Review the safety of Covid-19 mRNA vaccines: a review

COVID-19 mRNA Vaccination Mimicking Heart Attack in a Healthy 56-Year-Old Physician

We report our experience regarding a 56-year-old physician who developed severe symptoms mimicking a heart attack a few days after receiving the second dose of the new mRNA vaccine of Pfizer-BioNTech for COVID-19 protection. The patient is a healthy individual with no comorbidities and a normal clinical and laboratory profile. Five days after receiving the second dose on his left shoulder, he manifested sudden, severe pain on the whole left arm which lasted for about one hour, gradually intensifying and migrating to the chest and presenting as severe angina or heart attack. All work-up, however, was negative, with no evidence of ischemic heart attack or myocarditis. Severe acute symptoms lasted for about 20 h and completely resolved after 36 h. Although myocarditis as a potential side effect of the vaccine with associated heart pain has been identified, chest pain mimicking heart attack with otherwise normal workup has not been reported. Physicians must consider this likely rare and self-resolving symptom in order to increase awareness and prevent themselves and their patients from increased anxiety and unnecessary laboratory investigations.

Molecular docking and dynamics studies of Nicotinamide Riboside as a potential multi-target nutraceutical against SARS-CoV-2 entry, replication, and transcription: A new insight

The highly contagious Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which is a newborn infectious member of the dangerous beta-coronaviruses (β-CoVs) following SARS and MERS‐CoVs, can be regarded as the most significant issue afflicting the whole world shortly after December 2019. Considering CoVs as RNA viruses with a single-stranded RNA genome (+ssRNA), the critical viral enzyme RNA dependent RNA polymerase (RdRp) is a promising therapeutic target for the potentially fatal infection COVID-19. Nicotinamide riboside (NR), which is a naturally occurring analogue of Niacin (vitamin B3), is expected to have therapeutic effects on COVID-19 due to its super close structural similarity to the proven RdRp inhibitors. Thus, at the first phase of the current molecular docking and dynamics simulation studies, we targeted SARS-CoV-2 RdRp. On the next phase, SARS-CoV RdRp, human Angiotensin-converting enzyme 2, Inosine-5’-monophosphate dehydrogenase, and the SARS-CoV-2 Structural Glycoproteins Spike, Nonstructural viral protein 3-Chymotrypsin-like protease, and Papain-like protease were targeted using the docking simulation to find other possible antiviral effects of NR serendipitously. In the current study, the resulted scores from molecular docking and dynamics simulations as the primary determinative factor as well as the observed reliable binding modes have demonstrated that Nicotinamide Riboside and its active metabolite NMN can target human ACE2 and IMPDH, along with the viral S^pro, M^pro, PL^pro, and on top of all, RdRp as a potential competitive inhibitor.

COVID Vaccination in Athletes and Updated Interim Guidance on the Preparticipation Physical Examination During the SARS-Cov-2 Pandemic

ABSTRACT

The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.

The germinal centre B cell response to SARS-CoV-2

The germinal centre (GC) response is critical for the generation of affinity-matured plasma cells and memory B cells capable of mediating long-term protective immunity. Understanding whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination elicits a GC response has profound implications for the capacity of responding B cells to contribute to protection against infection. However, direct assessment of the GC response in humans remains a major challenge. Here we summarize emerging evidence for the importance of the GC response in the establishment of durable and broad immunity against SARS-CoV-2 and discuss new approaches to modulate the GC response to better protect against newly emerging SARS-CoV-2 variants. We also discuss new findings showing that the GC B cell response persists in the draining lymph nodes for at least 6 months in some individuals following vaccination with SARS-CoV-2 mRNA-based vaccines.

Influence of COVID-19 pandemic and vaccination on the menstrual cycle: A retrospective study in Hungary

Observations of women and clinicians indicated that the prevalence of menstrual cycle problems has escalated during the COVID-19 pandemic. However, it was not clear whether the observed menstrual cycle changes were related to vaccination, the disease itself or the COVID-19 pandemic-induced psychological alterations. To systematically analyze this question, we conducted a human online survey in women aged between 18 and 65 in Hungary. The menstrual cycle of 1563 individuals were analyzed in our study in relation to the COVID-19 vaccination, the COVID-19 infection, the pandemic itself and the mental health. We found no association between the COVID-19 vaccination, the vaccine types or the COVID-19 infection and the menstrual cycle changes. We also evaluated the menstrual cycle alterations focusing on three parameters of the menstrual cycle including the cycle length, the menses length and the cycle regularity in three pandemic phases: the pre-peak, the peak and the post-peak period in Hungary. Our finding was that the length of the menstrual cycle did not change in any of the periods. However, the menses length increased, while the regularity of the menstrual cycle decreased significantly during the peak of the COVID-19 pandemic when comparing to the pre- and post-peak periods. In addition, we exhibited that the length and the regularity of the menstrual cycle both correlated with the severity of depression during the post-peak period, therefore we concluded that the reported menstrual cycle abnormalities during the peak of COVID-19 in Hungary might be the result of elevated depressive symptoms.

Review of Ribosome Interactions with SARS-CoV-2 and COVID-19 mRNA Vaccine

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the causing pathogen of the unprecedented global Coronavirus Disease 19 (COVID-19) pandemic. Upon infection, the virus manipulates host cellular machinery and ribosomes to synthesize its own proteins for successful replication and to facilitate further infection. SARS-CoV-2 executes a multi-faceted hijacking of the host mRNA translation and cellular protein synthesis. Viral nonstructural proteins (NSPs) interact with a range of different ribosomal states and interfere with mRNA translation. Concurrent mutations on NSPs and spike proteins contribute to the epidemiological success of variants of concern (VOCs). The interactions between ribosomes and SARS-CoV-2 represent attractive targets for the development of antiviral therapeutics and vaccines. Recently approved COVID-19 mRNA vaccines also utilize the cellular machinery, to produce antigens and trigger immune responses. The design features of the mRNA vaccines are critical to efficient mRNA translation in ribosomes, and are directly related to the vaccine's efficacy, safety, and immunogenicity. This review describes recent knowledge of how the SARS-CoV-2 virus' genomic characteristics interfere with ribosomal function and mRNA translation. In addition, we discuss the current learning of the design features of mRNA vaccines and their impacts on translational activity in ribosomes. The understanding of ribosomal interactions with the virus and mRNA vaccines offers the foundation for antiviral therapeutic discovery and continuous mRNA vaccine optimization to lower the dose, to increase durability and/or to reduce adverse effects.

Emerging Phospholipid Nanobiomaterials for Biomedical Applications to Lab-on-a-Chip, Drug Delivery, and Cellular Engineering

The design of advanced nanobiomaterials to improve analytical accuracy and therapeutic efficacy has become an important prerequisite for the development of innovative nanomedicines. Recently, phospholipid nanobiomaterials including 2-methacryloyloxyethyl phosphorylcholine (MPC) have attracted great attention with remarkable characteristics such as resistance to nonspecific protein adsorption and cell adhesion for various biomedical applications. Despite many recent reports, there is a lack of comprehensive review on the phospholipid nanobiomaterials from synthesis to diagnostic and therapeutic applications. Here, we review the synthesis and characterization of phospholipid nanobiomaterials focusing on MPC polymers and highlight their attractive potentials for applications in micro/nanofabricated fluidic devices, biosensors, lab-on-a-chip, drug delivery systems (DDSs), COVID-19 potential usages for early diagnosis and even treatment, and artificial extracellular matrix scaffolds for cellular engineering.

The Development of mRNA Vaccines for Infectious Diseases: Recent Updates

mRNA-based technologies have been of interest for the past few years to be used for therapeutics. Several mRNA vaccines for various diseases have been in preclinical and clinical stages. With the outbreak of the COVID-19 pandemic, the emergence of mRNA vaccines has transformed modern science. Recently, two major mRNA vaccines have been developed and approved by global health authorities for administration on the general population for protection against SARS-CoV-2. They have been proven to be successful in conferring protection against the ongoing SARS-CoV-2 and its emerging variants. This will draw attention to various mRNA vaccines against infectious diseases that are in the early stages of clinical trials. mRNA vaccines offer several advantages ranging from rapid design, generation, manufacturing, and administration and have strong potential to be used against various diseases in the future. Here, we summarize the mRNA-based vaccines in development against various infectious diseases.

Nasal and Salivary Mucosal Humoral Immune Response Elicited by mRNA BNT162b2 COVID-19 Vaccine Compared to SARS-CoV-2 Natural Infection

SARS-CoV-2 antibody assays are crucial in managing the COVID-19 pandemic. Approved mRNA COVID-19 vaccines are well known to induce a serum antibody responses against the spike protein and its RBD. Mucosal immunity plays a major role in the fight against COVID-19 directly at the site of virus entry; however, vaccine abilities to elicit mucosal immune responses have not been reported. We detected anti-SARS-CoV-2 IgA-S1 and IgG-RBD in three study populations (healthy controls, vaccinated subjects, and subjects recovered from COVID-19 infection) on serum, saliva, and nasal secretions using two commercial immunoassays (ELISA for IgA-S1 and chemiluminescent assay for IgG-RBD). Our results show that the mRNA BNT162b2 vaccine Comirnaty (Pfizer/BioNTech, New York, NY, USA) determines the production of nasal and salivary IgA-S1 and IgG-RBD against SARS-CoV-2. This mucosal humoral immune response is stronger after the injection of the second vaccine dose compared to subjects recovered from COVID-19. Since there is a lack of validated assays on saliva and nasal secretions, this study shows that our pre-analytical and analytical procedures are consistent with the data. Our findings indicate that the mRNA COVID-19 vaccine elicits antigen-specific nasal and salivary immune responses, and that mucosal antibody assays could be used as candidates for non-invasive monitoring of vaccine-induced protection against viral infection.

Potential prophylactic efficacy of mast cell stabilizers against COVID-19 vaccine-induced anaphylaxis

To fight against coronavirus disease 2019 (COVID-19), the vaccination is currently the most effective approach. However, in addition to common systemic side effects, the vaccines can cause serious allergic reactions or anaphylaxis. In anaphylaxis, the exposure to the allergen causes a sudden release of chemical mediators from mast cells, for which adrenaline is the drug of first choice. In our previous basic studies, in addition to adrenaline, anti-allergic drugs (olopatadine, loratadine, tranilast and ketotifen), antibiotics (clarithromycin), corticosteroids (hydrocortisone and dexamethasone) and certain food constituents (caffeine and catechin) inhibited the process of exocytosis and showed their effectiveness as highly potent mast cell stabilizers. In these studies, since mast cells were pre-incubated with these drugs or the food constituents before exocytosis was induced, the findings strongly indicated their prophylactic efficacy in stabilizing mast cells. Considering such pharmacological properties of these commonly prescribed medications or the food constituents, their prophylactic use may potentially be beneficial in preventing anaphylaxis caused by COVID-19 vaccination.

A Case of Hepatotoxicity After Receiving a COVID-19 Vaccine

The coronavirus disease 2019 (COVID-19) has led to a global health crisis. Its clinical manifestations are well-documented, and severe complications among patients who survived the infection are being continuously reported. Several vaccines with well-established efficacies and excellent safety profiles have also been approved. To date, few side effects of vaccines have been reported. Drug-induced hepatotoxicity is an extremely rare side effect of these vaccines, with few reported instances. In this case report, we describe a patient who experienced hepatotoxicity after receiving the COVID-19 vaccine from Pfizer BioNTech.

Multimodal Imaging of Acute Foveolitis following COVID-19 Vaccination

PURPOSE

To report a case of unilateral acute foveolitis following COVID-19 vaccination.

METHODS

A case report.

RESULTS

A 24-year-old woman developed a sudden blurring of vision in the left eye (LE) 5 days after receiving the first dose of COVID-19 vaccine. Examination of the LE showed a visual acuity at 20/40, 2+ cells in the vitreous, and a small yellow-orange foveal subretinal lesion. Late-phase fluorescein angiography showed a mild diffuse retinal vascular leakage and a faint foveal hyperfluorescence. ICG angiography showed in the late-phase hypofluorescence of the centrofoveal lesion. OCT B-scan demonstrated a conical hyperreflective subfoveal lesion on the retinal pigment epithelium associated with disruption of the outer retinal layers. En-face OCT revealed granular hyperreflective specks mainly in the inner nuclear layer. Work-up results were unremarkable. The patient received oral prednisolone with subsequent full functional and anatomic recovery.

CONCLUSION

Foveolitis may rarely occur as a complication of COVID-19 vaccination.

CoV-RBD121-NP Vaccine Candidate Protects against Symptomatic Disease following SARS-CoV-2 Challenge in K18-hACE2 Mice and Induces Protective Responses That Prevent COVID-19-Associated Immunopathology

We developed a SARS-CoV-2 vaccine candidate (CoV-RBD121-NP) comprised of a tobacco mosaic virus-like nanoparticle conjugated to the receptor-binding domain of the spike glycoprotein of SARS-CoV-2 fused to a human IgG1 Fc domain. CoV-RBD121-NP elicits strong antibody responses in C57BL/6 mice and is stable for up to 12 months at 2-8 or 22-28 °C. Here, we showed that this vaccine induces a strong neutralizing antibody response in K18-hACE2 mice. Furthermore, we demonstrated that immunization protects mice from virus-associated mortality and symptomatic disease. Our data indicated that a sufficient pre-existing pool of neutralizing antibodies is required to restrict SARS-CoV-2 replication upon exposure and prevent induction of inflammatory mediators associated with severe disease. Finally, we identified a potential role for CXCL5 as a protective cytokine in SARS-CoV-2 infection. Our results suggested that disruption of the CXCL5 and CXCL1/2 axis may be important early components of the inflammatory dysregulation that is characteristic of severe cases of COVID-19.

COVID-19 vaccine hesitancy among staff and students in a Nigerian tertiary educational institution

Background:

COVID-19 was first reported on 31 December 2019 and has so far claimed over 2,000 lives in Nigeria. Through global and national efforts, about 4 million doses of the AstraZeneca vaccine was distributed and used in Nigeria from March 2021. Vaccine hesitancy could pose a serious problem for COVID-19 prevention and control.

Objectives:

To estimate the proportion of the Nnamdi Azikiwe University community that is willing to be vaccinated against COVID-19; level of hesitancy and its associated factors.

Methods:

A cross-sectional survey was conducted using online Google form distributed to staff and students of the university via different WhatsApp groups. The outcome measures were the proportion of persons willing to be vaccinated, vaccine hesitancy rates and reasons for this hesitancy. Data were analyzed using SPSS version 23 and Minitab version 19. Bivariate analysis was performed by the chi-square test, Odds Ratios (ORs) and statistical significance was accepted when p-value is < 0.05.

Results:

Only 349 of the survey responses were analyzed in the survey. Results show that 34.70 ± 5.00% of the university community were willing to receive the COVID-19 vaccine when it is offered to them. The COVID-19 hesitancy rate among staff and students was 65.04 ± 5.00%. It was discovered that marital status (OR = 2.06), age (OR = 0.802) and christian denominational affiliation (OR = 0.366) influenced respondents’ perception of COVID-19 vaccination. Gender, occupation, previous vaccination experience, awareness of COVID-19 and previous symptoms of COVID-19 did not significantly (p = 0.05) influence respondents’ willingness to be vaccinated.

Conclusion:

COVID-19 vaccine hesitancy is high among staff and students in a Nigerian university and is significantly influenced by marital status, respondents’ age and christian denominational affiliation.

Side Effects of COVID-19 Pfizer-BioNTech mRNA Vaccine in Children Aged 12-18 Years in Saudi Arabia

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.

COVID Vaccination in Athletes & Updated Interim Guidance on the Preparticipation Physical Examination during the SARS-CoV-2 Pandemic

ABSTRACT

The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.

Acute HIV infection syndrome mimicking COVID-19 vaccination side effects: a case report

Background

Symptoms of primary HIV infection, including fever, rash, and headache, are nonspecific and are often described as flu-like. COVID-19 vaccination side effects, such as fever, which occur in up to 10% of people following COVID-19 vaccination, can make the diagnosis of acute HIV infection even more challenging.

Case presentation

A 26-year-old man presented with fever and headache following COVID-19 vaccination. The symptoms were initially thought to be vaccine side effects. A diagnostic workup was conducted due to persisting fever and headache > 72 h following vaccination, and he was diagnosed with Fiebig stage II acute HIV infection, 3 weeks after having unprotected anal intercourse with another man.

Conclusion

Thorough anamnesis is key to estimating the individual risk of primary HIV infection, in patients presenting with flu-like symptoms. Early diagnosis and initiation of antiretroviral therapy is associated with better prognosis and limits transmission of the disease.

The Current Evidence Regarding COVID-19 and Pregnancy: Where Are We Now and Where Should We Head to Next?

Despite the volume of publications dedicated to unraveling the biological characteristics and clinical manifestations of SARS-CoV-2, available data on pregnant patients are limited. In the current review of literature, we present an overview on the developmental course, complications, and adverse effects of COVID-19 on pregnancy. A comprehensive review of the literature was performed in PubMed/Medline, Embase, and Cochrane Central databases up to June 2021. This article collectively presents what has been so far reported on the identified critical aspects, namely complications during pregnancy, delivery challenges, neonatal health care, potential routes of viral transmission, including vertical transmission or breastfeeding, along with the risks involved in the vaccination strategy during pregnancy. Despite the fact that we are still largely navigating uncharted territory, the observed publication explosion in the field is unprecedented. The overwhelming need for data is undoubtable, and this serves as the driver for the plethora of publications witnessed. Nonetheless, the quality of data sourced is variable. In the midst of the frenzy for reporting on SARS-CoV-2 data, monitoring this informational overload is where we should head to next, considering that poor quality research may in fact hamper our attempts to prevail against this unparalleled pandemic outbreak.

Dangers of mRNA vaccines

"Necessity is the mother of invention:" An adage was brought to life with the emergence of the mRNA vaccine against the backdrop of the foreboding and mercurial COVID-19 pandemic. Considering a negligible adverse-effect profile and a break-neck manufacturing speed, it shone bright as the ideal vaccine candidate. However, "all that glitters is not gold," as was evidenced by the significant reactogenicity, a host of multi-systemic side-effects, that are being reported by the vaccine recipients; which is palpably resulting in a shift of emotions for the vaccine, accounting for vaccine hesitancy. Anaphylaxis, antibody-dependent enhancements, and deaths, comprise the most serious side-effects, albeit occurring in sparing numbers. Storage and transportation require fastidious temperatures, rendering it substantially inaccessible to a country like India. The biggest jolt, however, was the unfolding of the biases in reporting vaccine efficacy, as only the attractively high numbers of the relatively equivocal relative risk reduction were reported while keeping at bay the meager numbers of the more forthright absolute risk reduction. Notwithstanding the fallacies, the mRNA vaccine still promises hope; and with the right precautions and finesse, can be potentiated, as "a watched pot never boils."

COVID-19 vaccines and vaccine hesitancy: Role of the allergist/immunologist in promotion of vaccine acceptance

Background: Vaccine hesitancy has been defined as a delay in acceptance or refusal of vaccines, despite the availability of vaccine services. In the past, despite an impressive record of vaccine effectiveness in the United States, several factors have contributed to a decreased acceptance of vaccines that has resulted in outbreaks of infectious diseases, e.g., measles. More recently, vaccine hesitancy has spread to coronavirus disease 2019 (COVID-19) vaccines. There are many causes of vaccine hesitancy, such as misinformation, fallacies, and myths, that have contributed to vaccine hesitancy. Objective: The purpose of the present report is to address the many causes of vaccine hesitancy and to suggest ways that the allergist/immunologist can be involved in the promotion of vaccine acceptance. Methods: The current COVID-19 vaccines were reviewed, together with their mechanisms(s) of action and adverse reactions to them. Results: The many causes of vaccine hesitancy include many doubts and concerns related to COVID-19 vaccines as well as a diminished level of confidence and trust by segments of the public in the nation's leaders in government, medical, and business communities, that those groups once enjoyed. Conclusion: Vaccination with COVID-19 vaccines is the only way that COVID-19 will be eliminated or at least controlled today, and vaccine hesitancy is the potential nemesis. The present report describes how the allergist/immunologist not only plays a major role in the delivery of specialized therapy of COVID-19 but also in educating the public with regard to the importance of COVID-19 vaccines, in dispelling misinformation, and in promoting trust for vaccine acceptance but must be informed with the most accurate and current information to do so.

COVID-19 vaccine causing Guillain-Barre syndrome, a rare potential side effect

Patients with neurological symptoms should be enquired about recent vaccination history. It is important after the COVID-19 mRNA vaccine, which is newly introduced as it might link to the development of a wider variety of neurological diseases.

A review on the advances and challenges of immunotherapy for head and neck cancer

Head and neck cancer (HNC), which includes lip and oral cavity, larynx, nasopharynx, oropharynx, and hypopharynx malignancies, is one of the most common cancers worldwide. Due to the interaction of tumor cells with immune cells in the tumor microenvironment, immunotherapy of HNCs, along with traditional treatments such as chemotherapy, radiotherapy, and surgery, has attracted much attention. Four main immunotherapy strategies in HNCs have been developed, including oncolytic viruses, monoclonal antibodies, chimeric antigen receptor T cells (CAR-T cells), and therapeutic vaccines. Oncorine (H101), an approved oncolytic adenovirus in China, is the pioneer of immunotherapy for the treatment of HNCs. Pembrolizumab and nivolumab are mAbs against PD-L1 that have been approved for recurrent and metastatic HNC patients. To date, several clinical trials using immunotherapy agents and their combination are under investigation. In this review, we summarize current the interaction of tumor cells with immune cells in the tumor microenvironment of HNCs, the main strategies that have been applied for immunotherapy of HNCs, obstacles that hinder the success of immunotherapies in patients with HNCs, as well as solutions for overcoming the challenges to enhance the response of HNCs to immunotherapies.

Administration of COVID-19 vaccines in immunocompromised patients

Since the beginning of vaccination programs against COVID-19 in different countries, several populations such as patients with specific immunological conditions have been considered as the priorities for immunization. In this regard, patients with autoimmune diseases or those receiving immunosuppressive agents and anti-cancer therapies, need special attention. However, no confirmed data is presently available regarding COVID-19 vaccines in these populations due to exclusion from the conducted clinical trials. Given the probable suppression or over-activation of the immune system in such patients, reaching a consensus for their vaccination is critical, besides gathering data and conducting trials, which could probably clarify this matter in the future. In this review, besides a brief on the available COVID-19 vaccines, considerations and available knowledge about administering similar vaccines in patients with cancer, hematopoietic stem cell transplantation, solid organ transplantation, multiple sclerosis (MS), inflammatory bowel disease (IBD), and rheumatologic and dermatologic autoimmune disorders are summarized to help in decision making. As discussed, live-attenuated viruses, which should be avoided in these groups, are not employed in the present COVID-19 vaccines. Thus, the main concern regarding efficacy could be met using a potent COVID-19 vaccine. Moreover, the vaccination timing for maximum efficacy could be decided according to the patient’s condition, indicated medications, and the guides provided here. Post-vaccination monitoring is also advised to ensure an adequate immune response. Further studies in this area are urgently warranted.

Double-Barrel Shotgun: Probiotic Lactic Acid Bacteria with Antiviral Properties Modified to Serve as Vaccines

Contrary to the general belief that the sole function of probiotics is to keep intestinal microbiota in a balanced state and stimulate the host’s immune response, several studies have shown that certain strains of lactic acid bacteria (LAB) have direct and/or indirect antiviral properties. LAB can stimulate the innate antiviral immune defence system in their host, produce antiviral peptides, and release metabolites that prevent either viral replication or adhesion to cell surfaces. The SARS-CoV (COVID-19) pandemic shifted the world’s interest towards the development of vaccines against viral infections. It is hypothesised that the adherence of SARS-CoV spike proteins to the surface of Bifidobacterium breve could elicit an immune response in its host and trigger the production of antibodies. The question now remains as to whether probiotic LAB could be genetically modified to synthesize viral antigens and serve as vaccines—this concept and the role that LAB play in viral infection are explored in this review.

Isolated Tachycardia Presenting After Pfizer-BioNTech COVID-19 Vaccination

A 29-year-old woman presented to the emergency department with palpitations and a heart rate of over 140 beats per minute that started approximately six to eight hours after administration of her second COVID-19 vaccination. Many side effects have been associated with the administration of vaccines. We present the first documented case of tachycardia and palpitations, in the absence of other signs or symptoms, presenting within hours of receiving the Pfizer-BioNTech COVID-19 vaccination. Clinicians should be aware that this appears to be benign and resolved within 24 hours in our patient.

Psychological Determinants of COVID-19 Vaccine Acceptance among Healthcare Workers in Kuwait: A Cross-Sectional Study Using the 5C and Vaccine Conspiracy Beliefs Scales

Acceptance of coronavirus disease 2019 (COVID-19) vaccination appears as a decisive factor necessary to control the ongoing pandemic. Healthcare workers (HCWs) are among the highest risk groups for infection. The current study aimed to evaluate COVID-19 vaccine acceptance among HCWs in Kuwait, with identification of the psychological determinants of COVID-19 vaccine hesitancy. The study was conducted using an online anonymous survey distributed between 18 March 2021 and 29 March 2021. The sampling strategy was convenience-based depending on chain-referral sampling. Psychological determinants of COVID-19 vaccine acceptance were assessed using the 5C subscales and the Vaccine Conspiracy Beliefs Scale (VCBS). The total number of study participants was 1019, with the largest group being physicians (28.7%), pharmacists (20.2%), dentists (16.7%), and nurses (12.5%). The overall rate for COVID-19 vaccine acceptance was 83.3%, with 9.0% who were not willing to accept vaccination and 7.7% who were unsure. The highest rate for COVID-19 vaccine acceptance was seen among dentists (91.2%) and physicians (90.4%), while the lowest rate was seen among nurses (70.1%; p < 0.001). A higher level of COVID-19 vaccine hesitancy was found among females, participants with a lower educational level, and HCWs in the private sector. A preference for mRNA vaccine technology and Pfizer-BioNTech COVID-19 vaccine was found among the majority of participants (62.6% and 69.7%, respectively). COVID-19 vaccine hesitancy was significantly linked to the embrace of vaccine conspiracy beliefs. The highest 5C psychological predictors of COVID-19 vaccine acceptance were high levels of collective responsibility and confidence, and lower levels of constraints and calculation. The VCBS and 5C subscales (except the calculation subscale) showed acceptable levels of predicting COVID-19 vaccine acceptance based on receiver operating characteristic analyses. The participants who depended on social media platforms, TV programs, and news releases as their main sources of knowledge about COVID-19 vaccines showed higher rates of COVID-19 vaccine hesitancy. An overall satisfactory level of COVID-19 vaccine acceptance was seen among HCWs in Kuwait, which was among the highest rates reported globally. However; higher levels of vaccine hesitancy were observed among certain groups (females, nurses and laboratory workers, HCWs in the private sector), which should be targeted with more focused awareness programs. HCWs in Kuwait can play a central role in educating their patients and the general public about the benefits of COVID-19 vaccination to halt the spread of SARS-CoV-2, considering the high rates of vaccine hesitancy observed among the general public in Kuwait and the Middle East.