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Safety of an inactivated, whole-virion COVID-19 vaccine (CoronaVac) in people aged 60 years or older in Hong Kong: a modified self-controlled case series. THE LANCET HEALTHY LONGEVITY 2022; 3:e491-e500. [PMID: 35813276 PMCID: PMC9252509 DOI: 10.1016/s2666-7568(22)00125-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Because evidence on the safety of COVID-19 vaccines in older adults is scarce, we aimed to evaluate the incidence and risk of adverse events after CoronaVac (Sinovac Biotech) vaccination in adults aged 60 years or older. Methods In this modified self-controlled case series, we enrolled adults aged 60 years or older who had received at least one dose of CoronaVac in Hong Kong between Feb 23, 2021, and Jan 31, 2022. We extracted population-based, electronic health record data from the clinical management system of the Hospital Authority on adverse events of special interest (from Jan 1, 2005, to Feb 23, 2022) and patients' demographic information (from Jan 1, 2018, to Jan 31, 2022), previous diagnoses (from Jan 1, 2018, to Jan 31, 2022), medication history (from Jan 1, 2018, to Jan 31, 2022), and laboratory tests, including those for SARS-CoV-2 infection (from Jan 1, 2018, to Jan 31, 2022). Details of vaccination status were provided by the Department of Health of the Hong Kong Government and were linked to data from the Hospital Authority with identity card numbers or passport numbers. Our outcomes were the overall incidence of any adverse event of special interest and the incidence rates of 30 adverse events of special interest, as suggested by the WHO Global Advisory Committee on Vaccine Safety, in the inpatient setting within 21 days (2 days for anaphylaxis) of either the first, second, or third CoronaVac dose compared with a baseline period. Individuals who had a history of a particular event between Jan 1, 2005, and Feb 23, 2021, were excluded from the corresponding analysis. We evaluated the risk of an adverse event of special interest using conditional Poisson regression, adjusting for seasonal effects. Findings Of 1 253 497 individuals who received at least one dose of CoronaVac during the study period, 622 317 (49·6%) were aged at least 60 years and were included in the analysis. Our analysis sample received 1 229 423 doses of CoronaVac and had a mean age of 70·40 years (SD 8·10). 293 086 (47·1%) of 622 317 participants were men and 329 231 (52·9%) were women. The incidence of individual adverse events of interest ranged from 0·00 per 100 000 people to 57·49 per 100 000 people (thromboembolism). The first and third doses of CoronaVac were not associated with a significant excess risk of an adverse event of special interest within 21 days (or 2 days for anaphylaxis) of vaccination. After the second dose, the only significantly increased risk was for anaphylaxis (adjusted incidence rate ratio 2·61, 95% CI 1·08–6·31; risk difference per 100 000 people 0·61, 95% CI 0·03–1·81). Interpretation Because older age is associated with poor outcomes after SARS-CoV-2 infection, the benefits of CoronaVac vaccination in older adults outweigh the risks in regions where COVID-19 is prevalent. Ongoing monitoring of vaccine safety is warranted. Funding The Food and Health Bureau of the Government, Hong Kong Special Administrative Region, China and AIR@InnoHK, administered by the Innovation and Technology Commission. Translation For the Chinese translation of the abstract see Supplementary Materials section.
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Mahler V, Junker AC. Anaphylaxie auf Zusatzstoffe in Impfstoffen. ALLERGO JOURNAL 2022; 31:22-39. [PMID: 35911653 PMCID: PMC9309021 DOI: 10.1007/s15007-022-5054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anaphylaxien im zeitlichen Zusammenhang mit der Verabreichung von Impfstoffen treten nur sehr selten auf. Auslöser von IgE-vermittelten und nicht IgE-vermittelten Anaphylaxien können neben dem Wirkstoff selbst Hilfsstoffe sein, die aufgrund spezieller Eigenschaften im Impfstoff enthalten sind. Bei den Hilfsstoffen in Arzneimitteln handelt es sich teilweise um dieselben Verbindungen, die als Zusatzstoffe in Lebensmitteln eingesetzt werden. Weiterhin kommen in Impfstoffen Rückstände aus dem Herstellungsprozess (z. B. Hühnereiweiß, Kasein, Antibiotika, Formaldehyd) oder Kontaminationen (z. B. aus dem Primärpackmittel) als potenzielle Auslöser von Anaphylaxien in Frage. Der vorliegende Review gibt einen Überblick über Bestandteile in Impfstoffen, von denen ein allergenes Risikopotenzial ausgeht. Die Bestandteile der in Deutschland zugelassenen COVID-19-Impfstoffe als potenzielle Auslöser von Anaphylaxien und mögliche pathophysiologische Mechanismen werden diskutiert. Zitierweise: Mahler V, Junker AC. Anaphylaxis to additives in vaccines. Allergo J Int 2022;31: 123-36 https://doi.org/10.1007/s40629-022-00215-8
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Affiliation(s)
- Vera Mahler
- Leitung Abt. Allergologie, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
| | - Ann-Christine Junker
- Leitung Abt. Allergologie, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
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Alharbi NK, Al-Tawfiq JA, Alwehaibe A, Alenazi MW, Almasoud A, Algaisi A, Alhumaydhi FA, Hashem AM, Bosaeed M, Alsagaby SA. Persistence of Anti-SARS-CoV-2 Spike IgG Antibodies Following COVID-19 Vaccines. Infect Drug Resist 2022; 15:4127-4136. [PMID: 35937784 PMCID: PMC9348632 DOI: 10.2147/idr.s362848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose This study was conducted to investigate antibody immune responses induced by BNT162b2 and AZD1222 human COVID-19 vaccines in Riyadh city, Saudi Arabia. Patients and Methods ELISA was used to evaluate antibodies, against the SARS-CoV-2 spike S1 protein, in serum samples from 432 vaccinated individuals at six time points: pre-vaccination (baseline), post-prime, post-boost, 6-months, and 1 year post-vaccination, and 3 weeks post a third dose. Virus microneutralization assay was used to confirm antibody responses in a subset of samples. Results Anti-SARS-CoV-2 spike IgG were detected in most subjects post-prime, reached a peak level post-boost, and remained at high level at the 6-month follow-up. At 1 year post-vaccine, the antibody levels were low but increased to a significant level higher than the peak following a third dose. The third dose was given at an average of 250 days after the second dose. The virus microneutralization assay confirmed the neutralization activity of the induced SARS-CoV-2 IgG antibodies. The vaccines induced higher IgG titres at post-prime (p=0.0001) and 6 months (p=0.006) in previously infected individuals. An increased interval between prime and boost, more than recommended time, appeared to enhance the IgG levels (p=0004). Moreover, the vaccines induced higher IgG levels in younger subjects (p=0.01). Conclusion These data provide insights and build on the current understanding of immune responses induced by these two vaccines; and support a third boosting dose for these COVID-19 vaccines.
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Affiliation(s)
- Naif Khalaf Alharbi
- Vaccine Development Unit, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
- Correspondence: Naif Khalaf Alharbi, Email
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Infectious Diseases Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amal Alwehaibe
- Vaccine Development Unit, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Mohamed W Alenazi
- Vaccine Development Unit, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Abdulrahman Almasoud
- Vaccine Development Unit, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Abdullah Algaisi
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Anwar M Hashem
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Bosaeed
- Vaccine Development Unit, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
- King Abdulaziz Medical City (KAMC), Ministry of National Guard – Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Suliman A Alsagaby
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
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Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10071025. [PMID: 35891189 PMCID: PMC9319755 DOI: 10.3390/vaccines10071025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
During the initial rollout of coronavirus disease 2019 (COVID-19) vaccination in Singapore, the Ministry of Health (MOH) issued a recommendation that patients with a history of any previous vaccine allergy be referred to an allergist for further review of their suitability to proceed with mRNA-based COVID-19 vaccines. Patients fulfilling the above criterion were divided into three groups: immediate reaction (Group A), delayed reaction (Group B) and no/irrelevant reaction (Group C). They were subjected to either a skin prick test (SPT) and intradermal test (IDT) with polyethylene glycol (PEG) or polysorbate-containing products; direct injection with the Pfizer BNT162b2 vaccine in the allergy clinic; or injection at community vaccination centres, respectively. Groups A and B were also invited to complete a questionnaire survey on post-vaccination reactions, and blood sampling pre-vaccination and 1 h after the first dose of the BNT162b2 vaccine to measure immunoglobulin (Ig) G, IgM and IgE antibodies to the Pfizer BNT162b2 vaccine via ELISA assays immobilised with the BNT162b2 vaccine, as well as levels of allergic cytokines interleukin (IL)-4 and IL-33, complement C5a and the endothelial activation marker intercellular adhesion molecule-1 (ICAM-1). Groups A and B comprised 62 (20.5%) patients each. In Group A, two subjects (3.2%) with equivocal IDT results tolerated both doses of the BNT162b2 vaccine without major allergic reactions. The remaining 60 (96.8%) in Group A and 62 (100%) in Group B completed both doses of BNT162b2 vaccination without major adverse reactions. Among the 99 who completed the questionnaire survey, 13 (13%) patients reported mild allergic reactions after the first dose of the vaccine. Immunoglobulin (Ig) G and M antibodies, but not IgE antibodies to the Pfizer BNT162b2 vaccine were detected in 67 subjects prior to vaccination. The presence of anti-Pfizer BNT162b2 IgG and IgM prior to vaccination did not result in major allergic reactions nor increases in Th2-related cytokines (IL-4, IL-33), complement activation products (C5a) or endothelial activation (ICAM-1). The majority of those with suspected reactions to non-COVID-19 polysorbate-containing vaccines tolerated the BNT162b2 vaccine. Excipient skin tests for PEG and polysorbate prior to vaccination are unnecessary.
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Current Evidence in SARS-CoV-2 mRNA Vaccines and Post-Vaccination Adverse Reports: Knowns and Unknowns. Diagnostics (Basel) 2022; 12:diagnostics12071555. [PMID: 35885461 PMCID: PMC9316835 DOI: 10.3390/diagnostics12071555] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 01/14/2023] Open
Abstract
The novel mRNA vaccinations against COVID-19 are gaining worldwide attention for their potential efficacy, as well as for the diagnosis of some post-vaccination-reported adverse reactions. In this state-of-the-art review article, we present the current evidence regarding mainly the diagnosis of spontaneous allergic reactions, the skin occurrences, the vascular, blood, endocrine and heart events, the respiratory reports, the gastrointestinal, hepatic and kidney events, the reproductive and pregnancy issues and the muscle events, as well as the ear, eye, neurologic and psychiatric events following mRNA vaccination against COVID-19. We further present some evidence regarding the mRNA strategies, we provide important information for side effects associated with the spike protein based LNP-mRNA vaccine and its adjuvants, as well as evidence for all the possible dangerous roles of the spike protein, and we discuss our expert opinion on the knowns and the unknowns towards the topic.
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Escudero C, Prieto-Montaño P, Audicana MT. Adverse Reactions to Anti-Infective Vaccines: an Emerging Problem in the COVID-19 Era. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:250-272. [PMID: 35789930 PMCID: PMC9244417 DOI: 10.1007/s40521-022-00311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/23/2022]
Abstract
Purpose of review Vaccines are an essential tool for preventing infectious diseases and reducing associated morbidity and mortality. Vaccination has a significant impact at both individual and community levels, and COVID‐19 vaccination programs are a new example of the great value of this public health strategy. However, adverse reactions, especially severe reactions such as anaphylaxis, prevent these programs from progressing properly, thus limiting vaccination uptake in the population. Recent findings The frequency of reactions and types of vaccine components, with special attention to COVID-19 vaccines studies, provides information on the magnitude and causes of adverse events. The understanding of mechanisms involved has made it possible to adequately guide diagnosis, especially to COVID-19 vaccine components, such as polyethylene glycol, trometamol, and polysorbate-80. Summary This review focuses on adverse reactions to vaccines, with emphasis on allergic reactions. A diagnostic pathway is suggested that, on the one hand, enables to take the necessary precautions in persons with a history of allergy to vaccine components or allergic reactions to vaccines and, on the other, supports administration of subsequent doses. The overall objective is to ensure that people with allergy can be vaccinated in the same way as the rest of the population, and that they are offered alternatives where necessary.
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107
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Padín-González E, Lancaster P, Bottini M, Gasco P, Tran L, Fadeel B, Wilkins T, Monopoli MP. Understanding the Role and Impact of Poly (Ethylene Glycol) (PEG) on Nanoparticle Formulation: Implications for COVID-19 Vaccines. Front Bioeng Biotechnol 2022; 10:882363. [PMID: 35747492 PMCID: PMC9209764 DOI: 10.3389/fbioe.2022.882363] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/09/2022] [Indexed: 12/27/2022] Open
Abstract
Poly (ethylene glycol) (PEG) is a widely used polymer in a variety of consumer products and in medicine. PEGylation refers to the conjugation of PEG to drugs or nanoparticles to increase circulation time and reduce unwanted host responses. PEG is viewed as being well-tolerated, but previous studies have identified anti-PEG antibodies and so-called pseudoallergic reactions in certain individuals. The increased use of nanoparticles as contrast agents or in drug delivery, along with the introduction of mRNA vaccines encapsulated in PEGylated lipid nanoparticles has brought this issue to the fore. Thus, while these vaccines have proven to be remarkably effective, rare cases of anaphylaxis have been reported, and this has been tentatively ascribed to the PEGylated carriers, which may trigger complement activation in susceptible individuals. Here, we provide a general overview of the use of PEGylated nanoparticles for pharmaceutical applications, and we discuss the activation of the complement cascade that might be caused by PEGylated nanomedicines for a better understanding of these immunological adverse reactions.
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Affiliation(s)
| | - Pearl Lancaster
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Massimo Bottini
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Lang Tran
- Institute of Occupational Medicine, Edinburgh, United Kingdom
| | - Bengt Fadeel
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Terence Wilkins
- School of Chemical and Process Engineering, University of Leeds, Leeds, United Kingdom
- Correspondence: Terence Wilkins, ; Marco P. Monopoli,
| | - Marco P. Monopoli
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
- Correspondence: Terence Wilkins, ; Marco P. Monopoli,
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Rama Raj P, Adler PA, Chalasani R, Wan SL. Acute Unilateral Central Serous Chorioretinopathy after Immunization with Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Literature Review. Semin Ophthalmol 2022; 37:690-698. [PMID: 35657058 DOI: 10.1080/08820538.2022.2082255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A 43-year-old Caucasian male presented to our ophthalmology clinic with blurry vision and metamorphopsia in his right eye, 24 hours after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. METHODS Clinical examination and imaging tests were consistent with acute unilateral central serous chorioretinopathy (CSCR) that completely resolved after 2 months without any treatment. He had no significant ophthalmic or medical history. He also lacked the classical risk factors for CSCR such as recent psychosocial stressors, Type-A personality traits, history of exogenous steroid use, connective tissue disorders and obstructive sleep apnea. RESULTS This appears to be only the second reported case of CSCR, temporally associated with a recombinant COVID-19 mRNA vaccine. We also present a summary of published reports demonstrating intraocular complications associated with the novel recombinant COVID-19 mRNA vaccines. CONCLUSION Findings in this report should not deter COVID-19 vaccinations given the rarity of aforementioned ocular complications and the greater benefit of protection from COVID-19 infection. Medical practitioners, however, should remain mindful of potential ocular complications, given the greater likelihood of occurrence with increasing vaccination booster rates.
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Affiliation(s)
- Palaniraj Rama Raj
- Department of Ophthalmology, Parke Street Specialist Centre, Katoomba, NSW, Australia.,Discipline of Clinical Ophthalmology and Eye Health/Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Paul A Adler
- Department of Ophthalmology, Parke Street Specialist Centre, Katoomba, NSW, Australia
| | - Rajeev Chalasani
- Department of Ophthalmology, Parke Street Specialist Centre, Katoomba, NSW, Australia
| | - Sue Ling Wan
- Department of Ophthalmology, Parke Street Specialist Centre, Katoomba, NSW, Australia
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Rosenblum HG, Gee J, Liu R, Marquez PL, Zhang B, Strid P, Abara WE, McNeil MM, Myers TR, Hause AM, Su JR, Markowitz LE, Shimabukuro TT, Shay DK. Safety of mRNA vaccines administered during the initial 6 months of the US COVID-19 vaccination programme: an observational study of reports to the Vaccine Adverse Event Reporting System and v-safe. THE LANCET. INFECTIOUS DISEASES 2022; 22:802-812. [PMID: 35271805 PMCID: PMC8901181 DOI: 10.1016/s1473-3099(22)00054-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND In December, 2020, two mRNA-based COVID-19 vaccines were authorised for use in the USA. We aimed to describe US surveillance data collected through the Vaccine Adverse Event Reporting System (VAERS), a passive system, and v-safe, a new active system, during the first 6 months of the US COVID-19 vaccination programme. METHODS In this observational study, we analysed data reported to VAERS and v-safe during Dec 14, 2020, to June 14, 2021. VAERS reports were categorised as non-serious, serious, or death. Reporting rates were calculated using numbers of COVID-19 doses administered as the denominator. We analysed v-safe survey reports from days 0-7 after vaccination for reactogenicity, severity (mild, moderate, or severe), and health impacts (ie, unable to perform normal daily activities, unable to work, or received care from a medical professional). FINDINGS During the study period, 298 792 852 doses of mRNA vaccines were administered in the USA. VAERS processed 340 522 reports: 313 499 (92·1%) were non-serious, 22 527 (6·6%) were serious (non-death), and 4496 (1·3%) were deaths. Over half of 7 914 583 v-safe participants self-reported local and systemic reactogenicity, more frequently after dose two (4 068 447 [71·7%] of 5 674 420 participants for local reactogenicity and 4 018 920 [70·8%] for systemic) than after dose one (4 644 989 [68·6%] of 6 775 515 participants for local reactogenicity and 3 573 429 [52·7%] for systemic). Injection-site pain (4 488 402 [66·2%] of 6 775 515 participants after dose one and 3 890 848 [68·6%] of 5 674 420 participants after dose two), fatigue (2 295 205 [33·9%] participants after dose one and 3 158 299 participants [55·7%] after dose two), and headache (1 831 471 [27·0%] participants after dose one and 2 623 721 [46·2%] participants after dose two) were commonly reported during days 0-7 following vaccination. Reactogenicity was reported most frequently the day after vaccination; most reactions were mild. More reports of being unable to work, do normal activities, or of seeking medical care occurred after dose two (1 821 421 [32·1%]) than after dose one (808 963 [11·9%]); less than 1% of participants reported seeking medical care after vaccination (56 647 [0·8%] after dose one and 53 077 [0·9%] after dose two). INTERPRETATION Safety data from more than 298 million doses of mRNA COVID-19 vaccine administered in the first 6 months of the US vaccination programme show that most reported adverse events were mild and short in duration. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Hannah G Rosenblum
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julianne Gee
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Ruiling Liu
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paige L Marquez
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bicheng Zhang
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Penelope Strid
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Winston E Abara
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael M McNeil
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tanya R Myers
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne M Hause
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John R Su
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauri E Markowitz
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom T Shimabukuro
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David K Shay
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hung SI, Preclaro IAC, Chung WH, Wang CW. Immediate Hypersensitivity Reactions Induced by COVID-19 Vaccines: Current Trends, Potential Mechanisms and Prevention Strategies. Biomedicines 2022; 10:1260. [PMID: 35740283 PMCID: PMC9219714 DOI: 10.3390/biomedicines10061260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/14/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
As the world deals with the COVID-19 pandemic, vaccination remains vital to successfully end this crisis. However, COVID-19-vaccine-induced immediate hypersensitivity reactions presenting with potentially life-threatening systemic anaphylactic reactions are one of the reasons for vaccine hesitancy. Recent studies have suggested that different mechanisms, including IgE-mediated and non-IgE-mediated mast cell activation, may be involved in immediate hypersensitivity. The main culprits triggering hypersensitivity reactions have been suggested to be the excipients of vaccines, including polyethylene glycol and polysorbate 80. Patients with a history of allergic reactions to drugs, foods, or other vaccines may have an increased risk of hypersensitivity reactions to COVID-19 vaccines. Various strategies have been suggested to prevent hypersensitivity reactions, including performing skin tests or in vitro tests before vaccination, administering different vaccines for the primary and following boosters, changing the fractionated doses, or pretreating the anti-IgE antibody. This review discusses the current trends, potential mechanisms, and prevention strategies for COVID-19-vaccine-induced immediate hypersensitivity reactions.
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Affiliation(s)
- Shuen-Iu Hung
- Cancer Vaccine & Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Ivan Arni C. Preclaro
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
| | - Wen-Hung Chung
- Cancer Vaccine & Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Taipei 105, Taiwan
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen 102218, China
- Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou 333, Taiwan
| | - Chuang-Wei Wang
- Cancer Vaccine & Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- Drug Hypersensitivity Clinical and Research Center, Department of Dermatology, Chang Gung Memorial Hospital, Taipei 105, Taiwan
- Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen 102218, China
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Jover Cerdá V, Rodríguez Pacheco R, Doménech Witek J, Alonso Hernández S, Durán García R, Real Panisello M, Marco de la Calle FM. Allergological study in patients vaccinated against COVID-19 with suspected allergic reactions. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:43. [PMID: 35624518 PMCID: PMC9136194 DOI: 10.1186/s13223-022-00685-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND One of the main barriers to vaccination against SARS-CoV-2 is the fear of developing hypersensitivity reactions to any of its components. Although these reactions are very rare, it is necessary to establish an effective protocol to detect patients at risk of developing them. The aim of this study was to evaluate hypersensitivity reactions in vaccinated patients in order to allow or not to complete the vaccination protocol. METHODS Descriptive and cross-sectional study in which patients with suspected hypersensitivity to SARS-CoV-2 vaccines were evaluated. All patients underwent skin prick test (SPT) and/or intradermal test (IDT) with the vaccines and their excipients. In patients with positive IDT with the vaccine, a histopathological and immunohistochemical study was performed by skin biopsy. A basophil activation test (BAT) and a lymphoblastic transformation test (LTT) were also performed. RESULTS Sixteen patients with suspected hypersensitivity to SARS-CoV-2 vaccine (12 received Comirnaty®, 3 received Vaxzevria®, and 1 received Spikevax®) were evaluated. Half had immediate hypersensitivity reactions and half had delayed reactions. All SPTs to excipients and vaccines were negative. IDTs with all excipients were negative. IDTs with vaccines were positive in 11 patients and negative in 5. The histological and immunohistochemical study of the two selected patients with positive IDT with vaccine showed T-lymphocyte involvement. BAT and LTT were negative in both cases. The vaccination protocol could be completed in 7 of 16 patients (44%) studied. The remaining 9 patients did not receive the second dose: 5 because vaccination was not required and 4 because they refused to be vaccinated. CONCLUSIONS Thanks to the allergological and immunohistochemical study, the vaccination protocol could be completed in about half of the patients who presented suspected hypersensitivity reactions to SARS-CoV-2 vaccines. IDTs with vaccines could be a valuable method for assessing the immunogenicity of the vaccines.
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Affiliation(s)
- Vicente Jover Cerdá
- Allergology Department, General University Hospital of Elda, Ctra. De Sax, s/n - 03600 Elda, Alicante, Spain.
| | - Ramón Rodríguez Pacheco
- Allergology Department, General University Hospital of Elda, Ctra. De Sax, s/n - 03600 Elda, Alicante, Spain
| | - Joan Doménech Witek
- Allergology Department, General University Hospital of Elda, Ctra. De Sax, s/n - 03600 Elda, Alicante, Spain
| | | | - Rafael Durán García
- Pathologic Anatomy Department, General University Hospital of Elda, Alicante, Spain
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Igawa G, Ai T, Yamamoto T, Ito K, Nojiri S, Saito K, Wakita M, Fukuda H, Hori S, Misawa S, Miida T, Seyama K, Takahashi K, Tabe Y, Naito T. Antibody response and seroprevalence in healthcare workers after the BNT162b2 vaccination in a University Hospital at Tokyo. Sci Rep 2022; 12:8707. [PMID: 35610464 PMCID: PMC9127282 DOI: 10.1038/s41598-022-12809-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/03/2022] [Indexed: 01/02/2023] Open
Abstract
In 2020, we reported a low seroprevalence of N-specific antibodies in 4147 health care workers (HCWs) at a frontline hospital in Tokyo, Japan. In Japan, a vaccine campaign was launched in early 2021. We re-evaluated seroprevalences of N- and S-specific antibodies in 2202 HCWs who took two doses of the BNT162b2 vaccine. In 2021, N-specific seroprevalence remains as low as 1.59%. The seroprevalences were comparable among all HCWs regardless of exposure levels. Almost all of the HCWs elicited S-specific antibodies after vaccination. However, the HCWs who had COVID-19 elicited higher S-specific antibody titers than those who did not have COVID-19. In the HCWs without a history of COVID-19, 1.1% (23 out of 2185) were seropositive with N-specific antibodies, indicating the existence of asymptomatic infections. Also, S-specific antibody titers were higher in females and younger HCWs, and in those who had severe side effects. However, S-specific antibody titers were lower depending on the number of days after the second dose of vaccination specifically in elderly individuals. In conclusion, this study indicates N-specific seroprevalence remains low in HCWs at a frontline hospital in Tokyo. The mRNA vaccine elicited S-specific antibody in HCWs, however, the titers decreased as the days proceeded.
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Affiliation(s)
- Gene Igawa
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Tomohiko Ai
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-2, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takamasa Yamamoto
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Kanami Ito
- Department of Safety and Health Promotion, Juntendo University, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Kaori Saito
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-2, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mitsuru Wakita
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Hiroshi Fukuda
- Department of Safety and Health Promotion, Juntendo University, Tokyo, Japan
- Department of General Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Hori
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Infection Control Unit, Juntendo University Hospital, Tokyo, Japan
- Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Misawa
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-2, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kuniaki Seyama
- Department of Safety and Health Promotion, Juntendo University, Tokyo, Japan
- Department of General Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Research Support Utilizing Bioresource Bank, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoko Tabe
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-2, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Department of Research Support Utilizing Bioresource Bank, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Toshio Naito
- Department of Safety and Health Promotion, Juntendo University, Tokyo, Japan
- Department of General Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Research Support Utilizing Bioresource Bank, Juntendo University Graduate School of Medicine, Tokyo, Japan
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García-Azorín D, Lázaro E, Ezpeleta D, Lecumberri R, Cámara RDL, Castellanos M, Martínez CI, Quiroga-González L, Rivas GE, Sancho-López A, Iglesias PR, Segovia E, Mejías C, Corominas DM. [Thrombosis with Thrombocytopenia Syndrome following adenovirus vector-based vaccines to prevent COVID-19: epidemiology and clinical presentation in Spain]. Neurologia 2022:S0213-4853(22)00067-6. [PMID: 35645442 PMCID: PMC9124923 DOI: 10.1016/j.nrl.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/24/2022] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND We describe the epidemiological and clinical characteristics of thrombosis with thrombocytopenia syndrome (TTS) cases reported in Spain. METHODS We included all venous or arterial thrombosis with thrombocytopenia following adenovirus vector-based vaccines (AstraZeneca or Janssen) to prevent COVID-19 disease between February 1st and September 26th, 2021. We describe the crude rate and the standardized morbidity ratio. We assessed the predictors of mortality. RESULTS Sixty-one cases were reported and 45 fulfilled eligibility criteria, 82% women. The crude TTS rate was 4/1,000,000 doses and 14-15/1,000,000 doses between 30-49 years. The number of observed cases of cerebral venous thrombosis was 6-18 higher than the expected in patients younger than 49 years. Symptoms started 10 (interquartile range (IQR): 7-14) days after vaccination. Eighty percent (95% confidence interval (CI): 65-90%) had thrombocytopenia at the time of the emergency department visit, and 65% (95% CI: 49-78%) had D-dimer >2000 ng/mL. Patients had multiple location thrombosis in 36% and fatal outcome in 24% cases. A platelet nadir <50,000 /μL (odds ratio (OR): 7.4; CI 95%: 1.2-47.5) and intracranial hemorrhage (OR: 7.9; IC95%: 1.3-47.0) were associated with fatal outcome. CONCLUSION TTS must be suspected in patients with symptoms 10 days after vaccination and thrombocytopenia and/or D-dimer increase.
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Affiliation(s)
- David García-Azorín
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Edurne Lázaro
- Pharm. División de Farmacoepidemiología y Farmacovigilancia. Departamento de Medicamentos de Uso Humano. Agencia Española de Medicamentos y Productos Sanitarios, España
| | - David Ezpeleta
- Servicio de Neurología. Hospital Universitario Quirónsalud Madrid. Pozuelo de Alarcón, Madrid, España
| | - Ramón Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, España. CIBER-CV, Instituto de Salud Carlos III, Madrid, España
| | | | - Mar Castellanos
- Servicio de Neurología; Complejo Hospitalario Universitario/Instituto de Investigación Biomédica de Coruña. RD16/0019/0004 Instituto de Salud Carlos III, España
| | - Cristina Iñiguez Martínez
- Servicio de Neurología. Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. Instituto de Investigación Sanitaria de Aragón (IIS Aragón), España
| | - Lara Quiroga-González
- Pharm. División de Farmacoepidemiología y Farmacovigilancia. Departamento de Medicamentos de Uso Humano. Agencia Española de Medicamentos y Productos Sanitarios, España
| | - Gabriela Elizondo Rivas
- Centro de Farmacovigilancia de Navarra. Departamento de Salud. Gobierno de Navarra, España. Presidenta del Comité Técnico del Sistema Español de Farmacovigilancia, España
| | - Aránzazu Sancho-López
- Servicio de Farmacología Clínica, Hospital Universitario Puerta de Hierro Majadahonda, España. Vocal SEFC, Grupo de Vacunas de FACME, España
| | - Pilar Rayón Iglesias
- División de Farmacoepidemiología y Farmacovigilancia. Departamento de Medicamentos de Uso Humano. Agencia Española de Medicamentos y Productos Sanitarios, España
| | - Eva Segovia
- División de Farmacoepidemiología y Farmacovigilancia. Departamento de Medicamentos de Uso Humano. Agencia Española de Medicamentos y Productos Sanitarios, España
| | - Consuelo Mejías
- División de Farmacoepidemiología y Farmacovigilancia. Departamento de Medicamentos de Uso Humano. Agencia Española de Medicamentos y Productos Sanitarios, España
| | - Dolores Montero Corominas
- División de Farmacoepidemiología y Farmacovigilancia. Departamento de Medicamentos de Uso Humano. Agencia Española de Medicamentos y Productos Sanitarios, España
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Chiang V, Saha C, Yim J, Au EYL, Kan AKC, Hui KSH, Li TS, Lo WLW, Hong YD, Ye J, Ng C, Ko WWK, Ho CTK, Lau CS, Quan J, Li PH. The Role of the Allergist in Coronavirus Disease 2019 Vaccine Allergy Safety: A Pilot Study on a "Hub-and-Spoke" Model for Population-Wide Allergy Service. Ann Allergy Asthma Immunol 2022; 129:308-312.e1. [PMID: 35605815 PMCID: PMC9121691 DOI: 10.1016/j.anai.2022.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023]
Abstract
Background Hong Kong started its coronavirus disease 2019 (COVID-19) vaccination program in February 2021. A territory-wide Vaccine Allergy Safety (VAS) clinic was set up to assess individuals deemed at “higher risk” of COVID-19 vaccine-associated allergies. A novel “hub-and-spoke” model was piloted to tackle the overwhelming demand of services by allowing nonallergists to conduct assessment. Objective To evaluate the outcomes of the VAS hub-and-spoke model for allergy assessment. Methods Records of patients attending the VAS hub-and-spoke Clinics between March and August 2021 were reviewed (n = 2725). We studied the overall results between the Hub (allergist led) and Spoke (nonallergist led) Clinics. The Hub and the Hong Kong West Cluster Spoke Clinic were selected for subgroup analysis as they saw the largest number of patients (n = 1411). Results A total of 2725 patients were assessed under the VAS hub-and-spoke model. Overall, 2324 patients (85.3%) were recommended to proceed with vaccination. Allergists recommended significantly more patients for vaccination than nonallergists (odds ratio = 21.58; P < .001). Subgroup analysis revealed that 881 of 1055 (83.5%) patients received their first dose of COVID-19 vaccination safely after assessment. Among those recommended vaccination, more patients assessed by allergists received their first dose of vaccination (odds ratio = 4.18; P < .001). Conclusion The hub-and-spoke model has proven to be successful for the vaccination campaign. This study has illustrated the crucial role of allergists in countering vaccine hesitancy. Results from the study revealed considerable differences in outcomes between allergist-led and nonallergist-led clinics. Precise reasons for these differences warrant further evaluation. We are hopeful that the hub-and-spoke model can be similarly adapted for other allergist-integrative services in the future.
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Affiliation(s)
- Valerie Chiang
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Chinmoy Saha
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jackie Yim
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Elaine Y L Au
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Andy K C Kan
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kong Siu Harris Hui
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Tin Sum Li
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wing Lam Whitney Lo
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yuh Dong Hong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jiaxi Ye
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Carmen Ng
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Welchie W K Ko
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Carmen T K Ho
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jianchao Quan
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Philip H Li
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.
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115
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Bian S, Li L, Wang Z, Cui L, Xu Y, Guan K, Zhao B. Allergic Reactions After the Administration of COVID-19 Vaccines. Front Public Health 2022; 10:878081. [PMID: 35655467 PMCID: PMC9152252 DOI: 10.3389/fpubh.2022.878081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022] Open
Abstract
Background Data on allergic reactions after the administration of coronavirus disease (COVID-19) vaccines are limited. Our aim is to analyze reports of allergic reactions after COVID-19 vaccine administration. Methods The Vaccine Adverse Event Reporting System database was searched for reported allergic reactions after the administration of any of the COVID-19 vaccines from December 2020 to June 2021. After data mapping, the demographic and clinical characteristics of the reported cases were analyzed. Potential factors associated with anaphylaxis were evaluated using multivariable logistic regression models. Results In total, 14,611 cases were reported. Most cases of allergic reactions comprised women (84.6%) and occurred after the first dose of the vaccine (63.6%). Patients who experienced anaphylaxis were younger (mean age 45.11 ± 5.6 vs. 47.01 ± 6.3 years, P < 0.001) and had a higher prevalence of a history of allergies, allergic rhinitis, asthma, and anaphylaxis than those who did not (P < 0.05). A history of allergies (odds ratio (OR) 1.632, 95% confidence interval (CI) 1.467-1.816, P < 0.001), asthma (OR 1.908, 95%CI 1.677-2.172, P < 0.001), and anaphylaxis (OR 7.164, 95%CI 3.504-14.646, P < 0.001) were potential risk factors for anaphylaxis. Among the 8,232 patients with reported outcomes, 16 died. Conclusions Female predominance in allergic reaction cases after the receipt of COVID-19 vaccines was observed. Previous histories of allergies, asthma, or anaphylaxis were risk factors for anaphylaxis post-vaccination. People with these risk factors should be monitored more strictly after COVID-19 vaccination.
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Affiliation(s)
- Sainan Bian
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Lisha Li
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Zixi Wang
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Le Cui
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Yingyang Xu
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Kai Guan
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Bin Zhao
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Novembre E, Tosca M, Caffarelli C, Calvani M, Cardinale F, Castagnoli R, Chiappini E, Cravidi C, Del Giudice MM, Duse M, Licari A, Manti S, Martelli A, Ricci G, Pingitore G, Marseglia GL. Management of BNT162b2 mRNA COVID-19 vaccine in children aged 5-11 years with allergies, asthma, and immunodeficiency: consensus of the Italian Society of Pediatric Allergy and Immunology (SIAIP). Ital J Pediatr 2022; 48:76. [PMID: 35578294 PMCID: PMC9109428 DOI: 10.1186/s13052-022-01272-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/04/2022] [Indexed: 01/31/2023] Open
Abstract
BNT162b2 vaccine, developed by BioNTech and Pfizer ha recently approved for use in children aged 5 to 11 years. Recent data show evidence of safety on the administration and serious adverse events have been rarely reported. However, allergic systemic reactions could occur. In some cases, a correct allergic evaluation allows identifying patients at risk of developing an anaphylactic reaction. Risk assessment of allergic reactions to COVID-19 vaccines is useful to limit contraindications to vaccination and help to safely vaccinate people supposed to be at risk of allergic reactions.
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Affiliation(s)
- Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | | | - Carlo Caffarelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, Parma, Italy.
| | - Mauro Calvani
- Operative Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Fabio Cardinale
- Pediatric Unit, Azienda Ospedaliero-Universitaria "Policlinico- Giovanni XXIII, Bari, Italy
| | - Riccardo Castagnoli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Elena Chiappini
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | | | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marzia Duse
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Sara Manti
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Catania, Italy
| | | | - Giampaolo Ricci
- Alma Mater Studiorum, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Kaushal N, Jain S, Baranwal M. Computational design of immunogenic peptide constructs comprising multiple HLA restricted Dengue virus envelope epitopes. J Mol Recognit 2022; 35:e2961. [PMID: 35514257 DOI: 10.1002/jmr.2961] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 11/09/2022]
Abstract
Dengue virus (DENV) is endemic in 100 countries with ability to impact nearly 50% of world population. DENV envelope (E) protein is responsible for viral attachment to host cells and has been target of various countermeasure development efforts. The current study focuses on a consensus computational approach to identify cross-reactive, immunogenic DENV-2 E peptides displaying promiscuity with a wide array of HLA molecules. Four conserved peptides (FP-1, FP-2, FP-3 and FP-4) containing multiple CD8+ and CD4+ T cell epitopes were identified by employment of various immunoinformatics tools. FP-1, FP-2, FP-3 and FP-4 were estimated to bind with 227, 1787, 1008 and 834 HLA alleles respectively. RMSD values obtained by Molecular docking (CABS-Dock) with 20 HLA alleles (10 each of HLA class I and II) resulted into comparable RMSD values of identified epitopes with native peptides which represents the natural presentation of epitopes to HLA molecules. These peptides were also found to be part of previous experimentally validated immunogenic peptides. Further, a dengue immunogenic peptide construct was generated by linking the four peptides, an adjuvant and a 6x histidine tag. The construct showed strong binding and stability with Toll-like receptor (TLR4). Collectively, these results provide strong evidence in the support of the immunogenic potential of the dengue immunogenic peptide construct. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Neha Kaushal
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala, Punjab, India
| | - Sahil Jain
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala, Punjab, India.,University Institute of Biotechnology, Chandigarh University, Mohali, India
| | - Manoj Baranwal
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala, Punjab, India
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Abstract
PURPOSE OF REVIEW We reviewed three leading strategies of vaccine development against coronavirus disease 2019 (COVID- 19): mRNA vaccines, adenoviral vector vaccines and recombinant nanoparticles. We also considered the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and their impact on the effectiveness of the most widely implemented vaccines. RECENT FINDINGS General properties, efficacy, safety and global uptake of Pfizer/BioNTech's Comirnaty (BNT162b2), Moderna's Spikevax (mRNA-1273), Oxford/AstraZeneca's ChAdOx1 nCoV-19, J&J/Janssen's Ad26.COV2.S and Novavax's NVX-CoV2373 vaccines at the end of the year 2021 were presented. We summarized the information on the effectiveness against COVID-19 infection, severe disease and death. We then focused on important missense mutations in the five variants of concern (VoC): Alpha, Beta, Gamma, Delta and Omicron. We explored the evidence for the effectiveness of the vaccines against those five VoC. SUMMARY It is difficult to predict the further development of the COVID-19 pandemic. The development of vaccines of an increasingly broad spectrum against coronaviruses, more easily deliverable and conferring more durable immune protection is likely. However, the very large number of infections may lead to new mutations with unpredictable impacts. Interventions that would control COVID-19 more effectively and enable a safer coexistence with the SARS-CoV-2 virus and its emerging variants are still needed in early 2022.
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Affiliation(s)
- Igor Rudan
- Usher Institute, University of Edinburgh, Edinburgh, UK
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119
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Lazarinis N, Bossios A, Gülen T. COVID-19 vaccination in the setting of mastocytosis-Pfizer-BioNTech mRNA vaccine is safe and well tolerated. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1377-1379. [PMID: 35123098 PMCID: PMC8810433 DOI: 10.1016/j.jaip.2022.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Nikolaos Lazarinis
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Mastocytosis Center Karolinska, Karolinska Institutet and Karolinska University, Hospital Huddinge, Stockholm, Sweden.
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Rudrapal M, Celik I, Chinnam S, Azam Ansari M, Khan J, Alghamdi S, Almehmadi M, Zothantluanga JH, Khairnar SJ. Phytocompounds as potential inhibitors of SARS-CoV-2 Mpro and PLpro through computational studies. Saudi J Biol Sci 2022; 29:3456-3465. [PMID: 35233172 PMCID: PMC8873046 DOI: 10.1016/j.sjbs.2022.02.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/04/2022] [Accepted: 02/20/2022] [Indexed: 12/13/2022] Open
Abstract
The inhibition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main protease (Mpro) and papain-like protease (PLpro) prevents viral multiplications; these viral enzymes have been recognized as one of the most favorable targets for drug discovery against SARS-CoV-2. In the present study, we screened 225 phytocompounds present in 28 different Indian spices to identify compounds as potential inhibitors of SARS-CoV-2 Mpro and PLpro. Molecular docking, molecular dynamics simulation, molecular mechanics Poisson-Boltzmann surface area (MM-PBSA) binding free energy calculations, and absorption, distribution, metabolism, excretion and toxicity (ADMET) studies were done. Based on binding affinity, dynamics behavior, and binding free energies, the present study identifies pentaoxahexacyclo-dotriacontanonaen-trihydroxybenzoate derivative (PDT), rutin, and dihyroxy-oxan-phenyl-chromen-4-one derivative (DOC), luteolin-7-glucoside-4'-neohesperidoside as promising inhibitors of SARS-CoV-2 Mpro and PLpro, respectively.
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Affiliation(s)
- Mithun Rudrapal
- Department of Pharmaceutical Chemistry, Rasiklal M. Dhariwal Institute of Pharmaceutical Education & Research, Pune 411019, Maharashtra, India
| | - Ismail Celik
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Erciyes University, Kayseri 38280, Turkey
| | - Sampath Chinnam
- Department of Chemistry, M. S. Ramaiah Institute of Technology (Affiliated to Visvesvaraya Technological University, Belgaum), Bengaluru 560054, Karnataka, India
| | - Mohammad Azam Ansari
- Department of Epidemic Disease Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Johra Khan
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
- Health and Basic Sciences Research Center, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Saad Alghamdi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Um Al-Qura University, Makkah 24382, Saudi Arabia
| | - Mazen Almehmadi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - James H. Zothantluanga
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh 786004, Assam, India
| | - Shubham J. Khairnar
- MET Institute of Pharmacy, Bhujbal Knowledge City, Nasik 422003, Maharashtra, India
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Romantowski J, Kruszewski J, Solarski O, Bant A, Chciałowski A, Pietrzyk I, Sańpruch P, Górska A, Chełmińska M, Knurowska A, Gawinowska M, Jassem E, Niedoszytko M. Protocol of safe vaccination against COVID-19 in patients with high risk of allergic reactions. Clin Transl Allergy 2022; 12:e12152. [PMID: 35601631 PMCID: PMC9112196 DOI: 10.1002/clt2.12152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 12/17/2022] Open
Abstract
Background Sars-CoV-2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients and practicing physicians being concerned about the safety of vaccine administration, particularly in people with severe anaphylactic reactions to multiple or unknown factors in their medical history.This study aimed to develop an allergic work-up protocol based on skin prick tests (SPT), intradermal testing (IDT) and intramuscular provocations, and desensitisation which may contribute to diagnosis and management of anti-COVID-19 vaccine allergy. Methods Two hundred and eighty-five patients were enrolled. Two hundred and five of them entered the study based on severe anaphylactic reaction to unknown or multiple factors in their medical history which disqualified them for standard treatment. Another 80 patients were enrolled after developing an allergic reaction to the first dose of one such vaccine. In all subjects, SPT and IDT were performed. Serum tryptase was assessed in 79 patients randomly chosen from the study group. Results Two hundred and seventy-seven patients with negative tests were given a vaccine without complications. Seven patients had positive skin tests. In two cases, tests confirmed Comirnaty allergy, while the other five confirmed solely skin sensitisation with no exposure prior to the study. Six patients with positive tests received titrated challenge using desensitisation protocol with a reasonable tolerance. One patient did not consent to desensitisation and one patient resigned despite negative tests. Overall, 283 (99%) patients were vaccinated using this newly developed protocol. Patients with adverse reactions to the first dose of the vaccine before the study had a significantly lower basal serum tryptase concentration (p = 0.001). Conclusion Skin tests with anti-COVID-19 vaccines are a useful tool in the vaccination protocol. This protocol enables safe immunisation of high-allergy-risk patients even in cases of positive skin tests.
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Affiliation(s)
- Jan Romantowski
- Department of AllergologyMedical University of GdanskGdańskPoland
| | - Jerzy Kruszewski
- Department of Infectious Diseases and AllergologyMilitary Institute of MedicineWarsawPoland
| | - Oskar Solarski
- Department of AllergologyChmielnik HospitalChmielnikPoland
| | - Andrzej Bant
- Department of Infectious Diseases and AllergologyMilitary Institute of MedicineWarsawPoland
| | - Andrzej Chciałowski
- Department of Infectious Diseases and AllergologyMilitary Institute of MedicineWarsawPoland
| | - Ilona Pietrzyk
- Department of AllergologyChmielnik HospitalChmielnikPoland
| | | | | | - Marta Chełmińska
- Department of AllergologyMedical University of GdanskGdańskPoland
| | - Agata Knurowska
- II Department of RadiologyMedical University of GdanskGdańskPoland
| | | | - Ewa Jassem
- Department of PneumonologyMedical University of GdańskGdańskPoland
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Toida R, Uezono S, Komatsu H, Toida T, Imamura A, Fujimoto S, Kaikita K. Takotsubo cardiomyopathy after vaccination for coronavirus disease 2019 in a patient on maintenance hemodialysis. CEN Case Rep 2022; 11:220-224. [PMID: 34731486 PMCID: PMC8564792 DOI: 10.1007/s13730-021-00657-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 01/15/2023] Open
Abstract
Coronavirus disease-2019 (COVID-19) has affected more than 220 million individuals since the global pandemic began. There is an urgent need for safe and effective vaccines, and vaccinations, such as mRNA vaccines, have been initiated worldwide. However, the adverse effects of these vaccines remain unclear. We herein present a case of an 80-year-old female on maintenance hemodialysis who developed takotsubo cardiomyopathy 4 days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. There was no obvious trigger for the onset of takotsubo cardiomyopathy other than the COVID-19 vaccination, which was the most significant event preceding her presentation. Echocardiograms obtained during her admission allowed us to monitor and show the recovery of left ventricular wall motion. We confirmed the diagnosis of takotsubo cardiomyopathy based on the findings, including transient left ventricular dysfunction, electrocardiographic abnormalities, an elevated troponin level, and the absence of occlusive coronary artery disease. In the present case, the vaccination may have triggered emotional or physical stress. Although difficulties are associated with proving the causal relationship in the present case, the temporal relationship between the vaccination and the onset of takotsubo cardiomyopathy is highly suggestive. The adverse effects associated with the vaccine are typical of COVID-19 vaccines administered to date, most of which are acceptable. Therefore, despite our experience of the present case, we still recommend the vaccination for COVID-19 because takotsubo cardiomyopathy induced by the COVID-19 vaccine is extremely rare and the prognosis of the patient was good. We herein present the first case of a patient on hemodialysis who developed takotsubo cardiomyopathy after receiving COVID-19 vaccination.
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Affiliation(s)
- Reiko Toida
- Department of Cardiology, Chiyoda Hospital, 88 Furuta, Hichiya, Hyuga city, Miyazaki, 883-0064, Japan.
| | - Shigehiro Uezono
- Department of Nephrology, Chiyoda Hospital, 88 Furuta, Hichiya, Hyuga city, Miyazaki, Japan
| | - Hiroyuki Komatsu
- Faculty of Medicine, Center for Medical Education and Career Development, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki city, Miyazaki, Japan
| | - Tatsunori Toida
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki city, Miyazaki, Japan
| | - Akiko Imamura
- Department of Nephrology, Chiyoda Hospital, 88 Furuta, Hichiya, Hyuga city, Miyazaki, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki city, Miyazaki, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki city, Miyazaki, Japan
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Atyabi SMH, Rommasi F, Ramezani MH, Ghane Ezabadi MF, Arani MA, Sadeghi MH, Ahmed MM, Rajabi A, Dehghan N, Sohrabi A, Seifi M, Nasiri MJ. Relationship between blood clots and COVID-19 vaccines: A literature review. Open Life Sci 2022; 17:401-415. [PMID: 35582622 PMCID: PMC9055170 DOI: 10.1515/biol-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 pandemic is one of the most critical pandemics during human civilization. Several therapeutic strategies for COVID-19 management have been offered; nonetheless, none of them seems to be sufficiently beneficial. In effect, vaccines have been proffered as a viable option. The critical issue now is to concentrate on protecting individuals against illness through immunization. One of the causes for concern among the researchers, physicians, and generally the whole community from the onset of vaccination has been the adverse effects (specifically blood clots) that may be observed after the injection of the COVID-19 vaccine. In some countries, such concerns have even resulted in the temporary or permanent discontinuation or abandonment of the application of some vaccines (especially AstraZeneca and Janssen). By evaluating rigorous studies published on this subject, the present article is aimed at identifying the association between blood clot incidence and COVID-19 vaccination. Various methods for producing the COVID-19 vaccines are analyzed, along with their possible pros and cons as well as common and rare side effects, especially VITT and blood clots. Finally, the differences of various vaccines on thrombotic events, WHO recommendations for VITT treatment, and blood clots statics are discussed.
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Affiliation(s)
| | - Foad Rommasi
- Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
- Microbiology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | | | | | | | | | - Mohammad Mehdi Ahmed
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Rajabi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Dehghan
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sohrabi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Seifi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chen L, Cai X, Zhao T, Han B, Xie M, Cui J, Zhang J, Wang C, Liu B, Lu Q, Cui F. Safety of Global SARS-CoV-2 Vaccines, a Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10040596. [PMID: 35455344 PMCID: PMC9030038 DOI: 10.3390/vaccines10040596] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines were developed in only a short amount of time and were widely distributed. We conducted this meta-analysis to understand the safety of SARS-CoV-2 vaccines. (2) Methods: We searched the corresponding literature published from 1 January 2020 to 20 October 2021. Information of adverse events (AEs) of each selected work was collected. The quality and bias of studies was evaluated, and meta-analysis was carried out by using Stata 17.0. (3) Results: Totally, 11,451 articles were retrieved, and 53 of them were included for analysis. The incidence rate of AEs was 20.05–94.48%. The incidence rate of vascular events increased after viral vector vaccination, while the incidence rate of vascular events decreased after mRNA vaccination. Viral vector vaccine had a higher AE rate compared to mRNA vaccines and inactivated vaccines. In most circumstances, the incidence of AEs was higher in older people, female and after the second dose. The sensitivity of meta-analysis was acceptable; however, the literature was subject to a certain publication bias. (4) Conclusions: The safety of SARS-CoV-2 vaccines was acceptable. The incidence of allergic symptoms and cardiovascular and cerebrovascular symptoms was low. Viral vector vaccine had a higher risk of leading to thrombosis events. The understanding of SARS-CoV-2 vaccine AEs should be enhanced, so as to promote the vaccination.
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Affiliation(s)
- Linyi Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.C.); (X.C.); (T.Z.); (B.H.); (M.X.)
| | - Xianming Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.C.); (X.C.); (T.Z.); (B.H.); (M.X.)
| | - Tianshuo Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.C.); (X.C.); (T.Z.); (B.H.); (M.X.)
| | - Bingfeng Han
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.C.); (X.C.); (T.Z.); (B.H.); (M.X.)
| | - Mingzhu Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.C.); (X.C.); (T.Z.); (B.H.); (M.X.)
| | - Jiahao Cui
- Faculty of Medicine, Imperial College London, London SW7 2AZ, UK;
| | - Jiayu Zhang
- Bioinformatics Program, School of Science, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China;
| | - Chao Wang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; (C.W.); (B.L.); (Q.L.)
| | - Bei Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; (C.W.); (B.L.); (Q.L.)
| | - Qingbin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; (C.W.); (B.L.); (Q.L.)
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; (C.W.); (B.L.); (Q.L.)
- Correspondence: ; Tel./Fax: +86-10-8280-1518
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Alorfi N, Ashour A. Evaluating Pharmacists’ Pharmacological Knowledge and Views Regarding Pfizer-BioNTech COVID-19 Vaccine in Saudi Arabia. Clin Pharmacol 2022; 14:27-35. [PMID: 35411192 PMCID: PMC8994594 DOI: 10.2147/cpaa.s356413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Pfizer-BioNTech COVID-19 vaccine has been widely used and approved for the prevention of 2019 coronavirus disease (COVID-19) for individuals aged 16 years and older in Saudi Arabia. The emergency use authorization of this vaccine is crucial to managing the pandemic in the Kingdom. This vaccination strategy requires proper usage, knowledge, and management by pharmacists and other health professionals. Methods This cross-sectional study was conducted using several previously validated questionnaires. Pharmacists working in different health sectors in Saudi Arabia in March–July 2021 participated via an online questionnaire. Comparative and descriptive analyses were used to analyze the data, and a P-value < 0.05 was considered significant. Results A total of 145 pharmacists with a mean age of 35.2 years (SD ± 5.59) were included. The study sample showed adequate general knowledge of COVID-19 and its causative virus signs. Overall, the results showed good knowledge of Pfizer-BioNTech COVID-19 vaccine and its pharmacological application among pharmacists in Saudi Arabia with significant chi square values (p< 0.0001). Conclusion Pharmacists have good knowledge and understanding of the Pfizer-BioNTech COVID-19 vaccine; interestingly, the majority expressed a high level of awareness and agreed that Pfizer-BioNTech COVID-19 vaccine is a valuable vaccine for COVID-19 management.
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Affiliation(s)
- Nasser Alorfi
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
- Correspondence: Nasser Alorfi, Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia, Tel +966500644261, Email
| | - Ahmed Ashour
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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Belete TM. The Immune Response, Safety, and Efficacy of Emergency Use Authorization-Granted COVID-19 Vaccines: A Review. Open Microbiol J 2022. [DOI: 10.2174/18742858-v16-e2201240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
COVID-19 has affected millions of people, causing a burden on healthcare systems as well as economies throughout the world. Antiviral drugs do not work well enough for everyone. The mortality rate in the world is still significant. Developing safe, effective, affordable, and fast-acting vaccines for COVID-19 is critical for reducing new viral strains in this pandemic and re-establishing normality in the future. Therefore, several pharmaceutical companies are racing to develop effective vaccines for COVID-19. Scientists have developed different kinds of candidate vaccines with various platforms. By March 2021, thirteen vaccines were approved for emergency use in several countries across the world, whilst over 90 vaccine candidates were under clinical trials. There are also several vaccine candidates in Phase 3 trials awaiting results and approval for their use. These candidate vaccines revealed positive results in the previous phase trials, whereby they can induce an immune response with less adverse reaction in the participants. This review focuses on the development of COVID-19 vaccines and highlights the efficacy and adverse reactions of vaccines authorized for emergency use.
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Yamashita E, Takita M, Kami M. Time-Dependent Changes in Death Reports and the Sex Ratio in the Safety Surveillance of SARS-CoV-2 Vaccination in Japan, the United States, and European Countries. Cureus 2022; 14:e23380. [PMID: 35475057 PMCID: PMC9022046 DOI: 10.7759/cureus.23380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/20/2022] Open
Abstract
The national safety surveillance of vaccines is a fundamental measure to ensure vaccination safety and maintain transparency and public trust. Our previous study revealed an early increase in death reports after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in Japanese surveillance despite our hypothesis that no time-dependent variations in the number of death reports would be seen if the vaccination is not related to serious adverse events. This study is an extensive investigation to determine whether the number of death reports varied consistently over time after vaccination in the older population in Japan, the US, and European countries. We collected the death reports after BNT162b2 mRNA vaccination in individuals aged 65 years or older using the open databases in Japan, the US (Vaccine Adverse Event Reporting System, VAERS), and European countries (EudraVigilance). We observed an early increase of death reports on Day 2 after the vaccination in all three databases. The female-to-male ratio was also assessed and showed a certain degree of time-dependence (R2 of linear regression 0.54, p =0.01) in Japan but not in the US and European countries. The findings suggest the existence of unknown predictors of the adverse events of the SARS-CoV-2 vaccination, especially for the older Japanese population. The continuous and careful monitoring safety aspects of the vaccines are warranted.
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Hasija V, Patial S, Raizada P, Thakur S, Singh P, Hussain CM. The environmental impact of mass coronavirus vaccinations: A point of view on huge COVID-19 vaccine waste across the globe during ongoing vaccine campaigns. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 813:151881. [PMID: 34826493 PMCID: PMC8609666 DOI: 10.1016/j.scitotenv.2021.151881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 05/23/2023]
Abstract
The vaccine innovation is a ubiquitous preventive measure to the transmission of highly infectious SARS-COV-2. The ongoing mass coronavirus vaccination programmes have inadvertently become the bulk producers of biomedical and plastic waste triggering severe impact on the environment. The sustainable management of bio hazardous vaccine waste in particular; syringes, needles, used/un-used vials and single-use plastic equipment is of utmost importance. This perspective presents a critical point of view in terms of the generated vaccine waste and the subsequent knock-on effect on all aspects of ecosystem. The discussion includes dire consequences due to the release of huge amount of plastic-based personal protective equipment into marine environment. The pivotal crisis of CO2 emission during the manufacture and storage of different vaccines has contributed to global warming. The unavoidable generation of microfibers upon incineration, autoclaving, pyrolysis and open dumping of vaccine waste has further jeopardized the environment. In this vein, exploration of biodegradable materials for vaccine inoculation and development of green technologies for sound waste management is suggested to mitigate the environment pollution.
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Affiliation(s)
- Vasudha Hasija
- School of Advanced Chemical Sciences, Shoolini University, Solan, Himachal Pradesh 173212, India
| | - Shilpa Patial
- School of Advanced Chemical Sciences, Shoolini University, Solan, Himachal Pradesh 173212, India
| | - Pankaj Raizada
- School of Advanced Chemical Sciences, Shoolini University, Solan, Himachal Pradesh 173212, India
| | - Sourbh Thakur
- Department of Organic Chemistry, Bioorganic Chemistry and Biotechnology, Silesian University of Technology, B. Krzywoustego 4, 44-100 Gliwice, Poland
| | - Pardeep Singh
- School of Advanced Chemical Sciences, Shoolini University, Solan, Himachal Pradesh 173212, India.
| | - Chaudhery Mustansar Hussain
- Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ 07102, USA.
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Cutaneous Complications of mRNA and AZD1222 COVID-19 Vaccines: A Worldwide Review. Microorganisms 2022; 10:microorganisms10030624. [PMID: 35336199 PMCID: PMC8953728 DOI: 10.3390/microorganisms10030624] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/07/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023] Open
Abstract
Because of the increasing emergence of cutaneous reactions from COVID-19 vaccines worldwide, we investigated the published reports of these complications. We searched the PubMed, Google Scholar, and Scopus databases and the preprint server bioRxiv for articles on cutaneous complications linked to mRNA-1273 (Moderna), BNT162b2 (Pfizer–BioNTech), and AZD1222 (AstraZeneca–Oxford University) vaccines published until 30 September 2021. Eighty studies describing a total of 1415 reactions were included. Cutaneous reactions were more prevalent in females (81.6%). Delayed large local reactions were the most common complication (40.4%), followed by local injection site reactions (16.5%), zoster (9.5%), and urticarial eruptions (9.0%). Injection site and delayed large local reactions were predominantly caused by the mRNA-1273 vaccine (79.5% and 72.0%, respectively). BNT162b2 vaccination was more closely linked to distant reactions (50.1%) than mRNA-1273 (30.0%). Zoster was the most common distant reaction. Of reactions with adequate information for both vaccine doses, 58.3% occurred after the first dose only, 26.9% after the second dose only, and 14.8% after both doses. Overall, a large spectrum of cutaneous reaction patterns occurred following the COVID-19 vaccination. Most were mild and without long-term health implications. Therefore, the occurrence of such dermatologic complications does not contraindicate subsequent vaccination.
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Ali SB, Perkins G, Ryoo D, Lee M, Tunbridge M, Yuson C, Smith W, Hissaria P, Le TT. AstraZeneca ChAdOx1-S COVID-19 vaccine can be safely administered in patients with EDTA allergy. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:22. [PMID: 35272714 PMCID: PMC8908291 DOI: 10.1186/s13223-022-00665-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/04/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Immediate hypersensitivity reactions to COVID-19 vaccines have been postulated to be linked to their excipients, such as polyethylene glycol (PEG) in Pfizer Comirnaty, or polysorbate 80 and ethylenediaminetetracetic acid (EDTA) in AstraZeneca ChAdOx1-S [recombinant] (Vaxzevria). These excipients are found in a range of other products, including injectable and oral medications as well as intravenous radiocontrast media (RCM) and various cosmetic products. Patients with proven excipient allergy may be advised to avoid a COVID-19 vaccine containing that excipient and/or potentially cross-reactive excipients. This may result in individual patients not receiving vaccines, especially if an alternate option is not available, and on a broader level contribute to vaccine hesitancy. We present two cases of previously confirmed EDTA anaphylaxis with positive intradermal testing, who had negative Vaxzevria vaccine in-vivo testing and subsequently tolerated the vaccine. CASE 1: A patient with history of anaphylaxis to RCM and local anaesthetics (LA) had positive intradermal test (IDT) to EDTA nine years earlier. Skin testing to Vaxzeria vaccine (up to 1:10 IDT), Comirnaty vaccine (up to 1:10 IDT) and EDTA 0.3 mg/mL IDT were negative. However, following EDTA 3 mg/ml IDT, he developed immediate generalised urticaria without anaphylaxis. Basophil activation testing was negative to disodium EDTA, Vaxzevria and Cominarty vaccines. Given the negative in-vitro and in-vivo testing to Vaxzevria vaccine, he proceeded to Vaxzevria immunisation and tolerated both doses. CASE 2: A patient with history of anaphylaxis to RCM had positive skin testing to EDTA and RCM containing EDTA six years earlier. Following referral to COVID19 vaccine clinic, Vaxzevria vaccine (1:10 IDT) and Cominarty vaccine (1:10 IDT) were negative whilst EDTA was positive at 0.3 mg/mL IDT. He subsequently tolerated both Vaxzevria vaccinations. CONCLUSION Excipient allergy does not necessarily preclude a patient from receiving a vaccine containing that excipient. Allergy testing can help identify excipient-allergic patients who may still tolerate vaccination, which is important in situations where COVID-19 vaccination options are limited.
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Affiliation(s)
- Syed B Ali
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia.,Department of Immunopathology, SA Pathology, Adelaide, Australia
| | - Griffith Perkins
- Department of Immunopathology, SA Pathology, Adelaide, Australia.,School of Biological Sciences, University of Adelaide, Adelaide, Australia
| | - Dongjae Ryoo
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - Maverick Lee
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - Matthew Tunbridge
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - Chino Yuson
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - William Smith
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia
| | - Pravin Hissaria
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia.,Department of Immunopathology, SA Pathology, Adelaide, Australia
| | - Thanh-Thao Le
- Department of Clinical Immunology and Allergy, Le. Royal Adelaide Hospital, 1 Port Road, Adelaide, South Australia, 5000, Australia.
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131
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Zothantluanga JH, Abdalla M, Rudrapal M, Tian Q, Chetia D, Li J. Computational Investigations for Identification of Bioactive Molecules from Baccaurea ramiflora and Bergenia ciliata as Inhibitors of SARS-CoV-2 M pro. Polycycl Aromat Compd 2022. [DOI: 10.1080/10406638.2022.2046613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- James H. Zothantluanga
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, India
| | - Mohnad Abdalla
- Key Laboratory of Chemical Biology (Ministry of Education), Department of Pharmaceutics, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Shandong Province, PR China
| | - Mithun Rudrapal
- Department of Pharmaceutical Chemistry, Rasiklal M. Dhariwal Institute of Pharmaceutical Education Research, Pune, Maharashtra, India
| | - Qiang Tian
- Department of Senile Neurology, The Central Hospital of Taian, Taian, Shandong, PR China
| | - Dipak Chetia
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, India
| | - Jin Li
- Key Laboratory of Chemical Biology (Ministry of Education), Department of Pharmaceutics, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Shandong Province, PR China
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132
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Macy E, Pandya S, Sheikh J, Burnette A, Shi JM, Chung J, Gin N, Crawford W, Zhang J. Population-Based Incidence, Severity, and Risk Factors Associated with Treated Acute-Onset COVID-19 mRNA Vaccination-Associated Hypersensitivity Reactions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:827-836. [PMID: 34971845 PMCID: PMC8714255 DOI: 10.1016/j.jaip.2021.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND COVID-19 mRNA vaccination-associated acute-onset hypersensitivity reactions have caused anxiety and may be contributing to vaccine hesitancy. OBJECTIVE To determine the incidence, severity, and risk factors for treated acute-onset COVID-19 mRNA vaccination-associated hypersensitivity reactions in a well-characterized population. METHODS All Kaiser Permanente Southern California (KPSC) members who received COVID-19 mRNA vaccinations between December 15, 2020, and March 11, 2021, at a KPSC facility were identified and characterized, along with all treated acute-onset vaccination-associated hypersensitivity events. RESULTS We identified 391,123 unique vaccine recipients (59.18% female, age 64.19 ± 17.86 years); 215,156 received 2 doses (53.54% Moderna), 157,615 only a first dose (50.13% Moderna) (1961 [1.46%] >2 weeks late getting a second dose), and 18,352 (74.43% Moderna) only a second dose. Only 104 (0.028%) (85.58% female, age 53.18 ± 15.96 years) had treated first dose events, 68 (0.030%) Moderna. Only 32 (0.014%) (93.75% female, age 57.28 ± 17.09 years) had treated second dose events, 21 (0.016%) Moderna. Only 2 (0.00033%) vaccinations resulted in anaphylaxis. Only 27 (20.77%) of those with treated first dose reactions failed to get a second dose. Only 6 of 77 (7.8%) with first dose reactions also had second dose reactions. Individuals with treated events were more likely to be female (P < .0001), younger (P < .0001), and had more pre-existing drug "allergies" (2.11 ± 2.12 vs 1.02 ± 1.41 [P < .0001] for average recipients). CONCLUSIONS Treated acute-onset hypersensitivity events were mostly benign, more common with first COVID-19 mRNA vaccine doses, more likely to occur in younger females with typical risk factors associated with multiple drug intolerance syndrome, and very unlikely to be primarily immunologically mediated.
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Affiliation(s)
- Eric Macy
- Allergy Department, Kaiser Permanente Southern California, San Diego, Calif.
| | - Shalin Pandya
- Allergy Department, Kaiser Permanente Southern California, Los Angeles, Calif
| | - Javed Sheikh
- Allergy Department, Kaiser Permanente Southern California, Los Angeles, Calif
| | - Amber Burnette
- Allergy Department, Kaiser Permanente Southern California, Los Angeles, Calif
| | - Jiaxiao M Shi
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Joanie Chung
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Nancy Gin
- Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, Calif
| | - William Crawford
- Allergy Department, Kaiser Permanente Southern California, Los Angeles, Calif
| | - Jing Zhang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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133
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Yeo A, Kuek B, Lau M, Tan SR, Chan S. Post COVID-19 vaccine deaths - Singapore's early experience. Forensic Sci Int 2022; 332:111199. [PMID: 35078041 PMCID: PMC8767909 DOI: 10.1016/j.forsciint.2022.111199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023]
Abstract
Singapore has been using mRNA vaccines developed by Pfizer-BioNTech and Moderna as part of the nation's COVID vaccination program since 30 December 2020. From 1 February 2021-30 June 2021, a total of 34 deaths that occurred within 72 h of the deceased receiving their COVID-19 vaccination were referred to the Forensic Medicine Division of the Health Sciences Authority of Singapore. Autopsies, histological sampling and ancillary investigations consisting of total tryptase level, Immunoglobulin E (IgE), and C-reactive Protein (CRP), were performed on 29 of these cases. Our study has shown no definite causative relationship between the mRNA vaccination and deaths of individuals who died within 72 h after receiving the vaccination, in particular with regards to anaphylactic reactions, myocarditis and pericarditis, and thrombotic complications. Further studies may consider increasing the incident time frame from 72 h to seven days post-vaccination or longer to include any potential delayed presentation of adverse effects.
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Affiliation(s)
- Audrey Yeo
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore.
| | - Benjamin Kuek
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Mandy Lau
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Shi Rui Tan
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Shijia Chan
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
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134
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Cohen DA, Greenberg P, Formanowski B, Parikh PD. Are COVID-19 mRNA vaccine side effects severe enough to cause missed work? Cross-sectional study of health care-associated workers. Medicine (Baltimore) 2022; 101:e28839. [PMID: 35363178 PMCID: PMC9282130 DOI: 10.1097/md.0000000000028839] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT The Coronavirus Disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome-coronavirus-2, has claimed 5,587,549 lives worldwide as of January 20, 2022. Fortunately, large-scale vaccination can mitigate the impact of COVID-19 by making the disease milder and less common. Although 75.2% of the United States population has received at least 1 dose of a COVID-19 vaccines thus far, concerns regarding vaccine side effects have contributed to vaccine hesitancy. Furthermore, nearly 50% of adults in the United States are concerned not only about side effects, but about their downstream impact, including missed work.The goal of this cross-sectional study was to investigate the effect of messenger RNA vaccine adverse effects on the propensity to miss work among employees associated with a single, large academic health center.Using Qualtrics, all employees, including faculty, staff, and trainees, of 5 large departments were surveyed to determine whether they received the COVID-19 vaccine and which type, and any symptoms they experienced after receipt of either vaccine dose. We hypothesized that vaccine recipients would be more likely to miss work or feel sick enough to miss work following the second dose.Thirty-seven percent of respondents experienced events severe enough that they needed to miss work from either of the doses, with the majority (27.8%) related to the second dose. These findings are consistent with and expand on the results from the phase 3 trials for Pfizer-BionTech and Moderna, which showed that vaccine side effects were more common after the second dose than after the first dose. Our statistically significant finding was more common among Asians, women, trainees/house staff, and nonphysician clinical employees.With an increasing number of individuals taking the vaccine, employers will need to account for the impact of adverse effects on their employees' ability to work. These findings will further help organizations better plan for staffing as vaccinations increase to mitigate the spread of COVID-19.
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Affiliation(s)
- David A. Cohen
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Patricia Greenberg
- Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Rutgers University, Piscataway, NJ
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ
| | - Brielle Formanowski
- Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Rutgers University, Piscataway, NJ
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ
| | - Payal D. Parikh
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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135
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Chan NN, Ong KW, Siau CS, Lee KW, Peh SC, Yacob S, Chia YC, Seow VK, Ooi PB. The lived experiences of a COVID-19 immunization programme: vaccine hesitancy and vaccine refusal. BMC Public Health 2022; 22:296. [PMID: 35164734 PMCID: PMC8842982 DOI: 10.1186/s12889-022-12632-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background The COVID-19 pandemic has resulted in a global health emergency and lock-down measures to curb the uncontrolled transmission chain. Vaccination is an effective measure against COVID-19 infections. In Malaysia amidst the national immunisation programme (NIP) which started in February 2021, there were rising concerns regarding the prevalence of vaccine hesitancy and refusal, and therefore, vaccine uptake among Malaysians. Although there are many quantitative studies on COVID-19 vaccination, the subjective experience of individuals was understudied. This study aims to explore the lived experiences of Malaysians regarding vaccine hesitancy and refusal, and facilitating factors that could enhance vaccine acceptance and uptake. Methods This qualitative study employed the hermeneutic phenomenological study design. Purposive sampling strategies were used to recruit Malaysians that had direct experiences with friends, family members and their community who were hesitating or refusing to accept the COVID-19 vaccines. A semi-structured interview guide was developed based on the expert knowledge of the investigators and existing literature on the topic. A series of focus group interviews (FGIs) was conducted online facilitated by a multidisciplinary team of experts. The group interviews were transcribed verbatim and analysed. Results Fifty-nine participants took part in seven FGIs. We found that “incongruence” was the overall thematic meaning that connected all the 3 main themes. These themes comprise firstly, the incongruence between the aims and implementation of the National Immunization Program which highlighted the gap between realities and needs on the ground. Secondly, the incongruence between Trust and Mistrust revealed a trust deficit in the government, COVID-19 news, and younger people’s preference to follow the examples of local vaccination “heroes”. Thirdly, the incongruence in communication showed the populace’s mixed views regarding official media and local social media. Conclusions This study provided rich details on the complex picture of the COVID-19 immunization program in Malaysia and its impact on vaccine hesitancy and refusal. The inter-related and incongruent factors explained the operational difficulty and complexity of the NIP and the design of an effective health communication campaign. Identified gaps such as logistical implementation and communication strategies should be noted by policymakers in implementing mitigation plans.
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Affiliation(s)
- Nee Nee Chan
- Department of English and Education, Faculty of Social Sciences, Quest International University, 30250, Ipoh, Perak, Malaysia.,Faculty of Social Sciences & Liberal Arts, UCSI University, 56000, Kuala Lumpur, Malaysia
| | - Khang Wei Ong
- Department of Pharmacology, Faculty of Medicine, Quest International University, 30250, Ipoh, Perak, Malaysia
| | - Ching Sin Siau
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, 43000, Kajang, Malaysia.,Centre for Research On Communicable Diseases, Universiti Tunku Abdul Rahman, 43000, Kajang, Malaysia
| | - Suat Cheng Peh
- Jeffrey Sachs Center On Sustainable Development, Sunway University, Bandar Sunway, Malaysia.,Department of Medical Sciences, School of Medical & Life Sciences, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
| | - Shakila Yacob
- Department of History, Faculty of Arts & Social Sciences, University of Malaya, 50603, Kuala Lumpur, Malaysia.,The International Institute of Public Policy and Management (INPUMA), University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yook Chin Chia
- Department of Medical Sciences, School of Medical & Life Sciences, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Vei Ken Seow
- Emergency Medicine Department, Sunway Medical Centre, 47500, Bandar Sunway, Selangor, Malaysia.
| | - Pei Boon Ooi
- Department of Medical Sciences, School of Medical & Life Sciences, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia.
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136
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Mahgoub AE, Awuah D, Hussain M, Deliwala S, Bachuwa G, Younas M. Development of Venous Thromboembolism After COVID-19 mRNA-1273 Vaccine Inoculation. Cureus 2022; 14:e22179. [PMID: 35308698 PMCID: PMC8923564 DOI: 10.7759/cureus.22179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 01/05/2023] Open
Abstract
A 79-year-old man suddenly developed right lower extremity (RLE) pain and swelling a few days after receiving his 1st dose of the mRNA-1273 COVID-19 vaccine. Despite this, he proceeded to receive the 2nd dose of his mRNA-1273 COVID-19 vaccine. Investigations confirmed extensive acute deep venous thrombosis and a concurrent acute pulmonary embolism. Therapeutic anticoagulation was initiated and he was eventually discharged home on supplemental oxygen. The overall benefits of the vaccine in curbing severe disease overwhelmingly outweigh the handful of cases of reported adverse events. To our knowledge, this is one of the first few cases of provoked venous thrombosis after receiving the mRNA-1273 COVID-19 vaccine during the pharmacovigilance period.
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137
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Propensity-Score-Matched Evaluation of Adverse Events Affecting Recovery after COVID-19 Vaccination: On Adenovirus and mRNA Vaccines. Vaccines (Basel) 2022; 10:vaccines10020284. [PMID: 35214742 PMCID: PMC8875227 DOI: 10.3390/vaccines10020284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to observe adverse events following immunisation (AEFIs) that affected recovery within two weeks after COVID-19 vaccination and investigate their risks in propensity-score-matched populations. Data were collected from 447,346 reports from the VAERS between 1 January 2021 and 31 July 2021. Propensity-score-matched populations were constructed by adjusting for demographic characteristics and 11 underlying diseases in eligible subjects who received 1 of 3 COVID-19 vaccines: 19,462 Ad26.COV2.S, 120,580 mRNA-1273, and 100,752 BNT162b2. We observed that 88 suspected AEFIs (22 in Ad26.COV2.S, 62 in mRNA-1273, and 54 in BNT162b2) were associated with an increased risk of delayed recovery within 2 weeks after COVID-19 vaccinations. Nervous system, musculoskeletal and connective tissue, gastrointestinal, skin, and subcutaneous tissue disorders were the most common AEFIs after COVID-19 vaccination. Interestingly, four local and systemic reactions affected recovery in different vaccine recipients during our study period: asthenic conditions and febrile disorders in Ad26.COV2.S and mRNA-1273; general signs and symptoms in mRNA-1273 and BNT162b2; injection site reactions in Ad26.COV2.S and BNT162b2. Although it is necessary to confirm a causal relationship with COVID-19 vaccinations, some symptoms, including paralysis, allergic disorders, breathing abnormalities, and visual impairment, may hinder the recovery of these recipients.
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138
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Lo Moro G, Cugudda E, Bert F, Raco I, Siliquini R. Vaccine Hesitancy and Fear of COVID-19 Among Italian Medical Students: A Cross-Sectional Study. J Community Health 2022; 47:475-483. [PMID: 35138490 PMCID: PMC9160103 DOI: 10.1007/s10900-022-01074-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
Medical students are in close contact with patients and should adhere to the same recommendations as healthcare workers. The study aimed to explore medical students' hesitancy towards COVID-19 vaccine and evaluate fear of COVID-19 and its relationship with hesitancy. A cross-sectional survey was conducted amongst a sample of medical students attending clinical years (November 2020–February 2021, Italy). Multivariable regressions were performed (p < 0.05 as significant). A total of 929 students participated (58.6% of eligible students). Hesitancy was reported by 6.7%; extreme fear of COVID-19 by 42.0%. Among hesitancy predictors, there were the survey completion before COVID-19 vaccine authorisation (adjOR = 6.43), adverse reactions after a vaccination (adjOR = 3.30), and receiving advice against COVID-19 vaccination from a relative (adjOR = 2.40). Students who received the recommended paediatric vaccinations (adjOR = 0.10), students with higher adherence to preventive measures (adjOR = 0.98), and students with fear of contracting COVID-19 with regard to the health of loved ones (adjOR = 0.17) were less likely to be hesitant. Females (adjOR = 1.85), students with poor health (adjOR = 1.64), students who had a loved one severely affected by COVID-19 (adjOR = 1.68), and students with fear of contracting flu (adjOR = 3.06) had a higher likelihood of reporting extreme fear. Hesitancy was remarkably lower than in similar studies. However, there is room for improvement in university activities that could deepen the competence in vaccines. Our focus on fear should not be overlooked, since the extent of extreme fear that we found might represent a substantial burden, considering the associations between fear and other health outcomes.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Eleonora Cugudda
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Fabrizio Bert
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - Immacolata Raco
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
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139
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Tuzer C, Terzioglu K. Evaluation of the Autoimmunity and Preexisting Risky Conditions for Hypersensitivity Reactions to COVID-19 Vaccines. Int Arch Allergy Immunol 2022; 183:651-661. [PMID: 35114667 PMCID: PMC9059002 DOI: 10.1159/000521709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The role of autoimmunity and other preexisting risky conditions in hypersensitivity reactions (HSRs) to COVID-19 vaccines seems unclear. The aim of the study was to investigate the autoimmunity and preexisting risky conditions in HSRs to COVID-19 vaccines. METHODS The patients aged ≥18 years with a history of HSR to CoronaVac or Pfizer-BioNTech COVID-19 vaccines within 24 h in 2 tertiary centers were assessed. The patients were divided according to the type of vaccine which they showed immediate-type (<4 h) HSR to (group A1 for CoronaVac and group B1 for Pfizer-BioNTech). Equal number of subjects who did not show HSR to two doses of either CoronaVac or Pfizer-BioNTech was recruited into the study as control groups (group A2 for CoronaVac and group B2 for Pfizer-BioNTech). The autologous serum skin test (ASST) was performed on patient and control groups. Later, the demographic, clinical, and laboratory features were compared between groups. RESULTS A total number of 27 patients were included in the study. Subjects with chronic spontaneous urticaria (CSU) were more frequent in group B1 than in group B2 (p:0.041). In addition to CSU, the presence of HSRs to drugs was higher in group A1 than in A2 (both p:0.007). The presence of autoimmunity and autoimmune diseases, positivity of antithyroid peroxidase antibody, and ASST were less in group A2 than in A1 (p:0.015, p:0.048, p:0.048, and p:0.037). Additionally, COVID-19 infection history was less in group A2 than in A1 (p:0.037). DISCUSSION/CONCLUSION Type IIb autoimmunity seems to play a role in immediate type HSRs to the CoronaVac vaccine as previously shown in autoimmune CSU and multidrug hypersensitivity.
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Affiliation(s)
- Can Tuzer
- Adult Immunology and Allergy Clinic, Batman Research and Education Hospital, Batman, Turkey
| | - Kadriye Terzioglu
- Adult Immunology and Allergy Clinic, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
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140
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Pack SM, Peters PJ. SARS-CoV-2-Specific Vaccine Candidates; the Contribution of Structural Vaccinology. Vaccines (Basel) 2022; 10:236. [PMID: 35214693 PMCID: PMC8877865 DOI: 10.3390/vaccines10020236] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
SARS-CoV-2 vaccine production has taken us by storm. We aim to fill in the history of concepts and the work of pioneers and provide a framework of strategies employing structural vaccinology. Cryo-electron microscopy became crucial in providing three-dimensional (3D) structures and creating candidates eliciting T and B cell-mediated immunity. It also determined structural changes in the emerging mutants in order to design new constructs that can be easily, quickly and safely added to the vaccines. The full-length spike (S) protein, the S1 subunit and its receptor binding domain (RBD) of the virus are the best candidates. The vaccine development to cease this COVID-19 pandemic sets a milestone for the pan-coronavirus vaccine's designing and manufacturing. By employing structural vaccinology, we propose that the mRNA and the protein sequences of the currently approved vaccines should be modified rapidly to keep up with the more infectious new variants.
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Affiliation(s)
| | - Peter J. Peters
- The Maastricht Multimodal Molecular Imaging Institute (M4i), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands;
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141
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Kamble B, Bashar MA, Mishra CP. Incidence, Pattern and Severity of Adverse Events Following Immunization (AEFIs) Associated With Chadox1 nCOV-19 Corona Virus Vaccine (Recombinant) Among the Healthcare Workers of a Tertiary Care Institute of Eastern Uttar Pradesh, India. Cureus 2022; 14:e21848. [PMID: 35273834 PMCID: PMC8901079 DOI: 10.7759/cureus.21848] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
Background In January 2020, the Government of India based on the recommendation of the Drugs Controller General of India (DCGI) and National Technical Advisory Group on Immunization (NTAGI) started the rollout of the COVID-19 vaccine in the country. Two vaccines, ChAdOx1 nCoV-19 coronavirus vaccine (recombinant), i.e., COVISHIELD produced by Serum Institute of India and COVAXIN developed indigenously by Bharat Biotech, were given emergency use authorisation (EUA) by the DCGI. Methods In this cohort study, we assessed the incidence, pattern and severity of adverse events following immunization (AEFI) observed among the healthcare workers of a large tertiary care institute in eastern U.P., India vaccinated with ChAdOx1 nCoV-19 Coronavirus vaccine (recombinant) within 30 minutes of vaccination by direct observation. Results Out of the total 836 healthcare workers who were vaccinated with the first dose of the vaccine, around 10% experienced any AEFI within the directly observed period. The most common AEFI was pain/tenderness at the injection site experienced by 59.3% of those who experienced any AEFI followed by headache/dizziness (35.3%), itching/rashes at the injection site (8.1%), nausea/vomiting (5.8%) and fever/chills (4.7%). The majority (95.3%) of the AEFIs observed were of minor severity with no serious AEFIs observed as per the WHO severity classification. Conclusion ChAdOx1 nCoV-19 Coronavirus vaccine (recombinant) is proven to be safe based on our findings as the majority of AEFIs observed were of minor grade only. However, the vaccine beneficiaries should be strictly observed for a minimum of 30 minutes at the vaccination site to look for any serious AEFI with arrangements to manage the same.
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142
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Watts MM, Maurer LE, Grammer LC, Saltoun CA, Stevens WW. Delayed angioedema after administration of the severe acute respiratory syndrome coronavirus 2 messenger RNA vaccine. Ann Allergy Asthma Immunol 2022; 128:215-216. [PMID: 34699970 PMCID: PMC8539818 DOI: 10.1016/j.anai.2021.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Melissa M Watts
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura E Maurer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leslie C Grammer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Carol A Saltoun
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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143
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Kaplan B, Farzan S, Coscia G, Rosenthal DW, McInerney A, Jongco AM, Ponda P, Bonagura VR. Allergic reactions to coronavirus disease 2019 vaccines and addressing vaccine hesitancy: Northwell Health experience. Ann Allergy Asthma Immunol 2022; 128:161-168.e1. [PMID: 34699968 PMCID: PMC8542398 DOI: 10.1016/j.anai.2021.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/03/2021] [Accepted: 10/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allergic and nonallergic adverse reactions have been reported with global coronavirus disease 2019 (COVID-19) vaccination. It was previously hypothesized that polyethylene glycol (PEG) may be responsible for anaphylactic reactions to messenger RNA (mRNA) COVID-19 vaccines. OBJECTIVE To report the workflow established at our institution, types, and frequency of adverse reactions to mRNA COVID-19 vaccines in patients presenting for allergy evaluation. METHODS A COVID-19 vaccine adverse reaction registry was established. We used PEG prick skin testing, followed by PEG challenges in selected cases, to ensure PEG tolerance and encourage completion of COVID-19 vaccination series. RESULTS A total of 113 patients were included. Most vaccine reactions (86.7%) occurred in women. Anaphylaxis occurred only in women, all of which had a history of allergic disease and two-thirds had asthma. Anaphylaxis rate was 40.6 cases per million. None of the anaphylactic cases developed hypotension, required intubation, or required hospital admission. Systemic allergic symptoms, not fulfilling anaphylaxis criteria, were significantly more common in Pfizer-BioNTech than Moderna-vaccinated patients (P = .02). We observed a higher incidence of dermatologic nonurticarial reactions in men (P = .004). Among first-dose reactors, 86.7% received and tolerated the second dose. We observed a high rate of false-positive intradermal skin test results and frequent subjective symptoms with oral PEG challenge. CONCLUSION Intradermal PEG testing has limited utility in evaluating anaphylaxis to mRNA vaccines. Most severe postvaccination allergic symptoms are not caused by hypersensitivity to PEG. Most people with reaction to the initial mRNA vaccine can be safely revaccinated. Patients with anaphylaxis to COVID-19 vaccines benefit from physician-observed vaccination.
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Affiliation(s)
- Blanka Kaplan
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
| | - Sherry Farzan
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Gina Coscia
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - David W Rosenthal
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Alissa McInerney
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York
| | - Artemio M Jongco
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Punita Ponda
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Vincent R Bonagura
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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144
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Arora S, Singh GK, Das P, Rahman R, Bellad P, Shrivastav R, Bahuguna A, Sapra D, Gupta A. A study of COVID‐19 vaccine (Covishield) induced dermatological adverse effects from India. J Eur Acad Dermatol Venereol 2022; 36:e402-e404. [DOI: 10.1111/jdv.17951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/25/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- S Arora
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - G K Singh
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - P Das
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - R Rahman
- Department of Physiology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - P Bellad
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | | | - Amit Bahuguna
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - Devyani Sapra
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - Akanksha Gupta
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
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145
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Halder A, Imamura H, Condon S, Boroughs K, Nilsson SC, Anderson T, Caterson ID. Pfizer/
BioNtech BNT162b2
: adverse events and insights from an Australian mass vaccination clinic for
COVID
‐19. Intern Med J 2022; 52:121-124. [DOI: 10.1111/imj.15623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/26/2021] [Accepted: 11/07/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Aditi Halder
- Vaccination Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Brain and Mind Centre The University of Sydney Sydney New South Wales Australia
| | - Hanaho Imamura
- Vaccination Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Stewart Condon
- Vaccination Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Kelly Boroughs
- Vaccination Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Sven C. Nilsson
- Vaccination Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Teresa Anderson
- Vaccination Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Ian D. Caterson
- Vaccination Clinic Royal Prince Alfred Hospital Sydney New South Wales Australia
- Boden Collaboration, Charles Perkins Centre The University of Sydney Sydney New South Wales Australia
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146
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Sobczak M, Pawliczak R. The risk of anaphylaxis behind authorized COVID-19 vaccines: a meta-analysis. Clin Mol Allergy 2022; 20:1. [PMID: 35039051 PMCID: PMC8762434 DOI: 10.1186/s12948-022-00167-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background A serious allergic reaction that may occur in response to medical products is anaphylaxis, which potentially can lead to anaphylactic shock. In the light of recent COVID-19 pandemic, much public attention had been paid to the severe allergic reactions occurring after COVID-19 vaccination. Therefore, in our study we would like to investigate the risk of authorized COVID-19 vaccines to induce anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and anaphylactoid shock. Methods We searched databases, such as PubMed, Web of Science and Embase and found eight articles about the incidence of anaphylactic and anaphylactoid reactions. Also, we used data from four databases from Canada, the U.S., the European Union and the United Kingdom. To calculate effect sizes, we used random effects model with inverse variance method. The risk ratio with 95% confidence interval were used for dichotomous outcomes. Statistical analysis was prepared in R. Results were considered statistically significant at p < 0.05. Results The most cases of anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and anaphylactoid shock were reported in female aged 18–85 years after BNT162b2 vaccine according to data from the EU. Analyzed COVID-19 vaccines can cause the anaphylaxis/anaphylactic reaction with risk of 106.99 (95% CI [39.95; 286.57], p < 0.0001, I2 = 59%), whereas the anaphylactoid reaction, anaphylactic and anaphylactoid shocks with risk of 113.3 (95% CI [28.11; 456.53], p < 0.0001), 344.2 (95% CI [85.77; 1381.39], p < 0.0001), 14.9, 95% CI [1.96; 112.79], p = 0.009), respectively. Conclusions Our meta-analysis shows that the risk of anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and anaphylactoid shock do not occur only after mRNA COVID-19 vaccines. Therefore, vaccination centers should be prepared to render assistance in the event of a reaction in all cases.
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Affiliation(s)
- Marharyta Sobczak
- Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, St. Zeligowskiego 7/9, 90-752, Lodz, Poland
| | - Rafał Pawliczak
- Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, St. Zeligowskiego 7/9, 90-752, Lodz, Poland.
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147
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Dursun AD, Saricam E, Sariyildiz GT, Iscanli MD, Cantekin ÖF. The Evaluation of Oxidative Stress in the Young Adults with COVID-19 mRNA Vaccines Induced Acute Pericarditis- Myopericarditis. Int J Gen Med 2022; 15:161-167. [PMID: 35023954 PMCID: PMC8747758 DOI: 10.2147/ijgm.s347977] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background During COVID-19 pandemic, several vaccines have been developed such as mRNA vaccines. However, acute pericarditis and myocarditis/myopericarditis cases have been described after mRNA vaccination. The mechanism for the development of cardiac involvement is unknown. Potential mechanism for oxidative stress associated with vaccine-induced heart involvement is unidentified. This study aimed to examine the role of oxidative stress and the heart involvement in young adults vaccinated with COVID-19 mRNA vaccines. Methods In this cross-sectional study, a total of 23 participants were included and 10 of these participants were asymptomatic patients (control group). Comparison of the cardiac involvement and control group was made by using troponin I, C-reactive protein (hsCRP), D-dimer levels, and oxidative stress tests including nitric oxide, and imaging techniques (ECG, echocardiography, cardiovascular magnetic resonance). Results The median age of acute pericarditis group (10 patients) was 22 years (Q1-Q3: 18.5–31), and the mean age was 24.4±7.5 years. The median age of myopericarditis group (3 patients) was 22 years (Q1–Q3 18.0–25.0), and the mean age was 21.6 ±3.5 years. All the myopericarditis cases were male. The patients with myopericarditis had higher troponin I level, hsCRP, and D-dimer levels (troponin I level; 1600.00 ng/mL; D-dimer; 1.20 μg/mL, hsCRP; 3.0 mg/L, respectively; p < 0.05). Serum nitric oxide levels and OSI (total oxidant status, H2O2/total antioxidant status) were lower in myopericarditis group than the control and acute pericarditis group (p < 0.05). This shows inflammatory and procoagulant state. Conclusion Vaccine-induced myopericarditis cases are associated with oxidative stress test abnormality (abnormal NO, OSI levels). However, there is no relationship between NO levels and other oxidative stress tests difference in vaccine-induced acute pericarditis. It is thought that vaccine-induced pericarditis and myopericarditis could have different pathogenesis. This could make it necessary to reassess the second dose of vaccination for vaccine-induced cardiac involvement cases.
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Affiliation(s)
- Ali Dogan Dursun
- Department of Physiology, Atılım University School of Medicine, Ankara, Turkey.,Check-Up Center, Home Care Services, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ersin Saricam
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey.,Department of Cardiology, Atılım University School of Medicine, Ankara, Turkey
| | - Gulcin Turkmen Sariyildiz
- Department of General Surgery, Medicana International Ankara Hospital, Ankara, Turkey.,Operating Room Services, Vocational School of Health Services, Atılım University, Ankara, Turkey
| | - Murat Doğan Iscanli
- Department of Emergency Medicine, Medicana International Ankara Hospital, Ankara, Turkey.,Department of Emergency Medicine, Atılım University School of Medicine, Ankara, Turkey
| | - Ömer Faruk Cantekin
- Faculty of Health Sciences, Department of Social Work, Gazi University, Ankara, Turkey
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148
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Seo Y, Ahn T, Paik J, Kang S. Should steroids be used for anaphylaxis after the COVID-19 vaccine? Clin Exp Emerg Med 2022; 8:251-254. [PMID: 35000352 PMCID: PMC8743684 DOI: 10.15441/ceem.21.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Youngho Seo
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Taekyu Ahn
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jinhui Paik
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Soo Kang
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
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150
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Hajra A, Gupta M, Ghosh B, Ashish K, Patel N, Manek G, Rai D, Sreenivasan J, Goel A, Lavie CJ, Bandyopadhyay D. Proposed Pathogenesis, Characteristics, and Management of COVID-19 mRNA Vaccine-Related Myopericarditis. Am J Cardiovasc Drugs 2022; 22:9-26. [PMID: 34817850 PMCID: PMC8612108 DOI: 10.1007/s40256-021-00511-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/21/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing coronavirus disease 2019 (COVID-19), has affected human lives across the globe. On 11 December 2020, the US FDA granted an emergency use authorization for the first COVID-19 vaccine, and vaccines are now widely available. Undoubtedly, the emergence of these vaccines has led to substantial relief, helping alleviate the fear and anxiety around the COVID-19 illness for both the general public and clinicians. However, recent cases of vaccine complications, including myopericarditis, have been reported after administration of COVID-19 vaccines. This article discusses the cases, possible pathogenesis of myopericarditis, and treatment of the condition. Most cases were mild and should not yet change vaccine policies, although prospective studies are needed to better assess the risk-benefit ratios in different groups.
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Affiliation(s)
- Adrija Hajra
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Binita Ghosh
- Burdwan Medical College, Burdwan, West Bengal India
| | - Kumar Ashish
- Crozer-Chester Medical Center, Upland, PA 19013 USA
| | | | - Gaurav Manek
- Department of Internal Medicine, University of Connecticut, Farmington, CT USA
| | - Devesh Rai
- Rochester General Hospital, Rochester, NY USA
| | | | - Akshay Goel
- New York Medical College at Westchester Medical Center, New York, NY USA
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA USA
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