research Evidence and Impact, McMaster University, Ontario, Canada
| | - Mark Loeb
- Department of Health Research Evidence and Impact, McMaster University, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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619
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Autoantibody Release in Children after Corona Virus mRNA Vaccination: A Risk Factor of Multisystem Inflammatory Syndrome? Vaccines (Basel) 2021; 9:vaccines9111353. [PMID: 34835284 PMCID: PMC8618727 DOI: 10.3390/vaccines9111353] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 01/23/2023] Open
Abstract
Multisystem inflammatory syndrome (MIS) is a new systemic inflammatory acute onset disease that mainly affects children (MIS-C) and, at a lesser frequency, adults (MIS-A); it typically occurs 3–6 weeks after acute SARS-CoV infection. It has been postulated and shown in adults that MIS may occur after SARS-CoV-2 vaccination (MIS-V). Our current case is one of the first published cases with a multisystem inflammatory syndrome in an 18-year-old adolescent after the SARS-CoV-2 vaccine from Pfizer/BionTech (BNT162b2), who fulfills the published level 1 criteria for a definitive disease: age < 21 years, fever > 3 consecutive days, pericardial effusion, elevated CRP/NT-BNP/Troponin T/D-dimeres, cardiac involvement, and positive SARS-CoV-2 antibodies. The disease starts 10 weeks after the second vaccination, with a fever (up to 40 °C) and was treated with amoxicillin for suspected pneumonia. The SARS CoV-2-PCR and several antigen tests were negative. With an ongoing fever, he was hospitalized 14 days later. A pericardial effusion (10 mm) was diagnosed by echocardiography. The C-reactive protein (174 mg/L), NT-BNP (280 pg/mL), and Troponin T (28 pg/mL) values were elevated. Due to highly elevated D-dimeres (>35,000 μg/L), a pulmonary embolism was excluded by thoracal computer tomography. If the boy did not improve with intravenous antibiotics, he was treated with intravenous immunoglobulins; however, the therapy was discontinued after 230 mg/kg if he developed high fever and hypotension. A further specialized clinic treated him with colchicine and ibuprofen. The MIS-V was discovered late, 4 months after the onset of the disease. As recently shown in four children with MIS-C after SARS-CoV-2 infection and a girl with Hashimoto thyroiditis after BNT162b2 vaccination, we found elevated functional autoantibodies against G-protein-coupled receptors that may be important for pathophysiology but are not conclusive for the diagnosis of MIS-C. Conclusion: We are aware that a misattribution of MIS-V as a severe complication of coronavirus vaccination can lead to increased vaccine hesitancy and blunt the global COVID-19 vaccination drive. However, the pediatric population is at a higher risk for MIS-C and a very low risk for COVID-19 mortality. The publication of such cases is very important to make doctors aware of this complication of the vaccination, so that therapy with intravenous immunoglobulins can be initiated at an early stage.
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620
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Knowledge about, attitude and acceptance towards, and predictors of intention to receive the COVID-19 vaccine among cancer patients in Eastern China: A cross-sectional survey. JOURNAL OF INTEGRATIVE MEDICINE 2021; 20:34-44. [PMID: 34774463 PMCID: PMC8559872 DOI: 10.1016/j.joim.2021.10.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has had a serious impact on health all over the world. Cancer patient, whose immunity is often compromised, faces a huge challenge. Currently, some COVID-19 vaccines are being developed and applied on general population; however, whether cancer patients should take COVID-19 vaccine remains unknown. Our study aimed to explore the knowledge, attitude, acceptance, and predictors of intention to receive the COVID-19 vaccine among cancer patients in Eastern China. METHODS A cross-sectional study was conducted in Eastern China from June 17th to September 3rd, 2021. Patients were selected using a convenience sampling method. A self-report questionnaire was developed to assess knowledge about the COVID-19 vaccine, attitude towards the vaccine and acceptance of the vaccine; following a review of similar studies previously published in the scientific literature, multivariate logistic regression analysis was used to determine the predictors associated with COVID-19 vaccine acceptance. RESULTS A total of 2158 cancer patients were enrolled in this study. The rate of vaccine hesitancy was 24.05% (519/2158); further, among the participants of vaccine acceptance, 767 had taken COVID-19 vaccine (35.54%), and 872 were willing to get vaccinated (40.01%). A total of 24 variables including demographic characteristics, clinical status of cancer, impact of COVID-19 pandemic on study participants, patients' knowledge about the COVID-19 vaccine, and attitude towards the vaccine, had significant differences between the "vaccine hesitancy" population and "vaccine acceptance" population. Multivariate logistic regression analysis indicated that parameters including alcohol consumption (odds ratio [OR] = 1.849; 95% confidence interval [CI]: 1.375-2.488; P-reference [P-Ref] < 0.001 vs non-drinkers), income impacted by COVID-19 pandemic (OR = 1.930, 2.037 and 2.688 for mild, moderate, and severe impact, respectively; all P-Ref < 0.01 vs no impact), knowledge of how the vaccine was developed (OR = 1.616; 95% CI: 1.126-2.318; P-Ref = 0.009 vs unknown), believing in the safety of the vaccine (OR = 1.502; 95% CI: 1.024-2.203; P-Ref = 0.038 vs denying the safety of vaccine), willingness to pay for the vaccine (OR = 3.042; 95% CI: 2.376-3.894; P-Ref < 0.001 vs unwilling), and willingness to recommend families and friends to get vaccinated (OR = 2.744; 95% CI: 1.759-4.280; P-Ref < 0.001 vs do not recommend) were contributors to vaccine acceptance. While such as being retired (OR = 0.586; 95% CI: 0.438-0.784; P-Ref < 0.001 vs unemployed), undergoing multiple therapies of cancer (OR = 0.408; 95% CI: 0.221-0.753; P-Ref = 0.004 vs no ongoing treatment), and worrying that the vaccine might deteriorate the prognosis of cancer (OR = 0.393; 95% CI: 0.307-0.504; P-Ref < 0.001 vs might not) were contributors to vaccine hesitancy. CONCLUSION This study provided preliminary estimates of the rates of vaccine acceptance and vaccine hesitancy among cancer patients in Eastern China. The intention to receive the COVID-19 vaccine was impacted by factors such as patient occupation, alcohol consumption, and some parts of knowledge about and attitude towards COVID-19 vaccine. It is recommended to develop individualized vaccination plans that meet the healthcare needs of cancer patients.
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621
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Multisystem Inflammation and Organ Dysfunction After BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccination. Crit Care Explor 2021; 3:e0578. [PMID: 34765984 PMCID: PMC8575416 DOI: 10.1097/cce.0000000000000578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Supplemental Digital Content is available in the text. The U.S. Food and Drug Administration has to date granted approval or emergency use authorization to three vaccines against severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019. In clinical trials and real-use observational studies, the Pfizer-BioNTech BNT162b2 messenger RNA coronavirus disease 2019 vaccine, as well as the Moderna mRNA-1273 messenger RNA coronavirus disease 2019 vaccine, have demonstrated high efficacy and few adverse events.
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622
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Uaprasert N, Panrong K, Rojnuckarin P, Chiasakul T. Thromboembolic and hemorrhagic risks after vaccination against SARS-CoV-2: a systematic review and meta-analysis of randomized controlled trials. Thromb J 2021; 19:86. [PMID: 34774069 PMCID: PMC8590131 DOI: 10.1186/s12959-021-00340-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/27/2021] [Indexed: 01/12/2023] Open
Abstract
Background Thromboembolic and bleeding events after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are major public concerns leading to vaccine hesitancy. Due to low incidence, an individual randomized controlled trial (RCT) is underpowered to determine whether SARS-CoV-2 vaccines increase the risks of thromboembolism and hemorrhage. Methods We performed a literature search using PubMed, EMBASE, Cochrane, medRxiv databases, and reference lists of relevant articles to identify RCTs that reported thromboembolic, hemorrhagic events, and thromboembolism/hemorrhage-related death after SARS-CoV-2 vaccination. The primary aim of this systematic review and meta-analysis was to estimate the pooled thromboembolic risk related to SARS-CoV-2 vaccines compared to placebo. The secondary outcomes included estimating the risks of arterial thromboembolism (ATE), venous thromboembolisms (VTE), hemorrhage, thrombocytopenia, and thromboembolism/hemorrhage-related death. Results Eight RCTs of 4 vaccine platforms comprised of 195,196 participants were retrieved. SARS-CoV-2 vaccines were not associated with an increased risk of overall thromboembolism (risk ratio [RR], 1.14; 95% CI [confidence interval], 0.61–2.14; I2 = 35%), ATE (RR, 0.97; 95% CI, 0.46–2.06; I2 = 21%), VTE (RR, 1.47; 95% CI, 0.72–2.99; I2 = 0%), hemorrhage (RR, 0.97; 95% CI, 0.35–2.68; I2 = 0), and thromboembolism/hemorrhage-related death (RR, 0.53; 95% CI, 0.16–1.79; I2 = 0). Compared to the baseline estimated risk of these outcomes in participants administered placebos, the risk differences with vaccines were very small and not statistically significant. These findings were consistent in the subgroup analysis across 4 vaccine platforms. Conclusion Vaccines against SARS-CoV-2 are not associated with an increased risk of thromboembolism, hemorrhage, and thromboembolism/hemorrhage-related death. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00340-4.
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Affiliation(s)
- Noppacharn Uaprasert
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. .,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| | - Krissana Panrong
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thita Chiasakul
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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623
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Kounis NG, Koniari I, Mplani V, Velissaris D, Tsigkas G. The pathogenesis of potential myocarditis induced by COVID-19 vaccine. Am J Emerg Med 2021; 56:382-383. [PMID: 34799207 PMCID: PMC8585566 DOI: 10.1016/j.ajem.2021.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece.
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Virginia Mplani
- Intensive care Unit, University of Patras Medical School, Patras, Greece
| | | | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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624
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Al-Karmalawy AA, Soltane R, Abo Elmaaty A, Tantawy MA, Antar SA, Yahya G, Chrouda A, Pashameah RA, Mustafa M, Abu Mraheil M, Mostafa A. Coronavirus Disease (COVID-19) Control between Drug Repurposing and Vaccination: A Comprehensive Overview. Vaccines (Basel) 2021; 9:1317. [PMID: 34835248 PMCID: PMC8622998 DOI: 10.3390/vaccines9111317] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
Respiratory viruses represent a major public health concern, as they are highly mutated, resulting in new strains emerging with high pathogenicity. Currently, the world is suffering from the newly evolving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This virus is the cause of coronavirus disease 2019 (COVID-19), a mild-to-severe respiratory tract infection with frequent ability to give rise to fatal pneumonia in humans. The overwhelming outbreak of SARS-CoV-2 continues to unfold all over the world, urging scientists to put an end to this global pandemic through biological and pharmaceutical interventions. Currently, there is no specific treatment option that is capable of COVID-19 pandemic eradication, so several repurposed drugs and newly conditionally approved vaccines are in use and heavily applied to control the COVID-19 pandemic. The emergence of new variants of the virus that partially or totally escape from the immune response elicited by the approved vaccines requires continuous monitoring of the emerging variants to update the content of the developed vaccines or modify them totally to match the new variants. Herein, we discuss the potential therapeutic and prophylactic interventions including repurposed drugs and the newly developed/approved vaccines, highlighting the impact of virus evolution on the immune evasion of the virus from currently licensed vaccines for COVID-19.
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Affiliation(s)
- Ahmed A Al-Karmalawy
- Department of Pharmaceutical Medicinal Chemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta 34518, Egypt
| | - Raya Soltane
- Department of Basic Sciences, Adham University College, Umm Al-Qura University, Makkah 21955, Saudi Arabia
- Department of Biology, Faculty of Sciences, Tunis El Manar University, Tunis 1068, Tunisia
| | - Ayman Abo Elmaaty
- Department of Medicinal Chemistry, Faculty of Pharmacy, Port Said University, Port Said 42526, Egypt
| | - Mohamed A Tantawy
- Hormones Department, Medical Research and Clinical Studies Research Institute, National Research Centre, Dokki 12622, Egypt
- Stem Cells Laboratory, Center of Excellence for Advanced Sciences, National Research Centre, Dokki 12622, Egypt
| | - Samar A Antar
- Department of Pharmacology, Faculty of Pharmacy, Horus University-Egypt, New Damietta 34518, Egypt
| | - Galal Yahya
- Microbiology and Immunology Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Amani Chrouda
- Department of Chemistry, College of Science Al-Zulfi, Majmaah University, Al-Majmaah 11932, Saudi Arabia
- Laboratory of Interfaces and Advanced Materials, Faculty of Sciences, Monastir University, Monastir 5000, Tunisia
- Institute of Analytical Sciences, UMR CNRS-UCBL-ENS 5280, 5 Rue la Doua, CEDEX, 69100 Villeurbanne, France
| | - Rami Adel Pashameah
- Department of Basic Sciences, Adham University College, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Muhamad Mustafa
- Department of Medicinal Chemistry, Deraya University, Minia 61111, Egypt
| | - Mobarak Abu Mraheil
- German Center for Infection Research (DZIF), Institute of Medical Microbiology, Justus-Liebig University, 35392 Giessen, Germany
| | - Ahmed Mostafa
- German Center for Infection Research (DZIF), Institute of Medical Microbiology, Justus-Liebig University, 35392 Giessen, Germany
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki 12622, Egypt
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625
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Side Effects of COVID-19 Pfizer-BioNTech mRNA Vaccine in Children Aged 12-18 Years in Saudi Arabia. Vaccines (Basel) 2021; 9:vaccines9111297. [PMID: 34835228 PMCID: PMC8621258 DOI: 10.3390/vaccines9111297] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Massive vaccination campaigns have been undertaken globally to combat the spread of the Coronavirus Disease 2019 (COVID-19). While most COVID-19 vaccines have shown excellent efficacy and safety profiles in clinical studies, real-world monitoring of vaccine safety is still important. In this study, we aimed to investigate the early side effects of Pfizer-BioNTech (BNT162b2) mRNA vaccine in children between 12–18 years old in Saudi Arabia. Method: To investigate the side effects in children in this age range following the administration of either one or two doses of Pfizer-BioNTech (BNT162b2) mRNA vaccine, we conducted a retrospective, cross-sectional study using a self-administered online survey. General and demographic data were collected, and vaccine-associated side effects following vaccination were evaluated. Results: The study recruited a total of 965 eligible participants. Overall, 571 (60%) of the study participants reported at least one side effect following Pfizer-BioNTech (BNT162b2) mRNA vaccination. The most frequently reported side effects were pain or redness at the site of injection (90%), fatigue (67%), fever (59%), headache (55%), nausea or vomiting (21%), and chest pain and shortness of breath (20%). Joint or bone pain were reported less frequently among our participants (2%). Our data showed that more female participants reported side effects compared to male participants, with 52% and 48%, respectively. Side effects were more common after the second dose compared to the first dose in our study cohort. Conclusions: While 60% of the children (12–18 years old) who received Pfizer-BioNTech (BNT162b2) mRNA vaccine reported side effects, our data showed that these side effects were not different from those that were reported in the clinical trials which lasted only for a few days. Side effects were more common after the second dose. Larger epidemiological and molecular studies are needed to evaluate the safety and the effectiveness of COVID-19 vaccine in protection of children against SARS-CoV-2 reinfections.
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626
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Nioi M, d’Aloja E, Fossarello M, Napoli PE. Dual Corneal-Graft Rejection after mRNA Vaccine (BNT162b2) for COVID-19 during the First Six Months of Follow-Up: Case Report, State of the Art and Ethical Concerns. Vaccines (Basel) 2021; 9:1274. [PMID: 34835205 PMCID: PMC8620000 DOI: 10.3390/vaccines9111274] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023] Open
Abstract
Present mass vaccination against Coronavirus Disease-19 (COVID-19) is the most widely used health policy and the most promising approach to curb the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic globally. However, new side effects are emerging from the mass vaccination not described during the experimental stages. In the present study, we discuss a case of acute corneal graft rejection, which has occurred 25 years after transplantation and 13 days after the administration of the BNT162b2 vaccine (Comirnaty, BioNTech/Pfizer), which was followed-up for a period of six months. In this period, the corneal inflammation appeared twice but was successfully managed with topical therapy and supplementation of Vitamin D. A risk of corneal graft rejection must be included in the list of potential vaccine complications, in order to inform the transplanted patient to undergo a preliminary and a follow-up ocular examination, and eventually to include corneal graft in the list of contraindications to vaccination.
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Affiliation(s)
- Matteo Nioi
- Forensic Medicine Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09040 Cagliari, Italy;
| | - Ernesto d’Aloja
- Forensic Medicine Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09040 Cagliari, Italy;
| | - Maurizio Fossarello
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy;
| | - Pietro Emanuele Napoli
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy;
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627
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Varicella zoster virus-induced neurological disease after COVID-19 vaccination: a retrospective monocentric study. J Neurol 2021; 269:1751-1757. [PMID: 34724572 PMCID: PMC8558363 DOI: 10.1007/s00415-021-10849-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 10/27/2022]
Abstract
The description of every possible adverse effect or event related to vaccines is mandatory during the ongoing worldwide COVID-19 vaccination program. Although cases of cutaneous varicella zoster virus (VZV) reactivation after COVID-19 vaccination have been increasingly reported in literature and database sets, a description of VZV-induced neurological disease (VZV-ND) is still lacking. In the present study, we retrospectively evaluated patients admitted to our clinic and diagnosed with VZV-ND during the COVID-19 vaccination campaign (January-April 2021) and in the same months in the previous two years. We identified three patients with VZV-ND after COVID-19 vaccination and 19 unvaccinated VZV-ND cases as controls. In the case-control analysis, the two groups showed no difference in clinical features, results of diagnostic investigations, and outcome. Thus, VZV reactivation with neurological involvement might be a possible event triggered by COVID-19 vaccination, but the benefit following COVID-19 vaccination overcomes significantly the potential risk associated with a VZV reactivation.
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628
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Dorfman AL, Murthy VL. Web Exclusive. Annals for Hospitalists Inpatient Notes - Myocarditis After Vaccination for SARS-CoV-2. Ann Intern Med 2021; 174:HO2-HO3. [PMID: 34781728 DOI: 10.7326/m21-3871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Adam L Dorfman
- University of Michigan, Ann Arbor, Michigan (A.L.D., V.L.M.)
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629
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Der Herbst ist da und die dritte Impfung kommt. HAUTNAH 2021. [PMCID: PMC8570061 DOI: 10.1007/s12326-021-00484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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630
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Fukuoka H, Fukuoka N, Kibe T, Tubbs RS, Iwanaga J. Oral Herpes Zoster Infection Following COVID-19 Vaccination: A Report of Five Cases. Cureus 2021; 13:e19433. [PMID: 34909338 PMCID: PMC8663753 DOI: 10.7759/cureus.19433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 02/01/2023] Open
Abstract
Recently, two cases of oral herpes zoster (HZ) following COVID-19 vaccines were reported. It was suggested that COVID-19 vaccine-related oral HZ cases might be missed or misdiagnosed as stomatitis or isolated oral herpes. In this report, five cases of oral HZ following COVID-19 vaccinations are presented. Four cases were observed on the hard palate (V2), and one case was found on the mandible (V3). Four patients did not receive any treatment for their oral HZ, but one patient also had skin reactions on her right orbit and ear and was thus treated with an antiviral drug. As these cases were seen during such a short period of time and in one practice, the relationship with the COVID-19 vaccination appears to be related.
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Affiliation(s)
| | | | - Toshiro Kibe
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Surgery, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
- Department of Anatomical Sciences, St. George's University, St. George's, GRD
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, USA
- Department of Anatomy, Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, JPN
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631
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Gurdasani D, Bhatt S, Costello A, Denaxas S, Flaxman S, Greenhalgh T, Griffin S, Hyde Z, Katzourakis A, McKee M, Michie S, Ratmann O, Reicher S, Scally G, Tomlinson C, Yates C, Ziauddeen H, Pagel C. Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis. J R Soc Med 2021; 114:513-524. [PMID: 34723680 PMCID: PMC8649477 DOI: 10.1177/01410768211052589] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To offer a quantitative risk-benefit analysis of two doses of SARS-CoV-2 vaccination among adolescents in England. SETTING England. DESIGN Following the risk-benefit analysis methodology carried out by the US Centers for Disease Control, we calculated historical rates of hospital admission, Intensive Care Unit admission and death for ascertained SARS-CoV-2 cases in children aged 12-17 in England. We then used these rates alongside a range of estimates for incidence of long COVID, vaccine efficacy and vaccine-induced myocarditis, to estimate hospital and Intensive Care Unit admissions, deaths and cases of long COVID over a period of 16 weeks under assumptions of high and low case incidence. PARTICIPANTS All 12-17 year olds with a record of confirmed SARS-CoV-2 infection in England between 1 July 2020 and 31 March 2021 using national linked electronic health records, accessed through the British Heart Foundation Data Science Centre. MAIN OUTCOME MEASURES Hospitalisations, Intensive Care Unit admissions, deaths and cases of long COVID averted by vaccinating all 12-17 year olds in England over a 16-week period under different estimates of future case incidence. RESULTS At high future case incidence of 1000/100,000 population/week over 16 weeks, vaccination could avert 4430 hospital admissions and 36 deaths over 16 weeks. At the low incidence of 50/100,000/week, vaccination could avert 70 hospital admissions and two deaths over 16 weeks. The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Benefit of vaccination exists at any case rate for the outcomes of death and long COVID, since neither have been associated with vaccination to date. CONCLUSIONS Given the current (as at 15 September 2021) high case rates (680/100,000 population/week in 10-19 year olds) in England, our findings support vaccination of adolescents against SARS-CoV2.
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Affiliation(s)
| | | | | | | | | | | | | | - Zoë Hyde
- University of Western Australia,
Crawley WA 6009, Australia
| | | | - Martin McKee
- London School of Hygiene and Tropical
Medicine, London WC1E 7HT, UK
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632
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Finsterer J. First Reported Case of Reversible Cerebral Vasoconstriction Syndrome After a SARS-CoV-2 Vaccine. Cureus 2021; 13:e19987. [PMID: 34987889 PMCID: PMC8716124 DOI: 10.7759/cureus.19987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/31/2022] Open
Abstract
This is the first report of reversible cerebral vasoconstriction syndrome (RCVS) as a complication of a SARS-CoV-2 vaccination. A 38-year-old female developed visual impairment due to scotomas and thunderclap headache 18 days after the second shot of the Moderna SARS-CoV-2 vaccine. Multimodal cerebral MRI revealed an acute cortical ischemic lesion in the territory of the right posterior cerebral artery (PCA) on T2-weighted images, diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps and absence of the PCA on magnetic resonance angiography (MRA). RCVS was diagnosed as the cause of the ischemic lesion. RCVS partially resolved upon nimodipine and anti-seizure drugs within nine days. In conclusion, this case shows that a SARS-CoV-2 vaccination can be followed by RCVS, manifesting as headache, stroke, and epileptiform discharges, and responding favorably to nimodipine.
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633
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Istampoulouoglou I, Dimitriou G, Späni S, Christ A, Zimmermanns B, Koechlin S, Stoeckmann O, Winterhalder C, Marono D, Toma V, Leuppi-Taegtmeyer AB. Myocarditis and pericarditis in association with COVID-19 mRNA-vaccination: cases from a regional pharmacovigilance centre. Glob Cardiol Sci Pract 2021; 2021:e202118. [PMID: 34805376 PMCID: PMC8587334 DOI: 10.21542/gcsp.2021.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022] Open
Abstract
In this article we summarize suspected adverse events following immunization (AEFI) of pericarditis, myocarditis and perimyocarditis that were reported by our regional pharmacovigilance centre after COVID-19 mRNA-vaccination and discuss their association with these vaccines. Seventeen cases were reported between March and July 2021. Of these, nine had perimyocarditis, five myocarditis and three pericarditis. Twelve patients were male (71%). The median age was 38 years (range 17–88). The most commonly observed presenting symptom was acute chest pain (65%). While 47% of the patients were previously healthy, 53% had at least one pre-existing comorbidity, with hypertension being the most prevalent (24%). The European Society of Cardiology diagnostic criteria for the reported AEFIs were fulfilled in twelve cases (71%). The AEFIs occurred after the first vaccine dose in six cases (35%), after the second vaccine dose in ten cases (59%) and after both doses in one case (6%). The median latency of all AEFIs taken together was 14 days (range 1–28) after the first vaccination and 3 days (range 1–17) after the second one. All patients except one were hospitalized (94%) with a median length of stay of 7.5 days (range 3–13). The majority of patients (n = 11, 65%) did not experience any complications, and 13 (77%) of the patients had recovered or were recovering at the time of discharge. In 16 of the 17 cases (94%), the association between the AEFI and mRNA-vaccination was considered possible by the pharmacovigilance centre.
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Affiliation(s)
- Ioanna Istampoulouoglou
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Switzerland
| | | | - Selina Späni
- Hospital Pharmacy, Cantonal Hospital Basel Landschaft, Liestal, Switzerland
| | - Andreas Christ
- Intensive Care Unit, Cantonal Hospital Basel Landschaft, Liestal, Switzerland
| | - Barbara Zimmermanns
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Switzerland.,Regional Pharmacovigilance Centre Basel, University Hospital Basel, Basel, Switzerland
| | - Sarah Koechlin
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Switzerland.,Regional Pharmacovigilance Centre Basel, University Hospital Basel, Basel, Switzerland
| | - Oliver Stoeckmann
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Switzerland.,Regional Pharmacovigilance Centre Basel, University Hospital Basel, Basel, Switzerland
| | | | - David Marono
- Medical Outpatient Department, University Hospital Basel, Basel, Switzerland
| | - Valeriu Toma
- Swissmedic, Swiss Agency for Therapeutic Products, Bern, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Switzerland.,Regional Pharmacovigilance Centre Basel, University Hospital Basel, Basel, Switzerland
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634
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Wu HHL, Kalra PA, Chinnadurai R. New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review. Vaccines (Basel) 2021; 9:1252. [PMID: 34835183 PMCID: PMC8622870 DOI: 10.3390/vaccines9111252] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/17/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney histopathology have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism that this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney histopathology following COVID-19 vaccination. METHODS A systematic literature search of published data up until 31 August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney histopathology in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language were selected for review. RESULTS Forty-eight cases from thirty-six articles were included in the qualitative synthesis of this systematic review. Minimal change disease (19 cases) was the most frequent pathology observed, followed by IgA nephropathy (14 cases) and vasculitis (10 cases). Other cases include relapse of membranous nephropathy, acute rejection of kidney transplant, relapse of IgG4 nephritis, new-onset renal thrombotic microangiopathy, and scleroderma renal crisis following COVID-19 vaccination. There was no mortality reported in any of the included cases. Patients in all but one case largely recovered and did not require long-term renal replacement therapy. CONCLUSION This systematic review provides insight into the relationship between various kidney pathologies that may have followed COVID-19 vaccination. Despite these reported cases, the protective benefits offered by COVID-19 vaccination far outweigh its risks. It would be recommended to consider early biopsy to identify histopathology amongst patients presenting with symptoms relating to new-onset kidney disease following vaccination and to monitor symptoms for those with potential relapsed disease.
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Affiliation(s)
- Henry H. L. Wu
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (P.A.K.); (R.C.)
| | - Philip A. Kalra
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (P.A.K.); (R.C.)
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance Foundation Trust, Salford M6 8HD, UK
| | - Rajkumar Chinnadurai
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (P.A.K.); (R.C.)
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance Foundation Trust, Salford M6 8HD, UK
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635
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Cari L, Alhosseini MN, Fiore P, Pierno S, Pacor S, Bergamo A, Sava G, Nocentini G. Cardiovascular, neurological, and pulmonary events following vaccination with the BNT162b2, ChAdOx1 nCoV-19, and Ad26.COV2.S vaccines: An analysis of European data. J Autoimmun 2021; 125:102742. [PMID: 34710832 PMCID: PMC8547775 DOI: 10.1016/j.jaut.2021.102742] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 12/21/2022]
Abstract
The ChAdOx1 nCoV-19 (ChA) (AstraZeneca) and Ad26.COV2.S (AD26) (Janssen) vaccines are virus-based coronavirus disease 2019 (COVID-19) vaccines used worldwide. In spring 2021, venous blood clots and thrombocytopenia were described in some vaccine recipients. We evaluated the frequency of severe adverse events (SAEs) documented in the EudraVigilance European database in young adult (18–64 years old) and older (≥65 years old) vaccine recipients up to 23 June 2021 and related them to coagulation disorders and arterial, cardiac, and nervous system events. Comparison between the frequency of SAEs and SAE-related deaths in ChA and AD26 vs. BNT162b2 COVID-19 (BNT) (Pfizer/BioNTech) vaccine recipients demonstrated: 1) ChA and AD26 recipients than BNT recipients had higher frequencies of not only SAEs caused by venous blood clots and hemorrhage, but also thromboembolic disease and arterial events, including myocardial infarction and stroke; 2) a corresponding higher frequency of SAE-related deaths. The frequency was higher in both young adults and older adults. Comparison between the frequency of SAEs and SAE-related deaths in AD26 vs. ChA recipients demonstrated in AD26 recipients: 1) lower frequency of thrombocytopenia; 2) lower frequency of SAEs in young adult recipients; 3) higher frequency of SAEs in older recipients. Interestingly, most of the venous thrombotic SAEs associated with ChA and AD26 vaccines were not associated with thrombocytopenia, suggesting that TTS (thrombosis with thrombocytopenia syndrome) is not the only type of thrombosis observed following virus-based vaccines. In conclusion, both virus-based COVID-19 vaccines show more SAEs than BNT, but the frequency of the SAE type in the different age groups differs, suggesting that the mechanisms responsible of SAEs overlap only partly.
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Affiliation(s)
- Luigi Cari
- University of Perugia, Department of Medicine and Surgery, Section of Pharmacology, 06129, Perugia, Italy
| | - Mahdieh Naghavi Alhosseini
- University of Perugia, Department of Medicine and Surgery, Section of Pharmacology, 06129, Perugia, Italy
| | - Paolo Fiore
- University of Perugia, Department of Medicine and Surgery, Section of Pharmacology, 06129, Perugia, Italy
| | - Sabata Pierno
- University of Bari, Department of Pharmacy-Drug Sciences, Section of Pharmacology, 70125, Bari, Italy
| | - Sabrina Pacor
- University of Trieste, Department of Life Sciences, 34127, Trieste, Italy
| | - Alberta Bergamo
- University of Trieste, Department of Life Sciences, 34127, Trieste, Italy
| | - Gianni Sava
- University of Trieste, Department of Life Sciences, 34127, Trieste, Italy
| | - Giuseppe Nocentini
- University of Perugia, Department of Medicine and Surgery, Section of Pharmacology, 06129, Perugia, Italy.
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636
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Blumenthal KG, Phadke NA, Bates DW. Safety Surveillance of COVID-19 mRNA Vaccines Through the Vaccine Safety Datalink. JAMA 2021; 326:1375-1377. [PMID: 34477809 DOI: 10.1001/jama.2021.14808] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute, Massachusetts General Hospital, Boston
| | - Neelam A Phadke
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - David W Bates
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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637
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638
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Shenai MB, Rahme R, Noorchashm H. Equivalency of Protection From Natural Immunity in COVID-19 Recovered Versus Fully Vaccinated Persons: A Systematic Review and Pooled Analysis. Cureus 2021; 13:e19102. [PMID: 34868754 PMCID: PMC8627252 DOI: 10.7759/cureus.19102] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 12/28/2022] Open
Abstract
We present a systematic review and pooled analysis of clinical studies to date that (1) specifically compare the protection of natural immunity in the COVID-recovered versus the efficacy of complete vaccination in the COVID-naive, and (2) the added benefit of vaccination in the COVID-recovered, for prevention of subsequent SARS-CoV-2 infection. Using the PRISMA 2020 guidance, we first conducted a systematic review of available literature on PubMed, MedRxIV and FDA briefings to identify clinical studies either comparing COVID vaccination to natural immunity or delineating the benefit of vaccination in recovered individuals. After assessing eligibility, studies were qualitatively appraised and formally graded using the NOS system for observational, case-control and RCTs. Incidence rates were tabulated for the following groups: never infected (NI) and unvaccinated (UV), NI and vaccinated (V), previously infected (PI) and UV, PI and V. Pooling were performed by grouping the RCTs and observational studies separately, and then all studies in total. Risk ratios and differences are reported for individual studies and pooled groups, in 1) NPI/V vs PI/UV and 2) PI/UV vs PI/V analysis. In addition, the number needed to treat (NNT) analysis was performed for vaccination in naïve and previously infected cohorts. Nine clinical studies were identified, including three randomized controlled studies, four retrospective observational cohorts, one prospective observational cohort, and a case-control study. The NOS quality appraisals of these articles ranged from four to nine (out of nine stars). All of the included studies found at least statistical equivalence between the protection of full vaccination and natural immunity; and, three studies found superiority of natural immunity. Four observational studies found a statistically significant incremental benefit to vaccination in the COVID-recovered individuals. In a total pooled analysis, the incidence in NPI/V trended higher than PI/UV groups (RR=1.86 [95%CI 0.77-4.51], P=0.17). Vaccination in COVID-recovered individuals provided modest protection from reinfection (RR=1.82 [95%CI 1.21-2.73], P=0.004), but the absolute risk difference was extremely small (AR= 0.004 person-years [95% CI 0.001-0.007], P=0.02). The NNT to prevent one annual case of infection in COVID-recovered patients was 218, compared to 6.5 in COVID-naïve patients, representing a 33.5-fold difference in benefit between the two populations. COVID-recovered individuals represent a distinctly different benefit-risk calculus. While vaccinations are highly effective at protecting against infection and severe COVID-19 disease, our review demonstrates that natural immunity in COVID-recovered individuals is, at least, equivalent to the protection afforded by complete vaccination of COVID-naïve populations. There is a modest and incremental relative benefit to vaccination in COVID-recovered individuals; however, the net benefit is marginal on an absolute basis. Therefore, vaccination of COVID-recovered individuals should be subject to clinical equipoise and individual preference.
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Affiliation(s)
| | - Ralph Rahme
- Neurosurgery, St. Barnabas Hospital, New York City, USA
| | - Hooman Noorchashm
- Cardiac/Thoracic/Vascular Surgery • Immunology, American Patient Defense Union, Yardley, USA
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639
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Dormann H, Knüppel-Ruppert A, Amann K, Erley C. Nephrotic Syndrome After Vaccination Against COVID-19: Three New Cases From Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:662-663. [PMID: 34919048 DOI: 10.3238/arztebl.m2021.0330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/07/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
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640
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Bouland AJ, March JA. Invited Editorial: Characteristics and outcomes of adverse events following COVID-19 vaccination. J Am Coll Emerg Physicians Open 2021; 2:e12566. [PMID: 34611651 PMCID: PMC8478148 DOI: 10.1002/emp2.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Andrew J. Bouland
- Department of Emergency MedicineDivision of EMS, Brody School of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Juan Alberto March
- Department of Emergency MedicineDivision of EMS, Brody School of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
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641
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Yan Z, Yang M, Lai CL. COVID-19 Vaccinations: A Comprehensive Review of Their Safety and Efficacy in Special Populations. Vaccines (Basel) 2021; 9:1097. [PMID: 34696205 PMCID: PMC8539110 DOI: 10.3390/vaccines9101097] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
COVID-19 has been spreading worldwide since late 2019. There is no definitive cure to date. Global vaccination programs are urgently required to confer herd immunity, reducing the incidence of COVID-19 infections and associated morbidity and mortality. However, a significant proportion of special populations are hesitant to receive vaccination due to their special conditions, namely, age (pediatrics and geriatrics), immunocompromised state, autoimmune diseases, chronic cardiovascular and pulmonary conditions, active or treated cancers, and pregnancy. This review aims to evaluate the existing evidence of COVID-19 vaccinations on these special populations and to provide clues to guide vaccination decision making to balance the benefits and risks of vaccinations.
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Affiliation(s)
- Zhipeng Yan
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Ming Yang
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
| | - Ching-Lung Lai
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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642
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Iwanaga J, Fukuoka H, Fukuoka N, Yutori H, Ibaragi S, Tubbs RS. A narrative review and clinical anatomy of herpes zoster infection following COVID-19 vaccination. Clin Anat 2021; 35:45-51. [PMID: 34554601 PMCID: PMC8652627 DOI: 10.1002/ca.23790] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION In this review, cases of herpes zoster (HZ) infection following receipt of COVID-19 vaccines will be analyzed. We also present two cases of oral HZ following the COVID-19 vaccine and discuss this clinical anatomy. MATERIALS AND METHODS A database search using PubMed was conducted in August 2021 and 20 articles were found to be eligible for review. Patient data and vaccine information were analyzed. In addition, two cases of oral HZ infection following the receipt of COVID-19 vaccines are presented. RESULTS A total of 399 cases were identified. The affected dermatomes mimicked the regular distribution of HZ. For the dermatomes of the face, the various reports used different ways to describe the areas involved; CNV, CNV1, CNV2, CNV3, lower jaw, forehead, and under the eyebrow (CNV, 2 cases; CNV1, 4 cases; CNV2, 3 cases; and CNV3, 3 cases). Some patients who had a history of varicella zoster virus vaccination had HZ following the COVID-19 vaccination. Two patients with oral HZ following vaccination were found to have involvement of the greater palatine nerve. CONCLUSIONS Vaccine-related HZ cases have been reported worldwide. Although many studies with a larger number of cases are ongoing, detailed information can be obtained from case reviews as reported herein.
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Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | | | | | - Hirokazu Yutori
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,University of Queensland, Brisbane, Australia
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643
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Furer V, Zisman D, Elkayam O. Comment on: Herpes zoster following BNT162b2 mRNA Covid-19 vaccination in patients with autoimmune inflammatory rheumatic diseases: a case series. Reply. Rheumatology (Oxford) 2021; 61:e30. [PMID: 34554242 PMCID: PMC8500033 DOI: 10.1093/rheumatology/keab702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Victoria Furer
- Rheumatology Department, Tel Aviv Sourasky Medical
Center affiliated with Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
- Correspondence to: Victoria Furer, Department of
Rheumatology, 6 Weizmann St, Tel Aviv-Yafo, Israel. E-mail:
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical
Center, Haifa, Israel
| | - Ori Elkayam
- Rheumatology Department, Tel Aviv Sourasky Medical
Center affiliated with Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
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644
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Abstract
The COVID-19 pandemic has rapidly emerged as one of the biggest public health concerns of the 21st century. Although it was initially reported as a cluster of pneumonia cases, it quickly became apparent that COVID-19 is not merely a respiratory tract infection. Its clinical course is often complicated by cardiovascular manifestations including venous and arterial thrombosis, electrical disturbances, and myocardial damage. In addition, the cardiovascular system is involved not only during infection but also preceding the contraction of the virus; having cardiovascular comorbidities indicates significant vulnerability to the pathogen. As longer-term data continue to accumulate, we now have concerns over its lasting cardiovascular effects after recovery. Moreover, there have been substantial collateral effects on the epidemiology of cardiovascular diseases. Reports of adverse cardiovascular events from vaccination have emerged as new hurdles to our efforts to bring an end to the pandemic. As such, the association between COVID-19 and the cardiovascular system and cardiovascular practice in general is expansive. In this review, we provide an overview of the knowledge and considerations in this field, based on the evidence available at the time of this writing.
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Affiliation(s)
- Daiki Tomidokoro
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan.
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645
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Parums DV. Editorial: First Full Regulatory Approval of a COVID-19 Vaccine, the BNT162b2 Pfizer-BioNTech Vaccine, and the Real-World Implications for Public Health Policy. Med Sci Monit 2021; 27:e934625. [PMID: 34483336 PMCID: PMC8434768 DOI: 10.12659/msm.934625] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In the past 18 months, accelerated vaccine development to prevent or reduce the severity of coronavirus disease 2019 (COVID-19) has resulted in rapid global emergency regulatory approvals, including the US Food and Drug Administration (FDA) emergency use authorization (EUA) approvals. On August 23, 2021, the US FDA gave the first full regulatory approval for a COVID-19 vaccine and approved the Pfizer-BioNTech COVID-19 vaccine (Comirnaty) for individuals 16 years and older. In the US, there is a continued EUA for individuals aged 12–15 years of age. Also, the EUA includes the administration of a third or booster dose in immunocompromised individuals at increased risk for severe COVID-19. This Editorial aims to present an update on the first COVID-19 vaccine to receive full regulatory approval, the Pfizer-BioNTech vaccine, and the implications for real-world public health during the global COVID-19 pandemic and increasing concerns for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern.
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Affiliation(s)
- Dinah V Parums
- Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA
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646
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Boehmer TK, Kompaniyets L, Lavery AM, Hsu J, Ko JY, Yusuf H, Romano SD, Gundlapalli AV, Oster ME, Harris AM. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data - United States, March 2020-January 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1228-1232. [PMID: 34473684 PMCID: PMC8422872 DOI: 10.15585/mmwr.mm7035e5] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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647
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Cornberg M, Eberhardt CS. Protected or not protected, that is the question - First data on COVID-19 vaccine responses in patients with NAFLD and liver transplant recipients. J Hepatol 2021; 75:265-266. [PMID: 34048861 PMCID: PMC8146269 DOI: 10.1016/j.jhep.2021.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Markus Cornberg
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School Hannover, Germany; Centre for Individualised Infection Medicine (CiiM), A Joint Venture of Helmholtz Centre for Infection Research and Hannover Medical School, Hannover, Germany; German Center for Infection Research (DZIF), Partner-Site Hannover-Braunschweig, Hannover, Germany.
| | - Christiane S. Eberhardt
- Center for Vaccinology, University Hospitals of Geneva and University of Geneva, Switzerland,Department of Paediatrics, Gynaecology and Obstetrics, Division of General Paediatrics, Faculty of Medicine, University of Geneva, Switzerland,Emory Vaccine Center, Emory University, Atlanta, GA, USA
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648
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Brosh-Nissimov T, Orenbuch-Harroch E, Chowers M, Elbaz M, Nesher L, Stein M, Maor Y, Cohen R, Hussein K, Weinberger M, Zimhony O, Chazan B, Najjar R, Zayyad H, Rahav G, Wiener-Well Y. BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel. Clin Microbiol Infect 2021; 27:1652-1657. [PMID: 34245907 PMCID: PMC8261136 DOI: 10.1016/j.cmi.2021.06.036] [Citation(s) in RCA: 217] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Objectives The mRNA coronavirus disease 2019 (COVID-19) vaccines have shown high effectiveness in the prevention of symptomatic COVID-19, hospitalization, severe disease and death. Nevertheless, a minority of vaccinated individuals might become infected and experience significant morbidity. Characteristics of vaccine breakthrough infections have not been studied. We sought to portray the population of Israeli patients, who were hospitalized with COVID-19 despite full vaccination. Methods A retrospective multicentre cohort study of 17 hospitals included patients fully vaccinated with Pfizer/BioNTech's BNT162b2 vaccine who developed COVID-19 more than 7 days after the second vaccine dose and required hospitalization. The risk for poor outcome, defined as a composite of mechanical ventilation or death, was assessed. Results A total of 152 patients were included, accounting for half of hospitalized fully vaccinated patients in Israel. Poor outcome was noted in 38 patients and mortality rate reached 22% (34/152). Notably, the cohort was characterized by a high rate of co-morbidities predisposing to severe COVID-19, including hypertension (108; 71%), diabetes (73; 48%), congestive heart failure (41; 27%), chronic kidney and lung diseases (37; 24% each), dementia (29; 19%) and cancer (36; 24%), and only six (4%) had no co-morbidities. Sixty (40%) of the patients were immunocompromised. Higher viral load was associated with a significant risk for poor outcome. Risk also appeared higher in patients receiving anti-CD20 treatment and in patients with low titres of anti-Spike IgG, but these differences did not reach statistical significance. Conclusions We found that severe COVID-19 infection, associated with a high mortality rate, might develop in a minority of fully vaccinated individuals with multiple co-morbidities. Our patients had a higher rate of co-morbidities and immunosuppression compared with previously reported non-vaccinated hospitalized individuals with COVID-19. Further characterization of this vulnerable population may help to develop guidance to augment their protection, either by continued social distancing, or by additional active or passive vaccinations.
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Affiliation(s)
- Tal Brosh-Nissimov
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
| | - Efrat Orenbuch-Harroch
- Division of Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Centre, Jerusalem, Israel; School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Chowers
- Meir Medical Centre, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Elbaz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Infectious Diseases, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Lior Nesher
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel; Infectious Disease Institute, Soroka Medical Centre, Beer Sheba, Israel
| | - Michal Stein
- Infectious Disease and Infection Control Unit, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yasmin Maor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Wolfson Medical Centre, Holon, Israel
| | - Regev Cohen
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infectious Diseases Unit, Sanz Medical Centre, Laniado Hospital, Netanya, Israel
| | - Khetam Hussein
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Rambam Health Care Campus, Haifa, Israel
| | - Miriam Weinberger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Shamir (Assaf Harofe) Medical Centre, Zerifin, Israel
| | - Oren Zimhony
- School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Infectious Diseases Unit, Kaplan Medical Centre, Rhovot, Israel
| | - Bibiana Chazan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infectious Diseases Unit, Emek Medical Centre, Afula, Israel
| | - Ronza Najjar
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Carmel Medical Centre, Haifa, Israel
| | - Hiba Zayyad
- Infectious Disease Unit, The Baruch Padeh Medical Centre, Tiberias, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Centre, Tel Hashomer, Israel
| | - Yonit Wiener-Well
- School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Shaare Zedek Medical Centre, Jerusalem, Israel
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