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Law JLM, Logan M, Joyce MA, Landi A, Hockman D, Crawford K, Johnson J, LaChance G, Saffran HA, Shields J, Hobart E, Brassard R, Arutyunova E, Pabbaraju K, Croxen M, Tipples G, Lemieux MJ, Tyrrell DL, Houghton M. SARS-COV-2 recombinant Receptor-Binding-Domain (RBD) induces neutralizing antibodies against variant strains of SARS-CoV-2 and SARS-CoV-1. Vaccine 2021; 39:5769-5779. [PMID: 34481699 PMCID: PMC8387217 DOI: 10.1016/j.vaccine.2021.08.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
SARS-CoV-2 is the etiological agent of COVID19. There are currently several licensed vaccines approved for human use and most of them target the spike protein in the virion envelope to induce protective immunity. Recently, variants that spread more quickly have emerged. There is evidence that some of these variants are less sensitive to neutralization in vitro, but it is not clear whether they can evade vaccine induced protection. In this study, we tested SARS-CoV-2 spike RBD as a vaccine antigen and explored the effect of formulation with Alum/MPLA or AddaS03 adjuvants. Our results show that RBD induces high titers of neutralizing antibodies and activates strong cellular immune responses. There is also significant cross-neutralization of variants B.1.1.7 and B.1.351 and to a lesser extent, SARS-CoV-1. These results indicate that recombinant RBD can be a viable candidate as a stand-alone vaccine or as a booster shot to diversify our strategy for COVID19 protection.
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Affiliation(s)
- John Lok Man Law
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada.
| | - Michael Logan
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Michael A Joyce
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Abdolamir Landi
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Darren Hockman
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Kevin Crawford
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Janelle Johnson
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Gerald LaChance
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Holly A Saffran
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Justin Shields
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Eve Hobart
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Raelynn Brassard
- Department of Biochemistry, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Elena Arutyunova
- Department of Biochemistry, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | | | | | - Graham Tipples
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada; Alberta Precision Laboratories, Edmonton, Canada
| | - M Joanne Lemieux
- Department of Biochemistry, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - D Lorne Tyrrell
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Michael Houghton
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada.
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202
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COVID-19 vaccines: Current evidence and considerations. Metabol Open 2021; 12:100124. [PMID: 34541483 PMCID: PMC8433053 DOI: 10.1016/j.metop.2021.100124] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/11/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a global crisis, with devastating health, business and social impacts. Vaccination is a safe, simple, and effective way of protecting a person against COVID-19. By the end of August 2021, only 24.6% of the world population has received two doses of a COVID-19 vaccine. Since the emergence of COVID-19, several COVID-19 vaccines have been developed and approved for emergency use. Current vaccines have shown efficacy with low risk of adverse effects. However, COVID-19 vaccines have been related to a relatively small number of cases of heart inflammation, anaphylaxis (allergic reactions), and blood clots formation. On the other hand, COVID-19 vaccination is not recommended for children less than 12 years of age. Furthermore, It has been proposed that some new variants (e.g., Lambda and Delta) are proficient in escaping from the antiviral immunity elicited by vaccination. Herein we present current considerations regarding the COVID-19 vaccines including: efficacy against new variants, challenges in distribution, disparities in availability, dosage gender and race difference, COVID-19 vaccine transport and storage, limitations in children and pregnant women. Long-time monitoring is essential in order to find vaccine efficacy and to rule out related side effects.
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203
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Mücke VT, Knop V, Mücke MM, Ochsendorf F, Zeuzem S. First description of immune complex vasculitis after COVID-19 vaccination with BNT162b2: a case report. BMC Infect Dis 2021; 21:958. [PMID: 34530771 PMCID: PMC8443965 DOI: 10.1186/s12879-021-06655-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cases of immune complex vasculitis have been reported following COVID-19 infections; so far none in association with novel mRNA-based COVID-19 vaccination. This case report describes a cutaneous immune complex vasculitis after vaccination with BNT162b2. CASE PRESENTATION A 76-year old male with liver cirrhosis developed an immune complex vasculitis 12 days after the second injection of BNT162b2. On physical examination, the patient presented with pruritic purpuric macules on hands and feet, flexor and extensor parts of both legs and thighs and lower abdomen, and bloody diarrhoea. Laboratory testing showed elevated inflammatory markers. After short treatment with oral steroids all clinical manifestations and laboratory findings resolved. CONCLUSIONS An increasing number of clinical manifestations have been attributed to COVID-19 infection and vaccination. This is the first written report of immune complex vasculitis after vaccination with BNT162b2. We present our case report and a discussion in the light of type three hypersensitivity reaction.
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Affiliation(s)
- Victoria Therese Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Viola Knop
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Marcus Maximilian Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Falk Ochsendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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204
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Arroliga ME, Dhanani K, Arroliga AC, Huddleston PS, Trahan J, Aguilar T, Weldon D. Allergic reactions and adverse events associated with administration of mRNA-based vaccines. A health-care system experience. Allergy Asthma Proc 2021; 42:395-399. [PMID: 34474708 DOI: 10.2500/aap.2021.42.210069] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Adverse reactions, including anaphylaxis, to messenger RNA coronavirus disease 2019 (COVID-19) vaccines rarely occur. Because of the need to administer a timely second dose in subjects who reported a reaction to their first dose, a panel of health-care professionals developed a safe triage of the employees and health care providers (EHCP) at a large health-care system to consider administration of future dosing. Methods: There were 28,544 EHCPs who received their first dose of COVID-19 vaccines between December 15, 2020, and March 8, 2021. The EHCPs self-reported adverse reactions to a centralized COVID-19 command center (CCC). The CCC screened and collected information on the quality of reaction, symptoms, and timing of the onset of the reaction. Results: Of 1253 calls to the CCC, 113 were identified as requiring consideration by a panel of three (American Board of Allergy and Immunology) ABAI-certified allergists for future dosing or formal in-person assessment. Of the 113 EHCPs, 94 (83.2%) were recommended to get their second dose. Eighty of 94 received their second planned dose without a severe or immediate reaction. Of the 14 of 113 identified as needing further evaluation, 6 were evaluated by a physician and subsequently received their second dose without a serious adverse reaction. Eight of 14 did not receive their second dose. Only 5 of the 113 EHCPs reported reactions (4.4%) were recommended to not take the second dose: 3 (2.6%) because of symptoms consistent with anaphylaxis, and 2 because of neurologic complications (seizure, stroke). Conclusion: The panel demonstrated that, by consideration of reaction history alone, the ECHPs could be appropriately triaged to receive scheduled second dosing of COVID-19 vaccines without delays for in-person evaluation and allergy testing.
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205
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Marcec R, Likic R. Postvaccination anaphylaxis and mRNA-based SARS-CoV-2 vaccines-Much ado about nothing? Br J Clin Pharmacol 2021; 87:3632-3633. [PMID: 33580602 PMCID: PMC8014484 DOI: 10.1111/bcp.14763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Robert Marcec
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Robert Likic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Unit of Clinical Pharmacology, Department of Internal Medicine, Clinical Hospital Centre Zagreb, Zagreb, Croatia
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206
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O'Leary ST, Maldonado YA. Myocarditis After SARS-CoV-2 Vaccination: True, True, and… Related? Pediatrics 2021; 148:peds.2021-052644. [PMID: 34088761 DOI: 10.1542/peds.2021-052644] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 01/30/2023] Open
Affiliation(s)
- Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado and Children's Hospital Colorado, Aurora, Colorado .,Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Yvonne A Maldonado
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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207
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Lim XR, Leung BP, Ng CYL, Tan JWL, Chan GYL, Loh CM, Tan GLX, Goh VHH, Wong LT, Chua CR, Tan SC, Lee SSM, Howe HS, Thong BYH, Leong KP. Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination. Vaccines (Basel) 2021; 9:vaccines9090974. [PMID: 34579211 PMCID: PMC8471482 DOI: 10.3390/vaccines9090974] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 02/02/2023] Open
Abstract
Anaphylactic reactions were observed after Singapore's national coronavirus disease 2019 (COVID-19) vaccination programme started in December 2020. We report the clinical and laboratory features of three patients in our institution who developed anaphylactic reactions after receiving the Pifzer BNT162b2 vaccine. IgM and IgG antibodies, but not IgE antibodies to the Pfizer BNT162b2 vaccine, were detected in all subjects. Similarly, mild to high elevated levels of anti-polyethylene glycol (PEG) IgG (1035-19709 U/mL, vs. vaccine-naive < 265 U/mL, vaccine-tolerant < 785 U/mL) and IgM (1682-5310 U/mL, vs. vaccine-naive < 1011 U/mL, vaccine-tolerant < 1007 U/mL) were detected in two out of three patients via commercial ELISA. High levels of serum anaphylatoxin C3a (79.0 ± 6.3 μg/mL, mean ± SD, vs. normal < 10 μg/mL) were observed in all three patients during the acute phase of the reaction, while tryptase levels, a marker of mast cell activation, were not elevated. Finally, one patient with the highest levels of anti-PEG IgG, IgM, and anti-Pfizer BNT162b2 IgG and IgM exhibited an enhanced Th2 cytokine serum profile during an acute reaction, with high levels of IL-4 (45.7 pg/mL, vs. vaccine-naive/tolerant < 2.30 pg/mL), IL-33 (86.4 pg/mL, vs. vaccine-naive/tolerant < 5.51 pg/mL) and IL-10 (22.9 pg/mL, vs. vaccine-naive/tolerant < 12.49 pg/mL) diminishing over time following corticosteroid treatment. Taken together, we propose these cases of anaphylaxis described are driven by a complement activation-related pseudoallergy (CAPRA), rather than classical IgE-mediated mechanisms.
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Affiliation(s)
- Xin Rong Lim
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
- Correspondence: ; Tel.: +(65)-6357-7822; Fax: +(65)-6357-2686
| | - Bernard Pui Leung
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
- Health and Social Sciences, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Carol Yee Leng Ng
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Justina Wei Lynn Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Grace Yin Lai Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Chien Mei Loh
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Gwendolyn Li Xuan Tan
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Valerie Hui Hian Goh
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Lok To Wong
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Chong Rui Chua
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Sze Chin Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Samuel Shang Ming Lee
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Hwee Siew Howe
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Bernard Yu Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Khai Pang Leong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
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208
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Joseph AK, Chong BF. Subacute cutaneous lupus erythematosus flare triggered by COVID-19 vaccine. Dermatol Ther 2021; 34:e15114. [PMID: 34455671 PMCID: PMC8646373 DOI: 10.1111/dth.15114] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Adrienne K Joseph
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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209
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Spyker DA, Bronstein AC, Weber JA. Making US poison centers a part of the solution to the COVID-19 pandemic. Clin Toxicol (Phila) 2021; 60:102-114. [PMID: 34448649 DOI: 10.1080/15563650.2021.1933510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our six goals are: 1) describe the relationship between the National Strategy for the COVID-19 Response and Pandemic Preparedness and the 55 US poison centers (PCs); 2) detail FDA emergency Use Authorization (EUA) COVID-19 vaccine-related regulatory procedures and associated acronyms; 3) list availability of specific vaccine clinical information to support PC staff COVID-19 vaccination and adverse event (AE) data collection; 4) describe required health care practitioner COVID-19 vaccine AE reporting to the Vaccine AE Reporting System (VAERS) and PC reporting options; 5) document public and health care professionals' use of PCs for COVID-19 vaccine information; and 6) propose strategy to maximize PCs contribution to the pandemic solution. METHODS We reviewed 13-Feb-2020 through 15-Apr-2021 National Poison Data System (NPDS) COVID-19 records for changes over time. We examined NPDS cases and VAERS COVID-19 vaccine reports 1-Nov-2020 through 2-Apr-2021 for vaccine manufacturer, patient characteristics, state, and clinical effects. RESULTS PCs reported 1,052,174 COVID-19 contacts; maximum (peak) contacts/day (12,163) on 16-Mar-2020. As of 5-Apr-2021 the US reported >167 million administrations of COVID-19 vaccines (Pfizer-BioNTech, Moderna or Janssen). US PCs reported 162,052 COVID-19 vaccine contacts. Most (61.1%) were medical information calls, 34.9% were drug information, and 2.58% were exposures. Over the same period VAERS reported 49,078 COVID-19 vaccine cases reporting 226,205 symptoms - headache most frequent, ranging from 20% to 40% across the 3 vaccines. CONCLUSIONS AND RECOMMENDATIONS Although differences exist between the intent and content of the 2 data sets, NPDS volume is compelling. The PC nationwide 800 number facilitates data collection and suggests comingling the 2 data streams has merit. PC professionals received tens of thousands of calls and can: 1) support fact-based vaccine information; 2) contribute vaccine AE follow-up information: 3) advocate for best-case coding and reporting, especially for vaccine adverse experiences.
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Affiliation(s)
- Daniel A Spyker
- Adjunct Assistant Professor of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Alvin C Bronstein
- Emergency Medical Services, Injury Prevention System Branch, Hawaii Department of Health, Honolulu, HI, USA
| | - Julie A Weber
- Missouri Poison Center, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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210
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A case series of cutaneous COVID-19 vaccine reactions at Loma Linda University Department of Dermatology. JAAD Case Rep 2021; 16:53-57. [PMID: 34423106 PMCID: PMC8372465 DOI: 10.1016/j.jdcr.2021.07.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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211
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Lee E, Lee YK, Kim TE, Hwang I, Jung YH, Lee HR, Song J, Park Y, Cho E, Lee YK. Reports of anaphylaxis after coronavirus disease 2019 vaccination, South Korea, 26 February to 30 April 2021. Euro Surveill 2021; 26. [PMID: 34414880 PMCID: PMC8380974 DOI: 10.2807/1560-7917.es.2021.26.33.2100694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The South Korea mass vaccination programme administered 3.8 million doses of COVID-19 vaccinations between 26 February and 30 April 2021. After 173 suspected anaphylaxis reports to the nationwide monitoring system for adverse events following immunisation, 44 anaphylaxis cases were confirmed using Brighton Collaboration case definitions. The rates per million doses were 18.2 cases and 6.2 cases for Vaxzevria and Comirnaty, respectively. Median time of onset was 14 min after vaccination and most cases had recovered at the time of review.
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Affiliation(s)
- Eunju Lee
- Adverse Event Management Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Yeon-kyeong Lee
- Adverse Event Management Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Tae Eun Kim
- Adverse Event Management Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Insob Hwang
- Adverse Event Management Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Yeon Haw Jung
- Adverse Event Investigation Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Hye Ryeon Lee
- Adverse Event Investigation Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Jeongsuk Song
- Adverse Event Management Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Youngjoon Park
- Adverse Event Investigation Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Enhi Cho
- Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Yeon-Kyeng Lee
- Adverse Event Management Team, Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
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212
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Adams KE, Smith D, White K. COVID-19 Vaccine Distribution: Bolstering the Air Force Immunizations Model. Mil Med 2021; 187:29-34. [PMID: 34411247 DOI: 10.1093/milmed/usab334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/03/2021] [Accepted: 07/30/2021] [Indexed: 11/14/2022] Open
Abstract
From its emergence and declaration as a worldwide pandemic, coronavirus disease-2019 (COVID-19) has been associated with significant medical and logistical challenges. Initial obstacles ranged from the need to develop testing platforms to the determination of effective treatments to decrease the significant morbidity and mortality associated with the disease. Due to significant scientific breakthroughs, the most recent pressing challenge has been the distribution of vaccines against severe acute respiratory syndrome coronavirus 2 to prevent the spread of the infection across the world. Historically, the U.S. Military has been involved in immunizations delivery to prevent disease among its troops. This experience has led to the establishment of programs designed to distribute safe vaccinations to service members and beneficiaries. It is upon this infrastructure that the Air Force (AF) medical community was thrust to devise and execute COVID-19 vaccine delivery implementation across all military treatment facilities. In the AF, specialty trained allergist and immunologists provide the technical expertise for the establishment and execution of the AF immunizations program. These medical professionals have the proficiency, knowledge, and experience to run efficient mass immunization events in order to provide vaccines in a safe and rapid environment. Despite this, significant challenges attributable to the variable and novel nature of COVID-19 vaccine logistical requirements have led to unanswered questions and debate that needed resolution before and during the launch of this program. Here we describe the process for establishing a mass vaccination program for COVID-19 vaccine delivery and our experience-based problem solving approach at a large AF military treatment facility.
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Affiliation(s)
- Karla E Adams
- Department of Medicine, Allergy and Immunology Division, Wilford Hall Ambulatory Surgical Center, San Antonio, TX 78236, USA
| | - Derek Smith
- Department of Medicine, Allergy and Immunology Division, Wilford Hall Ambulatory Surgical Center, San Antonio, TX 78236, USA
| | - Kevin White
- Department of Medicine, Allergy and Immunology Division, Wilford Hall Ambulatory Surgical Center, San Antonio, TX 78236, USA
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McMurry R, Lenehan P, Awasthi S, Silvert E, Puranik A, Pawlowski C, Venkatakrishnan AJ, Anand P, Agarwal V, O'Horo JC, Gores GJ, Williams AW, Badley AD, Halamka J, Virk A, Swift MD, Carlson K, Doddahonnaiah D, Metzger A, Kayal N, Berner G, Ramudu E, Carpenter C, Wagner T, Rajasekharan A, Soundararajan V. Real-time analysis of a mass vaccination effort confirms the safety of FDA-authorized mRNA COVID-19 vaccines. MED 2021; 2:965-978.e5. [PMID: 34230920 PMCID: PMC8248717 DOI: 10.1016/j.medj.2021.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND As the coronavirus disease 2019 (COVID-19) vaccination campaign unfolds, it is important to continuously assess the real-world safety of Food and Drug Administration (FDA)-authorized vaccines. Curation of large-scale electronic health records (EHRs) enables near-real-time safety evaluations that were not previously possible. METHODS In this retrospective study, we deployed deep neural networks over a large EHR system to automatically curate the adverse effects mentioned by physicians in over 1.2 million clinical notes between December 1, 2020 and April 20, 2021. We compared notes from 68,266 individuals who received at least one dose of BNT162b2 (n = 51,795) or mRNA-1273 (n = 16,471) to notes from 68,266 unvaccinated individuals who were matched by demographic, geographic, and clinical features. FINDINGS Individuals vaccinated with BNT162b2 or mRNA-1273 had a higher rate of return to the clinic, but not the emergency department, after both doses compared to unvaccinated controls. The most frequently documented adverse effects within 7 days of each vaccine dose included myalgia, headache, and fatigue, but the rates of EHR documentation for each side effect were remarkably low compared to those derived from active solicitation during clinical trials. Severe events, including anaphylaxis, facial paralysis, and cerebral venous sinus thrombosis, were rare and occurred at similar frequencies in vaccinated and unvaccinated individuals. CONCLUSIONS This analysis of vaccine-related adverse effects from over 1.2 million EHR notes of more than 130,000 individuals reaffirms the safety and tolerability of the FDA-authorized mRNA COVID-19 vaccines in practice. FUNDING This study was funded by nference.
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Affiliation(s)
- Reid McMurry
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Patrick Lenehan
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Samir Awasthi
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Eli Silvert
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Arjun Puranik
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Colin Pawlowski
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | - Praveen Anand
- nference Labs, 2nd Floor, 22 3rd Cross Rd, Murgesh Pallya, Bengaluru, Karnataka 560017, India
| | - Vineet Agarwal
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | | | | | | | | | | | | | - Katie Carlson
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | - Anna Metzger
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Nikhil Kayal
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Gabi Berner
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Eshwan Ramudu
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | - Tyler Wagner
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | - Venky Soundararajan
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
- nference Labs, 2nd Floor, 22 3rd Cross Rd, Murgesh Pallya, Bengaluru, Karnataka 560017, India
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214
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Altrichter S, Wöhrl S, Horak F, Idzko M, Jordakieva G, Untersmayr E, Szepfalusi Z, Zieglmayer P, Jensen-Jarolim E, Wiedermann U, Rosenkranz A, Hötzenecker W. Antworten auf brennende Fragen an klinische Allergolog*innen im Zusammenhang mit den neuen COVID-19-Impfstoffen. ALLERGO JOURNAL 2021; 30:48-54. [PMID: 34393385 PMCID: PMC8349618 DOI: 10.1007/s15007-021-4847-0] [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] [Indexed: 11/03/2022]
Abstract
Hintergrund: Mit den neu zugelassenen Impfungen gegen COVID-19 kam es zu ersten Berichten über allergische beziehungsweise Unverträglichkeitsreaktionen. In der Folge stellte sich die Frage, ob von diesen Impfstoffen eine erhöhte Gefahr für Unverträglichkeitsreaktionen ausgeht und ob Allergiker gegebenenfalls hierfür ein höheres Risiko aufweisen. Ergebnisse: Allergische Reaktionen nach COVID-19-Impfungen wurden berichtet, jedoch meist von mildem Ausprägungsgrad und in bei Impfstoffen normaler (Moderna®) oder nur gering erhöhter Frequenz (BioNTech/Pfizer®). Das Risiko einer allergischen Reaktion auf die neu zugelassenen Vektorimpfstoffe (AstraZeneca®, Johnson & Johnson®) kann noch nicht abschließend beurteilt werden, scheint jedoch ebenfalls gering. Es gibt aktuell keinen Hinweis, dass Patienten mit Allergien häufiger oder schwerer reagieren. Man geht momentan davon aus, dass Unverträglichkeitsreaktionen vom Soforttyp einerseits Typ-I-allergisch (IgE-vermittelt) oder über Komplement-Aktivierung (CARPA, "complement activation-related pseudoallergy") stattfinden. Als Auslöser hierfür werden Polyethylenglycol (PEG) oder Polysorbat, die als Stabilisatoren in den Impfstoffen vorhanden sind, vermutet. Diskussion: Die bisher verfügbaren Daten zeigen kein wesentlich erhöhtes Risiko hinsichtlich allergischer Reaktionen vom Soforttyp bei Allergikern. Allergiker können zumeist problemlos geimpft werden. Standardisierte Testungen zur Nachverfolgung möglicher Allergien oder CARPA-vermittelten Reaktionen sind derzeit nur begrenzt verfügbar. Zitierweise: Altrichter S, Wöhrl S, Horak F, Idzko M, Jordakieva G, Untersmayr E, Szepfalusi Z, Zieglmayer P, Jensen-Jarolim E, Wiedermann U, Rosenkranz A, Hötzenecker W. Answers to burning questions for clinical allergologists related to the new COVID-19 vaccines. Allergo J Int 2021; 30:169-75 https://doi.org/10.1007/s40629-021-00177-3
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Affiliation(s)
- Sabine Altrichter
- Universitätsklinik für Dermatologie und Venerologie,, Kepler Universitätsklinikum, Krankenhausstraße 9, 4020 Linz, Österreich
| | - Stefan Wöhrl
- Pius-Parsch-Platz 1/3, Floridsdorfer Allergiezentrum (FAZ), Währinger Gürtel 18-20, 1210 Wien, Österreich
| | | | - Marco Idzko
- Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Wien, Österreich
| | - Galateja Jordakieva
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Eva Untersmayr
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
| | - Zsolt Szepfalusi
- Universitätsklinik für Kinder und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Petra Zieglmayer
- Allergieambulatorium Wien West, Hütteldorferstr. 46, 1150 Wien, Österreich
| | - Erika Jensen-Jarolim
- Institut für Pathophysiologie AKH Wien, Ebene 3 Q, Währinger Gürtel 18-20, 1090 Wien, Österreich
| | - Ursula Wiedermann
- Institut für Spezifische Prophylaxe und Tropenmedizin, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Rosenkranz
- Klinische Abteilung für Nephrologie, Universitätsklinik für Innere Medizin, Graz, Graz, Österreich
| | - Wolfram Hötzenecker
- Klinik für Dermatologie und Venerologie, Kepler Universitätsklinikum / Med Campus III., Krankenhausstr. 9, 4021 Linz, Österreich
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Hallett AM, Greenberg RS, Boyarsky BJ, Shah PD, Ou MT, Teles AT, Krach MR, López JI, Werbel WA, Avery RK, Bae S, Tobian AA, Massie AB, Higgins RSD, Garonzik-Wang JM, Segev DL, Bush EL. SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients. J Heart Lung Transplant 2021; 40:1579-1588. [PMID: 34456108 PMCID: PMC8349311 DOI: 10.1016/j.healun.2021.07.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023] Open
Abstract
Background While several studies have observed that solid organ transplant recipients experience diminished antibody responses to SARS-CoV-2 mRNA vaccination, data specific to heart and lung transplant (HT/LT) recipients remains sparse. Methods US adult HT and LT recipients completed their vaccine series between January 7 and April 10, 2021. Reactogencity and SARS-CoV-2 anti-spike antibody were assessed after a priming dose (D1) and booster dose (D2). Modified Poisson regression with robust variance estimator was used to evaluate associations between participant characteristics and antibody development. Results Of 134 heart recipients, there were 38% non-responders (D1-/D2-), 48% booster responders (D1-/D2+), and 14% priming dose responders (D1+/D2+). Of 103 lung recipients, 64% were non-responders, 27% were booster responders, and 9% were priming dose responders. Lung recipients were less likely to develop antibodies (p < .001). Priming dose antibody response was associated with younger recipient age (p = .04), transplant-to-vaccination time ≥6 years (p < .01), and lack of anti-metabolite maintenance immunosuppression (p < .001). Pain at injection site was the most commonly reported reaction (85% after D1, 76% after D2). Serious reactions were rare, the most common being fatigue (2% after D1 and 3% after D2). No serious adverse events were reported. Conclusions HT and LT recipients experienced diminished antibody response following vaccination; reactogenicity was comparable to that of the general population. LT recipients may exhibit a more impaired antibody response than HT recipients. While current recommendations are to vaccinate eligible candidates and recipients, further studies characterizing the cell-mediated immune response and clinical efficacy of these vaccines in this population are needed.
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Affiliation(s)
- Andrew M Hallett
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ross S Greenberg
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pali D Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Ou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aura T Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle R Krach
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia I López
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A Tobian
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S D Higgins
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Errol L Bush
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Al-Ansari RY, Al-Sharari M, Al-Saadi T. Palms and soles itchiness as a side effect of COVID-19 vaccination. J Infect Public Health 2021; 14:1389-1391. [PMID: 34391695 PMCID: PMC8349407 DOI: 10.1016/j.jiph.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
Background COVID-19 is a pandemic disease that has no definite treatment or preventive medication until late 2020 when vaccines were developed. Vaccines are a very useful new tool against COVID-19 that stimulate the immune system after recognition of viruses or their parts. Complications post vaccination could happen and they depend on the types, vaccine mechanism of action as well as some other patients' factors. Case report We are reporting a 39 years old lady who is known as allergic to a strawberry and kiwi, otherwise medically free. She presented to the outpatient unit with a ten-days history of palms of the hands and soles of the feet itchiness that is associated with occasional redness after receiving the first dose of COVID-19 vaccination. There were no skin rashes or pruritis at any other sites. The patient was treated conservatively by antihistamine and the symptoms gradually resolved within five days. Conclusion Allergic reaction is one of the expected complications post any COVID-19 or non-COVID-19 vaccination. Although the type, distributions and severity of allergic reactions are variable from person to another, yet isolated itching to palms and soles could be a rare side effect post first dose of COVID-19 vaccination (Pfizer-BioNTech) which is worth reporting. This presentation could be a type of allergic reaction which may require holding further doses, debate is there for further case reporting, research or evaluation. Learning points: Isolated itching to palms and soles could be one of the side effects of COVID-19 vaccination (Pfizer-BioNTech) which is worth reporting.
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Affiliation(s)
- Rehab Y Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia.
| | | | - Talal Al-Saadi
- Internal Medicine Department, KFMMC, Dhahran 31932, Saudi Arabia
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217
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Su Z, McDonnell D, Cheshmehzangi A, Li X, Maestro D, Šegalo S, Ahmad J, Hao X. With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines. JMIR Public Health Surveill 2021; 7:e26111. [PMID: 33560997 PMCID: PMC8341090 DOI: 10.2196/26111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/24/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
Although COVID-19 vaccines are becoming increasingly available, their ability to effectively control and contain the spread of the COVID-19 pandemic is highly contingent on an array of factors. This paper discusses how limitations to vaccine accessibility, issues associated with vaccine side effects, concerns regarding vaccine efficacy, along with the persistent prevalence of vaccine hesitancy among the public, including health care professionals, might impact the potential of COVID-19 vaccines to curb the pandemic. We draw insights from the literature to identify practical solutions that could boost people’s adoption of COVID-19 vaccines and their accessibility. We conclude with a discussion on health experts’ and government officials’ moral and ethical responsibilities to the public, even in light of the urgency to adopt and endorse “the greatest amount of good for the greatest number” utilitarian philosophy in controlling and managing the spread of COVID-19.
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Affiliation(s)
- Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, Ireland
| | - Ali Cheshmehzangi
- Department of Architecture and Built Environment, University of Nottingham Ningbo China, Ningbo, China.,Hiroshima University, Hiroshima, Japan
| | - Xiaoshan Li
- Program of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China
| | - Daniel Maestro
- Department of Environmental Health, Institute for Public Health of Federation Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Sabina Šegalo
- Department of Microbiology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Junaid Ahmad
- Prime Institute of Public Health, Peshawar Medical College, Peshawar, Pakistan
| | - Xiaoning Hao
- Division of Health Security Research, China National Health Development Research Center, National Health Commission, P.R. China, Beijing, China
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218
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Yang Q, Lin F, Wang Y, Zeng M, Luo M. Long Noncoding RNAs as Emerging Regulators of COVID-19. Front Immunol 2021; 12:700184. [PMID: 34408749 PMCID: PMC8366413 DOI: 10.3389/fimmu.2021.700184] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which has high incidence rates with rapid rate of transmission, is a pandemic that spread across the world, resulting in more than 3,000,000 deaths globally. Currently, several drugs have been used for the clinical treatment of COVID-19, such as antivirals (radecivir, baritinib), monoclonal antibodies (tocilizumab), and glucocorticoids (dexamethasone). Accumulating evidence indicates that long noncoding RNAs (lncRNAs) are essential regulators of virus infections and antiviral immune responses including biological processes that are involved in the regulation of COVID-19 and subsequent disease states. Upon viral infections, cellular lncRNAs directly regulate viral genes and influence viral replication and pathology through virus-mediated changes in the host transcriptome. Additionally, several host lncRNAs could help the occurrence of viral immune escape by inhibiting type I interferons (IFN-1), while others could up-regulate IFN-1 production to play an antiviral role. Consequently, understanding the expression and function of lncRNAs during severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection will provide insights into the development of lncRNA-based methods. In this review, we summarized the current findings of lncRNAs in the regulation of the strong inflammatory response, immune dysfunction and thrombosis induced by SARS-CoV-2 infection, discussed the underlying mechanisms, and highlighted the therapeutic challenges of COVID-19 treatment and its future research directions.
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Affiliation(s)
- Qinzhi Yang
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Drug Discovery Research Center, Southwest Medical University, Luzhou, China
- Laboratory for Cardiovascular Pharmacology of Department of Pharmacology, The School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Fang Lin
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Drug Discovery Research Center, Southwest Medical University, Luzhou, China
- Laboratory for Cardiovascular Pharmacology of Department of Pharmacology, The School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Yanan Wang
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Drug Discovery Research Center, Southwest Medical University, Luzhou, China
- Laboratory for Cardiovascular Pharmacology of Department of Pharmacology, The School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Min Zeng
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Mao Luo
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Drug Discovery Research Center, Southwest Medical University, Luzhou, China
- Laboratory for Cardiovascular Pharmacology of Department of Pharmacology, The School of Pharmacy, Southwest Medical University, Luzhou, China
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Shrestha S, Khatri J, Shakya S, Danekhu K, Khatiwada AP, Sah R, KC B, Paudyal V, Khanal S, Rodriguez-Morales AJ. Adverse events related to COVID-19 vaccines: the need to strengthen pharmacovigilance monitoring systems. DRUGS & THERAPY PERSPECTIVES 2021; 37:376-382. [PMID: 34366660 PMCID: PMC8327058 DOI: 10.1007/s40267-021-00852-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2021] [Indexed: 12/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new species of β-coronavirus genus named severe acute respiratory syndrome coronavirus 2. The COVID-19 pandemic, which started in late 2019 and continues as at mid-2021, has caused enormous damage to health and lives globally. The urgent public health need has led to the development of vaccines against COVID-19 in record-breaking time. The COVID-19 vaccines have been widely rolled out for the masses by many countries following approval for emergency use by the World Health Organization and regulatory agencies in many countries. In addition, several COVID-19 vaccine candidates are undergoing clinical trials. However, myths, fears, rumors, and misconceptions persist, particularly in regard to adverse events. In this commentary, we describe the adverse events associated with COVID-19 vaccines and discuss why it is essential to have a functional adverse event monitoring system in this context.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Malaysia
| | - Januka Khatri
- Department of Pharmacy, School of Science, Kathmandu University, Dhulikhel, Kavre Nepal
| | - Sujyoti Shakya
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
- Department of Pharmacy, Nobel College, Sinamangal, Kathmandu, Nepal
| | - Krisha Danekhu
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Asmita Priyadarshini Khatiwada
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Ranjit Sah
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- National Public Health Laboratory, Kathmandu, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Malaysia
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Saval Khanal
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de Las Americas, Pereira, Risaralda Colombia
- School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia
- Universidad Cientifica del Sur, Lima, Peru
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220
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Shavit R, Maoz-Segal R, Iancovici-Kidon M, Offengenden I, Haj Yahia S, Machnes Maayan D, Lifshitz-Tunitsky Y, Niznik S, Frizinsky S, Deutch M, Elbaz E, Genaim H, Rahav G, Levy I, Belkin A, Regev-Yochay G, Afek A, Agmon-Levin N. Prevalence of Allergic Reactions After Pfizer-BioNTech COVID-19 Vaccination Among Adults With High Allergy Risk. JAMA Netw Open 2021; 4:e2122255. [PMID: 34463744 PMCID: PMC8408666 DOI: 10.1001/jamanetworkopen.2021.22255] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Allergic reactions among some individuals who received the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine discourage patients with allergic conditions from receiving this vaccine and physicians from recommending the vaccine. OBJECTIVE To describe the assessment and immunization of highly allergic individuals with the BNT162b2 vaccine. DESIGN, SETTING, AND PARTICIPANTS In a prospective cohort study from December 27, 2020, to February 22, 2021, 8102 patients with allergies who applied to the COVID 19 vaccine referral center at the Sheba Medical Center underwent risk assessment using an algorithm that included a detailed questionnaire. High-risk patients (n = 429) were considered "highly allergic" and were immunized under medical supervision. EXPOSURES Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. MAIN OUTCOMES AND MEASURES Allergic and anaphylactic reactions after the first and second doses of BNT162b2 vaccine among highly allergic patients. RESULTS Of the 429 individuals who applied to the COVID-19 referral center and were defined as highly allergic, 304 (70.9%) were women and the mean (SD) age was 52 (16) years. This highly allergic group was referred to receive immunization under medical supervision. After the first dose of the BNT162b2 vaccine, 420 patients (97.9%) had no immediate allergic event, 6 (1.4%) developed minor allergic responses, and 3 (0.7%) had anaphylactic reactions. During the study period, 218 highly allergic patients (50.8%) received the second BNT162b2 vaccine dose, of which 214 (98.2%) had no allergic reactions and 4 patients (1.8%) had minor allergic reactions. Other immediate and late reactions were comparable with those seen in the general population, except for delayed itch and skin eruption, which were more common among allergic patients. CONCLUSIONS AND RELEVANCE The rate of allergic reactions to BNT162b2 vaccine, is higher among patients with allergies, particularly among a subgroup with a history of high-risk allergies. This study suggests that most patients with a history of allergic diseases and, particularly, highly allergic patients can be safely immunized by using an algorithm that can be implemented in different medical facilities and includes a referral center, a risk assessment questionnaire, and a setting for immunization under medical supervision of highly allergic patients. Further studies are required to define more specific risk factors for allergic reactions to the BNT162b2 vaccine.
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Affiliation(s)
- Ronen Shavit
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Ramit Maoz-Segal
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Mona Iancovici-Kidon
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irena Offengenden
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Soad Haj Yahia
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Diti Machnes Maayan
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Lifshitz-Tunitsky
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stanley Niznik
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Shirly Frizinsky
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Michal Deutch
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Eti Elbaz
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Hosney Genaim
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Galia Rahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Itzchak Levy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Anna Belkin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Gili Regev-Yochay
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infection Prevention and Control Unit, Sheba Medical Center, Israel
| | - Arnon Afek
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Tel Hashomer, Israel
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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221
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Wei WE, Tan WK, Cook AR, Hsu LY, Teo YY, Lee VJM. Living with COVID-19: The road ahead. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:619-628. [PMID: 34472557 DOI: 10.47102/annals-acadmedsg.2021244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has affected the world for more than a year, with multiple waves of infections resulting in morbidity, mortality and disruption to the economy and society. Response measures employed to control it have generally been effective but are unlikely to be sustainable over the long term. METHODS We examined the evidence for a vaccine-driven COVID-19 exit strategy including academic papers, governmental reports and epidemiological data, and discuss the shift from the current pandemic footing to an endemic approach similar to influenza and other respiratory infectious diseases. RESULTS A desired endemic state is characterised by a baseline prevalence of infections with a generally mild disease profile that can be sustainably managed by the healthcare system, together with the resumption of near normalcy in human activities. Such an endemic state is attainable for COVID-19 given the promising data around vaccine efficacy, although uncertainty remains around vaccine immunity escape in emergent variants of concern. Maintenance of non-pharmaceutical interventions remains crucial until high vaccination coverage is attained to avoid runaway outbreaks. It may also be worthwhile to de-escalate measures in phases, before standing down most measures for an endemic state. If a variant that substantially evades immunity emerges, it will need to be managed akin to a new disease threat, with pandemic preparedness and response plans. CONCLUSION An endemic state for COVID-19, characterised by sustainable disease control measures, is likely attainable through vaccination.
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Bianchi L, Biondi F, Hansel K, Murgia N, Tramontana M, Stingeni L. Skin tests in urticaria/angioedema and flushing to Pfizer-BioNTech SARS-CoV-2 vaccine: Limits of intradermal testing. Allergy 2021; 76:2605-2607. [PMID: 33811344 PMCID: PMC8251329 DOI: 10.1111/all.14839] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Leonardo Bianchi
- Department of Medicine and SurgerySection of DermatologyUniversity of PerugiaPerugiaItaly
| | - Filippo Biondi
- Department of Medicine and SurgerySection of DermatologyUniversity of PerugiaPerugiaItaly
| | - Katharina Hansel
- Department of Medicine and SurgerySection of DermatologyUniversity of PerugiaPerugiaItaly
| | - Nicola Murgia
- Department of Medicine and SurgerySection of Occupational Medicine, Respiratory Diseases and ToxicologyUniversity of PerugiaPerugiaItaly
| | - Marta Tramontana
- Department of Medicine and SurgerySection of DermatologyUniversity of PerugiaPerugiaItaly
| | - Luca Stingeni
- Department of Medicine and SurgerySection of DermatologyUniversity of PerugiaPerugiaItaly
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Heidari S, Durrheim DN, Faden R, Kochhar S, MacDonald N, Olayinka F, Goodman TS. Time for action: towards an intersectional gender approach to COVID-19 vaccine development and deployment that leaves no one behind. BMJ Glob Health 2021; 6:e006854. [PMID: 34389628 PMCID: PMC8366282 DOI: 10.1136/bmjgh-2021-006854] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/23/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Shirin Heidari
- Gender, Equity and Human Rights Unit, World Health Organization, Geneva, Switzerland
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - David N Durrheim
- Public Health Medicine, University of Newcastle, Newcastle, New South Wales, Australia
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
| | - Ruth Faden
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonali Kochhar
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Global Health, Global Healthcare Consulting, New Delhi, India
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Noni MacDonald
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Department of Pediatrics, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Member WHO Strategic Advisory Group of Experts (SAGE), Geneva, Switzerland
| | - Folake Olayinka
- Member of WHO Strategic Advisory Group of Experts (SAGE) COVID-19 Vaccines Working Group, Geneva, Geneva, Switzerland
- Member WHO Strategic Advisory Group of Experts (SAGE), Geneva, Switzerland
- Public Health Institute/STAR, Washington, DC, USA
| | - Tracey S Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Fix OK, Blumberg EA, Chang KM, Chu J, Chung RT, Goacher EK, Hameed B, Kaul DR, Kulik LM, Kwok RM, McGuire BM, Mulligan DC, Price JC, Reau NS, Reddy KR, Reynolds A, Rosen HR, Russo MW, Schilsky ML, Verna EC, Ward JW, Fontana RJ. American Association for the Study of Liver Diseases Expert Panel Consensus Statement: Vaccines to Prevent Coronavirus Disease 2019 Infection in Patients With Liver Disease. Hepatology 2021; 74:1049-1064. [PMID: 33577086 PMCID: PMC8014184 DOI: 10.1002/hep.31751] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
The aim of this document is to provide a concise scientific review of the currently available COVID-19 vaccines and those in development, including mRNA, adenoviral vectors, and recombinant protein approaches. The anticipated use of COVID-19 vaccines in patients with chronic liver disease (CLD) and liver transplant (LT) recipients is reviewed and practical guidance is provided for health care providers involved in the care of patients with liver disease and LT about vaccine prioritization and administration. The Pfizer and Moderna mRNA COVID-19 vaccines are associated with a 94%-95% vaccine efficacy compared to placebo against COVID-19. Local site reactions of pain and tenderness were reported in 70%-90% of clinical trial participants, and systemic reactions of fever and fatigue were reported in 40%-70% of participants, but these reactions were generally mild and self-limited and occurred more frequently in younger persons. Severe hypersensitivity reactions related to the mRNA COVID-19 vaccines are rare and more commonly observed in women and persons with a history of previous drug reactions for unclear reasons. Because patients with advanced liver disease and immunosuppressed patients were excluded from the vaccine licensing trials, additional data regarding the safety and efficacy of COVID-19 vaccines are eagerly awaited in these and other subgroups. Remarkably safe and highly effective mRNA COVID-19 vaccines are now available for widespread use and should be given to all adult patients with CLD and LT recipients. The online companion document located at https://www.aasld.org/about-aasld/covid-19-resources will be updated as additional data become available regarding the safety and efficacy of other COVID-19 vaccines in development.
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Affiliation(s)
- Oren K Fix
- Elson S. Floyd College of MedicineWashington State UniversitySpokaneWAUSA
| | | | - Kyong-Mi Chang
- University of PennsylvaniaPhiladelphiaPAUSA.,The Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPAUSA
| | - Jaime Chu
- Icahn School of Medicine at Mount SinaiNew YorkNYUSA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mark W Russo
- Atrium HealthCarolinas Medical CenterCharlotteNCUSA
| | | | | | - John W Ward
- Coalition for Global Hepatitis EliminationDecaturGAUSA
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225
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COVID-19 Vaccines in Children with Cow's Milk and Food Allergies. Nutrients 2021; 13:nu13082637. [PMID: 34444795 PMCID: PMC8401713 DOI: 10.3390/nu13082637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 01/05/2023] Open
Abstract
The COVID-19 pandemic is the most challenging global health crisis of our times. Vaccination against COVID-19 plays a key role to control the current pandemic situation. The risk of allergic reactions to new COVID-19 vaccines is low. However, there is a debate on the safety in allergic patients following post marketing findings by different agencies. Our aim is to understand from current experiences whether children with cow’s milk or food allergy are at higher risk than a general population for allergic reactions to COVID-19 vaccines. Current data indicate that patients with a history of allergy to cow’s milk or other foods, even if severe, should receive COVID-19 vaccine in a setting with availability of treatments for anaphylactic reactions and under medical supervision. Recipients should be discharged after a protracted observation period of 30 min if no reaction developed.
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226
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Wu Q, Dudley MZ, Chen X, Bai X, Dong K, Zhuang T, Salmon D, Yu H. Evaluation of the safety profile of COVID-19 vaccines: a rapid review. BMC Med 2021; 19:173. [PMID: 34315454 PMCID: PMC8315897 DOI: 10.1186/s12916-021-02059-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The rapid process of research and development and lack of follow-up time post-vaccination aroused great public concern about the safety profile of COVID-19 vaccine candidates. To provide comprehensive overview of the safety profile of COVID-19 vaccines by using meta-analysis technique. METHODS English-language articles and results posted on PubMed, Embase, Web of Science, PMC, official regulatory websites, and post-authorization safety surveillance data were searched through June 12, 2021. Publications disclosing safety data of COVID-19 candidate vaccines in humans were included. A meta-analysis of proportions was performed to estimate the pooled incidence and the pooled rate ratio (RR) of safety outcomes of COVID-19 vaccines using different platforms. RESULTS A total of 87 publications with safety data from clinical trials and post-authorization studies of 19 COVID-19 vaccines on 6 different platforms were included. The pooled rates of local and systemic reactions were significantly lower among inactivated vaccines (23.7%, 21.0%), protein subunit vaccines (33.0%, 22.3%), and DNA vaccines (39.5%, 29.3%), compared to RNA vaccines (89.4%, 83.3%), non-replicating vector vaccines (55.9%, 66.3%), and virus-like particle vaccines (100.0%, 78.9%). Solicited injection-site pain was the most common local reactions, and fatigue and headache were the most common systemic reactions. The frequency of vaccine-related serious adverse events was low (< 0.1%) and balanced between treatment groups. Vaccine platforms and age groups of vaccine recipients accounted for much of the heterogeneity in safety profiles between COVID-19 vaccines. Reporting rates of adverse events from post-authorization observational studies were similar to results from clinical trials. Crude reporting rates of adverse events from post-authorization safety monitoring (passive surveillance) were lower than in clinical trials and varied between countries. CONCLUSIONS Available evidence indicates that eligible COVID-19 vaccines have an acceptable short-term safety profile. Additional studies and long-term population-level surveillance are strongly encouraged to further define the safety profile of COVID-19 vaccines.
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Affiliation(s)
- Qianhui Wu
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Matthew Z Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Xinghui Chen
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Xufang Bai
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Kaige Dong
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Tingyu Zhuang
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Daniel Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hongjie Yu
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China.
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
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227
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Crum T, Mooney K, Tiwari BR. Current situation of vaccine injury compensation program and a future perspective in light of COVID-19 and emerging viral diseases. F1000Res 2021; 10:652. [PMID: 35035888 PMCID: PMC8733825 DOI: 10.12688/f1000research.51160.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Vaccines have had a great impact on disease prevention and reducing mortality. Very rarely, vaccines also can result in serious adverse effects. In consideration of this fact, vaccine injury compensation programs have been implemented in many countries to compensate a vaccinee for associated adverse effects. The existing vaccine injury compensation system addresses routine immunization schemes. However, there are rising concerns about the compensation for adverse effects caused by new vaccines such as those developed for coronavirus disease 2019 (COVID-19). This review focuses on vaccine injury compensation programs and highlights the necessity to include all upcoming new vaccines for COVID-19 and other emerging viral diseases in the compensation schemes. Methods: Published articles relating to vaccine compensation injury programs, vaccines, injuries, disabilities, illnesses, and deaths resulting from vaccination were searched in data bases. Through a careful review of the abstracts, 25 relevant articles were selected for analysis. Results: We identified 27 countries on four continents with vaccine injury compensation schemes: 17 countries in Europe, 7 countries in Asia, the United States, a Canadian Province and New Zealand. No programs were identified in Africa and in South America. Program design, funding, and eligibility for compensation vary vastly between countries. We identified 17 countries operating well-established vaccine injury compensation programs. However, minimal information is available on numerous other countries. Conclusion: We conclude that the vaccine injury compensation programs are available in limited number of countries across four continents - mostly in Europe. Lack of standard approach and scope of injury prevention and compensation programs across the countries exists. Some important limitations include limited scientific material, which hindered our research. Therefore, additional data concerning payout for each type of injury and the number of claimants related to a specific vaccine injury worldwide could provide a more comprehensive analysis.
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Affiliation(s)
- Tommie Crum
- Department of Microbiology, Saint James School of Medicine, Albert Lake Dr The Quarter, AL-2640, Anguilla
| | - Kirsten Mooney
- Department of Microbiology, Saint James School of Medicine, Albert Lake Dr The Quarter, AL-2640, Anguilla
| | - Birendra R. Tiwari
- Department of Microbiology and Immunology, American University of Barbados, School of Medicine, Saint Michael, Wildey, BB 11100, Barbados
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228
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B C, R A, Tanno LK, Ansotegui IJ, Morais-Almeida M. Anaphylaxis and COVID-19 vaccines: Real-time interest using Google Trends. World Allergy Organ J 2021; 14:100570. [PMID: 34306300 PMCID: PMC8289624 DOI: 10.1016/j.waojou.2021.100570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/03/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Camacho B
- Allergy Centre, CUF Descobertas Hospital, Lisbon, Portugal.,Pediatrics Department, Central Hospital of Funchal, Funchal, Portugal
| | - Aguiar R
- Allergy Centre, CUF Descobertas Hospital, Lisbon, Portugal
| | - Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, France.,Desbrest Institute of Epidemiology and Public Health, UMR UA-11 INSERM, University of Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Ignacio J Ansotegui
- Department of Allergy & Immunology. Hospital Quironsalud Bizkaia, Bilbao, Spain
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229
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Murdych TM. A case of severe autoimmune hemolytic anemia after a receipt of a first dose of SARS-CoV-2 vaccine. Int J Lab Hematol 2021; 44:e10-e12. [PMID: 34258873 PMCID: PMC8444646 DOI: 10.1111/ijlh.13653] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022]
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230
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Altrichter S, Wöhrl S, Horak F, Idzko M, Jordakieva G, Untersmayr E, Szepfalusi Z, Zieglmayer P, Jensen-Jarolim E, Wiedermann U, Rosenkranz A, Hötzenecker W. Answers to burning questions for clinical allergologists related to the new COVID-19 vaccines. ACTA ACUST UNITED AC 2021; 30:169-175. [PMID: 34277326 PMCID: PMC8278365 DOI: 10.1007/s40629-021-00177-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Background Along with the newly approved vaccines against coronavirus disease 2019 (COVID-19), first reports of allergic or intolerance reactions were published. Subsequently, questions arose whether these vaccines pose an increased risk for intolerance reactions and whether allergic patients may be at higher risk for this. Results Allergic reactions following COVID-19 vaccinations have been reported, but mostly of mild severity and at normal (Moderna®) or only slightly increased frequency (BioNTech/Pfizer®) compared to established conventional vaccines. The risk of allergic reaction to the newly licensed vector vaccines (AstraZeneca®, Johnson&Johnson®) cannot be conclusively assessed yet, but also appears to be low. There is currently no evidence that patients with allergic diseases (atopic patients) react more frequently or more severely to these vaccines. It is currently assumed that intolerance reactions of the immediate-type are either type I allergic (IgE-mediated) reactions or occur via complement activation (CARPA, “complement activation-related pseudoallergy”). Polyethylene glycol (PEG) or polysorbate, which are present as stabilizers in the vaccines, are suspected as triggers for this. Conclusion The data available so far do not show a significantly increased risk of immediate-type allergic reactions in atopic persons. In almost all cases, atopic patients can be vaccinated without problems. Standardized follow-up tests after suspected allergic reactions or CARPA-mediated reactions are currently limited.
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Affiliation(s)
- Sabine Altrichter
- Department of Dermatology und Venerology, Comprehensive Allergy Center, Kepler University Hospital, Krankenhausstraße 9, 4020 Linz, Austria.,Department of Dermatology und Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Wöhrl
- Floridsdorfer Allergiezentrum (FAZ), Vienna, Austria
| | | | - Marco Idzko
- Department for Medicine II, Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva Untersmayr
- Department of Pathophysiology und Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Zsolt Szepfalusi
- Department of Pediatrics and Adolescent Medicine, Division for Pediatric Pulmonology, Allergology and Endokrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Petra Zieglmayer
- Competence Center for Allergology and Immunology, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems, Austria
| | - Erika Jensen-Jarolim
- Department of Pathophysiology und Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Department of Interdisciplinary Life Sciences, Messerli Research Institute, University of Veterinary Medicine, Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Alexander Rosenkranz
- Division of Nephrology, Department for Medicine, Medical University Graz, Graz, Austria
| | - Wolfram Hötzenecker
- Department of Dermatology und Venerology, Comprehensive Allergy Center, Kepler University Hospital, Krankenhausstraße 9, 4020 Linz, Austria
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231
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Multisociety statement on coronavirus disease 2019 (COVID-19) vaccination as a condition of employment for healthcare personnel. Infect Control Hosp Epidemiol 2021; 43:3-11. [PMID: 34253266 PMCID: PMC8376851 DOI: 10.1017/ice.2021.322] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).
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232
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Novak N, Tordesillas L, Cabanillas B. Adverse rare events to vaccines for COVID-19: From hypersensitivity reactions to thrombosis and thrombocytopenia. Int Rev Immunol 2021; 41:438-447. [PMID: 34251972 PMCID: PMC8290371 DOI: 10.1080/08830185.2021.1939696] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/14/2021] [Accepted: 05/29/2021] [Indexed: 01/18/2023]
Abstract
Vaccines for the prevention of coronavirus disease 2019 (COVID-19) started to be developed since the initiation of the COVID-19 pandemic. Up to now, four vaccines have been authorized by international agencies such as European Medicines Agency (EMA). Two are DNA vaccines (ChAdOx1 nCov-19 and Ad26.COV2.S) and two mRNA vaccines (BNT162b2 and mRNA-1273). The administration of the vaccines has been associated with a strong decrease in the infections by SARS-CoV-2 and deaths associated with it. However, in parallel to these results, some rare adverse events have also been described. In that sense, events of thrombosis, thrombocytopenia, and hemorrhage have been described in close temporal proximity to the administration of the DNA vaccines ChAdOx1 nCov-19 and Ad26.COV2.S, but also mRNA vaccines. Recent scientific reports have been released with updated information on the possible association of thrombotic thrombocytopenia and COVID-19 vaccines. On the other hand, since the initiation of the vaccination campaigns, adverse hypersensitivity reactions have been described after mRNA and DNA vaccines administration for COVID-19. Although globally these adverse events are rare, a high proportion of the world population will be exposed to these vaccines. For that reason, their safety and tolerance should be carefully considered. In this review, we provide an updated review of the last scientific findings that can explain the rare side effects that the vaccines for COVID-19 can produce.
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany
| | - Leticia Tordesillas
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Beatriz Cabanillas
- Department of Allergy, Research Institute Hospital 12 de Octubre, Madrid, Spain
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233
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Cazzato G, Romita P, Foti C, Cimmino A, Colagrande A, Arezzo F, Sablone S, Barile A, Lettini T, Resta L, Ingravallo G. Purpuric Skin Rash in a Patient Undergoing Pfizer-BioNTech COVID-19 Vaccination: Histological Evaluation and Perspectives. Vaccines (Basel) 2021; 9:760. [PMID: 34358176 PMCID: PMC8310051 DOI: 10.3390/vaccines9070760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 pandemic has affected the entire planet, and within about a year and a half, has led to 174,502,686 confirmed cases of COVID-19 worldwide, with 3,770,361 deaths. Although it is now clear that SARS-CoV-2 can affect various different organs, including the lungs, brain, skin, vessels, placenta and others, less is yet known about adverse reactions from vaccines, although more and more reports are starting to emerge. Among the adverse events, we focused particularly on skin rashes. In this short report, we describe the case of a patient vaccinated with Comirnaty, who developed a purpuric rash resistant to oral steroid therapy after 2 weeks. To date, this is one of the very few cases in which skin biopsy was performed to better characterize the histopathological picture of this rash. Finally, we conduct a literature review of the cases of rashes from SARS-CoV-2 vaccines described in the literature, with the aim of laying foundations for future, larger case studies.
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Affiliation(s)
- Gerardo Cazzato
- Section of Pathology, Departmente of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.F.); (A.C.); (A.C.); (A.B.); (T.L.); (L.R.); (G.I.)
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, 70124 Bari, Italy;
| | - Caterina Foti
- Section of Pathology, Departmente of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.F.); (A.C.); (A.C.); (A.B.); (T.L.); (L.R.); (G.I.)
| | - Antonietta Cimmino
- Section of Pathology, Departmente of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.F.); (A.C.); (A.C.); (A.B.); (T.L.); (L.R.); (G.I.)
| | - Anna Colagrande
- Section of Pathology, Departmente of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.F.); (A.C.); (A.C.); (A.B.); (T.L.); (L.R.); (G.I.)
| | - Francesca Arezzo
- Department of Biomedical Sciences and Human Oncology, Gynecologic and Obstetrics Clinic, 70124 Bari, Italy;
| | - Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Policlinico di Bari Hospital, University of Bari, 70124 Bari, Italy;
| | - Angela Barile
- Section of Pathology, Departmente of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.F.); (A.C.); (A.C.); (A.B.); (T.L.); (L.R.); (G.I.)
| | - Teresa Lettini
- Section of Pathology, Departmente of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.F.); (A.C.); (A.C.); (A.B.); (T.L.); (L.R.); (G.I.)
| | - Leonardo Resta
- Section of Pathology, Departmente of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.F.); (A.C.); (A.C.); (A.B.); (T.L.); (L.R.); (G.I.)
| | - Giuseppe Ingravallo
- Section of Pathology, Departmente of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (C.F.); (A.C.); (A.C.); (A.B.); (T.L.); (L.R.); (G.I.)
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Stingeni L, Bianchi L, Zalaudek I, Pigatto PD, Peris K, Patruno C, Fabbrocini G, Micali G, Napolitano M, Tramontana M, Hansel K. Adverse cutaneous and mucous reactions from anti SARS-CoV-2 vaccines: recommendations from the Italian Society of Dermatology (SIDeMaST). Ital J Dermatol Venerol 2021; 156:115-117. [PMID: 33960747 DOI: 10.23736/s2784-8671.21.06992-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy -
| | - Iris Zalaudek
- Dermatologic Clinic, University of Trieste, Trieste, Italy
| | - Paolo D Pigatto
- Unit of Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Ketty Peris
- Section of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Cataldo Patruno
- Section of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | | | | | - Maddalena Napolitano
- Department of Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Chakraborty C, Sharma AR, Bhattacharya M, Lee SS. From COVID-19 to Cancer mRNA Vaccines: Moving From Bench to Clinic in the Vaccine Landscape. Front Immunol 2021; 12:679344. [PMID: 34305909 PMCID: PMC8293291 DOI: 10.3389/fimmu.2021.679344] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
Recently, mRNA vaccines have become a significant type of therapeutic and have created new fields in the biopharmaceutical industry. mRNA vaccines are promising next-generation vaccines that have introduced a new age in vaccinology. The recent approval of two COVID-19 mRNA vaccines (mRNA-1273 and BNT162b2) has accelerated mRNA vaccine technology and boosted the pharmaceutical and biotechnology industry. These mRNA vaccines will help to tackle COVID-19 pandemic through immunization, offering considerable hope for future mRNA vaccines. Human trials with data both from mRNA cancer vaccines and mRNA infectious disease vaccines have provided encouraging results, inspiring the pharmaceutical and biotechnology industries to focus on this area of research. In this article, we discuss current mRNA vaccines broadly in two parts. In the first part, mRNA vaccines in general and COVID-19 mRNA vaccines are discussed. We presented the mRNA vaccine structure in general, the different delivery systems, the immune response, and the recent clinical trials for mRNA vaccines (both for cancer mRNA vaccines and different infectious diseases mRNA vaccines). In the second part, different COVID-19 mRNA vaccines are explained. Finally, we illustrated a snapshot of the different leading mRNA vaccine developers, challenges, and future prospects of mRNA vaccines.
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Affiliation(s)
- Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, India
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do, South Korea
| | - Ashish Ranjan Sharma
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do, South Korea
| | | | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do, South Korea
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236
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Lai CC, Chen IT, Chao CM, Lee PI, Ko WC, Hsueh PR. COVID-19 vaccines: concerns beyond protective efficacy and safety. Expert Rev Vaccines 2021; 20:1013-1025. [PMID: 34180347 DOI: 10.1080/14760584.2021.1949293] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Several vaccine candidates have been developed using different platforms, including nucleic acids (DNA and RNA), viral vectors (replicating and non-replicating), virus-like particles, peptide-based, recombinant proteins, live attenuated, and inactivated virus modalities. Although many of these vaccines are undergoing pre-clinical trials, several large clinical trials investigating the clinical efficacy and safety of coronavirus disease 2019 (COVID-19) vaccines have produced promising findings. AREAS COVERED In this review, we provide a status update on COVID-19 vaccines currently undergoing clinical trials and discuss issues of concern beyond vaccine efficacy and safety, including dosing regimens, the mixed vaccine strategy, prior severe acute respiratory syndrome coronavirus-2 infection, antibody levels, cellular immunity and protection, variants of concern, COVID-19 vaccine distribution, vaccination willingness, herd immunity, immunity passports, and vaccine indications. EXPERT OPINION Four vaccines have obtained emergency use authorization, 87 are at the clinical development stage, and 186 are in pre-clinical development. While the knowledge and development of COVID-19 vaccines is rapidly expanding, the benefits of COVID-19 vaccines must outweigh the potential risks of adverse events. To combat the COVID-19 pandemic, clinicians should consistently update COVID-19-associated information, and healthcare authorities and manufacturers should work together to provide adequate and appropriate vaccinations for the prevention of COVID-19. PLAIN LANGUAGE SUMMARY What is the context?Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) caused a global pandemic: the coronavirus disease 2019 (COVID-19) outbreak. The development and implementation of the COVID-19 vaccine could be an important measure to control the COVID-19 pandemic.What is new?Several phase 3 clinical trials have demonstrated the effectiveness and safety of COVID-19 vaccines for the prevention of SARS-CoV-2 infections. Several COVID-19 vaccines have obtained emergency use authorization and been implemented in many countries. Although concerns regarding unusual blood clots and low platelet counts have been raised, the benefits of COVID-19 vaccines outweigh the potential risks of adverse events.What is the impact?Except for children, the COVID-19 vaccine is recommended for all people, including those pregnant or immunocompromised. Healthcare authorities should advise people receiving the vaccine that they must seek medical attention if they have associated thromboembolism and thrombocytopenia symptoms. More studies are necessary to determine the appropriate vaccine dose and regimen strategy, as well as the effectiveness of COVID-19 vaccines against variants of concerns. A global effort must be made to achieve widespread vaccination and herd immunity.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - I-Tzu Chen
- Department of Pharmacy, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Children's Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Rela M, Jothimani D, Vij M, Rajakumar A, Rammohan A. Auto-immune hepatitis following COVID vaccination. J Autoimmun 2021; 123:102688. [PMID: 34225251 DOI: 10.1016/j.jaut.2021.102688] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 12/13/2022]
Abstract
Unprecedented loss of life due to the COVID pandemic has necessitated the development of several vaccines in record time. Most of these vaccines have received approval without being extensively whetted for their adverse effect and efficacy profiles. Most adverse effects have been mild, nonetheless, more serious thromboembolic events have also been reported. Autoimmune hepatitis (AIH) can occur in predisposed individuals where an immune mediated reaction against hepatocytes is triggered by environmental factors. Vaccines are a very rare cause of AIH. We report two such cases of AIH triggered by COVID (Covishield) vaccination. While one patient made an uneventful recovery, another succumbed to the liver disease. Ours is the first report of Covishield vaccination related AIH and second ever after any form of COVID vaccination. We hope that our report does not deter COVID vaccination drives. However, we also hope to raise awareness of its potential side effects and the increased role of pharmacovigilance in guiding treatment.
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Affiliation(s)
- Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
| | - Dinesh Jothimani
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
| | - Mukul Vij
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
| | - Akila Rajakumar
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
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Rasmussen TH, Mortz CG, Georgsen TK, Rasmussen HM, Kjaer HF, Bindslev‐Jensen C. Patients with suspected allergic reactions to COVID-19 vaccines can be safely revaccinated after diagnostic work-up. Clin Transl Allergy 2021; 11:e12044. [PMID: 34331522 PMCID: PMC8315275 DOI: 10.1002/clt2.12044] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND When initiating the Danish vaccination program against COVID-19, the incidence of anaphylaxis was estimated to be 10 times higher compared to other virus-based vaccines. In this study, we present data on patients referred with suspected allergic reactions to COVID-19 vaccines. The main purpose of the study is to investigate the incidence and severity of the allergic reactions, and to evaluate the safety of revaccination. METHODS All patients in the region of Southern Denmark with case histories of allergic reactions to COVID-19 vaccines in a defined period are included in this study. Diagnostic work up consisted of a detailed case history, evaluation of Brighton level of diagnostic certainty and World Allergy Organization grade of anaphylaxis and skin prick testing- and basophil histamine release testing with COVID-19 vaccines and relevant drug excipients. Patients were revaccinated at the Allergy Center when possible. RESULTS Sixty-one patients are included in this study. In 199,377 doses administered, nine patients fulfilled the criteria of anaphylaxis when using the Brighton Criteria (incidence being 45 per million). Of 55 patients with reactions to the first dose, 52 patients were revaccinated without adverse reactions. We found no proven cases of immediate anaphylaxis due to COVID-19 vaccines. By skin prick test, we diagnosed three patients with drug excipient allergy and further a patient with mastocytosis was found. CONCLUSIONS Anaphylactic reactions to COVID-19 vaccines are rare and the incidence is similar to what is seen with other virus-based vaccines. Revaccination is safe in the majority of patients; however, allergological evaluation is important since some prove to have drug excipient allergy.
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Affiliation(s)
- Trine Holm Rasmussen
- Department of Dermatology and Allergy CenterOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
| | - Charlotte Gotthard Mortz
- Department of Dermatology and Allergy CenterOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
| | - Torbjorn Kabel Georgsen
- Department of Dermatology and Allergy CenterOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
| | - Helene Marlies Rasmussen
- Department of Dermatology and Allergy CenterOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
| | - Henrik Fomsgaard Kjaer
- Department of Dermatology and Allergy CenterOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy CenterOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
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Prentice RE, Rentsch C, Al‐Ani AH, Zhang E, Johnson D, Halliday J, Bryant R, Begun J, Ward MG, Lewindon PJ, Connor SJ, Ghaly S, Christensen B. SARS-CoV-2 vaccination in patients with inflammatory bowel disease. GASTROHEP 2021; 3:212-228. [PMID: 34539248 PMCID: PMC8441891 DOI: 10.1002/ygh2.473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The current COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has drastically impacted societies worldwide. Vaccination against SARS-CoV-2 is expected to play a key role in the management of this pandemic. Inflammatory conditions such as inflammatory bowel disease (IBD) often require chronic immunosuppression, which can influence vaccination decisions. AIM This review article aims to describe the most commonly available SARS-CoV-2 vaccination vectors globally, assess the potential benefits and concerns of vaccination in the setting of immunosuppression and provide medical practitioners with guidance regarding SARS-CoV-2 vaccination in patients with IBD. METHODS All published Phase 1/2 and/or Phase 3 and 4 studies of SARS-CoV-2 vaccinations were reviewed. IBD international society position papers, safety registry data and media releases from pharmaceutical companies as well as administrative and medicines regulatory bodies were included. General vaccine evidence and recommendations in immunosuppressed patients were reviewed for context. Society position papers regarding special populations, including immunosuppressed, pregnant and breast-feeding individuals were also evaluated. Literature was critically analysed and summarised. RESULTS Vaccination against SARS-CoV-2 is supported in all adult, non-pregnant individuals with IBD without contraindication. There is the potential that vaccine efficacy may be reduced in those who are immunosuppressed; however, medical therapies should not be withheld in order to undertake vaccination. SARS-CoV-2 vaccines are safe, but data specific to immunosuppressed patients remain limited. CONCLUSIONS SARS-CoV-2 vaccination is essential from both an individual patient and community perspective and should be encouraged in patients with IBD. Recommendations must be continually updated as real-world and trial-based evidence emerges.
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Affiliation(s)
- Ralley E. Prentice
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVICAustralia
| | - Clarissa Rentsch
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVICAustralia
| | - Aysha H. Al‐Ani
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVICAustralia
| | - Eva Zhang
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVICAustralia
| | - Douglas Johnson
- Departments of Infectious Diseases and General MedicineThe Royal Melbourne HospitalMelbourneVICAustralia
- Department of MedicineRoyal Melbourne HospitalUniversity of MelbourneMelbourneVICAustralia
| | - John Halliday
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVICAustralia
| | - Robert Bryant
- Department of GastroenterologyThe Queen Elizabeth HospitalAdelaideAustralia
| | - Jacob Begun
- Department of GastroenterologyMater HospitalBrisbaneAustralia
| | - Mark G. Ward
- Department of GastroenterologyAlfred HealthMelbourneVICAustralia
- Monash UniversityMelbourneVICAustralia
| | - Peter J. Lewindon
- Department of GastroenterologyLady Cilento Children’s HospitalBrisbaneQLDAustralia
- Queensland Children’s Medical Research InstituteUniversity of QueenslandBrisbaneQLDAustralia
| | - Susan J. Connor
- Department of Gastroenterology & HepatologyLiverpool HospitalLiverpoolNSWAustralia
- South West Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
- Ingham Institute of Applied Medical ResearchSydneyNSWAustralia
| | - Simon Ghaly
- Department of GastroenterologySt. Vincent’s Hospital SydneySydneyNSWAustralia
- St. Vincent’s Clinical SchoolUniversity of New South Wales SydneySydneyNSWAustralia
| | - Britt Christensen
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVICAustralia
- University of MelbourneMelbourneVICAustralia
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Shaker M, Phillips E, Blumenthal KG, Abrams EM, Banerji A, Oppenheimer J, Vander Leek TK, Mack DP, Wickner PG, Singer AG, Khan DA, Greenhawt M. The Importance of a Timely Second Dose of the 2021 COVID-19 mRNA Vaccine Depends on the Protection Afforded by a First Dose and Subsequent Risk of Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:2556-2561. [PMID: 33892171 PMCID: PMC8056986 DOI: 10.1016/j.jaip.2021.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022]
Abstract
Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents our greatest hope to combat the devastating coronavirus disease 2019 (COVID-19) pandemic. Amid ongoing global vaccination efforts, rare cases of severe allergic reactions to COVID-19 mRNA vaccines have received significant attention. Although the exact nature of these reactions may be heterogeneous, various approaches exist to engage with patients, communities, public health departments, primary care providers, and other clinicians in a multidisciplinary approach to advance population health. Whereas it is optimal for patients to receive COVID-19 vaccination as outlined in emergency use authorizations, second-dose deferral of mRNA vaccines may be a consideration within a shared decision-making paradigm of care in select circumstances characterized by high durable first-vaccine-dose protection and significant elevations of vaccine anaphylaxis risk. Still, the durability of protection afforded by a single dose of a COVID-19 mRNA vaccine is uncertain, and alternative approaches to complete vaccination, including precautionary use of a COVID-19 viral vector vaccine, also remain patient-preference-sensitive options. There is an urgent need to define correlates of COVID-19 immunity and the level of longer-term protection afforded by COVID-19 vaccination.
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Affiliation(s)
- Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - Elizabeth Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | | | - Timothy K Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas P Mack
- McMaster University, Hamilton, and Halton Pediatric Allergy, Burlington, Ontario, Canada
| | - Paige G Wickner
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Alexander G Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Denver, Colo
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Allergy to COVID-19 vaccines: A current update. Allergol Int 2021; 70:313-318. [PMID: 33962863 PMCID: PMC8062405 DOI: 10.1016/j.alit.2021.04.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/20/2021] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
Adverse allergic reactions due to the administration of the vaccines developed for the protection of coronavirus disease 2019 (COVID-19) have been reported since the initiation of the vaccination campaigns. Current analyses provided by the Center for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) in the United States have estimated the rates of anaphylactic reactions in 2.5 and 11.1 per million of mRNA-1273 and BNT162b2 vaccines administered, respectively. Although rather low, such rates could have importance due to the uncommon fact that a large majority of the world population will be subjected to vaccination with the aforementioned vaccines in the following months and vaccination will most likely be necessary every season as for influenza vaccines. Health regulators have advised that any subject with a previous history of allergy to drugs or any component of the vaccines should not be vaccinated, however, certain misunderstanding exists since allergy to specific excipients in drugs and vaccines are in occasions misdiagnosed due to an absence of suspicion to specific excipients as allergenic triggers or due to inaccurate labeling or nomenclature. In this review, we provide an updated revision of the most current data regarding the anaphylactic reactions described for BNT162b2 vaccine, mRNA-1273 vaccine, and AZD1222 vaccine. We extensively describe the different excipients in the vaccines with the potential to elicit systemic allergic reactions such as polyethylene glycol (PEG), polysorbates, tromethamine/trometamol, and others and the possible immunological mechanisms involved.
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242
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Konstantinidis TG, Zisaki S, Mitroulis I, Konstantinidou E, Kontekaki EG, Romanidou G, Karvelas A, Nanousi I, Lazidis L, Cassimos D, Tsigalou C, Martinis G, Panopoulou M. Levels of Produced Antibodies after Vaccination with mRNA Vaccine; Effect of Previous Infection with SARS-CoV-2. J Clin Med 2021; 10:jcm10132842. [PMID: 34199029 PMCID: PMC8268570 DOI: 10.3390/jcm10132842] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to estimate the immunogenic effect of mRNA vaccine against SARS-CoV-2. This study included 510 participants who received mRNA vaccine. The measurement of anti-COVID-19 antibodies was performed using the Abbott SARS-CoV-2 IgG quantitative assay (Abbott). Overall, mean titer of anti-Spike antibodies was 19,319.2 ± 1787.5 AU/mL. Vaccination induced a robust immunogenic response in those previously infected with SARS-CoV-2 compared with non-infected subjects. Additionally, individuals that were asymptomatic after vaccination produced lower levels of antibodies compared to feverish individuals. In conclusion, remarkably high levels of anti-Spike COVID-19 antibodies were observed after vaccination.
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Affiliation(s)
- Theocharis G. Konstantinidis
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (S.Z.); (E.G.K.); (I.N.); (L.L.); (G.M.)
- Laboratory of Microbiology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (A.K.); (C.T.); (M.P.)
- Correspondence: ; Tel.: +30-2551352005
| | - Stavroula Zisaki
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (S.Z.); (E.G.K.); (I.N.); (L.L.); (G.M.)
| | - Ioannis Mitroulis
- First Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | | | - Eftychia G. Kontekaki
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (S.Z.); (E.G.K.); (I.N.); (L.L.); (G.M.)
| | - Gioulia Romanidou
- Nephrology Department, General Hospital “Sismanogleio”, 69100 Komotini, Greece;
| | - Alexandros Karvelas
- Laboratory of Microbiology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (A.K.); (C.T.); (M.P.)
| | - Ioanna Nanousi
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (S.Z.); (E.G.K.); (I.N.); (L.L.); (G.M.)
| | - Leonidas Lazidis
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (S.Z.); (E.G.K.); (I.N.); (L.L.); (G.M.)
| | - Dimitrios Cassimos
- Pediatric Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Christina Tsigalou
- Laboratory of Microbiology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (A.K.); (C.T.); (M.P.)
| | - Georges Martinis
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (S.Z.); (E.G.K.); (I.N.); (L.L.); (G.M.)
| | - Maria Panopoulou
- Laboratory of Microbiology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece; (A.K.); (C.T.); (M.P.)
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Edriss M, Farshchian M, Daveluy S. Localized cutaneous reaction to an mRNA COVID-19 vaccine. J Cosmet Dermatol 2021; 20:2380-2381. [PMID: 34129749 PMCID: PMC8447073 DOI: 10.1111/jocd.14288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/31/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Manar Edriss
- Wayne State University School of MedicineDetroitMichiganUSA
| | - Mehdi Farshchian
- Department of DermatologyWayne State UniversityDetroitMichiganUSA
| | - Steven Daveluy
- Department of DermatologyWayne State UniversityDetroitMichiganUSA
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Wolfson AR, Robinson LB, Li L, McMahon AE, Cogan AS, Fu X, Wickner P, Samarakoon U, Saff RR, Blumenthal KG, Banerji A. First-Dose mRNA COVID-19 Vaccine Allergic Reactions: Limited Role for Excipient Skin Testing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3308-3320.e3. [PMID: 34166844 PMCID: PMC8217699 DOI: 10.1016/j.jaip.2021.06.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention state that a severe or immediate allergic reaction to the first dose of an mRNA COVID-19 vaccine is a contraindication for the second dose. OBJECTIVE To assess outcomes associated with excipient skin testing after a reported allergic reaction to the first dose of mRNA COVID-19 vaccine. METHODS We identified a consecutive sample of patients with reported allergic reactions after the first dose of mRNA COVID-19 vaccine who underwent allergy assessment with skin testing to polyethylene glycol (PEG) and, when appropriate, polysorbate 80. Skin testing results in conjunction with clinical phenotyping of the first-dose mRNA COVID-19 vaccine reaction guided second-dose vaccination recommendation. Second-dose mRNA COVID-19 vaccine reactions were assessed. RESULTS Eighty patients with reported first-dose mRNA COVID-19 vaccine allergic reactions (n = 65; 81% immediate onset) underwent excipient skin testing. Of those, 14 (18%) had positive skin tests to PEG (n = 5) and/or polysorbate 80 (n = 12). Skin testing result did not affect tolerance of the second dose in patients with immediate or delayed reactions. Of the 70 patients who received the second mRNA COVID-19 vaccine dose (88%), 62 had either no reaction or a mild reaction managed with antihistamines (89%), but 2 patients required epinephrine treatment. Three patients with positive PEG-3350 intradermal (methylprednisolone) testing tolerated second-dose mRNA COVID-19 vaccination. Refresh Tears caused nonspecific skin irritation. CONCLUSIONS Most individuals with a reported allergic reaction to the first dose of mRNA COVID-19 vaccines, regardless of skin test result, received the second dose safely. More data are needed on the value of skin prick testing to PEG (MiraLAX) in evaluating patients with mRNA COVID-19 vaccine anaphylaxis. Refresh Tears should not be used for skin testing.
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Affiliation(s)
- Anna R Wolfson
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
| | - Lacey B Robinson
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Lily Li
- Harvard Medical School, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Aubree E McMahon
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Amelia S Cogan
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Paige Wickner
- Harvard Medical School, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Upeka Samarakoon
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Rebecca R Saff
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Kimberly G Blumenthal
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass
| | - Aleena Banerji
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
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245
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Rutkowski K, Mirakian R, Till S, Rutkowski R, Wagner A. Adverse reactions to COVID-19 vaccines: A practical approach. Clin Exp Allergy 2021; 51:770-777. [PMID: 33813758 PMCID: PMC8250847 DOI: 10.1111/cea.13880] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/10/2021] [Indexed: 12/19/2022]
Abstract
COVID-19-related mortality in high-risk individuals is substantial and current treatment options are limited. There is convincing evidence that the COVID-19 vaccines reduce the severity of infection and prevent deaths. Three COVID-19 vaccines are approved in the United Kingdom with many more in development. There are limited data on the triggers and mechanisms of anaphylaxis to these vaccines. We review the potential allergenic compounds in the COVID-19 vaccines and describe an innovative allergy support model for the vaccination hubs that allows most patients with severe allergy be immunized. Finally, we propose a practical algorithm for the investigations of anaphylaxis to these vaccines.
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Affiliation(s)
| | - Rita Mirakian
- Department of AllergyAddenbrooke’s HospitalCambridgeUK
| | - Stephen Till
- Department of Adult AllergyGuy’s and St Thomas’ HospitalLondonUK
- Peter Gorer Department of ImmunobiologySchool of Immunology and Microbial SciencesSchool of MedicineGuy’s HospitalKing’s College LondonLondonUK
| | - Ryszard Rutkowski
- Department of Respiratory Diagnostics and BronchofiberoscopyMedical UniversityBialystokPoland
| | - Annette Wagner
- Department of Adult AllergyGuy’s and St Thomas’ HospitalLondonUK
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246
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Tammaro A, Adebanjo GAR, Parisella FR, De Marco G, Rello J. Local reactions to the second dose of the BNT162 COVID-19 vaccine. Dermatol Ther 2021; 34:e15000. [PMID: 34031953 PMCID: PMC8209913 DOI: 10.1111/dth.15000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/20/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Antonella Tammaro
- Department of NESMOS Dermatology, Sapienza University of Rome, Rome, Italy
| | | | | | - Gabriella De Marco
- Department of NESMOS Dermatology, Sapienza University of Rome, Rome, Italy
| | - Jordi Rello
- Centro de Investigación Biomedica en Red de Enfermedades Respirorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain.,Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain.,Clinical Research, CHU Nîmes, Université Montpellier-Nimes, Nîmes, France
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247
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Sampath V, Rabinowitz G, Shah M, Jain S, Diamant Z, Jesenak M, Rabin R, Vieths S, Agache I, Akdis M, Barber D, Breiteneder H, Chinthrajah S, Chivato T, Collins W, Eiwegger T, Fast K, Fokkens W, O'Hehir RE, Ollert M, O'Mahony L, Palomares O, Pfaar O, Riggioni C, Shamji MH, Sokolowska M, Jose Torres M, Traidl-Hoffmann C, van Zelm M, Wang DY, Zhang L, Akdis CA, Nadeau KC. Vaccines and allergic reactions: The past, the current COVID-19 pandemic, and future perspectives. Allergy 2021; 76:1640-1660. [PMID: 33811364 PMCID: PMC8251022 DOI: 10.1111/all.14840] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 12/11/2022]
Abstract
Vaccines are essential public health tools with a favorable safety profile and prophylactic effectiveness that have historically played significant roles in reducing infectious disease burden in populations, when the majority of individuals are vaccinated. The COVID-19 vaccines are expected to have similar positive impacts on health across the globe. While serious allergic reactions to vaccines are rare, their underlying mechanisms and implications for clinical management should be considered to provide individuals with the safest care possible. In this review, we provide an overview of different types of allergic adverse reactions that can potentially occur after vaccination and individual vaccine components capable of causing the allergic adverse reactions. We present the incidence of allergic adverse reactions during clinical studies and through post-authorization and post-marketing surveillance and provide plausible causes of these reactions based on potential allergenic components present in several common vaccines. Additionally, we review implications for individual diagnosis and management and vaccine manufacturing overall. Finally, we suggest areas for future research.
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Affiliation(s)
- Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA
| | - Grace Rabinowitz
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA
| | - Mihir Shah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA
| | - Surabhi Jain
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA
| | - Zuzana Diamant
- Departmentt of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
- Department of Clinical Pharmacy &Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Milos Jesenak
- Department of Pediatrics and Department of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Center for Vaccination in Special Situations, University Hospital in Martin, Comenius University in Bratislava, Bratislava, Slovakia
| | - Ronald Rabin
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Stefan Vieths
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Zurich, Switzerland
| | - Domingo Barber
- Departamento de CienciasMédicasBásicas, Facultad de Medicina, Instituto de Medicina Molecular Aplicada (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, España
- Instituto de Salud Carlos III, RETIC ARADYAL, Madrid, Spain
| | - Heimo Breiteneder
- Division of Medical Biotechnology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - William Collins
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA
- Department of Medicine, Division of Hospital Medicine, Stanford University, Stanford, CA, USA
| | - Thomas Eiwegger
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Toronto, ON, Canada
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Katharine Fast
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA
| | - Wytske Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Robyn E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, and Alfred Health, Melbourne, Vic, Australia
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Liam O'Mahony
- Department of Medicine and School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Carmen Riggioni
- Department of Paediatrics, Allergy and Clinical Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Mohamed H Shamji
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- Centre in Allergic Mechanisms of Asthma, London, UK
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Zurich, Switzerland
| | - Maria Jose Torres
- Allergy Unit, Malaga Regional University Hospital-UMA-ARADyAL, Málaga, Spain
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Medical Faculty, University Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Zentrum München German Research Center for Environmental Health, Neuherberg, Germany
| | - Menno van Zelm
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, VIC, Australia
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Zurich, Switzerland
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
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248
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Sokolowska M, Eiwegger T, Ollert M, Torres MJ, Barber D, Del Giacco S, Jutel M, Nadeau KC, Palomares O, Rabin RL, Riggioni C, Vieths S, Agache I, Shamji MH. EAACI statement on the diagnosis, management and prevention of severe allergic reactions to COVID-19 vaccines. Allergy 2021; 76:1629-1639. [PMID: 33452689 PMCID: PMC8013422 DOI: 10.1111/all.14739] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
The first approved COVID‐19 vaccines include Pfizer/BioNTech BNT162B2, Moderna mRNA‐1273 and AstraZeneca recombinant adenoviral ChAdOx1‐S. Soon after approval, severe allergic reactions to the mRNA‐based vaccines that resolved after treatment were reported. Regulatory agencies from the European Union, Unites States and the United Kingdom agree that vaccinations are contraindicated only when there is an allergy to one of the vaccine components or if there was a severe allergic reaction to the first dose. This position paper of the European Academy of Allergy and Clinical Immunology (EAACI) agrees with these recommendations and clarifies that there is no contraindication to administer these vaccines to allergic patients who do not have a history of an allergic reaction to any of the vaccine components. Importantly, as is the case for any medication, anaphylaxis may occur after vaccination in the absence of a history of allergic disease. Therefore, we provide a simplified algorithm of prevention, diagnosis and treatment of severe allergic reactions and a list of recommended medications and equipment for vaccine centres. We also describe potentially allergenic/immunogenic components of the approved vaccines and propose a workup to identify the responsible allergen. Close collaboration between academia, regulatory agencies and vaccine producers will facilitate approaches for patients at risks, such as incremental dosing of the second injection or desensitization. Finally, we identify unmet research needs and propose a concerted international roadmap towards precision diagnosis and management to minimize the risk of allergic reactions to COVID‐19 vaccines and to facilitate their broader and safer use.
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Affiliation(s)
- Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF University of Zurich Zurich Switzerland
| | - Thomas Eiwegger
- Division of Immunology and Allergy Food Allergy and Anaphylaxis ProgramThe Hospital for Sick Children Toronto ON Canada
- Translational Medicine Program, Research InstituteThe Hospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
| | - Markus Ollert
- Department of Infection and Immunity Luxembourg Institute of Health Esch‐sur‐Alzette Luxembourg
- Department of Dermatology and Allergy Center Odense Research Center for AnaphylaxisOdense University HospitalUniversity of Southern Denmark Odense Denmark
| | - Maria J. Torres
- AllergyClinical UnitHospital Regional Universitario de Málaga‐UMA‐ARADyAL Málaga Spain
| | - Domingo Barber
- Departamento de Ciencias Médicas Básicas Facultad de Medicina Instituto de Medicina Molecular Aplicada (IMMAUniversidad San Pablo‐CEUCEU Universities Madrid España
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wrocław Poland
| | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
- Department of Medicine Division of Pulmonary and Critical Care Medicine Stanford University Stanford CA USA
- Department of Medicine Division of Allergy, Immunology and Rheumatology Stanford University Stanford CA USA
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
| | - Ronald L. Rabin
- Office of Vaccines Research and Review Center for Biologics Evaluation and Research US Food and Drug Administration Silver Spring MD USA
| | - Carmen Riggioni
- Allergy and Clinical Immunology Department of Paediatrics Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
- Institut de Recerca Sant Joan de Déu Barcelona Spain
| | - Stefan Vieths
- Paul‐Ehrlich‐Institut Paul‐Ehrlich‐Str. 51‐59 Langen63225Germany
| | | | - Mohamed H. Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology Inflammation, Repair and DevelopmentNational Heart and Lung InstituteImperial College London. Asthma UK Centre in Allergic Mechanisms of Asthma London UK
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249
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Shaker MS, Phillips E, Blumenthal KG, Abrams EM, Banerji A, Oppenheimer J, Vander Leek TK, Mack DP, Wickner PG, Singer AG, Khan DA, Greenhawt M. Reply to "How important is the second dose of the COVID-19 mRNA vaccine?". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:2537-2539. [PMID: 34112481 PMCID: PMC8181594 DOI: 10.1016/j.jaip.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Marcus S Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - Elizabeth Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | | | - Timothy K Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Douglas P Mack
- McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, Burlington, ON, Canada
| | - Paige G Wickner
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Alexander G Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - David A Khan
- Division of Allergy & Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Denver, Colo
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250
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Sun Q, Fathy R, McMahon DE, Freeman EE. COVID-19 Vaccines and the Skin: The Landscape of Cutaneous Vaccine Reactions Worldwide. Dermatol Clin 2021; 39:653-673. [PMID: 34556254 PMCID: PMC8165093 DOI: 10.1016/j.det.2021.05.016] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Qisi Sun
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Ramie Fathy
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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