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Nittner-Marszalska M, Rosiek-Biegus M, Kopeć A, Pawłowicz R, Kosińska M, Łata A, Szenborn L. Pfizer-BioNTech COVID-19 Vaccine Tolerance in Allergic versus Non-Allergic Individuals. Vaccines (Basel) 2021; 9:vaccines9060553. [PMID: 34070671 PMCID: PMC8230004 DOI: 10.3390/vaccines9060553] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022] Open
Abstract
Individuals with a history of allergy are potentially at risk of suffering from adverse effects after COVID-19 vaccination. We sought to assess the tolerance towards the Pfizer-BioNTech vaccine in allergic patients. To address this issue, we used a questionnaire conducted on-line in a group of medical professionals who were vaccinated with the Pfizer-BioNTech vaccine. A total of 1808 respondents, out of whom 1707 received two doses of the vaccine, returned the questionnaire. Local reactions after injection were more frequent in allergic individuals after both doses (swelling p = 0.0003). Systemic adverse events (AE-SYS) occurred more often after the second than the first dose in both groups (allergic persons: 77.29% vs. 41.06%); vomiting and arthralgia occurred more often in allergic subjects (p = 0.0009). AE-SYS in allergic individuals lasted longer than in non-allergic ones after the first (p = 0.01) and the second dose (p = 0.0009). Allergic reactions after vaccination were reported more frequently in allergic subjects: after the first dose (p = 0.00001) and after the second dose (p = 0.001). Rhinitis was the most frequent symptom observed more often in allergic patients. No severe allergic reactions occurred during the full cycle of vaccination. Although the Pfizer-BioNTech vaccine is tolerated worse by allergic than non-allergic individuals, the occurring adverse symptoms are mild and do not preclude a successful completion of the vaccination cycle. The presence of symptoms suggestive of allergy does not constitute a condition of increased risk of developing clinically significant adverse events following Pfizer COVID-19 vaccination.
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Affiliation(s)
- Marita Nittner-Marszalska
- Department and Clinic of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Str. Marii Skłodowskiej-Curie 66, 50-369 Wrocław, Poland; (M.N.-M.); (M.R.-B.); (A.K.); (M.K.); (A.Ł.)
| | - Marta Rosiek-Biegus
- Department and Clinic of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Str. Marii Skłodowskiej-Curie 66, 50-369 Wrocław, Poland; (M.N.-M.); (M.R.-B.); (A.K.); (M.K.); (A.Ł.)
| | - Agnieszka Kopeć
- Department and Clinic of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Str. Marii Skłodowskiej-Curie 66, 50-369 Wrocław, Poland; (M.N.-M.); (M.R.-B.); (A.K.); (M.K.); (A.Ł.)
| | - Robert Pawłowicz
- Department and Clinic of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Str. Marii Skłodowskiej-Curie 66, 50-369 Wrocław, Poland; (M.N.-M.); (M.R.-B.); (A.K.); (M.K.); (A.Ł.)
- Correspondence:
| | - Magdalena Kosińska
- Department and Clinic of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Str. Marii Skłodowskiej-Curie 66, 50-369 Wrocław, Poland; (M.N.-M.); (M.R.-B.); (A.K.); (M.K.); (A.Ł.)
| | - Aleksandra Łata
- Department and Clinic of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Str. Marii Skłodowskiej-Curie 66, 50-369 Wrocław, Poland; (M.N.-M.); (M.R.-B.); (A.K.); (M.K.); (A.Ł.)
| | - Leszek Szenborn
- Department of Paediatrics and Infectious Diseases, Wroclaw Medical University, Str. Chałubińskiego 2-2a, 50-368 Wrocław, Poland;
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Safety of COVID-19 vaccination in patients with mastocytosis and monoclonal mast cell activation syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3198-3199. [PMID: 34033981 PMCID: PMC8141687 DOI: 10.1016/j.jaip.2021.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022]
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Chen G, Li X, Sun M, Zhou Y, Yin M, Zhao B, Li X. COVID-19 mRNA Vaccines Are Generally Safe in the Short Term: A Vaccine Vigilance Real-World Study Says. Front Immunol 2021; 12:669010. [PMID: 34093567 PMCID: PMC8177815 DOI: 10.3389/fimmu.2021.669010] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/04/2021] [Indexed: 12/26/2022] Open
Abstract
Background The prophylactic vaccination of COVID-19 mRNA vaccines is the first large-scale application of this kind in the human world. Over 1.8 million doses of the COVID-19 vaccine had been administered in the US until December 2020, and around 0.2% submitted AE reports to the Vaccine Adverse Event Reporting System (VAERS). This study aimed to evaluate the AEs following immunization (AEFIs) and analyze the potential associations based on the information from the VAERS database. Methods We searched the VAERS database recorded AEFIs after COVID-19 vaccines in December 2020. After data mapping, we summarized demographic and clinical features of reported cases. Fisher exact test was used to comparing the clinical characteristics among AE groups with an anaphylactic response, concerning neurological disorders and death. Results VAERS reported 3,908 AEFIs of COVID-19 vaccines in December 2020. Most (79.68%) were reported after the first dose of the vaccine. Among the reported cases, we found that general disorders (48.80%), nervous system disorders (46.39%), and gastrointestinal disorders (25.54%) were the most common AEFIs. The allergy history was more frequent in vaccine recipients with anaphylactic reactions than those without (64.91% vs. 49.62%, OR = 1.88, P <0.017). History of anxiety or depression was more common in subjects reporting severe neurological AEFIs than those reporting other AEFIs (18.37% vs. 7.85%, OR = 2.64, P <0.017). Cases reporting death were significantly older (79.36 ± 10.41-year-old vs. 42.64 ± 12.55-year-old, P <0.01, 95% CI 29.30-44.15) and more likely experienced hypertension (50.00% vs. 11.42%, OR = 7.76, P <0.01) and neurological disorders (50.00% vs. 5.36%, OR = 17.65, P <0.01) than other vaccine recipients. The outpatient and emergency room visit rates were 11.92 and 22.42% for AEFIs, and 2.53% of cases needed hospitalization. Conclusion AEFIs of COVID-19 mRNA vaccines were generally non-severe local or systemic reactions. A prior allergy history is the risk factor for anaphylaxis, while a history of anxiety may link with severe neurological AEs. Such vaccine recipients need further evaluation and monitor.
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Affiliation(s)
- Gang Chen
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaolin Li
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Meixing Sun
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangzhong Zhou
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Meifang Yin
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Zhao
- Pharmacy Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuemei Li
- Nephrology Department, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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254
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Snook ML, Beigi RH, Legro RS, Paules CI. Should women undergoing in vitro fertilization treatment or who are in the first trimester of pregnancy be vaccinated immediately against COVID-19. Fertil Steril 2021; 116:16-24. [PMID: 34148583 PMCID: PMC8118645 DOI: 10.1016/j.fertnstert.2021.05.083] [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: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Meredith L Snook
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richard H Beigi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richard S Legro
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Catharine I Paules
- Division of Infectious Diseases, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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255
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Hildreth JEK, Alcendor DJ. Targeting COVID-19 Vaccine Hesitancy in Minority Populations in the US: Implications for Herd Immunity. Vaccines (Basel) 2021; 9:489. [PMID: 34064726 PMCID: PMC8151325 DOI: 10.3390/vaccines9050489] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 02/08/2023] Open
Abstract
There has been a continuous underrepresentation of minorities in healthcare research and vaccine trials, along with long-standing systemic racism and discrimination that have been fueling the distrust of the healthcare system among these communities for decades. The history and legacy of racial injustices and negative experiences within a culturally insensitive healthcare system have greatly contributed to vaccine hesitancy among ethnic minorities. COVID-19 vaccine hesitancy will impact vaccine uptake in the US, subsequently hindering the establishment of herd immunity (75-85% of the population vaccinated) to mitigate SARS-CoV-2 infection and transmission. Information targeting underserved racial/ethnic minorities in the US in a culturally competent manner has been lacking. This information is crucial for educating these communities about COVID-19 vaccines and their distribution as well as dispelling misinformation regarding vaccine trials, safety, and efficacy. This lack of education has greatly contributed to COVID-19 vaccine hesitancy and will increase disparities in vaccine uptake. Moreover, timely vaccinations are also essential to curtailing virus transmission and the emergence of SARS-CoV-2 variants that may evade the immune response produced by the three existing COVID-19 vaccines.
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Affiliation(s)
- James E. K. Hildreth
- Center for AIDS Health Disparities Research, Department of Microbiology and Immunology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208-3599, USA;
- Department of Internal Medicine, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208-3599, USA
- Center for AIDS Health Disparities Research, Department of Microbiology, Immunology, and Physiology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Donald J. Alcendor
- Center for AIDS Health Disparities Research, Department of Microbiology and Immunology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208-3599, USA;
- Center for AIDS Health Disparities Research, Department of Microbiology, Immunology, and Physiology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
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256
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Klimek L, Bergmann KC, Brehler R, Pfützner W, Worm M, Hartmann K, Jakob T, Novak N, Ring J, Hamelmann E, Ankermann T, Schmidt SM, Untersmayr E, Hötzenecker W, Jensen-Jarolim E, Zuberbier T. Praktischer Umgang mit allergischen Reaktionen auf COVID-19-Impfstoffe. ALLERGO JOURNAL 2021; 30:22-43. [PMID: 33967401 PMCID: PMC8091634 DOI: 10.1007/s15007-021-4773-1] [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] [Indexed: 02/06/2023]
Abstract
Hintergrund: Zur vorbeugenden Behandlung von COVID-19 (Coronaviruserkrankung 2019) wurden in einer beispiellosen weltweiten Forschungsanstrengung Sicherheit und Wirksamkeit neuer Impfstoffplattformen studiert, die noch nie zuvor am Menschen eingesetzt wurden. Weniger als ein Jahr nach der Entdeckung der SARS-CoV-2-Virussequenz (SARS-CoV-2, "severe acute respiratory syndrome coronavirus type 2") wurden diese in zahlreichen Ländern für den Einsatz zugelassen und es wurde mit Massenimpfungen begonnen. Die bislang in der Europäischen Union (EU) zugelassenen mRNA-Impfstoffe (mRNA, "messenger"-RNA) gegen SARS-CoV-2 BNT162b2 und mRNA-1273 basieren auf einer ähnlichen lipidbasierten Nanopartikelträgertechnologie; die Lipidkomponenten unterscheiden sich jedoch. Schwere allergische Reaktionen und Anaphylaxien nach COVID-19-Impfungen sind sehr seltene unerwünschte Nebenwirkungen, die aber aufgrund potenziell letaler Ausgänge viel Aufmerksamkeit erhalten und ein hohes Maß an Verunsicherung ausgelöst haben. Methoden: Das aktuelle Wissen zu anaphylaktischen Reaktionen auf Impfstoffe und speziell zu den derzeit neuen mRNA-COVID-19-Impfstoffen wurde zusammengestellt mittels einer Literaturanalyse durch Recherchen in Medline, Pubmed sowie den nationalen und internationalen Studien- und Leitlinienregistern, der Cochrane Library und dem Internet unter besonderer Berücksichtigung offizieller Webseiten der World Health Oranization (WHO), der Centers for Disease Control and Prevention (CDC), der European Medicines Agency (EMA), des Robert-Koch-Instituts (RKI) und des Paul-Ehrlich-Instituts (PEI). Ergebnisse: Basierend auf der internationalen Literatur und bisheriger Erfahrungen zu schweren allergischen Reaktionen im Kontext der COVID-19-Impfungen werden von einem Expertengremium Empfehlungen für Prophylaxe, Diagnostik und Therapie dieser allergischen Reaktionen gegeben. Schlussfolgerung: Vor einer COVID-19-Impfung mit den derzeit zugelassenen Impfstoffen sind Allergietests für die allermeisten Allergiker nicht notwendig. Bei allergischer/anaphylaktischer Reaktion auf den verabreichten COVID-19-Impfstoff wird eine allergologische Abklärung empfohlen, wie auch für eine kleine potenzielle Risikopopulation vor der ersten Impfung. Die Evaluierung und Zulassung von Testverfahren sollten hierfür erfolgen. Zitierweise: Klimek L, Bergmann K-C, Brehler R, Pfützner W, Zuberbier T, Hartmann K, Jakob T, Novak N, Ring J, Merk H; Hamelmann E, Ankermann T, Schmidt S, Untersmayr E, Hötzenecker W, Jensen-Jarolim E, Brockow K, Mahler V, Worm M. Practical Handling of Allergic Reactions to COVID-19 vaccines. A Position Paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and ÖGAI. Allergo J Int 2021;30:79-95 https: //doi.org/10.1007/s40629-021-00165-7
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Affiliation(s)
- Ludger Klimek
- Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | | | - Randolf Brehler
- Wilhelm-Univ. Münster, Abtlg. Dermatologie, Von-Esmarch-Str. 58, 48149 Münster, Germany
| | - Wolfgang Pfützner
- Klinik für Dermatologie und Allergologie, Baldingerstraße, 35043 Marburg, Germany
| | - Margitta Worm
- Allergie-Centrum-Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Thilo Jakob
- Universitäts-Hautklinik Gießen, Gießen, Germany
| | - Natalija Novak
- Klinik u. Poliklinik f. Dermatologie u. Allergologie, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Johannes Ring
- Haut- und Laserzentrum an der Oper, Perusastraße 5, 80333 München, Germany
| | - Eckard Hamelmann
- Evangelisches Krankenhaus Bielefeld gGmbH, Grenzweg 10, 33617 Bielefeld, Germany
| | - Tobias Ankermann
- Klinik f. Allg. Pädiatrie, Univ. Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | | | - Eva Untersmayr
- Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
| | - Wolfram Hötzenecker
- Kepler Universitätsklinikum \/ Med Campus III., Krankenhausstr. 9, 4021 Linz, Österreich
| | - Erika Jensen-Jarolim
- Institut für Pathophysiologie AKH Wien, Ebene 3 Q, Währinger Gürtel 18-20, 1090 Wien, Österreich
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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257
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Özdemir İH, Özlek B, Özen MB, Gündüz R, Bayturan Ö. Type 1 Kounis Syndrome Induced by Inactivated SARS-COV-2 Vaccine. J Emerg Med 2021; 61:e71-e76. [PMID: 34148772 PMCID: PMC8103145 DOI: 10.1016/j.jemermed.2021.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/10/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022]
Abstract
Background Vaccination is the most important way out of the novel coronavirus disease 2019 (COVID-19) pandemic. Vaccination practices have started in different countries for community immunity. In this process, health authorities in different countries have preferred different type of COVID-19 vaccines. Inactivated COVID-19 vaccine is one of these options and has been administered to more than 7 million people in Turkey. Inactivated vaccines are generally considered safe. Kounis syndrome (KS) is a rare clinical condition defined as the co-existence of acute coronary syndromes and allergic reactions. Case Report We present the case of a 41-year-old woman with no cardiovascular risk factors who was admitted at our emergency department with flushing, palpitation, dyspnea, and chest pain 15 min after the first dose of inactivated CoronaVac (Sinovac Life Sciences, Beijing, China). Electrocardiogram (ECG) showed V4-6 T wave inversion, and echocardiography revealed left ventricular wall motion abnormalities. Troponin-I level on arrival was elevated. Coronary angiography showed no sign of coronary atherosclerosis. She was diagnosed with type 1 KS. The patient's symptoms resolved and she was discharged from hospital in a good condition. Why Should an Emergency Physician Be Aware of This? To the best of our knowledge, this is the first case of allergic myocardial infarction secondary to inactivated coronavirus vaccine. This case demonstrates that KS can occur after inactivated virus vaccine against COVID-19. Although the risk of severe allergic reaction after administration of CoronaVac seems to be very low, people who developed chest pain after vaccine administration should be followed by ECG and troponin measurements.
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Affiliation(s)
| | - Bülent Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | | | - Ramazan Gündüz
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - Özgür Bayturan
- Department of Cardiology, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
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258
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Dages KN, Pitlick MM, Joshi AY, Park MA. Risk of allergic reaction in patients with atopic disease and recent coronavirus disease 2019 vaccination. Ann Allergy Asthma Immunol 2021; 127:257-258. [PMID: 33962029 PMCID: PMC8096529 DOI: 10.1016/j.anai.2021.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Kelley N Dages
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mitchell M Pitlick
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Avni Y Joshi
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Miguel A Park
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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259
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Jeon M, Kim J, Oh CE, Lee JY. Adverse Events Following Immunization Associated with Coronavirus Disease 2019 Vaccination Reported in the Mobile Vaccine Adverse Events Reporting System. J Korean Med Sci 2021; 36:e114. [PMID: 33942578 PMCID: PMC8093606 DOI: 10.3346/jkms.2021.36.e114] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Vaccination against coronavirus disease 2019 (COVID-19) is underway globally to prevent the infection caused by the severe acute respiratory syndrome coronavirus 2. We aimed to investigate the adverse events following immunization (AEFIs) for COVID-19 among healthcare workers (HCWs). METHODS This was a retrospective study of the AEFIs associated with the first dose of the ChAdOx1 nCoV-19 vaccine at the Kosin University Gospel Hospital from March 3 to March 22, 2021. We investigated the systemic and local adverse events during the 7 days following the vaccination using the Mobile Vaccine Adverse Events Reporting System (MVAERS) developed by our hospital. RESULTS A total of 1,503 HCWs were vaccinated, and the data of 994 HCWs were reported in the MVAERS. The most commonly reported AEFIs were tenderness at the injection site (94.5%), fatigue (92.9%), pain at the injection site (88.0%), and malaise (83.8%). The severity of most AEFIs was mild-to-moderate, and the severity and number of AEFIs were less in the older age group. There were no serious events requiring hospitalization, and most AEFIs improved within a few days. CONCLUSION The AEFIs associated with the ChAdOx1 nCoV-19 vaccine were tolerable, and the use of the MVAERS was helpful in monitoring the AEFIs. The use of MVAERS will help in sharing accurate and ample information about vaccination against COVID-19.
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Affiliation(s)
- Minji Jeon
- Division of Infectious Diseases, Department of Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Jehun Kim
- Division of Pulmonary and Critical Care Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Chi Eun Oh
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Jin Young Lee
- Division of Infectious Diseases, Department of Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
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Abstract
Vaccination has played a crucial role in the improvement of global health. Some of the world's deadliest diseases, like smallpox and rinderpest, have been eradicated with the help of vaccines, and many others have been restrained. The appearance of the strain of coronavirus disease 2019 (COVID-19) severe acute respiratory syndrome coronavirus 2 and its impact on global health have made the development of effective and safe vaccines crucial for this new lethal disease. So far, there are three main types of COVID-19 vaccines in use around the world: messenger RNA-based vaccines, adenoviral vector vaccines, and inactivated whole-virus vaccines. Some of them have passed through phase 3 of safety and efficacy trials and are widely used for prophylaxis of COVID-19 infection. A plethora of cutaneous adverse events have been reported, most of them mild or moderate injection-site reactions. Some rare delayed inflammatory reactions such as "COVID arm" have also been reported, posing questions on their pathophysiology and clinical importance. Some rare serious adverse events, such as vaccine-induced prothrombotic immune thrombocytopenia and anaphylaxis, have been described raising great concerns on the safety of some widely spread vaccines. More data need to be collected with further and more detailed analysis. The overall risk of such severe adverse reactions remains extremely low, and the benefits of the existing vaccines in combating the widespread threat of COVID-19 continue to outweigh the risk of their side effects.
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Affiliation(s)
- Georgi Bogdanov
- Department of Pharmacology and Toxicology, Medical University Sofia, Sofia, Bulgaria.
| | - Ivan Bogdanov
- Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Jana Kazandjieva
- Department of Dermatology and Venerology, Medical University Sofia, Sofia, Bulgaria
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Singh B, Kaur P, Kumar V, Maroules M. COVID-19 vaccine induced Axillary and Pectoral Lymphadenopathy on PET scan. Radiol Case Rep 2021; 16:1819-1821. [PMID: 33968285 PMCID: PMC8084621 DOI: 10.1016/j.radcr.2021.04.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/09/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the ongoing global pandemic. It can manifest a wide range of complications depending upon the severity of infection and comorbidities of the patient. Vaccines are very important measure to provide protection against COVID‐19. We report a case of 72-year-old female with past medical history of hypertension and diabetes mellitus who underwent imaging with positron emission tomography (PET) scan imaging for staging of her small cell urinary bladder cancer and was found to have hypermetabolic uptake in the deltoid muscle of the left shoulder and hypermetabolic left axillary and pectoral lymph nodes due to mRNA BNT-162b2 (Pfizer-BioNTech COVID-19 vaccine) vaccine administrated 3 days ago prior to PET scan.
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Affiliation(s)
- Balraj Singh
- Department of Hematology & Oncology, Saint Joseph's University Medical Center Paterson, 703. Main Street, Paterson NJ, 07503 USA
| | - Parminder Kaur
- Department of Cardiology, Saint Joseph's University Medical Center Paterson, 703. Main Street, Paterson NJ, 07503 USA
| | - Vinod Kumar
- Department of Hematology & Oncology, Saint Joseph's University Medical Center Paterson, 703. Main Street, Paterson NJ, 07503 USA
| | - Michael Maroules
- Department of Hematology & Oncology, Saint Joseph's University Medical Center Paterson, 703. Main Street, Paterson NJ, 07503 USA
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263
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Bekkali N, Allard T, Lengellé C, Estève E. [Eczematiform eruption after Pfizer-BioNTech COVID-19 vaccine]. Therapie 2021; 76:364-365. [PMID: 34272069 PMCID: PMC8276112 DOI: 10.1016/j.therap.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Nihal Bekkali
- Service de dermatologie, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France.
| | - Tanguy Allard
- Service de dermatologie, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France
| | - Céline Lengellé
- Centre régional de pharmacovigilance Centre-Val de Loire, CHRU de Tours, 37044 Tours, France
| | - Eric Estève
- Service de dermatologie, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France
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Kraft M, Renaudin JM, Ensina LF, Kleinheinz A, Bilò MB, Scherer Hofmeier K, Dölle-Bierke S, Worm M. Anaphylaxis to vaccination and polyethylene glycol: a perspective from the European Anaphylaxis Registry. J Eur Acad Dermatol Venereol 2021; 35:e659-e662. [PMID: 33914977 PMCID: PMC8242778 DOI: 10.1111/jdv.17327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M Kraft
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Department of Emergency Medicine, University Hospital Halle (Saale), Medical Faculty of Martin Luther University Halle-Wittenberg, Halle, Germany
| | - J M Renaudin
- Presidency on behalf of Allergy Vigilance Network, Vandoeuvre les Nancy, France
| | - L F Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - A Kleinheinz
- Department of Dermatology, Elbe Medical Centre, Buxtehude, Germany
| | - M B Bilò
- Department of Clinical and Molecular Sciences, Marche Polytechnic University - Allergy Unit, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - K Scherer Hofmeier
- Division of Allergy, Department of Dermatology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - S Dölle-Bierke
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Watad A, De Marco G, Mahajna H, Druyan A, Eltity M, Hijazi N, Haddad A, Elias M, Zisman D, Naffaa ME, Brodavka M, Cohen Y, Abu-Much A, Abu Elhija M, Bridgewood C, Langevitz P, McLorinan J, Bragazzi NL, Marzo-Ortega H, Lidar M, Calabrese C, Calabrese L, Vital E, Shoenfeld Y, Amital H, McGonagle D. Immune-Mediated Disease Flares or New-Onset Disease in 27 Subjects Following mRNA/DNA SARS-CoV-2 Vaccination. Vaccines (Basel) 2021; 9:vaccines9050435. [PMID: 33946748 PMCID: PMC8146571 DOI: 10.3390/vaccines9050435] [Citation(s) in RCA: 264] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Infectious diseases and vaccines can occasionally cause new-onset or flare of immune-mediated diseases (IMDs). The adjuvanticity of the available SARS-CoV-2 vaccines is based on either TLR-7/8 or TLR-9 agonism, which is distinct from previous vaccines and is a common pathogenic mechanism in IMDs. METHODS We evaluated IMD flares or new disease onset within 28-days of SARS-CoV-2 vaccination at five large tertiary centres in countries with early vaccination adoption, three in Israel, one in UK, and one in USA. We assessed the pattern of disease expression in terms of autoimmune, autoinflammatory, or mixed disease phenotype and organ system affected. We also evaluated outcomes. FINDINGS 27 cases included 17 flares and 10 new onset IMDs. 23/27 received the BNT - 162b2 vaccine, 2/27 the mRNA-1273 and 2/27 the ChAdOx1 vaccines. The mean age was 54.4 ± 19.2 years and 55% of cases were female. Among the 27 cases, 21 (78%) had at least one underlying autoimmune/rheumatic disease prior the vaccination. Among those patients with a flare or activation, four episodes occurred after receiving the second-dose and in one patient they occurred both after the first and the second-dose. In those patients with a new onset disease, two occurred after the second-dose and in one patient occurred both after the first (new onset) and second-dose (flare). For either dose, IMDs occurred on average 4 days later. Of the cases, 20/27 (75%) were mild to moderate in severity. Over 80% of cases had excellent resolution of inflammatory features, mostly with the use of corticosteroid therapy. Other immune-mediated conditions included idiopathic pericarditis (n = 2), neurosarcoidosis with small fiber neuropathy (n = 1), demyelination (n = 1), and myasthenia gravis (n = 2). In 22 cases (81.5%), the insurgence of Adverse event following immunization (AEFI)/IMD could not be explained based on the drug received by the patient. In 23 cases (85.2%), AEFI development could not be explained based on the underlying disease/co-morbidities. Only in one case (3.7%), the timing window of the insurgence of the side effect was considered not compatible with the time from vaccine to flare. INTERPRETATION Despite the high population exposure in the regions served by these centers, IMDs flares or onset temporally-associated with SARS-CoV-2 vaccination appear rare. Most are moderate in severity and responsive to therapy although some severe flares occurred. FUNDING none.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine ‘B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 10457, Israel; (A.W.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Gabriele De Marco
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Hussein Mahajna
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Gastroenterology Department, Sheba Medical Center, Tel-Aviv 10457, Israel
| | - Amit Druyan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Mailam Eltity
- Department of Neurology, Sheba Medical Center, Tel-Aviv 10457, Israel;
| | - Nizar Hijazi
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Muna Elias
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Mohammad E. Naffaa
- Department of Rheumatology, Galilee Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Safed 22100, Israel;
| | - Michal Brodavka
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Yael Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Arsalan Abu-Much
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Tel Aviv 10457, Israel;
| | - Muhanad Abu Elhija
- Rheumatology Unit, Carmel Medical Center, Michal Street, Haifa 3436212, Israel; (N.H.); (A.H.); (M.E.); (D.Z.); (M.A.E.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Charlie Bridgewood
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Pnina Langevitz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Joanna McLorinan
- Department of Rheumatology, Mid Yorkshire Hospitals, West Yorkshire WF8 1PL, UK;
| | - Nicola Luigi Bragazzi
- Centre for Disease Modelling, Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
- Fields-CQAM Laboratory of Mathematics for Public Health (MfPH), York University, Toronto, ON M3J 1P3, Canada
- Correspondence: (N.L.B.); (D.M.)
| | - Helena Marzo-Ortega
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Cassandra Calabrese
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A50, Cleveland, OH 44195, USA; (C.C.); (L.C.)
| | - Leonard Calabrese
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A50, Cleveland, OH 44195, USA; (C.C.); (L.C.)
| | - Edward Vital
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
| | - Yehuda Shoenfeld
- Department of Medicine ‘B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 10457, Israel; (A.W.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
| | - Howard Amital
- Department of Medicine ‘B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 10457, Israel; (A.W.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (H.M.); (A.D.); (M.B.); (Y.C.); (P.L.); (M.L.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer 10457, Israel
| | - Dennis McGonagle
- NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (G.D.M.); (C.B.); (H.M.-O.); (E.V.)
- Correspondence: (N.L.B.); (D.M.)
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266
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Nel AE, Miller JF. Nano-Enabled COVID-19 Vaccines: Meeting the Challenges of Durable Antibody Plus Cellular Immunity and Immune Escape. ACS NANO 2021; 15:5793-5818. [PMID: 33793189 PMCID: PMC8029448 DOI: 10.1021/acsnano.1c01845] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
At the time of preparing this Perspective, large-scale vaccination for COVID-19 is in progress, aiming to bring the pandemic under control through vaccine-induced herd immunity. Not only does this vaccination effort represent an unprecedented scientific and technological breakthrough, moving us from the rapid analysis of viral genomes to design, manufacture, clinical trial testing, and use authorization within the time frame of less than a year, but it also highlights rapid progress in the implementation of nanotechnology to assist vaccine development. These advances enable us to deliver nucleic acid and conformation-stabilized subunit vaccines to regional lymph nodes, with the ability to trigger effective humoral and cellular immunity that prevents viral infection or controls disease severity. In addition to a brief description of the design features of unique cationic lipid and virus-mimicking nanoparticles for accomplishing spike protein delivery and presentation by the cognate immune system, we also discuss the importance of adjuvancy and design features to promote cooperative B- and T-cell interactions in lymph node germinal centers, including the use of epitope-based vaccines. Although current vaccine efforts have demonstrated short-term efficacy and vaccine safety, key issues are now vaccine durability and adaptability against viral variants. We present a forward-looking perspective of how vaccine design can be adapted to improve durability of the immune response and vaccine adaptation to overcome immune escape by viral variants. Finally, we consider the impact of nano-enabled approaches in the development of COVID-19 vaccines for improved vaccine design against other infectious agents, including pathogens that may lead to future pandemics.
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Affiliation(s)
- André E. Nel
- Division of NanoMedicine, Department of Medicine, David Geffen School of Medicine University of California, Los Angeles, Los Angeles, California, 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Jeff F. Miller
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, California, 90095, United States
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267
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Corbeddu M, Diociaiuti A, Vinci MR, Santoro A, Camisa V, Zaffina S, El Hachem M. Transient cutaneous manifestations after administration of Pfizer-BioNTech COVID-19 Vaccine: an Italian single-centre case series. J Eur Acad Dermatol Venereol 2021; 35:e483-e485. [PMID: 33834563 PMCID: PMC8251208 DOI: 10.1111/jdv.17268] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- M Corbeddu
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M R Vinci
- Health Directorate and Occupational Medicine, Health Technology Assessment and Safety Research Unit, Clinical-Technological Innovations Research Area, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - A Santoro
- Health Directorate and Occupational Medicine, Health Technology Assessment and Safety Research Unit, Clinical-Technological Innovations Research Area, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - V Camisa
- Health Directorate and Occupational Medicine, Health Technology Assessment and Safety Research Unit, Clinical-Technological Innovations Research Area, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - S Zaffina
- Health Directorate and Occupational Medicine, Health Technology Assessment and Safety Research Unit, Clinical-Technological Innovations Research Area, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - M El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Restivo V, Candore G, Barrale M, Caravello E, Graziano G, Onida R, Raineri M, Tiralongo S, Brusca I. Allergy to Polyethilenglicole of Anti-SARS CoV2 Vaccine Recipient: A Case Report of Young Adult Recipient and the Management of Future Exposure to SARS-CoV2. Vaccines (Basel) 2021; 9:vaccines9050412. [PMID: 33919151 PMCID: PMC8143141 DOI: 10.3390/vaccines9050412] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Abstract
The main contraindication to the anti-SARS CoV2 vaccine is an anaphylactic reaction to a vaccine component. The need to vaccinate allergic people who are at higher risk can be of public health interest and this report shows a case of an allergic reaction to PEG of a HCW who had received the first dose of anti-SARS CoV2 vaccine. For 5 h after the administration of the vaccine, she had the appearance of erythematous spots on the face and neck, and a feeling of a slurred mouth and hoarseness. In order to treat the event, she was administered 8 mg intravenous dexamethasone, 1 vial intravenous chlorphenamine maleate, 250 mL intravenous 0.9% NaCl, and conventional oxygen therapy (2 L/min) with complete resolution of the suspected adverse drug reaction. According to the contraindication to the cutaneous test for this patient, BAT was used for further investigations. The patient who suffered the adverse reaction to the COVID-19 vaccine and other five allergic patients who did not report any adverse reaction after the vaccination were tested. There was a significant activation of the vaccine-reactive patient’s basophils with 14.79 CD203chigh% at the concentration of 0.2 mg/mL, while other patients were negative. People who have a confirmed reaction to a vaccine component should undergo further investigation to discover other possible cross-reactions and select the right vaccine to immunize them.
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Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (E.C.); (G.G.); (S.T.)
- Correspondence:
| | - Giuseppina Candore
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy;
| | - Maria Barrale
- Laboratory of Clinical Pathology, “Buccheri La Ferla” Hospital, 90127 Palermo, Italy; (M.B.); (R.O.); (I.B.)
| | - Ester Caravello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (E.C.); (G.G.); (S.T.)
| | - Giorgio Graziano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (E.C.); (G.G.); (S.T.)
| | - Rosa Onida
- Laboratory of Clinical Pathology, “Buccheri La Ferla” Hospital, 90127 Palermo, Italy; (M.B.); (R.O.); (I.B.)
| | - Maurizio Raineri
- Department of Biopathology and Medical Biotechnologies, University of Palermo, 90127 Palermo, Italy;
| | - Salvatore Tiralongo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (E.C.); (G.G.); (S.T.)
| | - Ignazio Brusca
- Laboratory of Clinical Pathology, “Buccheri La Ferla” Hospital, 90127 Palermo, Italy; (M.B.); (R.O.); (I.B.)
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269
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Klimek L, Bergmann KC, Brehler R, Pfützner W, Zuberbier T, Hartmann K, Jakob T, Novak N, Ring J, Merk H, Hamelmann E, Ankermann T, Schmidt S, Untersmayr E, Hötzenecker W, Jensen-Jarolim E, Brockow K, Mahler V, Worm M. Practical handling of allergic reactions to COVID-19 vaccines: A position paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and ÖGAI. ALLERGO JOURNAL INTERNATIONAL 2021; 30:79-95. [PMID: 33898162 PMCID: PMC8054127 DOI: 10.1007/s40629-021-00165-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND For the preventive treatment of the 2019 coronavirus disease (COVID-19) an unprecedented global research effort studied the safety and efficacy of new vaccine platforms that have not been previously used in humans. Less than one year after the discovery of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral sequence, these vaccines were approved for use in the European Union (EU) as well as in numerous other countries and mass vaccination efforts began. The so far in the EU approved mRNA vaccines BNT162b2 and mRNA-1273 are based on similar lipid-based nanoparticle carrier technologies; however, the lipid components differ. Severe allergic reactions and anaphylaxis after COVID-19 vaccination are very rare adverse events but have drawn attention due to potentially lethal outcomes and have triggered a high degree of uncertainty. METHODS Current knowledge on anaphylactic reactions to vaccines and specifically the new mRNA COVID-19 vaccines was compiled using a literature search in Medline, PubMed, as well as the national and international study and guideline registries, the Cochrane Library, and the Internet, with special reference to official websites of the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), Robert Koch Institute (RKI), and Paul Ehrlich Institute (PEI). RESULTS Based on the international literature and previous experience, recommendations for prophylaxis, diagnosis and therapy of these allergic reactions are given by a panel of experts. CONCLUSION Allergy testing is not necessary for the vast majority of allergic patients prior to COVID-19 vaccination with currently licensed vaccines. In case of allergic/anaphylactic reactions after vaccination, allergy workup is recommended, as it is for a small potential risk population prior to the first vaccination. Evaluation and approval of diagnostic tests should be done for this purpose.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Karl-Christian Bergmann
- Clinic for Dermatology, Venereology and Allergy, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Charité—Medical University Berlin, Berlin, Germany
| | - Randolf Brehler
- Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, General Dermatology and Venereology, Department of Skin Diseases, Münster University Hospital, Münster, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Marburg, UKGM, Philipps University Marburg, Marburg, Germany
| | - Torsten Zuberbier
- Clinic for Dermatology, Venereology and Allergy, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Charité—Medical University Berlin, Berlin, Germany
| | - Karin Hartmann
- Department of Dermatology and Allergology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thilo Jakob
- Department of Dermatology and Allergology, Giessen University Hospital, UKGM, Justus Liebig University Giessen, Giessen, Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Johannes Ring
- Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich, Germany
| | - Hans Merk
- Department of Dermatology and Allergology, RWTH Aachen University Hospital, Aachen, Germany
| | - Eckard Hamelmann
- Pediatric and Adolescent Medicine, Bethel Children’s Center, OWL University Hospital, Bielefeld University, Bielefeld, Germany
| | - Tobias Ankermann
- Clinic for Pediatric and Adolescent Medicine, Municipal Hospital Kiel GmbH, Kiel, Germany
| | - Sebastian Schmidt
- Center for Pediatric and Adolescent Medicine, Clinic and Polyclinic for Pediatric and Adolescent Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Eva Untersmayr
- Institute for Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Wolfram Hötzenecker
- Clinic for Dermatology and Venereology, Allergy Center, Kepler University Hospital GmbH, Linz, Austria
| | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Inter-university Messerli Research Institute Vienna, Vienna, Austria
| | - Knut Brockow
- Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich, Germany
| | | | - Margitta Worm
- Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité—University Medicine Berlin, Berlin, Germany
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270
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Joob B, Wiwanitkit V. [COVID-19 vaccine and anaphylaxis]. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2021; 205:631. [PMID: 33875896 PMCID: PMC8047300 DOI: 10.1016/j.banm.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Affiliation(s)
- B Joob
- Sanitation1 medical academic center, Bangkok, Thaïlande
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271
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Banerji A, Wolfson AR, Wickner PG, Cogan AS, McMahon AE, Saff R, Robinson LB, Phillips E, Blumenthal KG. COVID-19 Vaccination in Patients with Reported Allergic Reactions: Updated Evidence and Suggested Approach. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2135-2138. [PMID: 33866033 PMCID: PMC8049186 DOI: 10.1016/j.jaip.2021.03.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Anna R Wolfson
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Paige G Wickner
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Amelia S Cogan
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Aubree E McMahon
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Rebecca Saff
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lacey B Robinson
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - 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
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272
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Side effects of BNT162b2 mRNA COVID-19 vaccine: A randomized, cross-sectional study with detailed self-reported symptoms from healthcare workers. Int J Infect Dis 2021; 106:376-381. [PMID: 33866000 PMCID: PMC8049195 DOI: 10.1016/j.ijid.2021.04.047] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Concerns are prevailing about the safety and side effects of the BNT162b2 mRNA vaccine for coronavirus disease 2019 (COVID-19). Methods A randomized, cross-sectional study was performed to investigate the side effects of the BNT162b2 vaccine using an independent online questionnaire gathering responses from healthcare workers (HCWs) with detailed review of organ systems. Results Of all HCWs, 87.98% (1245/1415) completed the survey. Of them, 64.5% (803/1245) received the BNT162b2 mRNA vaccine and reported at least one or more symptoms (classified based on organ systems and occurrence rate) post vaccination. Of these, 640/803 (79.7%) were able to continue activities of daily living (ADL), 103/803 (12.83%) had trouble temporarily to perform ADL, 99/803 (12.33%) took time off work temporarily, 20/803 (2.49%) required help from an outpatient provider, 5/803 (0.62%) required help from an emergency department and 2/803 (0.25%) required hospitalization. Despite this, 97.61% intended to have the second dose and 92.9% had already received it. Conclusions Commonly reported symptoms (occurrence in descending order) were soreness, fatigue, myalgia, headache, chills, fever, joint pain, nausea, muscle spasm, sweating, dizziness, flushing, feelings of relief, brain fogging, anorexia, localized swelling, decreased sleep quality, itching, tingling, diarrhoea, nasal stuffiness and palpitations. Despite this, remarkable acceptance for the second dose of the BNT162b2 vaccine was found among HCWs.
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273
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Park JW, Lagniton PN, Liu Y, Xu RH. mRNA vaccines for COVID-19: what, why and how. Int J Biol Sci 2021; 17:1446-1460. [PMID: 33907508 PMCID: PMC8071766 DOI: 10.7150/ijbs.59233] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/15/2021] [Indexed: 01/09/2023] Open
Abstract
The Coronavirus disease-19 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2), has impacted human lives in the most profound ways with millions of infections and deaths. Scientists and pharmaceutical companies have been in race to produce vaccines against SARS-CoV-2. Vaccine generation usually demands years of developing and testing for efficacy and safety. However, it only took less than one year to generate two mRNA vaccines from their development to deployment. The rapid production time, cost-effectiveness, versatility in vaccine design, and clinically proven ability to induce cellular and humoral immune response have crowned mRNA vaccines with spotlights as most promising vaccine candidates in the fight against the pandemic. In this review, we discuss the general principles of mRNA vaccine design and working mechanisms of the vaccines, and provide an up-to-date summary of pre-clinical and clinical trials on seven anti-COVID-19 mRNA candidate vaccines, with the focus on the two mRNA vaccines already licensed for vaccination. In addition, we highlight the key strategies in designing mRNA vaccines to maximize the expression of immunogens and avoid intrinsic innate immune response. We also provide some perspective for future vaccine development against COVID-19 and other pathogens.
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Affiliation(s)
| | | | | | - Ren-He Xu
- Institute of Translational Medicine, and Centre of Reproduction, Development and Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
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274
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Ackerman M, Henry D, Finon A, Binois R, Esteve E. Persistent maculopapular rash after the first dose of Pfizer-BioNTech COVID-19 vaccine. J Eur Acad Dermatol Venereol 2021; 35:e423-e425. [PMID: 33783017 PMCID: PMC8250698 DOI: 10.1111/jdv.17248] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
- M Ackerman
- Centre Hospitalier Regional d' Orleans, Orleans, France
| | - D Henry
- Centre Hospitalier Regional d' Orleans, Orleans, France
| | - A Finon
- Centre Hospitalier Regional d' Orleans, Orleans, France
| | - R Binois
- Centre Hospitalier Regional d' Orleans, Orleans, France
| | - E Esteve
- Centre Hospitalier Regional d' Orleans, Orleans, France
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275
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Ramphul K, Ramphul Y, Park Y, Lohana P, Dhillon BK, Sombans S. A comprehensive review and update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Coronavirus disease 2019 (COVID-19): what do we know now in 2021? Arch Med Sci Atheroscler Dis 2021; 6:e5-e13. [PMID: 34027207 PMCID: PMC8117074 DOI: 10.5114/amsad.2021.105065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023] Open
Abstract
It has been more than a year since the new virus called severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China. The disease it causes was named Coronavirus disease 2019 (COVID-19), and on 11 March 2020 it was declared a pandemic. As the virus continues to spread, the number of patients worldwide has already crossed the 100 million mark with more than 2 million deaths. We sought to provide an update on the progress made in identifying the virus, its pathophysiology, risk factors such as hypertension, diabetes, and smoking, as well as various methods of treatment. Our review also provided an overview of the different vaccines.
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Affiliation(s)
- Kamleshun Ramphul
- Department of Pediatrics, Shanghai Xin Hua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yogeshwaree Ramphul
- Department of Medicine, Sir Seewoosagur Ramgoolam National Hospital, Pamplemousses, Mauritius
| | - Yun Park
- Department of Orthodontics, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Petras Lohana
- Department of Medicine, Liaquat University of Medical and Health Sciences Hospital Jamshoro, Pakistan
| | | | - Shaheen Sombans
- Department of Medicine, Bharati Vidyapeeth University Medical College and Hospital, Pune, India
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276
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Anaphylactic reactions to mRNA COVID-19 vaccines: A call for further study. Vaccine 2021; 39:2605-2607. [PMID: 33846043 PMCID: PMC8023205 DOI: 10.1016/j.vaccine.2021.03.073] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/20/2021] [Indexed: 11/02/2022]
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277
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Ring J, Worm M, Wollenberg A, Thyssen JP, Jakob T, Klimek L, Bangert C, Barbarot S, Bieber T, de Bruin-Weller MS, Chernyshov PV, Christen-Zaech S, Cork M, Darsow U, Flohr C, Fölster-Holst R, Gelmetti C, Gieler U, Gutermuth J, Heratizadeh A, Hijnen DJ, von Kobyletzki LB, Kunz B, Paul C, De Raeve L, Seneschal J, Simon D, Spuls PI, Stalder JF, Svensson A, Szalai Z, Taieb A, Torrelo A, Trzeciak M, Vestergaard C, Werfel T, Weidinger S, Deleuran M. Risk of severe allergic reactions to COVID-19 vaccines among patients with allergic skin diseases - practical recommendations. A position statement of ETFAD with external experts. J Eur Acad Dermatol Venereol 2021; 35:e362-e365. [PMID: 33752263 PMCID: PMC8250791 DOI: 10.1111/jdv.17237] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/23/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Affiliation(s)
- J Ring
- Department Dermatology Allergy Biederstein, Technical University Munich, Munich, Germany
| | - M Worm
- Divison Allergy and Immunology, Department of Dermatology and Allergology, Charité University Hospital, Berlin, Germany
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University Munich, Munich, Germany
| | - J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | - T Jakob
- Department of Dermatology, University Hospital Giessen-Marburg, Marburg, Germany
| | - L Klimek
- Allergy Center Wiesbaden, Wiesbaden, Germany
| | - C Bangert
- Department of Dermatology University, Vienna, Austria
| | - S Barbarot
- Department of Dermatology, Nantes Université, CHU Nantes UMR 1280 PhAN, INRAE, Nantes, France
| | - T Bieber
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - M S de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - M Cork
- Sheffield Dermatology Research. Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - U Darsow
- Department Dermatology Allergy Biederstein, Technical University Munich, Munich, Germany
| | - C Flohr
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - R Fölster-Holst
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Venereology and Allergology, Kiel, Germany
| | - C Gelmetti
- Unit of Pediatric Dermatology, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - U Gieler
- Department of Dermatology, University Hospital Giessen-Marburg, Marburg, Germany
| | - J Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Free University of Brussels (VUB), Brussels, Belgium
| | - A Heratizadeh
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - D J Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - L B von Kobyletzki
- Faculty of Medicine, University Healthcare Research Center, Lund University, Lund, Sweden.,Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - B Kunz
- Dermatologikum Hamburg, Hamburg, Germany
| | - C Paul
- Department of Dermatology, Toulouse University, Toulouse, France
| | - L De Raeve
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Free University of Brussels (VUB), Brussels, Belgium
| | - J Seneschal
- Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - P I Spuls
- Department of Dermatology. Amsterdam Public Health/Infection and Immunology, Location AMC, Amsterdam, The Netherlands
| | - J F Stalder
- Department of Dermatology, Nantes Université, CHU Nantes UMR 1280 PhAN, INRAE, Nantes, France
| | - A Svensson
- Department of Dermatology, Skane University Hospital, Malmö, Sweden
| | - Z Szalai
- Department of Dermatology of Heim, Pál National Children's Institute Budapest, Budapest, Hungary
| | - A Taieb
- Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - A Torrelo
- Department of Dermatology, Hospital Infantil Niño Jesús, Madrid, Spain
| | - M Trzeciak
- Department of Dermatology, Venereology and Allergology Medical, University of Gdansk, Gdansk, Poland
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Venereology and Allergology, Kiel, Germany
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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278
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Prolonged Anaphylaxis to Pfizer Coronavirus Disease 2019 Vaccine: A Case Report and Mechanism of Action. Crit Care Explor 2021; 3:e0397. [PMID: 33834172 PMCID: PMC8021358 DOI: 10.1097/cce.0000000000000397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: In response to the devastating effects of the coronavirus disease 2019 pandemic, several vaccine prototypes have been developed, with the Pfizer/BioNTech (BNT162b2) platform being the first to receive emergency use authorization. Although taken to market on an unprecedented timeline, the safety profile of the drug during clinical trials was shown to be favorable. Shortly after release, reports from the Centers for Disease Control and Prevention demonstrated a higher-than-average rate of anaphylaxis to the vaccine that has been the cause for concern for safety officials and the general public alike. Here, we present a unique case of protracted anaphylaxis in a recipient of the BNT162b2. Case Summary: The patient is a 55-year-old female with a history of multiple allergic reactions who presented with respiratory distress and hives after receiving the first dose of the BNT162b2, despite premedication with IV steroids and diphenhydramine. The refractory nature of her reaction was demonstrated by edema of her tongue (visualized on nasolaryngoscopy), requiring an epinephrine infusion for nearly 3 days. She was discharged from the hospital with instructions not to receive the second dose of the vaccine. Conclusion: Although the exact etiology of anaphylaxis secondary to this messenger RNA-based vaccine is not completely clear, our literature search and review of the patient’s course support either polyethylene glycol versus other excipient-related allergy as a possible cause. Based on the protracted nature to our patient’s anaphylaxis, critical care management for patients with a true anaphylactic reaction to BNT162b2 may require monitoring for an extended period of time.
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279
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Palmer-Ross A, Ovseiko PV, Heidari S. Inadequate reporting of COVID-19 clinical studies: a renewed rationale for the Sex and Gender Equity in Research (SAGER) guidelines. BMJ Glob Health 2021; 6:e004997. [PMID: 33846144 PMCID: PMC8047552 DOI: 10.1136/bmjgh-2021-004997] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 01/12/2023] Open
Affiliation(s)
| | - Pavel V Ovseiko
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland
- Global Health Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
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280
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Hasan T, Beardsley J, Marais BJ, Nguyen TA, Fox GJ. The Implementation of Mass-Vaccination against SARS-CoV-2: A Systematic Review of Existing Strategies and Guidelines. Vaccines (Basel) 2021; 9:326. [PMID: 33915829 PMCID: PMC8066252 DOI: 10.3390/vaccines9040326] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 02/01/2023] Open
Abstract
The global drive to vaccinate against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) began in December 2020 with countries in Europe, Middle East, and North America leading the roll out of a mass-vaccination program. This systematic review synthesised all available English-language guidelines and research regarding mass-vaccination for COVID-19 until 1 March 2021-the first three months of the global mass-vaccination effort. Data were extracted from national websites, PubMed, Embase, Medline and medRxiv, including peer and non-peer review research findings. A total of 15 national policy documents were included. Policies were summarised according to the World Health Organisation (WHO) framework for mass vaccination. All included policies prioritised front-line health care workers and the elderly. Limited information was available regarding staffing, cold chain, communication strategies and infrastructure requirements for effective vaccine delivery. A total of 26 research studies were identified, reporting roll-out strategies, vaccine uptake and reasons for refusal, adverse effects, and real-life estimates of efficacy. Early data showed a reduction in SARS-CoV-2 cases, hospitalisation and deaths in settings with good coverage. Very low rates of vaccine-related serious adverse events were observed. These findings provide an overview of current practice and early outcomes of COVID-19 mass-vaccination, guiding countries where roll-out is yet to commence.
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Affiliation(s)
- Tasnim Hasan
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (T.H.); (J.B.)
- The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia;
| | - Justin Beardsley
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (T.H.); (J.B.)
| | - Ben J. Marais
- Marie Bahir Institute, The University of Sydney, Westmead, NSW 2145, Australia;
| | - Thu Anh Nguyen
- The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia;
| | - Greg J. Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (T.H.); (J.B.)
- The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia;
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281
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Kelso JM. Misdiagnosis of systemic allergic reactions to mRNA COVID-19 vaccines. Ann Allergy Asthma Immunol 2021; 127:133-134. [PMID: 33781933 PMCID: PMC7997851 DOI: 10.1016/j.anai.2021.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Affiliation(s)
- John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California.
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282
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Meylan S, Livio F, Foerster M, Genoud PJ, Marguet F, Wuerzner G. Stage III Hypertension in Patients After mRNA-Based SARS-CoV-2 Vaccination. Hypertension 2021; 77:e56-e57. [PMID: 33764160 PMCID: PMC8115421 DOI: 10.1161/hypertensionaha.121.17316] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sylvain Meylan
- Department of Medicine, Infectious Diseases Service, University Hospital Lausanne and University of Lausanne, Switzerland (S.M.)
| | - Françoise Livio
- Service of Clinical Pharmacology, Department of Laboratories (F.L.), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Maryline Foerster
- Emergency Department (M.F.), University Hospital of Lausanne, Switzerland
| | - Patrick James Genoud
- Nursing Directorate (P.J.G., F.M.), University Hospital of Lausanne, Switzerland
| | - François Marguet
- Nursing Directorate (P.J.G., F.M.), University Hospital of Lausanne, Switzerland
| | - Gregoire Wuerzner
- Department of Medicine, Service of Nephrology and Hypertension (G.W.), Lausanne University Hospital and University of Lausanne, Switzerland
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283
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Loo KY, Letchumanan V, Ser HL, Teoh SL, Law JWF, Tan LTH, Ab Mutalib NS, Chan KG, Lee LH. COVID-19: Insights into Potential Vaccines. Microorganisms 2021; 9:605. [PMID: 33804162 PMCID: PMC8001762 DOI: 10.3390/microorganisms9030605] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
People around the world ushered in the new year 2021 with a fear of COVID-19, as family members have lost their loved ones to the disease. Millions of people have been infected, and the livelihood of many has been jeopardized due to the pandemic. Pharmaceutical companies are racing against time to develop an effective vaccine to protect against COVID-19. Researchers have developed various types of candidate vaccines with the release of the genetic sequence of the SARS-CoV-2 virus in January. These include inactivated viral vaccines, protein subunit vaccines, mRNA vaccines, and recombinant viral vector vaccines. To date, several vaccines have been authorized for emergency use and they have been administered in countries across the globe. Meanwhile, there are also vaccine candidates in Phase III clinical trials awaiting results and approval from authorities. These candidates have shown positive results in the previous stages of the trials, whereby they could induce an immune response with minimal side effects in the participants. This review aims to discuss the different vaccine platforms and the clinical trials of the candidate vaccines.
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Affiliation(s)
- Ke-Yan Loo
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
| | - Vengadesh Letchumanan
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
| | - Hooi-Leng Ser
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia;
| | - Jodi Woan-Fei Law
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
| | - Loh Teng-Hern Tan
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru 80100, Malaysia
| | - Nurul-Syakima Ab Mutalib
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
- UKM Medical Molecular Biology Institute (UMBI), UKM Medical Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
- International Genome Centre, Jiangsu University, Zhenjiang 212013, China
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
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Vander Leek TK, Chan ES, Connors L, Derfalvi B, Ellis AK, Upton JEM, Abrams EM. COVID-19 vaccine testing & administration guidance for allergists/immunologists from the Canadian Society of Allergy and Clinical Immunology (CSACI). ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2021; 17:29. [PMID: 33722299 PMCID: PMC7957441 DOI: 10.1186/s13223-021-00529-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/19/2021] [Indexed: 03/03/2023]
Abstract
BACKGROUND Safe and effective vaccines provide the first hope for mitigating the devastating health and economic impacts resulting from coronavirus disease 2019 (COVID-19) and related public health orders. Recent case reports of reactions to COVID-19 vaccines have raised questions about their safety for use in individuals with allergies and those who are immunocompromised. In this document, we aim to address these concerns and provide guidance for allergists/immunologists. METHODS Scoping review of the literature regarding COVID-19 vaccination, adverse or allergic reactions, and immunocompromise from PubMed over the term of December 2020 to present date. We filtered our search with the terms "human" and "English" and limited the search to the relevant subject age range with the term "adult." Reports resulting from these searches and relevant references cited in those reports were reviewed and cited on the basis of their relevance. RESULTS Assessment by an allergist is warranted in any individual with a suspected allergy to a COVID-19 vaccine or any of its components. Assessment by an allergist is NOT required for individuals with a history of unrelated allergies, including to allergies to foods, drugs, insect venom or environmental allergens. COVID-19 vaccines should be offered to immunocompromised patients if the benefit is deemed to outweigh any potential risks of vaccination. INTERPRETATION This review provides the first Canadian guidance regarding assessment of an adolescent and adult with a suspected allergy to one of the COVID-19 vaccines currently available, or any of their known allergenic components, and for patients who are immunocompromised who require vaccination for COVID-19. As information is updated this guidance will be updated accordingly.
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Affiliation(s)
- Timothy K Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, 207-10430 61 Ave NW, Edmonton, AB, T6H 2J3, Canada.
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Beata Derfalvi
- Division of Immunology, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Julia E M Upton
- Division of Immunology and Allergy, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MN, Canada
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
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285
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Buttery JP. Developing standard safety outcomes for COVID-19 vaccines. Vaccine 2021; 39:3025-3027. [PMID: 33888324 PMCID: PMC7953438 DOI: 10.1016/j.vaccine.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Jim P Buttery
- Centre for Health Informatics, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Murdoch Childrens Research Institute, Flemington Rd, Parkville 3052, Victoria, Australia.
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286
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Shaker M, Abrams EM, Greenhawt M. A Cost-Effectiveness Evaluation of Hospitalizations, Fatalities, and Economic Outcomes Associated with Universal Versus Anaphylaxis Risk-Stratified COVID-19 Vaccination Strategies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2658-2668.e3. [PMID: 33711496 PMCID: PMC7942189 DOI: 10.1016/j.jaip.2021.02.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Vaccine-associated anaphylaxis is a rare event (1.34 events/million doses; 0.00017% occurrence over 26 years). Several reports of allergic reactions concerning for anaphylaxis have been reported early into the Pfizer-BioNTech and Moderna coronavirus disease 2019 (COVID-19) vaccine campaign in the United States, Canada, and the United Kingdom. OBJECTIVE To perform a cost-effectiveness analysis characterizing the risks of COVID-19 versus vaccine anaphylaxis, comparing universal COVID-19 vaccination versus risk-stratified vaccination approaches. METHODS Cohort analysis models were created to evaluate the cost-effectiveness of universal vaccination versus risk-stratified vaccination (eg, contraindicated in persons with a history of any previous episode of anaphylaxis) with a threshold for cost-effective care at $10,000,000 per death prevented. In the base case, risk of anaphylaxis was estimated at 0.1%, with case-fatality estimated at 0.3%. RESULTS On a population level (n = 300,000,000 simulated persons), universal vaccination was associated with a cost-savings of $503,596,316 and saved 7,607 lives, but the cost-savings was sensitive to increasing rates of vaccine-associated anaphylaxis. The universal strategy dominated at higher rates of COVID-19 infection and low rates of vaccine-associated anaphylaxis in both the health care and societal perspectives. When the risk of vaccine-associated anaphylaxis exceeded 0.8%, the risk-stratified approach to vaccination was the most cost-effective strategy. There was also an interaction between anaphylaxis risk and anaphylaxis fatality, with a risk-stratified approach becoming cost-effective as each risk increased concurrently. Stratified observation time by anaphylaxis history (15 minutes vs 30 minutes) was not cost-effective until a 1% anaphylaxis case-fatality was assumed and risk of vaccine anaphylaxis exceeded 6%. CONCLUSIONS This study demonstrates that unless vaccine anaphylaxis rates exceed 0.8%, a universal vaccination approach dominates a risk-stratified approach where persons with any history of anaphylaxis would be contraindicated from vaccination, with lower cost and superior health outcomes.
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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
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Greenhawt
- Section of Allergy/Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
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287
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Doulberis M, Papaefthymiou A, Kotronis G, Gialamprinou D, Soteriades ES, Kyriakopoulos A, Chatzimichael E, Kafafyllidou K, Liatsos C, Chatzistefanou I, Anagnostis P, Semenin V, Ntona S, Gkolia I, Papazoglou DD, Tsinonis N, Papamichos S, Kirbas H, Zikos P, Niafas D, Kountouras J. Does COVID-19 Vaccination Warrant the Classical Principle " ofelein i mi vlaptin"? MEDICINA (KAUNAS, LITHUANIA) 2021; 57:253. [PMID: 33803295 PMCID: PMC7999356 DOI: 10.3390/medicina57030253] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 12/20/2022]
Abstract
The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic warrants an imperative necessity for effective and safe vaccination, to restrain Coronavirus disease 2019 (COVID-19) including transmissibility, morbidity, and mortality. In this regard, intensive medical and biological research leading to the development of an arsenal of vaccines, albeit incomplete preconditioned evaluation, due to emergency. The subsequent scientific gap raises some concerns in the medical community and the general public. More specifically, the accelerated vaccine development downgraded the value of necessary pre-clinical studies to elicit medium- and long-term beneficial or harmful consequences. Previous experience and pathophysiological background of coronaviruses' infections and vaccine technologies, combined with the global vaccines' application, underlined the obligation of a cautious and qualitative approach, to illuminate potential vaccination-related adverse events. Moreover, the high SARS-CoV-2 mutation potential and the already aggregated genetical alterations provoke a rational vagueness and uncertainty concerning vaccines' efficacy against dominant strains and the respective clinical immunity. This review critically summarizes existing evidence and queries regarding SARS-CoV-2 vaccines, to motivate scientists' and clinicians' interest for an optimal, individualized, and holistic management of this unprecedented pandemic.
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Affiliation(s)
- Michael Doulberis
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54652 Thessaloniki, Greece; (M.D.); (A.P.); (S.P.)
| | - Apostolis Papaefthymiou
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54652 Thessaloniki, Greece; (M.D.); (A.P.); (S.P.)
- Department of Gastroenterology, University Hospital of Larisa, Mezourlo, 41110 Larisa, Greece
| | - Georgios Kotronis
- Department of Internal Medicine, General Hospital Aghios Pavlos of Thessaloniki, 55134 Thessaloniki, Greece;
| | - Dimitra Gialamprinou
- Second Neonatal Department and NICU, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece;
| | - Elpidoforos S. Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia 2252, Cyprus;
- Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Anthony Kyriakopoulos
- Nasco AD Biotechnology Laboratory, Department of Research and Development, 18536 Piraeus, Greece;
| | - Eleftherios Chatzimichael
- Center for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - Kyriaki Kafafyllidou
- Department of Pediatrics, University Children’s Hospital of Zurich, 8032 Zurich, Switzerland;
| | - Christos Liatsos
- Department of Gastroenterology, 401 Army General Hospital of Athens, 11525 Athens, Greece;
| | - Ioannis Chatzistefanou
- Department of Maxillofacial Surgery, 424 General Military Hospital, Ring Road Efkarpia, 56429 Thessaloniki, Greece;
| | - Paul Anagnostis
- ORL and Psychiatry Private Practice, 8032 Zurich, Switzerland;
| | - Vitalii Semenin
- Neurology and Psychiatry Private Practice, 2502 Biel, Switzerland;
| | - Smaragda Ntona
- Alexandrovska University Hospital, Medical University Sofia, 1431 Sofia, Bulgaria;
| | - Ioanna Gkolia
- Psychiatric Hospital of Thessaloniki, Stavroupolis, 56429 Thessaloniki, Greece;
| | - Dimitrios David Papazoglou
- Department of General, Visceral and Thoracic Surgery, Bürgerspital Solothurn, 4500 Solothurn, Switzerland;
| | | | - Spyros Papamichos
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54652 Thessaloniki, Greece; (M.D.); (A.P.); (S.P.)
| | - Hristos Kirbas
- Department of Nuclear Medicine, “Thegeneio” Cancer Hospital, 54007 Thessaloniki, Greece;
| | - Petros Zikos
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | | | - Jannis Kountouras
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54652 Thessaloniki, Greece; (M.D.); (A.P.); (S.P.)
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288
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Huh K, Kim YE, Radnaabaatar M, Lee DH, Kim DW, Shin SA, Jung J. Estimating Baseline Incidence of Conditions Potentially Associated with Vaccine Adverse Events: a Call for Surveillance System Using the Korean National Health Insurance Claims Data. J Korean Med Sci 2021; 36:e67. [PMID: 33686812 PMCID: PMC7940120 DOI: 10.3346/jkms.2021.36.e67] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Vaccines against coronavirus disease 2019 (COVID-19) are raising concerns about vaccine safety, particularly in the context of large-scale immunization. To address public concerns, we measured the baseline incidence rates of major conditions potentially related to vaccine-related adverse events (VAEs). We aimed to provide a basis for evaluating VAEs and verifying causality. METHODS Conditions of interest were selected from the US Vaccine Adverse Event Reporting System Table of Reportable Events and a recent report from a European consortium on vaccine surveillance. We used the National Health Insurance Service database in Korea to identify the monthly numbers of cases with these conditions. Data from January 2006 to June 2020 were included. Prediction models were constructed from the observed incidences using an autoregressive integrated moving average. We predicted the incidences of the conditions and their respective 95% confidence intervals (CIs) for January through December 2021. In addition, subgroup analysis for the expected vaccination population was conducted. RESULTS Mean values (95% CIs) of the predicted monthly incidence of vasovagal syncope, anaphylaxis, brachial neuritis, acute disseminated encephalomyelitis, Bell's palsy, Guillain-Barré syndrome, encephalopathy, optic neuritis, transverse myelitis, immune thrombocytopenic purpura, and systemic lupus erythematosus in 2021 were 23.89 (19.81-27.98), 4.72 (3.83-5.61), 57.62 (51.37-63.88), 0.03 (0.01-0.04), 8.58 (7.90-9.26), 0.26 (0.18-0.34), 2.13 (1.42-2.83), 1.65 (1.17-2.13), 0.19 (0.14-0.25), 0.75 (0.61-0.90), and 3.40 (2.79-4.01) cases per 100,000 respectively. The majority of the conditions showed an increasing trend with seasonal variations in their incidences. CONCLUSION We measured the incidence of a total of 11 conditions that could potentially be associated with VAEs to predict the monthly incidence in 2021. In Korea, conditions that could potentially be related to VAEs occur on a regular basis, and an increasing trend is observed with seasonality.
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Affiliation(s)
- Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Munkhzul Radnaabaatar
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dae Ho Lee
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dong Wook Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Soon Ae Shin
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea.
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea.
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289
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Black SB, Law B, Chen RT, Dekker CL, Sturkenboom M, Huang WT, Gurwith M, Poland G. The critical role of background rates of possible adverse events in the assessment of COVID-19 vaccine safety. Vaccine 2021; 39:2712-2718. [PMID: 33846042 PMCID: PMC7936550 DOI: 10.1016/j.vaccine.2021.03.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
Beginning in December of 2019, a novel coronavirus, SARS-CoV-2, emerged in China and is now a global pandemic with extensive morbidity and mortality. With the emergence of this threat, an unprecedented effort to develop vaccines against this virus began. As vaccines are now being introduced globally, we face the prospect of millions of people being vaccinated with multiple types of vaccines many of which use new vaccine platforms. Since medical events happen without vaccines, it will be important to know at what rate events occur in the background so that when adverse events are identified one has a frame of reference with which to compare the rates of these events so as to make an initial assessment as to whether there is a potential safety concern or not. Background rates vary over time, by geography, by sex, socioeconomic status and by age group. Here we describe two key steps for post-introduction safety evaluation of COVID-19 vaccines: Defining a dynamic list of Adverse Events of Special Interest (AESI) and establishing background rates for these AESI. We use multiple examples to illustrate use of rates and caveats for their use. In addition we discuss tools available from the Brighton Collaboration that facilitate case evaluation and understanding of AESI.
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Affiliation(s)
- Steven B Black
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA.
| | - Barbara Law
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Robert T Chen
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Cornelia L Dekker
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | | | - Wan-Ting Huang
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Marc Gurwith
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
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290
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Funk CD, Laferrière C, Ardakani A. Target Product Profile Analysis of COVID-19 Vaccines in Phase III Clinical Trials and Beyond: An Early 2021 Perspective. Viruses 2021; 13:418. [PMID: 33807839 PMCID: PMC7998902 DOI: 10.3390/v13030418] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
The coronavirus SARS-CoV-2, which causes Coronavirus disease 2019 (COVID-19), has infected more than 100 million people globally and caused over 2.5 million deaths in just over one year since its discovery in Wuhan, China in December 2019. The pandemic has evoked widespread collateral damage to societies and economies, and has destabilized mental health and well-being. Early in 2020, unprecedented efforts went into the development of vaccines that generate effective antibodies to the SARS-CoV-2 virus. Teams developing twelve candidate vaccines, based on four platforms (messenger RNA, non-replicating viral vector, protein/virus-like particle, and inactivated virus) had initiated or announced the Phase III clinical trial stage by early November 2020, with several having received emergency use authorization in less than a year. Vaccine rollout has proceeded around the globe. Previously, we and others had proposed a target product profile (TPP) for ideal/optimal and acceptable/minimal COVID-19 vaccines. How well do these candidate vaccines stack up to a harmonized TPP? Here, we perform a comparative analysis in several categories of these candidate vaccines based on the latest available trial data and highlight the early successes as well as the hurdles and barriers yet to be overcome for ending the global COVID-19 pandemic.
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Affiliation(s)
- Colin D. Funk
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
- Scientific Research Division, Novateur Ventures Inc., Vancouver, BC V6E 3P3, Canada; (C.L.); (A.A.)
| | - Craig Laferrière
- Scientific Research Division, Novateur Ventures Inc., Vancouver, BC V6E 3P3, Canada; (C.L.); (A.A.)
| | - Ali Ardakani
- Scientific Research Division, Novateur Ventures Inc., Vancouver, BC V6E 3P3, Canada; (C.L.); (A.A.)
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291
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Affiliation(s)
- S Moein Moghimi
- School of Pharmacy, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
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292
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Abstract
We present the case of a 96-year-old female, with no known cardiac history, who suffered a myocardial infarction (MI) one hour after her first Moderna coronavirus disease 2019 (COVID-19) vaccination. The patient was medically managed and discharged three days later. We are unable to attribute the cause of the patient's MI to the Moderna vaccine unless further data are published. As healthcare providers, we need to be aware of attempts to correlate bad outcomes with the vaccine without substantiated data, and anticipate patient questions that may arise from these reports. Any research on the topic should be written carefully and avoid overstating the findings. If more reports of serious side effects in older adults are published, providers should consider additional screenings prior to COVID-19 vaccination.
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Affiliation(s)
- Zachary Boivin
- Emergency Medicine, University of Connecticut Emergency Medicine Residency, Farmington, USA
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293
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Klimek L, Eckrich J, Hagemann J, Casper I, Huppertz J. [Allergic reactions to COVID-19 vaccines: evidence and practice-oriented approach]. Internist (Berl) 2021; 62:326-332. [PMID: 33580823 PMCID: PMC7881317 DOI: 10.1007/s00108-021-00959-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
Less than a year after the first detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), vaccines have been approved for routine use in numerous countries and have already been used in mass vaccination programs. Vaccines include the mRNA BNT162b2 and mRNA 1273. Allergic reactions and anaphylaxis account for a substantial proportion of the adverse reactions to these vaccines observed to date, but overall they are rare. The incidence of anaphylaxis in the context of SARS-CoV‑2 vaccination with the mRNA vaccines appears to be approximately 10-fold higher than with previous vaccines, at approximately 1 per 100,000 vaccine injections. One focus of the present article is a systematic review of the components of mRNA vaccines against " coronavirus disease 2019 " (COVID-19). Differences from established vaccines are addressed and the allergic potential of liposomes, polyethylene glycol, tromethamine/trometamol, and mRNA are discussed. Another focus is on the clinical presentation and course of allergic reactions to the COVID-19 vaccines. This is followed by a discussion of the therapeutic approach to anaphylactic reactions, as well as the drugs and medical supplies required to treat them. It is important to note that any vaccinee may be affected by anaphylaxis, regardless of whether or not allergic diseases are already known. Therefore, every vaccination site and every vaccinator must be prepared to recognize and treat severe allergic reactions.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183, Wiesbaden, Deutschland.
| | - J Eckrich
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - J Hagemann
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - I Casper
- Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183, Wiesbaden, Deutschland
| | - J Huppertz
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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294
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Abstract
BNT162b2 (Comirnaty®; BioNTech and Pfizer) is a lipid nanoparticle-formulated, nucleoside-modified mRNA vaccine for the prevention of the novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. BNT162b2 encodes the SARS-CoV-2 spike protein, the expression of which elicits immune responses against the antigen in recipients. In early December 2020, BNT162b2 received a temporary emergency use authorization (EUA) in the UK and, subsequently, a series of approvals or authorizations for emergency use in Bahrain, Canada, Mexico, Saudi Arabia and the USA. Soon after, BNT162b2 received conditional marketing authorizations in Switzerland (19 December 2020) and the EU (21 December 2020) for active immunization to prevent COVID-19 caused by SARS-CoV-2 in individuals 16 years of age and older. BNT162b2 is administered intramuscularly in a two-dose regimen. This article summarizes the milestones in the development of BNT162b2 leading to these first approvals for the prevention of COVID-19.
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Affiliation(s)
- Yvette N Lamb
- Springer Nature, Mairangi Bay, Private Bag 65901, Auckland, 0754, New Zealand.
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295
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Shimabukuro T. Allergic reactions including anaphylaxis after receipt of the first dose of Moderna COVID-19 vaccine - United States, December 21, 2020-January 10, 2021. Am J Transplant 2021; 21:1326-1331. [PMID: 33641268 PMCID: PMC8013433 DOI: 10.1111/ajt.16517] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Tom Shimabukuro
- CDC COVID-19 Response Team, Atlanta, Georgia, USA,Food and Drug Administration, Washington, DC, USA,Correspondence Tom Shimabukuro
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296
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Jung J. Preparing for the Coronavirus Disease (COVID-19) Vaccination: Evidence, Plans, and Implications. J Korean Med Sci 2021; 36:e59. [PMID: 33619920 PMCID: PMC7900528 DOI: 10.3346/jkms.2021.36.e59] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/26/2022] Open
Abstract
The formation of herd immunity through vaccination is a key point in overcoming the coronavirus disease 2019 (COVID-19) pandemic. To acquire herd immunity, a high vaccination rate is required, which is necessary to instill confidence in the public regarding the effectiveness and safety of the vaccine. In the real-world setting, thorough preparation of components, such as priority setting, vaccine delivery, logistics, and side-effect monitoring is necessary to overcome vaccine hesitancy. Each country prioritizes vaccination since healthcare workers, nursing facility residents, and the elderly population, and similar trends are found between countries. Vaccination is performed at large centers and medical institutions operated by the country, and variations are dependent on the environment of each country. The transport of mRNA vaccines is a challenging task, and to this end, each government is striving for safe distribution. In addition, each authority operates a surveillance system to monitor the safety of vaccines, and Korea needs to produce evidence for monitoring effects and side effects with expertise. Even after the acquisition of herd immunity, COVID-19 is highly likely to remain an endemic infectious disease, and a higher immunity level may be required because of variants of the virus. If the spread of variants of concern continues, a booster vaccination may be required. Therefore, non-pharmaceutical interventions, such as social distancing, wearing a mask, and epidemiological investigation should be maintained.
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Affiliation(s)
- Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
- Artificial Intelligence and Big-Data Convergence Center, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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297
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Hendaus MA, Jomha FA. mRNA Vaccines for COVID-19: A Simple Explanation. Qatar Med J 2021; 2021:07. [PMID: 33643864 DOI: 10.5339/qmj.2021.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/30/2021] [Indexed: 01/22/2023] Open
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298
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14 vragen over de coronavaccinatie. Nursing 2021; 27:18-25. [PMID: 33584126 PMCID: PMC7867859 DOI: 10.1007/s41193-021-0025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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299
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Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine - United States, December 21, 2020-January 10, 2021. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:125-129. [PMID: 33507892 PMCID: PMC7842812 DOI: 10.15585/mmwr.mm7004e1] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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300
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Worm M, Bauer A, Wedi B, Treudler R, Pfuetzner W, Brockow K, Buhl T, Zuberbier T, Fluhr J, Wurpts G, Klimek L, Jakob T, Merk HF, Mülleneisen N, Roeseler S, Dickel H, Raap U, Kleine-Tebbe J. Practical recommendations for the allergological risk assessment of the COVID-19 vaccination - a harmonized statement of allergy centers in Germany. Allergol Select 2021; 5:72-76. [PMID: 33521511 PMCID: PMC7841415 DOI: 10.5414/alx02225e] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Severe allergic reactions to vaccines are very rare. Single severe reactions have occurred worldwide after vaccination with the new mRNA-based COVID-19 vaccines. PEG2000 is discussed as a possible trigger. We provide guidance on risk assessment regarding COVID-19 vaccination in patients with allergic diseases and suggest a standardized, resource-oriented diagnostic and therapeutic procedure. Reports of severe allergic reactions in the context of COVID-19 vaccination can be made via www.anaphylaxie.net using an online questionnaire.
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Affiliation(s)
- Margitta Worm
- Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Campus Charité Mitte, University Medicine Berlin
| | - Andrea Bauer
- Clinic and Polyclinic for Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden
| | - Bettina Wedi
- Department of Dermatology, Allergology and Venereology Comprehensive Allergy Center (CAC) Treatment Center for Hereditary Angioedema in the ZSE, Hannover Medical School
| | - Regina Treudler
- Clinic of Dermatology, Venereology and Allergology, Leipzig University Medical Center
| | - Wolfgang Pfuetzner
- Hesse Allergy Center, Clinic for Dermatology and Allergology, Marburg University Hospital
| | - Knut Brockow
- Dermatology Clinic Campus Biederstein, Klinikum rechts der Isar, Technical University of Munich
| | - Timo Buhl
- Dermatology Venereology and Allergology Clinic, University Medical Center Göttingen Georg-August-University
| | - Torsten Zuberbier
- Department of Dermatology and Allergy, Comprehensive Allergy Center Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
| | - Joachim Fluhr
- Department of Dermatology and Allergy, Comprehensive Allergy Center Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health
| | - Gerda Wurpts
- Department of Dermatology and Allergology, University Hospital Aachen
| | - Ludger Klimek
- Center for Rhinology and Allergology of the ENT University Clinic Mannheim, Wiesbaden
| | - Thilo Jakob
- Department of Dermatology, Venerology and Allergology, University Hospital Giessen
| | | | | | - Stefani Roeseler
- Allergy, Asthma and Anaphylaxis Center, Clinic of Pneumology, Allergology, Sleep and Respiratory Medicine, Augustinians Hospital, Cologne
| | - Heinrich Dickel
- Department of Allergology, Occupational and Environmental Dermatology, Clinic for Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum
| | - Ulrike Raap
- Department of Experimental Allergology and Immunodermatology, Department of Human Medicine, University of Oldenburg, and
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