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Kuwano A, Nagasawa S, Koga Y, Tanaka K, Yada M, Masumoto A, Motomura K. Diagnostic features of autoimmune hepatitis in SARS‑CoV‑2‑vaccinated vs. unvaccinated individuals. Exp Ther Med 2024; 28:337. [PMID: 39006455 PMCID: PMC11240278 DOI: 10.3892/etm.2024.12626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/06/2024] [Indexed: 07/16/2024] Open
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected millions of lives, leading to significant morbidity and mortality. With >772 million cases and nearly seven million deaths reported worldwide to date, the development of vaccines has been a critical step in mitigating the impact of COVID-19. However, concerns have arisen regarding the potential for SARS-CoV-2 mRNA vaccination to trigger autoimmune diseases, including autoimmune hepatitis (AIH). The present single-center, retrospective study aimed to compare the clinical and pathological features of AIH in patients with or without a history of SARS-CoV-2 mRNA vaccination. A total of 72 patients with AIH were examined. Among them, 10 had received the SARS-CoV-2 mRNA vaccination prior to AIH onset. These patients exhibited more pronounced CD4+ T cell infiltration into the liver tissue compared with those who were unvaccinated. No significant differences in the levels of other liver enzymes, autoimmune antibodies, or CD8+ T cell infiltration were observed between the groups. Moreover, the AIH patients with a history of SARS-CoV-2 mRNA vaccination had more extensive CD4+ T cell infiltration in their liver tissues than the unvaccinated patients. These findings suggested that the immune response to SARS-CoV-2 mRNA vaccination may influence the pathogenesis of AIH, highlighting the need for further research into the relationship between SARS-CoV-2 mRNA vaccination and autoimmune liver diseases. Such studies will also help clarify the distinction between vaccine-induced liver injury and traditional AIH.
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Affiliation(s)
- Akifumi Kuwano
- Department of Hepatology, Aso Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Shigehiro Nagasawa
- Department of Hepatology, Aso Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Yuta Koga
- Department of Hepatology, Aso Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Kosuke Tanaka
- Department of Hepatology, Aso Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Masayoshi Yada
- Department of Hepatology, Aso Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Akihide Masumoto
- Department of Hepatology, Aso Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Kenta Motomura
- Department of Hepatology, Aso Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
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2
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Semple JW, Schifferli A, Cooper N, Saad H, Mytych DT, Chea LS, Newland A. Immune thrombocytopenia: Pathophysiology and impacts of Romiplostim treatment. Blood Rev 2024:101222. [PMID: 38942688 DOI: 10.1016/j.blre.2024.101222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/04/2024] [Accepted: 06/18/2024] [Indexed: 06/30/2024]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune bleeding disease caused by immune-mediated platelet destruction and decreased platelet production. ITP is characterized by an isolated thrombocytopenia (<100 × 109/L) and increased risk of bleeding. The disease has a complex pathophysiology wherein immune tolerance breakdown leads to platelet and megakaryocyte destruction. Therapeutics such as corticosteroids, intravenous immunoglobulins (IVIg), rituximab, and thrombopoietin receptor agonists (TPO-RAs) aim to increase platelet counts to prevent hemorrhage and increase quality of life. TPO-RAs act via stimulation of TPO receptors on megakaryocytes to directly stimulate platelet production. Romiplostim is a TPO-RA that has become a mainstay in the treatment of ITP. Treatment significantly increases megakaryocyte maturation and growth leading to improved platelet production and it has recently been shown to have additional immunomodulatory effects in treated patients. This review will highlight the complex pathophysiology of ITP and discuss the usage of Romiplostim in ITP and its ability to potentially immunomodulate autoimmunity.
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Affiliation(s)
- John W Semple
- Division of Hematology and Transfusion Medicine, Lund University, Lund, Sweden, Clinical Immunology and Transfusion Medicine, Office of Medical Services, Region Skåne, Lund, Sweden; Departments of Pharmacology, Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, USA.
| | - Alexandra Schifferli
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
| | | | | | | | | | - Adrian Newland
- Barts and The London School of Medicine and Dentistry, London, UK.
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3
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Liu X, Gan X, Xu J, Wang Y, Huang J, He X, Li Y, Gong Y, Peng B, Niu T. Protective effects of COVID-19 vaccination in splenectomized patients with immune thrombocytopenia. Br J Haematol 2024; 204:2217-2221. [PMID: 38632670 DOI: 10.1111/bjh.19405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024]
Abstract
Splenectomy is an effective treatment for immune thrombocytopenia (ITP). The effect of COVID-19 vaccination on splenectomized patients with ITP during the COVID-19 pandemic has not been reported. Therefore, this study aimed to investigate the effect of COVID-19 vaccination on clinical outcomes in these patients. This was a longitudinal study of splenectomized patients with ITP. A total of 191 splenectomized patients were included in this study. After a median follow-up of 114 months, 146 (76.4%) patients had a sustained response to splenectomy. During COVID-19 infection, vaccinated patients showed a lower risk of severe infections (odds ratio [OR], 0.13; 95% confidence interval [CI]: 0.05-0.36; p < 0.001), hospitalization (OR, 0.13; 95% CI, 0.04-0.48; p = 0.002), and ITP exacerbation (OR, 0.16; 95% CI, 0.04-0.67; p = 0.012). These findings indicate that COVID-19 vaccination plays a protective role in splenectomized patients with ITP.
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Affiliation(s)
- Xiang Liu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinai Gan
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jing Xu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Yutong Wang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jie Huang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Xu He
- Department of Hematology, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Yan Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuping Gong
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Peng
- Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
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4
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Meier RT, Porcelijn L, Hofstede-van Egmond S, Caram-Deelder C, Coutinho JM, Henskens YMC, Kruip MJHA, Stroobants AK, Zwaginga JJ, van der Schoot CE, de Haas M, Kapur R. Antibodies against Platelet Glycoproteins in Clinically Suspected VITT Patients. Antibodies (Basel) 2024; 13:35. [PMID: 38804303 PMCID: PMC11130846 DOI: 10.3390/antib13020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
Vaccine-induced thrombotic thrombocytopenia (VITT) is a rare but severe complication following COVID-19 vaccination, marked by thrombocytopenia and thrombosis. Analogous to heparin-induced thrombocytopenia (HIT), VITT shares similarities in anti-platelet factor 4 (PF4) IgG-mediated platelet activation via the FcγRIIa. To investigate the involvement of platelet-antibodies in VITT, we analyzed the presence of platelet-antibodies directed against glycoproteins (GP)IIb/IIIa, GPV and GPIb/IX in the serum of 232 clinically suspected VITT patients determined based on (suspicion of) occurrence of thrombocytopenia and/or thrombosis in relation to COVID-19 vaccination. We found that 19% of clinically suspected VITT patients tested positive for anti-platelet GPs: 39%, 32% and 86% patients tested positive for GPIIb/IIIa, GPV and GPIb/IX, respectively. No HIT-like VITT patients (with thrombocytopenia and thrombosis) tested positive for platelet-antibodies. Therefore, it seems unlikely that platelet-antibodies play a role in HIT-like anti-PF4-mediated VITT. Platelet-antibodies were predominantly associated with the occurrence of thrombocytopenia. We found no association between the type of vaccination (adenoviral vector vaccine versus mRNA vaccine) or different vaccines (ChAdOx1 nCoV-19, Ad26.COV2.S, mRNA-1273, BTN162b2) and the development of platelet-antibodies. It is essential to conduct more research on the pathophysiology of VITT, to improve diagnostic approaches and identify preventive and therapeutic strategies.
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Affiliation(s)
- Romy T. Meier
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, 1066 CX Amsterdam, The Netherlands; (R.T.M.); (C.E.v.d.S.)
| | - Leendert Porcelijn
- Sanquin Diagnostic Services, Department of Immunohematology Diagnostics, Sanquin, 1066 CX Amsterdam, The Netherlands; (L.P.); (S.H.-v.E.); (M.d.H.)
| | - Suzanne Hofstede-van Egmond
- Sanquin Diagnostic Services, Department of Immunohematology Diagnostics, Sanquin, 1066 CX Amsterdam, The Netherlands; (L.P.); (S.H.-v.E.); (M.d.H.)
| | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | | | - Yvonne M. C. Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands;
| | - Marieke J. H. A. Kruip
- Department of Haematology, Erasmus MC, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands;
| | - An K. Stroobants
- Department of Clinical Chemistry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Jaap J. Zwaginga
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - C. Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, 1066 CX Amsterdam, The Netherlands; (R.T.M.); (C.E.v.d.S.)
| | - Masja de Haas
- Sanquin Diagnostic Services, Department of Immunohematology Diagnostics, Sanquin, 1066 CX Amsterdam, The Netherlands; (L.P.); (S.H.-v.E.); (M.d.H.)
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Rick Kapur
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, 1066 CX Amsterdam, The Netherlands; (R.T.M.); (C.E.v.d.S.)
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5
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Nahalka J. 1-L Transcription of SARS-CoV-2 Spike Protein S1 Subunit. Int J Mol Sci 2024; 25:4440. [PMID: 38674024 PMCID: PMC11049929 DOI: 10.3390/ijms25084440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The COVID-19 pandemic prompted rapid research on SARS-CoV-2 pathogenicity. Consequently, new data can be used to advance the molecular understanding of SARS-CoV-2 infection. The present bioinformatics study discusses the "spikeopathy" at the molecular level and focuses on the possible post-transcriptional regulation of the SARS-CoV-2 spike protein S1 subunit in the host cell/tissue. A theoretical protein-RNA recognition code was used to check the compatibility of the SARS-CoV-2 spike protein S1 subunit with mRNAs in the human transcriptome (1-L transcription). The principle for this method is elucidated on the defined RNA binding protein GEMIN5 (gem nuclear organelle-associated protein 5) and RNU2-1 (U2 spliceosomal RNA). Using the method described here, it was shown that 45% of the genes/proteins identified by 1-L transcription of the SARS-CoV-2 spike protein S1 subunit are directly linked to COVID-19, 39% are indirectly linked to COVID-19, and 16% cannot currently be associated with COVID-19. The identified genes/proteins are associated with stroke, diabetes, and cardiac injury.
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Affiliation(s)
- Jozef Nahalka
- Institute of Chemistry, Centre for Glycomics, Slovak Academy of Sciences, Dubravska Cesta 9, SK-84538 Bratislava, Slovakia;
- Institute of Chemistry, Centre of Excellence for White-Green Biotechnology, Slovak Academy of Sciences, Trieda Andreja Hlinku 2, SK-94976 Nitra, Slovakia
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6
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Salamango DJ. Finally neutralizing the threat? A novel SARS-CoV-2 vaccine platform that elicits enhanced neutralizing antibody responses. mBio 2024; 15:e0006724. [PMID: 38407097 PMCID: PMC11005347 DOI: 10.1128/mbio.00067-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak took the world by storm due to its rapid global spread and unpredictable disease outcomes. The extraordinary ascension of SARS-CoV-2 to pandemic status motivated a world-wide effort to rapidly develop vaccines that could effectively suppress virus spread and mitigate severe disease. These efforts culminated in the development and deployment of several highly effective vaccines that were heralded as the beginning-of-the-end of the pandemic. However, these successes were short lived due to the unexpected and continuous emergence of more transmissible and immune-evasive SARS-CoV-2 variants. Thus, attention has shifted toward developing novel vaccine platforms that elicit more robust and sustained neutralizing antibody responses. Recent findings by Muñoz-Alía and colleagues address this by combining a live recombinant measles vaccine platform with novel biochemical approaches to generate vaccine candidates that bolster the potency of neutralizing antibody responses against diverse SARS-CoV-2 spike proteins (M. Á. Muñoz-Alía, R. A. Nace, B. Balakrishnan, L. Zhang, et al., mBio 9:e02928-23, 2024, https://doi.org/10.1128/mbio.02928-23).
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Affiliation(s)
- Daniel J. Salamango
- Department of Microbiology, Immunology, and Molecular Genetics, University of Texas Health Science Center, San Antonio, Texas, USA
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7
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Xu H, Zhang B, Xie L. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study. Open Med (Wars) 2024; 19:20240928. [PMID: 38584820 PMCID: PMC10997003 DOI: 10.1515/med-2024-0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Background Since the outbreak of COVID-19 in December 2019, countries around the world, including China, have been administering COVID-19 vaccines in response to the pandemic. Our center has observed that treating patients with primary immune thrombocytopenia (ITP) has become more challenging in this context. Methods This study compared the treatment response of 25 de novo ITP patients who had received a COVID-19 vaccination (Group 1) with an equal number of de novo ITP patients randomly selected from the 2 years prior to the COVID-19 pandemic (Group 2) by using the Mann-Whitney U test and Fisher's exact. Results Patients in both groups had predominantly female gender with similar age and baseline platelet counts. However, on Day 3, the median platelets were 22 and 49 × 109/L, and on Day 7, they were 74 and 159 × 109/L, respectively (P < 0.05). Compared to Group 2, Group 1 showed a suboptimal short-term response to glucocorticoid monotherapy, with a higher proportion of patients requiring combination therapy with other drugs including intravenous immunoglobulin, thrombopoietin receptor agonists, and rituximab. After subgroup analysis, a significant difference was observed in the proportion of patients requiring second-line therapy between the two groups. Conclusions Our study suggests that COVID-19 vaccination may lead to a lower response rate to first-line treatment in de novo ITP patients. Nevertheless, it is crucial to acknowledge the inherent limitations in this conclusion. Further studies are needed to confirm these findings and investigate the underlying mechanisms.
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Affiliation(s)
- Huiping Xu
- Department of Clinical Nutrition, The First Hospital of Putian City, Putian351100, Fujian, P.R. China
| | - Beibei Zhang
- Department of Hematology, The First Hospital of Putian City, Putian351100, Fujian, P.R. China
| | - Linjun Xie
- Department of Hematology, The First Hospital of Putian City, Putian351100, Fujian, P.R. China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou350001, Fujian, P.R. China
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8
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Chang HW, Ahn S, Kim JS, Han HJ, Park YK, Kim KM, Kim SY, Jung JC, Lee JH, Kim DJ, Lim C, Park K. Influence of Preoperative COVID-19 Vaccination on Outcomes After Coronary Artery Bypass Grafting-A Propensity Score-Matched Analysis. J Am Heart Assoc 2024; 13:e032426. [PMID: 38471836 PMCID: PMC11010012 DOI: 10.1161/jaha.123.032426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Reports of intravascular thrombosis and cardiac complications have raised concerns about the safety of COVID-19 vaccinations, particularly in patients with high cardiovascular risk. Herein, we aimed to analyze the impact of preoperative COVID-19 vaccination on outcomes after coronary artery bypass grafting (CABG). METHODS AND RESULTS Among 520 patients who underwent isolated CABG from 2020 to 2022, 481 patients (mean±SD age: 67±11 years, 86 women) whose COVID-19 vaccination status could be confirmed were included. A total of 249 patients who had not received any COVID-19 vaccine before CABG (never vaccinated group) and 214 patients who had completed primary vaccination (fully vaccinated group) were subjected to 1:1 propensity score matching, and 156 pairs of patients were matched. There was no significant difference in early mortality between the 2 groups after matching. After matching, overall survival (P=0.930) and major adverse cardiovascular and cerebrovascular event-free survival (P=0.636) did not differ between the 2 groups. One-year graft patency also did not differ significantly between the 2 groups; all patent grafts in 85/104 patients (82%) and 62/73 patients (85%) in the never vaccinated and fully vaccinated groups, respectively (P=0.685). Subgroup analysis showed equivalent overall and major adverse cardiovascular and cerebrovascular event-free survival among AstraZeneca and Pfizer vaccine recipients and between those with ≤30 days versus >30 days from vaccination to CABG. CONCLUSIONS Despite the very high cardiovascular risk for patients undergoing CABG, COVID-19 vaccination did not affect major outcomes after CABG. Therefore, there is no reason for patients with coronary artery disease requiring CABG to avoid preoperative COVID-19 vaccination.
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Affiliation(s)
- Hyoung Woo Chang
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Soyeon Ahn
- Biostatistics, Medical Research Collaborating CenterSeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Hyun Jeong Han
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - You Kyeong Park
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Kang Min Kim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Sang Yoon Kim
- Department of Thoracic and Cardiovascular SurgeryChungnam National University HospitalDaejeonRepublic of Korea
| | - Joon Chul Jung
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Jae Hang Lee
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Dong Jung Kim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Kay‐Hyun Park
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
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9
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Najary S, Vatankhah M, Khadivi G, Salehi SN, Tabari MAK, Samieefar N, Behnaz M. A comprehensive review of oral microenvironment changes and orofacial adverse reactions after COVID-19 vaccination: The good, the bad, and the ugly. Health Sci Rep 2024; 7:e1967. [PMID: 38482134 PMCID: PMC10935892 DOI: 10.1002/hsr2.1967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND AND AIMS Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have the potential to alter several biological systems concurrently with remolding the immune system, most of which are related to immunization, while some others are known as adverse effects. This review aims to explore the potential effects of vaccination on the oral microenvironment and classifies them as good, bad, or ugly, with a brief review of facial diseases following coronavirus disease 2019 (COVID-19) vaccination. METHODS This study was a comprehensive review conducted through searching related articles in Medline, Scopus, and Google Scholar databases. RESULTS On one side, the "Good" impacts of vaccination on the oro-nasal mucosa are explained as if the mucosal immune responses followed by SARS-CoV-2 vaccines are enough to provide immunity. On the other side, the possible "Bad" and "Ugly" effects of the vaccine, which manifest as orofacial adverse events and autoimmune reactivations, respectively, should be noted. Exacerbation of pre-existing autoimmune conditions such as lichen planus, pemphigus vulgaris, bullous pemphigoid, and Stevens-Johnson syndrome have been reported. CONCLUSION COVID-19 vaccines could affect different biological systems alongside stimulating the immune system, and some of these effects are referred to as adverse effects. Nonetheless, these adverse effects are treatable, and healthcare professionals should not prevent patients from taking the first available vaccination.
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Affiliation(s)
- Shaghayegh Najary
- School of DentistryShahid Beheshti University of Medical SciencesTehranIran
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Mohammadreza Vatankhah
- Center for Craniofacial Molecular Biology, Herman Ostrow School of DentistryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Gita Khadivi
- School of DentistryShahid Beheshti University of Medical SciencesTehranIran
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
| | - Seyyede N. Salehi
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
- Dentistry Student, Executive Secretary of Research Committee, Board Director of Scientific Society, Dental FacultyIslamic Azad UniversityTehranIran
| | - Mohammad A. K. Tabari
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
- USERN OfficeMazandaran University of Medical SciencesSariIran
| | - Noosha Samieefar
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Mohammad Behnaz
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
- Dental Research Center, Research Institute of Dental Sciences, School of DentistryShahid Beheshti University of Medical SciencesTehranIran
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10
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Muñoz-Alía MÁ, Nace RA, Balakrishnan B, Zhang L, Packiriswamy N, Singh G, Warang P, Mena I, Narjari R, Vandergaast R, Peng KW, García-Sastre A, Schotsaert M, Russell SJ. Surface-modified measles vaccines encoding oligomeric, prefusion-stabilized SARS-CoV-2 spike glycoproteins boost neutralizing antibody responses to Omicron and historical variants, independent of measles seropositivity. mBio 2024; 15:e0292823. [PMID: 38193729 PMCID: PMC10865805 DOI: 10.1128/mbio.02928-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Serum titers of SARS-CoV-2-neutralizing antibodies (nAbs) correlate well with protection from symptomatic COVID-19 but decay rapidly in the months following vaccination or infection. In contrast, measles-protective nAb titers are lifelong after measles vaccination, possibly due to persistence of the live-attenuated virus in lymphoid tissues. We, therefore, sought to generate a live recombinant measles vaccine capable of driving high SARS-CoV-2 nAb responses. Since previous clinical testing of a live measles vaccine encoding a SARS-CoV-2 spike glycoprotein resulted in suboptimal anti-spike antibody titers, our new vectors were designed to encode prefusion-stabilized SARS-CoV-2 spike glycoproteins, trimerized via an inserted peptide domain, and displayed on a dodecahedral miniferritin scaffold. Additionally, to circumvent the blunting of vaccine efficacy by preformed anti-measles antibodies, we extensively modified the measles surface glycoproteins. Comprehensive in vivo mouse testing demonstrated the potent induction of high titer nAbs in measles-immune mice and confirmed the significant contributions to overall potency afforded by prefusion stabilization, trimerization, and miniferritin display of the SARS-CoV-2 spike glycoprotein. In animals primed and boosted with a measles virus (MeV) vaccine encoding the ancestral SARS-CoV-2 spike, high-titer nAb responses against ancestral virus strains were only weakly cross-reactive with the Omicron variant. However, in primed animals that were boosted with a MeV vaccine encoding the Omicron BA.1 spike, antibody titers to both ancestral and Omicron strains were robustly elevated, and the passive transfer of serum from these animals protected K18-ACE2 mice from infection and morbidity after exposure to BA.1 and WA1/2020 strains. Our results demonstrate that by engineering the antigen, we can develop potent measles-based vaccine candidates against SARS-CoV-2.IMPORTANCEAlthough the live-attenuated measles virus (MeV) is one of the safest and most efficacious human vaccines, a measles-vectored COVID-19 vaccine candidate expressing the SARS-CoV-2 spike failed to elicit neutralizing antibody (nAb) responses in a phase-1 clinical trial, especially in measles-immune individuals. Here, we constructed a comprehensive panel of MeV-based COVID-19 vaccine candidates using a MeV with extensive modifications on the envelope glycoproteins (MeV-MR). We show that artificial trimerization of the spike is critical for the induction of nAbs and that their magnitude can be significantly augmented when the spike protein is synchronously fused to a dodecahedral scaffold. Furthermore, preexisting measles immunity did not abolish heterologous immunity elicited by our vector. Our results highlight the importance of antigen optimization in the development of spike-based COVID-19 vaccines and therapies.
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Affiliation(s)
- Miguel Á. Muñoz-Alía
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Vyriad Inc, Rochester, Minnesota, USA
| | - Rebecca A. Nace
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Lianwen Zhang
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Gagandeep Singh
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Prajakta Warang
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ignacio Mena
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Kah-Whye Peng
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Vyriad Inc, Rochester, Minnesota, USA
- Imanis Life Sciences, Rochester, Minnesota, USA
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Schotsaert
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen J. Russell
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Vyriad Inc, Rochester, Minnesota, USA
- Imanis Life Sciences, Rochester, Minnesota, USA
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Alkhelaiwy L, Fatani JA, Alhamoud I, Chaballout A. Immune Thrombocytopenia After COVID-19 Vaccine Requiring Splenectomy: A Case Report and Review of the Literature. Cureus 2024; 16:e53955. [PMID: 38469016 PMCID: PMC10926895 DOI: 10.7759/cureus.53955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Abstract
Post-vaccination immune thrombocytopenia (ITP) is a rare but recognized adverse event believed to result from an autoimmune reaction triggered by the vaccine. This case report presents the fourth documented instance of severe ITP requiring splenectomy following the administration of a COVID-19 vaccine. The patient, a 54-year-old previously healthy female with no familial history of autoimmune or hematological disorders, developed ITP two weeks after the first dose of the COVID-19 vaccine. While most ITP cases associated with COVID-19 vaccines manifested after the second dose, this unique case demonstrated symptoms following the initial vaccination. Initially responsive to first-line management, the patient experienced a relapse upon receiving the second dose from a different vaccine manufacturer. Despite exhaustive medical interventions, the refractory nature of the condition persisted, ultimately mandating splenectomy for the achievement of complete remission. This case underscores the potential for serious, refractory ITP with the second dose of a COVID-19 vaccine, particularly in patients who initially developed ITP after the first dose, even if they had seemingly achieved complete remission. These findings emphasize the importance of vigilant monitoring and individualized treatment strategies in such cases, contributing valuable insights to the growing body of knowledge surrounding vaccine-induced ITP.
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Affiliation(s)
| | | | | | - Ahmed Chaballout
- General Surgery/Kidney Transplant and Vascular Surgery, Specialized Medical Center, Riyadh, SAU
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12
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Boretti A. mRNA vaccine boosters and impaired immune system response in immune compromised individuals: a narrative review. Clin Exp Med 2024; 24:23. [PMID: 38280109 PMCID: PMC10821957 DOI: 10.1007/s10238-023-01264-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/05/2023] [Indexed: 01/29/2024]
Abstract
Over the last 24 months, there has been growing evidence of a correlation between mRNA COVID-19 vaccine boosters and increased prevalence of COVID-19 infection and other pathologies. Recent works have added possible causation to correlation. mRNA vaccine boosters may impair immune system response in immune compromised individuals. Multiple doses of the mRNA COVID-19 vaccines may result in much higher levels of IgG 4 antibodies, or also impaired activation of CD4 + and CD8 + T cells. The opportunity for mRNA vaccine boosters to impair the immune system response needs careful consideration, as this impacts the cost-to-benefit ratio of the boosters' practice.
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Affiliation(s)
- Alberto Boretti
- Melbourne Institute of Technology, The Argus, 288 La Trobe St, Melbourne, VIC 3000, Australia.
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13
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Zhan XY, Chen H, Kong H, Meng T, Ye J, Liu Y, Ng MHL, Li L, Zhang Y, Huang J, Peng Q, Chen C, He Y, Yang M. Platelet dropping, bleeding and new treatment requirements in ITP patients after inactivated COVID-19 vaccination. Immunol Lett 2023; 264:56-63. [PMID: 38006954 DOI: 10.1016/j.imlet.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 11/27/2023]
Abstract
Significant decreases in platelet counts and ITP relapses have been documented in ITP patients receiving COVID-19 mRNA vaccines; however, the effect of the inactivated COVID-19 vaccine on ITP patients remains unclear. The present study aimed to investigate the impact of inactivated COVID-19 vaccines on ITP patients, with a focus on platelet dropping events, bleeding events/scores, and the requirement of a new round of treatment. A total of 118 ITP patients, with 97 chronic ITP and 21 persistent ITP, who received inactivated COVID-19 immunization were investigated retrospectively. Following vaccination (within 1 month), ITP patients reported platelet dropping (31.36 %), new bleeding events (22.88 %), increases in bleeding scores (23.73 %), and new treatment requirements (22.03 %). Among them, persistent ITP patients with disease duration of 3-12 months had higher ratios of the above adverse events (71.43 %, 57.14 %, 61.90 % and 71.43 %, respectively) than chronic ITP patients with duration > 1 year (22.68 %, 15.46 %, 15.46 % and 11.34 %, respectively); patients' disease duration was negatively correlated with platelet dropping events and new treatment requirements. Furthermore, logistic regression analysis also supported the above findings, revealing that persistent ITP patients had 9.40-9.70, 7.24-10.08, and 27.17-28.51 times incidence of having platelet dropping events, new bleeding events, and new treatment requirements after vaccination, respectively, when compared to chronic ITP patients. In conclusion, the present study demonstrates that after receiving inactivated COVID-19 vaccines, ITP patients may experience platelet dropping, which may lead to new bleeding events and the requirement of a new round of treatment for ITP recurrence. As a result, platelet level monitoring is crucial for ITP patients during the vaccination, especially those with persistent ITP.
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Affiliation(s)
- Xiao-Yong Zhan
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hui Chen
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Huimin Kong
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | | | - Jieyu Ye
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Liu
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Margaret H L Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Liang Li
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yuming Zhang
- Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China
| | - Jinqi Huang
- Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China
| | - Qiang Peng
- The Third Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Chun Chen
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Yulong He
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Mo Yang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China.
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14
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Rodriguez Guerra MA, Chinta S, Urena Neme AP, Gupta S, Roa Gomez G. A Successfully Treated COVID-19 Vaccine Induced Immune Thrombocytopenic Purpura. Cureus 2023; 15:e49878. [PMID: 38174163 PMCID: PMC10761320 DOI: 10.7759/cureus.49878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Immune Thrombocytopenic Purpura (ITP) is a life-threatening condition where an accurate initial assessment is essential to be able to offer the proper therapy in a timely matter to improve the outcome of the patient. Here, we present a case of ITP secondary to the coronavirus disease 2019 (COVID-19) vaccine (BioNTech, Pfizer vaccine). A 61-year-old obese African American female presented to the emergency room (ER) from a clinic with a platelet count of 11k/ul 21 days after she received the second dose of the BioNTech, Pfizer vaccine. The patient was immediately started on intravenous immunoglobulin (IVIG) 1g/kg twice daily (bid) and dexamethasone 20 mg IV every 12 hrs (q12h). The next day, the platelet count increased to 63 k/ul, and after the second dose of IVIG, the platelet count improved to 122 k/ul and trended up. The early detection of ITP induced by the mRNA COVID-19 vaccine is determinant to guide the early and proper therapy with immunoglobulins and steroids to improve the outcome of our patients.
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Affiliation(s)
| | | | - Ana P Urena Neme
- Cardiology, Medicina Cardiovascular Asociada, Santo Domingo, DOM
| | - Sorab Gupta
- Department of Hematology and Oncology, Einstein Healthcare Network, Philadelphia, USA
| | - Gabriella Roa Gomez
- Pulmonary and Critical Care Medicine, Albert Einstein College of Medicine, Bronx, USA
- Pulmonary and Critical Care Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, USA
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15
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Lee J, Ong KW, Wan Abdul Halim WH, Mohd Khialdin S, Yong MH. Case Report: Branch Retinal Vein Occlusion Post-mRNA SARS-CoV-2 (COVID-19) Vaccination. Optom Vis Sci 2023; 100:799-803. [PMID: 37844608 DOI: 10.1097/opx.0000000000002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
SIGNIFICANCE Systemic thromboembolic complications are well documented to be associated with coronavirus disease 2019 (COVID-19); however, there have been a growing number of reports regarding ocular complications stemming from COVID-19 vaccinations. This case illustrates a clear temporal and possible causal relationship of COVID-19 vaccination with an ocular microvascular disorder, namely, retinal vein occlusion. PURPOSE This study aimed to report a case of inferotemporal branch retinal vein occlusion after messenger RNA Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CASE REPORT A middle-aged woman developed right eye central scotoma 2 days after COVID-19 vaccination. She had transient hypertension during the first 2 days post-vaccination. A decrease in visual acuity (6/18) was documented. Initial retinal findings included flame-shaped hemorrhages and cotton-wool spots along inferotemporal branch retinal vessels. Optical coherence tomography revealed right eye cystoid macular edema. Laboratory investigation revealed mildly raised erythrocyte sedimentation rate and C-reactive protein. Other systemic examinations were unremarkable. She was treated for right eye inferotemporal branch retinal vein occlusion with cystoid macular edema and was given intravitreal anti-vascular endothelial growth factor monthly in three doses. Her visual acuity improved to 6/6 with resolved cystoid macular edema. CONCLUSIONS This case illustrates a clear temporal and possible causal relationship between COVID-19 vaccination and retinal vein occlusion. Post-vaccination transient hypertension or the immunological and inflammatory response to the vaccine may have contributed to the venous occlusive event in this case. Eye care providers should remain aware of this possibility. The effectiveness of intravitreal anti-vascular endothelial growth factor for the treatment of macular edema secondary to branch retinal vein occlusion was demonstrated in this patient.
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Affiliation(s)
- Jing Lee
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kah Wei Ong
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Safinaz Mohd Khialdin
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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16
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Zaiem A, Ferchichi K, Lakhoua G, Kaabi W, Aouinti I, Rebii Debbiche S, Kastalli S, Kallel L, Charfi O, El Aidli S. Autoimmune hepatitis following mRNA COVID-19 vaccine. Therapie 2023; 78:760-761. [PMID: 37704459 DOI: 10.1016/j.therap.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 09/15/2023]
Affiliation(s)
- Ahmed Zaiem
- National Center Chalbi Belkahia of Pharmacovigilance, 1006, Tunis, Tunisia; Research unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, La Rabta, 1007 Tunis, Tunisia.
| | - Khouloud Ferchichi
- Research unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, La Rabta, 1007 Tunis, Tunisia
| | - Ghozlane Lakhoua
- National Center Chalbi Belkahia of Pharmacovigilance, 1006, Tunis, Tunisia; Research unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, La Rabta, 1007 Tunis, Tunisia
| | - Widd Kaabi
- National Center Chalbi Belkahia of Pharmacovigilance, 1006, Tunis, Tunisia; Research unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, La Rabta, 1007 Tunis, Tunisia
| | - Imen Aouinti
- National Center Chalbi Belkahia of Pharmacovigilance, 1006, Tunis, Tunisia; Research unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, La Rabta, 1007 Tunis, Tunisia
| | | | - Sarrah Kastalli
- National Center Chalbi Belkahia of Pharmacovigilance, 1006, Tunis, Tunisia; Research unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, La Rabta, 1007 Tunis, Tunisia
| | - Lamia Kallel
- Gastroenterology Department, Mahmoud Matri Hospital, 2080 Ariana, Tunisia
| | - Ons Charfi
- National Center Chalbi Belkahia of Pharmacovigilance, 1006, Tunis, Tunisia; Research unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, La Rabta, 1007 Tunis, Tunisia
| | - Sihem El Aidli
- National Center Chalbi Belkahia of Pharmacovigilance, 1006, Tunis, Tunisia; Research unit: UR17ES12, Faculty of Medicine, University of Tunis El Manar, La Rabta, 1007 Tunis, Tunisia
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17
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Sekulovski M, Mileva N, Vasilev GV, Miteva D, Gulinac M, Peshevska-Sekulovska M, Chervenkov L, Batselova H, Vasilev GH, Tomov L, Lazova S, Vassilev D, Velikova T. Blood Coagulation and Thrombotic Disorders following SARS-CoV-2 Infection and COVID-19 Vaccination. Biomedicines 2023; 11:2813. [PMID: 37893186 PMCID: PMC10604891 DOI: 10.3390/biomedicines11102813] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
Although abundant data confirm the efficacy and safety profile of the developed vaccines against COVID-19, there are still some concerns regarding vaccination in high-risk populations. This is especially valid for patients susceptible to thrombotic or bleeding events and hesitant people due to the fear of thrombotic incidents following vaccination. This narrative review focuses on various inherited and acquired thrombotic and coagulation disorders and the possible pathophysiologic mechanisms interacting with the coagulation system during immunization in view of the currently available safety data regarding COVID-19 vaccines. Inherited blood coagulation disorders and inherited thrombotic disorders in the light of COVID-19, as well as blood coagulation and thrombotic disorders and bleeding complications following COVID-19 vaccines, along with the possible pathogenesis hypotheses, therapeutic interventions, and imaging for diagnosing are discussed in detail. Lastly, the lack of causality between the bleeding and thrombotic events and COVID-19 vaccines is debated, but still emphasizes the importance of vaccination against COVID-19, outweighing the minimal risk of potential rare adverse events associated with coagulation.
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Affiliation(s)
- Metodija Sekulovski
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Kozyak Str., 1407 Sofia, Bulgaria
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
| | - Niya Mileva
- Medical Faculty, Medical University of Sofia, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria;
| | - Georgi Vasilev Vasilev
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Clinic of Endocrinology and Metabolic Disorders, University Multiprofil Hospital Active Treatement “Sv. Georgi”, 4000 Plovdiv, Bulgaria
| | - Dimitrina Miteva
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Department of Genetics, Faculty of Biology, Sofia University “St. Kliment Ohridski”, 8 Dragan Tzankov Str., 1164 Sofia, Bulgaria
| | - Milena Gulinac
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Department of General and Clinical Pathology, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria
| | - Monika Peshevska-Sekulovska
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Department of Gastroenterology, University Hospital Lozenetz, 1407 Sofia, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria;
| | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University of Plovdiv, University Hospital “St George”, 4000 Plovdiv, Bulgaria;
| | - Georgi Hristov Vasilev
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Laboratory of Hematopathology and Immunology, National Specialized Hospital for Active Treatment of Hematological Diseases, 1756 Sofia, Bulgaria
| | - Latchezar Tomov
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Department of Informatics, New Bulgarian University, Montevideo 21 Str., 1618 Sofia, Bulgaria
| | - Snezhina Lazova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Pediatric Clinic, University Hospital “N. I. Pirogov”, 21 “General Eduard I. Totleben” Blvd, 1606 Sofia, Bulgaria
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Bialo More 8 Str., 1527 Sofia, Bulgaria
| | - Dobrin Vassilev
- Faculty of Public Health and Healthcare, Ruse University Angel Kanchev, 7017 Ruse, Bulgaria;
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
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18
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Bernardi FF, Mascolo A, Sarno M, Capoluongo N, Trama U, Ruggiero R, Sportiello L, Fusco GM, Bisogno M, Coscioni E, Iervolino A, Di Micco P, Capuano A, Perrella A. Thromboembolic Events after COVID-19 Vaccination: An Italian Retrospective Real-World Safety Study. Vaccines (Basel) 2023; 11:1575. [PMID: 37896978 PMCID: PMC10611339 DOI: 10.3390/vaccines11101575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Real-world safety studies can provide important evidence on the thromboembolic risk associated with COVID-19 vaccines, considering that millions of people have been already vaccinated against COVID-19. In this study, we aimed to estimate the incidence of thromboembolic events after COVID-19 vaccination and to compare the Oxford-AstraZeneca vaccine with other COVID-19 vaccines. METHODS We conducted a retrospective real-world safety study using data from two different data sources: the Italian Pharmacovigilance database (Rete Nazionale di Farmacovigilanza, RNF) and the Campania Region Health system (Sistema INFOrmativo saNità CampanIA, SINFONIA). From the start date of the COVID-19 vaccination campaign (27 December 2021) to 27 September 2022, information on COVID-19 vaccinations and thromboembolic events were extracted from the two databases. The reporting rate (RR) and its 95% confidence interval (95%CI) of thromboembolic events for 10,000 doses was calculated for each COVID-19 vaccine. Moreover, the odds of being vaccinated with the Oxford-AstraZeneca vaccine vs. the other COVID-19 vaccines in cases with thromboembolic events vs. controls without thromboembolic events were computed. RESULTS A total of 12,692,852 vaccine doses were administered in the Campania Region, of which 6,509,475 (51.28%) were in females and mostly related to the Pfizer-BioNtech vaccine (65.05%), followed by Moderna (24.31%), Oxford-AstraZeneca (9.71%), Janssen (0.91%), and Novavax (0.02%) vaccines. A total of 641 ICSRs with COVID-19 vaccines and vascular events were retrieved from the RNF for the Campania Region, of which 453 (70.67%) were in females. Most ICSRs reported the Pfizer-BioNtech vaccine (65.05%), followed by Oxford-AstraZeneca (9.71%), Moderna (24.31%), and Janssen (0.91%). A total of 2451 events were reported in the ICSRs (3.8 events for ICSRs), of which 292 were thromboembolic events. The higher RRs of thromboembolic events were found with the Oxford-AstraZeneca vaccine (RR: 4.62, 95%CI: 3.50-5.99) and Janssen vaccine (RR: 3.45, 95%CI: 0.94-8.82). Thromboembolic events were associated with a higher likelihood of exposure to the Oxford-AstraZeneca vaccine compared to Pfizer-BioNtech (OR: 6.06; 95%CI: 4.22-8.68) and Moderna vaccines (OR: 6.46; 95%CI: 4.00-10.80). CONCLUSION We observed a higher reporting of thromboembolic events with viral-vector-based vaccines (Oxford-AstraZeneca and Janssen) and an increased likelihood of being exposed to the Oxford-AstraZeneca vaccine compared to the mRNA vaccines (Pfizer-BioNtech and Moderna) among thromboembolic cases.
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Affiliation(s)
- Francesca Futura Bernardi
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Marina Sarno
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
| | - Nicolina Capoluongo
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
| | - Ugo Trama
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Giovanni Maria Fusco
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Massimo Bisogno
- Regional Special Office for Digital Transformation, Campania Region, 80100 Naples, Italy;
| | - Enrico Coscioni
- Division of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy;
| | - Anna Iervolino
- Directorate-General AORN Ospedali dei Colli, Campania Region, 80131 Naples, Italy;
| | - Pierpaolo Di Micco
- General Medicine, Santa Maria delle Grazie Hospital, ASL NA2 Nord, 80078 Pozzuoli, Italy;
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Alessandro Perrella
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
- Regional Observatory for Infectious Disease, Campania Region, 80131 Naples, Italy
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19
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Phianhasin L, Ruksakulpiwat S, Kruahong S, Kuntajak P, Kelman GB, Benjasirisan C. Management and Characteristics of Embolism and Thrombosis After COVID-19 Vaccination: Scoping Review. J Multidiscip Healthc 2023; 16:2745-2772. [PMID: 37750162 PMCID: PMC10518144 DOI: 10.2147/jmdh.s421291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
This scoping review aims to 1) identify characteristics of participants who developed embolism and/or thrombotic event(s) after COVID-19 vaccination and 2) review the management during the new vaccine development of the unexpected event(s). This review was conducted following PRISMA for scoping review guidelines. Peer-reviewed articles were searched for studies involving participants with embolism and/or thrombotic event(s) after COVID-19 vaccination with the management described during the early phase after the approval of vaccines. The 12 studies involving 63 participants were included in this review. The majority of participants' ages ranged from 22 to 49 years. The embolism and/or thrombotic event(s) often occur within 30 days post-vaccination. Five of the included studies reported the event after receiving viral vector vaccines and suggested a vaccine-induced immune thrombotic thrombocytopenia as a plausible mechanism. Cerebral venous sinus thrombosis was the most frequently reported post-vaccination thrombosis complication. In summary, the most frequently reported characteristics and management from this review were consistent with international guidelines. Future studies are recommended to further investigate the incidence and additional potential complications to warrant the benefit and safety after receiving COVID-19 vaccine and other newly developed vaccines.
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20
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Yamamoto Y, Ogino K, Yasuhara S, Kawashima Y, Miki T. Three Cases of Arteritic Anterior Optic Neuropathy Several Months after COVID-19 Vaccination. Case Rep Ophthalmol Med 2023; 2023:8845850. [PMID: 37727533 PMCID: PMC10506880 DOI: 10.1155/2023/8845850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023] Open
Abstract
Background Vaccines have been approved worldwide to control the coronavirus disease-19 (COVID-19). However, the postvaccination side effects remain controversial. Here, we describe three Japanese cases of arteritic anterior ischaemic optic neuropathy (AAION) following COVID-19 vaccination. Case presentation. The first case involved an 87-year-old woman who presented with vision loss in the right eye 2 months after her second COVID-19 vaccine and in the left eye 2 days later. The second case involved an 88-year-old woman who presented with vision loss in both eyes 3 months after receiving a second vaccine. The third case involved an 80-year-old man who presented with vision loss in the right eye 5 months after receiving a second vaccine. The C-reactive protein level and erythrocyte sedimentation rate were elevated in all patients. Biopsy of the temporal artery or auricular cartilage showed arteritic occlusion in case 2 and polychondritis in case 3. These patients were referred to a local Japanese hospital in 2021 over a period of no longer than 3 months. Conclusion We observed three cases of AAION after the affected individuals received their second COVID-19 vaccine. Further long-term investigations of ophthalmological events after COVID-19 vaccination are warranted.
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Affiliation(s)
- Yuichi Yamamoto
- Department of Ophthalmology, Japanese Red Cross Wakayama Medical Centre, Wakayama, Japan
| | - Ken Ogino
- Department of Ophthalmology, Japanese Red Cross Wakayama Medical Centre, Wakayama, Japan
| | - Satoshi Yasuhara
- Department of Ophthalmology, Japanese Red Cross Wakayama Medical Centre, Wakayama, Japan
| | - Yu Kawashima
- Department of Ophthalmology, Japanese Red Cross Wakayama Medical Centre, Wakayama, Japan
| | - Toshiya Miki
- Department of Ophthalmology, Japanese Red Cross Wakayama Medical Centre, Wakayama, Japan
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21
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Sistanizad M, Sabaghian T, Amini H, Hadavand F, Nabavi M, Kouchek M, Miri MM, Salarian S, Shojaei S, Moradi O. Sinopharm (HB02)-associated vaccine-induced immune thrombotic thrombocytopenia: a case report. J Med Case Rep 2023; 17:383. [PMID: 37679815 PMCID: PMC10486117 DOI: 10.1186/s13256-023-04086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/17/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Vaccine-induced thrombotic thrombocytopenia is associated with the coronavirus disease 2019 vaccines. It has been reported by vector-based vaccines. To the best of our knowledge, there is no report about vaccine-induced thrombotic thrombocytopenia in whole-virus vaccines. We are presenting the first case of vaccine-induced thrombotic thrombocytopenia with this type of vaccine. CASE PRESENTATION An 18-year-old male Caucasian patient with complaints of severe abdominal, low back, and lower extremity pain presented to the medical center. He received the first dose of the Sinopharm (HB02) vaccine against coronavirus disease 2019 10 days before hospital attendance. In the laboratory examination, decreased platelet count and increased D-dimer were observed. During hospital admission, the diagnosis of pulmonary embolism was reached. He received vaccine-induced thrombotic thrombocytopenia therapy consisting of intravenous immune globulin and direct oral anticoagulant. Platelet count increased and he was discharged after 1 month. CONCLUSION This case highlights the possibility of vaccine-induced thrombotic thrombocytopenia occurrence by whole-virus coronavirus disease 2019 vaccines. Compared with vector-based vaccines, this phenomenon is rare for whole-virus vaccines. More studies on this type of vaccine regarding thrombotic thrombocytopenia should be considered.
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Affiliation(s)
- Mohammad Sistanizad
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Sabaghian
- Division of Nephrology, Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Amini
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Hadavand
- Infectious Diseases and Tropical Medicine Research Center, Imam Hossein Teaching and Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, Imam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Nabavi
- Infectious Diseases and Tropical Medicine Research Center, Imam Hossein Teaching and Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, Imam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Kouchek
- Department of Pulmonary and Critical Care Medicine, Imam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mir Mohammad Miri
- Department of Pulmonary and Critical Care Medicine, Imam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Salarian
- Department of Pulmonary and Critical Care Medicine, Imam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedpouzhia Shojaei
- Department of Pulmonary and Critical Care Medicine, Imam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Moradi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, 7919691982, Iran.
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22
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Widhani A, Hasibuan AS, Rismawati R, Maria S, Koesnoe S, Hermanadi MI, Ophinni Y, Yamada C, Harimurti K, Sari ANL, Yunihastuti E, Djauzi S. Efficacy, Immunogenicity, and Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:1456. [PMID: 37766132 PMCID: PMC10535431 DOI: 10.3390/vaccines11091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with autoimmune diseases are among the susceptible groups to COVID-19 infection because of the complexity of their conditions and the side effects of the immunosuppressive drugs used to treat them. They might show impaired immunogenicity to COVID-19 vaccines and have a higher risk of developing COVID-19. Using a systematic review and meta-analysis, this research sought to summarize the evidence on COVID-19 vaccine efficacy, immunogenicity, and safety in patients with autoimmune diseases following predefined eligibility criteria. Research articles were obtained from an initial search up to 26 September 2022 from PubMed, Embase, EBSCOhost, ProQuest, MedRxiv, bioRxiv, SSRN, EuroPMC, and the Cochrane Center of Randomized Controlled Trials (CCRCT). Of 76 eligible studies obtained, 29, 54, and 38 studies were included in systematic reviews of efficacy, immunogenicity, and safety, respectively, and 6, 18, and 4 studies were included in meta-analyses for efficacy, immunogenicity, and safety, respectively. From the meta-analyses, patients with autoimmune diseases showed more frequent breakthrough COVID-19 infections and lower total antibody (TAb) titers, IgG seroconversion, and neutralizing antibodies after inactivated COVID-19 vaccination compared with healthy controls. They also had more local and systemic adverse events after the first dose of inactivated vaccination compared with healthy controls. After COVID-19 mRNA vaccination, patients with autoimmune diseases had lower TAb titers and IgG seroconversion compared with healthy controls.
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Affiliation(s)
- Alvina Widhani
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
- Department of Internal Medicine, Universitas Indonesia Hospital, Depok 16424, Indonesia
| | - Anshari Saifuddin Hasibuan
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Retia Rismawati
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Suzy Maria
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Sukamto Koesnoe
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Muhammad Ikrar Hermanadi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Youdiil Ophinni
- Division of Clinical Virology, Center for Infectious Diseases, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan;
- Department of Host Defense, Immunology Frontier Research Center, Osaka University, Osaka 565-0871, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto 606-8304, Japan;
| | - Chika Yamada
- Center for Southeast Asian Studies, Kyoto University, Kyoto 606-8304, Japan;
| | - Kuntjoro Harimurti
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia;
| | - Aldean Nadhyia Laela Sari
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Evy Yunihastuti
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Samsuridjal Djauzi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
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23
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González-López TJ, Provan D, Bárez A, Bernardo-Gutiérrez A, Bernat S, Martínez-Carballeira D, Jarque-Ramos I, Soto I, Jiménez-Bárcenas R, Fernández-Fuertes F. Primary and secondary immune thrombocytopenia (ITP): Time for a rethink. Blood Rev 2023; 61:101112. [PMID: 37414719 DOI: 10.1016/j.blre.2023.101112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
There are not many publications that provide a holistic view of the management of primary and secondary ITP as a whole, reflecting the similarities and differences between the two. Given the lack of major clinical trials, we believe that comprehensive reviews are much needed to guide the diagnosis and treatment of ITP today. Therefore, our review addresses the contemporary diagnosis and treatment of ITP in adult patients. With respect to primary ITP we especially focus on establishing the management of ITP based on the different and successive lines of treatment. Life-threatening situations, "bridge therapy" to surgery or invasive procedures and refractory ITP are also comprehensively reviewed here. Secondary ITP is studied according to its pathogenesis by establishing three major differential groups: Immune Thrombocytopenia due to Central Defects, Immune Thrombocytopenia due to Blocked Differentiation and Immune Thrombocytopenia due to Defective Peripheral Immune Response. Here we provide an up-to-date snapshot of the current diagnosis and treatment of ITP, including a special interest in addressing rare causes of this disease in our daily clinical practice. The target population of this review is adult patients only and the target audience is medical professionals.
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Affiliation(s)
| | - Drew Provan
- Academic Haematology Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Abelardo Bárez
- Department of Hematology. Complejo Asistencial de Ávila, Ávila, Spain
| | | | - Silvia Bernat
- Department of Hematology, Hospital Universitario de la Plana, Villarreal, Castellón, Spain
| | | | - Isidro Jarque-Ramos
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Inmaculada Soto
- Department of Hematology, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | | | - Fernando Fernández-Fuertes
- Department of Hematology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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24
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Fortmann SD, Patton MJ, Frey BF, Tipper JL, Reddy SB, Vieira CP, Hanumanthu VS, Sterrett S, Floyd JL, Prasad R, Zucker JD, Crouse AB, Huls F, Chkheidze R, Li P, Erdmann NB, Harrod KS, Gaggar A, Goepfert PA, Grant MB, Might M. Circulating SARS-CoV-2+ megakaryocytes are associated with severe viral infection in COVID-19. Blood Adv 2023; 7:4200-4214. [PMID: 36920790 PMCID: PMC10022176 DOI: 10.1182/bloodadvances.2022009022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Several independent lines of evidence suggest that megakaryocytes are dysfunctional in severe COVID-19. Herein, we characterized peripheral circulating megakaryocytes in a large cohort of inpatients with COVID-19 and correlated the subpopulation frequencies with clinical outcomes. Using peripheral blood, we show that megakaryocytes are increased in the systemic circulation in COVID-19, and we identify and validate S100A8/A9 as a defining marker of megakaryocyte dysfunction. We further reveal a subpopulation of S100A8/A9+ megakaryocytes that contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) protein and RNA. Using flow cytometry of peripheral blood and in vitro studies on SARS-CoV-2-infected primary human megakaryocytes, we demonstrate that megakaryocytes can transfer viral antigens to emerging platelets. Mechanistically, we show that SARS-CoV-2-containing megakaryocytes are nuclear factor κB (NF-κB)-activated, via p65 and p52; express the NF-κB-mediated cytokines interleukin-6 (IL-6) and IL-1β; and display high surface expression of Toll-like receptor 2 (TLR2) and TLR4, canonical drivers of NF-κB. In a cohort of 218 inpatients with COVID-19, we correlate frequencies of megakaryocyte subpopulations with clinical outcomes and show that SARS-CoV-2-containing megakaryocytes are a strong risk factor for mortality and multiorgan injury, including respiratory failure, mechanical ventilation, acute kidney injury, thrombotic events, and intensive care unit admission. Furthermore, we show that SARS-CoV-2+ megakaryocytes are present in lung and brain autopsy tissues from deceased donors who had COVID-19. To our knowledge, this study offers the first evidence implicating SARS-CoV-2+ peripheral megakaryocytes in severe disease and suggests that circulating megakaryocytes warrant investigation in inflammatory disorders beyond COVID-19.
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Affiliation(s)
- Seth D. Fortmann
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL
| | - Michael J. Patton
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL
- Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham, Birmingham, AL
| | - Blake F. Frey
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer L. Tipper
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sivani B. Reddy
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL
| | - Cristiano P. Vieira
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL
| | - Vidya Sagar Hanumanthu
- Division of Clinical Immunology and Rheumatology, Department of Medicine and Microbiology, University of Alabama at Birmingham, Birmingham, AL
| | - Sarah Sterrett
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jason L. Floyd
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL
| | - Ram Prasad
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL
| | - Jeremy D. Zucker
- Biological Sciences Division, Pacific Northwest National Laboratories, Richland, WA
| | - Andrew B. Crouse
- Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham, Birmingham, AL
| | - Forest Huls
- Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham, Birmingham, AL
| | - Rati Chkheidze
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Peng Li
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Nathaniel B. Erdmann
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kevin S. Harrod
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Amit Gaggar
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Paul A. Goepfert
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Maria B. Grant
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew Might
- Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham, Birmingham, AL
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25
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Aldali JA, Alotaibi BA, Aldali HJ, Alasiri GA, Alaseem A, Almuqrin AM, Alshalani A, Alotaibi FT. Assessing the Impact of COVID-19 Vaccines on Sickle Cell Anaemia Patients: A Comparative Analysis of Biochemical and Haematological Parameters. Biomedicines 2023; 11:2203. [PMID: 37626700 PMCID: PMC10452730 DOI: 10.3390/biomedicines11082203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) vaccines have been developed to help prevent the spread of the virus infections. The COVID-19 vaccines, including Pfizer, Moderna, and AstraZeneca, have undergone rigorous testing and have demonstrated both safety and effectiveness. Extensive evidence supports their effectiveness in preventing severe illness, hospitalization, and mortality associated with COVID-19 infection. The administration of COVID-19 vaccines can directly affect hematological and biochemical parameters, with reported cases showing an association with thrombosis and thrombocytopenia. Therefore, it was hypothesized that COVID-19 vaccines may also influence hematological and biochemical markers in sickle cell patients. This study aimed to investigate the side effects of COVID-19 vaccines on sickle cell patients, providing a comprehensive evaluation of hematological and biochemical parameters. To our knowledge, this is the first study of its kind conducted in Saudi Arabia. The study included the evaluation of Pfizer and Oxford-AstraZeneca vaccines in sickle cell patients, measuring key parameters. Our findings revealed varying impacts of both vaccines on the ALT, AST, and CRP levels. Notably, CRP and ALT exhibited potential as indicators for renal disease, diabetes, and arthritis. However, further investigations are necessary to uncover the underlying mechanisms that drive these observed differences and comprehend their clinical implications for this vulnerable patient population. The unique nature of our study fills a crucial research gap and underscores the need for additional research in this area.
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Affiliation(s)
- Jehad A. Aldali
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Badi A. Alotaibi
- Department of Clinical Laboratory Sciences, Collage of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Hamzah J. Aldali
- Cellular and Molecular Medicine, College of Biomedical Science, University of Bristol, Bristol BS8 1QU, UK
| | - Glowi A. Alasiri
- Department of Biochemistry, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Ali Alaseem
- Department of Pharmacology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Abdulaziz M. Almuqrin
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Abdulrahman Alshalani
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Fahad T. Alotaibi
- Department of Physiology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 5701, Saudi Arabia
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26
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Bin Rubaian NF, Aljalfan AA, Almuhaidib SR. Management of coronavirus disease 2019 vaccine-induced cutaneous complications: A comprehensive literature review. J Family Community Med 2023; 30:161-170. [PMID: 37675215 PMCID: PMC10479027 DOI: 10.4103/jfcm.jfcm_3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 09/08/2023] Open
Abstract
Despite the numerous reports of cutaneous manifestations associated with vaccines for coronavirus disease 2019 (COVID-19), the relationship between COVID-19 vaccines and cutaneous side effects remains unevaluated. In this review, we examine these manifestations and their management. Reported dermatoses included injection-site reaction (early and delayed), type I allergic reaction, morbilliform eruption, pityriasis rosea, Sweet syndrome, lichen planus, psoriasis, herpes zoster reactivation, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN). The most common COVID-19 vaccination-related cutaneous manifestations are delayed local reactions, approximately 66% of which are associated with the Moderna vaccine, and 33% with the Pfizer vaccine. Aside from mild injection-site reactions, severe reactions include anaphylaxis and TEN. Most reactions, except for Stevens-Johnson syndrome and anaphylaxis, though unpredictable and unpreventable are mild and can be treated symptomatically. Findings from this review should allow primary care physicians and dermatologists to reach faster diagnosis and initiate prompt intervention.
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Affiliation(s)
- Nouf F. Bin Rubaian
- Department of Dermatology, King Fahad University Hospital, Al-Khobar, Saudi Arabia
| | - Abdullah A. Aljalfan
- Department of Dermatology, King Fahad University Hospital, Al-Khobar, Saudi Arabia
| | - Serene R. Almuhaidib
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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27
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Takedani K, Notsu M, Ishiai N, Asami Y, Uchida K, Kanasaki K. Graves' disease after exposure to the SARS-CoV-2 vaccine: a case report and review of the literature. BMC Endocr Disord 2023; 23:132. [PMID: 37316819 DOI: 10.1186/s12902-023-01387-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/12/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is characterized by immune system dysregulation after exposure to adjuvants, such as aluminum. Although cases of autoimmune thyroid diseases caused by ASIA have been reported, Graves' disease is one of the rarer diseases. There are some reports that vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause ASIA. Here, we describe a case of Graves' disease following SARS-CoV-2 vaccination and a review of the literature. CASE PRESENTATION A 41-year-old woman was admitted to our hospital because of palpitations and fatigue. Two weeks after receiving the second SARS-CoV-2 vaccine (BNT162b2, Coronavirus Modified Uridine messenger RNA (mRNA) Vaccine, Pfizer), she developed fatigue and gradually worsened. On admission, she exhibited thyrotoxicosis (thyroid-stimulating hormone (TSH) < 0.01 mIU/L (0.08-0.54), free triiodothyronine (FT3) 33.2 pmol/L (3.8-6.3), and free thyroxine (FT4) 72.1 pmol/L (11.6-19.3)) and palpitations associated with atrial fibrillation. TSH receptor antibody (TRAb) was positive (TRAb 5.0 IU/L (< 2.0)), and 99mTc scintigraphy showed diffuse uptake in the thyroid gland, suggesting that the thyrotoxicosis in this case was caused by Graves' disease. Thiamazole was prescribed to correct her condition, and soon after this treatment was initiated, her symptoms and thyroid hormone levels were significantly reduced. CONCLUSIONS This case report reinforces the potential correlation between ASIA affecting the thyroid and SARS-CoV-2 mRNA vaccines. The clinical course suggests that it is essential to consider the possibility of developing ASIA, such as Graves' disease, after exposure to the SARS-CoV-2 vaccine.
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Affiliation(s)
- Kai Takedani
- Department of Internal Medicine, Masuda Red Cross Hospital, Masuda, Shimane, Japan
- Department of Internal Medicine 1, Faculty of Medicine, Shimane University, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan
| | - Masakazu Notsu
- Department of Internal Medicine 1, Faculty of Medicine, Shimane University, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan.
| | - Naoto Ishiai
- Department of Internal Medicine, Masuda Red Cross Hospital, Masuda, Shimane, Japan
| | - Yu Asami
- Department of Internal Medicine, Masuda Red Cross Hospital, Masuda, Shimane, Japan
| | - Kazuhiko Uchida
- Department of Cardiology, Masuda Red Cross Hospital, Masuda, Shimane, Japan
| | - Keizo Kanasaki
- Department of Internal Medicine 1, Faculty of Medicine, Shimane University, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan
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Ogino Y, Namba K, Iwata D, Suzuki K, Mizuuchi K, Hiraoka M, Kitaichi N, Ishida S. A case of APMPPE-like panuveitis presenting with extensive outer retinal layer impairment following COVID-19 vaccination. BMC Ophthalmol 2023; 23:233. [PMID: 37226110 DOI: 10.1186/s12886-023-02978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Vaccination against the worldwide pandemic coronavirus disease 2019 (COVID-19) is underway; however, some cases of new onset uveitis after vaccination have been reported. We report a case of bilateral acute posterior multifocal placoid pigment epitheliopathy-like (AMPPE-like) panuveitis after COVID-19 vaccination in which the patient's pathological condition was evaluated using multimodal imaging. CASE PRESENTATION A 31-year-old woman experienced bilateral hyperemia and blurred vision starting 6 days after her second inoculation of the COVID-19 vaccination. At her first visit, her visual acuity was decreased bilaterally, and severe bilateral anterior chamber inflammation and bilateral scattering of cream-white placoid lesions on the fundus were detected. Optical coherence tomography (OCT) showed serous retinal detachment (SRD) and choroidal thickening in both eyes (OU). Fluorescein angiography (FA) revealed hypofluorescence in the early phase and hyperfluorescence in the late phase corresponding to the placoid legions. Indocyanine green angiography (ICGA) showed sharply marginated hypofluorescent dots of various sizes throughout the mid-venous and late phases OU. The patient was diagnosed with APMPPE and was observed without any medications. Three days later, her SRD disappeared spontaneously. However, her anterior chamber inflammation continued, and oral prednisolone (PSL) was given to her. Seven days after the patient's first visit, the hyperfluorescent lesions on FA and hypofluorescent dots on ICGA partially improved; however, the patient's best corrected visual acuity (BCVA) recovered only to 0.7 OD and 0.6 OS, and the impairment of the outer retinal layer was broadly detected as hyperautofluorescent lesions on fundus autofluorescence (FAF) examination and as irregularity in or disappearance of the ellipsoid and interdigitation zones on OCT, which were quite atypical for the findings of APMPPE. Steroid pulse therapy was performed. Five days later, the hyperfluorescence on FAF had disappeared, and the outer retinal layer improved on OCT. Moreover, the patient's BCVA recovered to 1.0 OU. Twelve months after the end of treatment, the patient did not show any recurrences. CONCLUSIONS We observed a case of APMPPE-like panuveitis after COVID-19 vaccination featuring some atypical findings for APMPPE. COVID-19 vaccination may induce not only known uveitis but also atypical uveitis, and appropriate treatment is required for each case.
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Affiliation(s)
- Yo Ogino
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Miki Hiraoka
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
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Lee ZM, Chen YC, Liu SC, Wang CC. Immune thrombocytopenia following SARS-CoV-2 vaccination in a female: Report of one case. Pediatr Blood Cancer 2023; 70:e30211. [PMID: 36726145 DOI: 10.1002/pbc.30211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Zon-Min Lee
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pharmacy, Tajen University, Pingtung, Taiwan
| | - Yu-Chieh Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Traditional Medicine, Chang Gung University, Linkou, Taiwan
| | - Shu-Chen Liu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chia-Chen Wang
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Moga S, Petric PS, Miron AA, Ifteni P, Teodorescu A. Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection. Am J Ther 2023:00045391-990000000-00146. [PMID: 37097999 DOI: 10.1097/mjt.0000000000001633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had multiple consequences for the health care system, especially for patients with mental illnesses. Schizophrenia patients particularly appear to have a higher risk of complications due to coronavirus-19 (COVID-19). Clozapine remains the gold standard for treatment-resistant schizophrenia (TRS). However, the COVID-19 pandemic had an important negative impact on clozapine treatment, mainly because of its administration protocol, which was very difficult to follow during the restrictions imposed in the pandemic, and its side effects in patients with COVID-19 infection. Vaccination is an effective method of avoiding SARS-CoV-2 infection or its severe complications, especially in susceptible populations. Data on adverse events after vaccination against COVID-19 are limited, both in the general population and in schizophrenia patients. STUDY QUESTION The study aimed to investigate the safety of COVID-19 vaccination in patients treated with clozapine for hematological parameters. STUDY DESIGN We conducted an analytical cross-sectional study between July 1, 2021, and June 30, 2022. We compared 2 groups of COVID-19 vaccinated patients who had previously experienced SARS-CoV-2 infection: The first group was treated with clozapine, whereas the second group was treated with other antipsychotics. MEASURES AND OUTCOMES The primary objective was to identify granulocytopenia, leukocytopenia, and lymphocytopenia. The results were measured after the second dose of the Pfizer-BioNTech vaccine. RESULTS This study included 100 patients. White blood cell count changes were limited to a few cases of mild granulocytopenia (8.16% in the clozapine group and 3.92% in the nonclozapine group, P = 0.37) with no cases of severe granulocytopenia or agranulocytosis. CONCLUSIONS As far as leukocyte counts are concerned, mRNA COVID-19 vaccination seems to be safe in patients treated with clozapine who previously had SARS-CoV-2 infection. Leukocyte changes had no clinical implications.
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Affiliation(s)
- Silvia Moga
- Universitatea Transilvania din Braşov, Facultatea de Medicina, Braşov, România; and
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, România
| | - Paula Simina Petric
- Universitatea Transilvania din Braşov, Facultatea de Medicina, Braşov, România; and
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, România
| | - Ana Aliana Miron
- Universitatea Transilvania din Braşov, Facultatea de Medicina, Braşov, România; and
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, România
| | - Petru Ifteni
- Universitatea Transilvania din Braşov, Facultatea de Medicina, Braşov, România; and
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, România
| | - Andreea Teodorescu
- Universitatea Transilvania din Braşov, Facultatea de Medicina, Braşov, România; and
- Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, România
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31
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Yangi K, Demir DD, Uzunkol A. Intracranial Hemorrhage After Pfizer-BioNTech (BNT162b2) mRNA COVID-19 Vaccination: A Case Report. Cureus 2023; 15:e37747. [PMID: 37214039 PMCID: PMC10193189 DOI: 10.7759/cureus.37747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
The Coronavirus 2019 (COVID-19) pandemic has affected over 700 million people worldwide and caused nearly 7 million deaths. Vaccines currently developed or in development are the most effective tools for curbing the pandemic and mitigating its impacts. In Turkey, inoculation with the Pfizer-BioNTech COVID-19 vaccine (BNT162b2, also known as tozinameran) has been approved. We report a 56-year-old female patient with underlying essential hypertension who experienced intracranial hemorrhage after receiving her first dose of tozinameran. The patient underwent immediate surgical evacuation of the hematoma, during which a left middle cerebral artery bifurcation aneurysm was macroscopically identified and clipped. The patient was pronounced deceased on the second postoperative day. This is the second case of intracranial hemorrhage following tozinameran administration caused by a ruptured middle cerebral artery bifurcation aneurysm. Upon analyzing the case, there might be a connection between the vaccine's potential immune-triggering effect on hemodynamic patterns and the rupture of the previously unknown cerebral aneurysm. However, these severe complications do not justify avoiding vaccines; further studies are needed. This study emphasizes the need for increased vigilance in patients with underlying systemic comorbidities who have recently been vaccinated and to share our insights into the potential relationship between tozinameran and intracranial hemorrhage.
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Affiliation(s)
- Kivanc Yangi
- Neurological Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, TUR
| | - Doga D Demir
- Emergency Medicine, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, TUR
| | - Ajlan Uzunkol
- Neurological Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, TUR
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Chu B, Qu Y. Comment on: Effects of COVID-19 vaccination on platelet counts and bleeding in children, adolescents, and young adults with immune thrombocytopenia. Pediatr Blood Cancer 2023; 70:e30123. [PMID: 36468649 PMCID: PMC9877669 DOI: 10.1002/pbc.30123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Bingyang Chu
- Department of Hematology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Sichuan, China
| | - Ying Qu
- Department of Hematology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Sichuan, China
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Bidari A, Asgarian S, Pour Mohammad A, Naderi D, Anaraki SR, Gholizadeh Mesgarha M, Naderkhani M. Immune thrombocytopenic purpura secondary to COVID-19 vaccination: A systematic review. Eur J Haematol 2023; 110:335-353. [PMID: 36562217 PMCID: PMC9880659 DOI: 10.1111/ejh.13917] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This systematic review aimed to retrieve patients diagnosed with de novo immune thrombocytopenic purpura (ITP) after COVID-19 immunization to determine their epidemiological characteristics, clinical course, therapeutic strategies, and outcome. MATERIALS AND METHODS We conducted the review using four major databases, comprising PubMed, Scopus, Web of Science, and the Cochrane library, until April 2022. A systematic search was performed in duplicate to access eligible articles in English. Furthermore, a manual search was applied to the chosen papers' references to enhance the search sensitivity. Data were extracted and analyzed with the SPSS 20.1 software. RESULTS A total of 77 patients with de novo COVID-19 vaccine-associated ITP were identified from 41 studies, including 31 case reports and 10 case series. The median age of patients who developed COVID-19 vaccine-associated ITP was 54 years (IQR 36-72 years). The mRNA-based COVID-19 vaccines, including BNT16B2b2 and mRNA-1273, were most implicated (75.4%). Those were followed by the adenovirus vector-based vaccines, inclusive of ChAdOx1 nCoV-19 and vAd26.COV2.S. No report was found relating ITP to other COVID-19 vaccines. Most cases (79.2%) developed ITP after the first dose of COVID-19 vaccination. 75% of the patients developed ITP within 12 days of vaccination, indicating a shorter lag time compared to ITP after routine childhood vaccinations. Sixty-seven patients (87%) patients were hospitalized. The management pattern was similar to primary ITP, and systemic glucocorticoids, IVIg, or both were the basis of the treatment in most patients. Most patients achieved therapeutic goals; only two individuals required a secondary admission, and one patient who presented with intracranial hemorrhage died of the complication. CONCLUSIONS De novo ITP is a rare complication of COVID-19 vaccination, and corresponding reports belong to mRNA-based and adenovirus vector-based vaccines, in order of frequency. This frequency pattern may be related to the scale of administration of individual vaccines and their potency in inducing autoimmunity. The more the COVID-19 vaccine is potent to induce antigenic challenge, the shorter the lag time would be. Most patients had a benign course and responded to typical treatments of primary ITP.
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Affiliation(s)
- Ali Bidari
- Department of Rheumatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sara Asgarian
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Arash Pour Mohammad
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Delaram Naderi
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | | | - Mahya Naderkhani
- Department of Emergency medicine, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Jacobs JW, Booth GS, Adkins BD. Analysis of hematologic adverse events reported to a national surveillance system following COVID-19 bivalent booster vaccination. Ann Hematol 2023; 102:955-959. [PMID: 36795118 PMCID: PMC9933824 DOI: 10.1007/s00277-023-05136-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
Hematologic complications, including vaccine-induced immune thrombotic thrombocytopenia (VITT), immune thrombocytopenia (ITP), and autoimmune hemolytic anemia (AIHA), have been associated with the original severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. However, on August 31, 2022, new formulations of the Pfizer-BioNTech and Moderna vaccines were approved for use without clinical trial testing. Thus, any potential adverse hematologic effects with these new vaccines remain unknown. We queried the US Centers for Disease Control Vaccine Adverse Event Reporting System (VAERS), a national surveillance database, through February 3, 2023, all reported hematologic adverse events that occurred within 42 days of administration of either the Pfizer-BioNTech or Moderna Bivalent COVID-19 Booster vaccine. We included all patient ages and geographic locations and utilized 71 unique VAERS diagnostic codes pertaining to a hematologic condition as defined in the VAERS database. Fifty-five reports of hematologic events were identified (60.0% Pfizer-BioNTech, 27.3% Moderna, 7.3% Pfizer-BioNTech bivalent booster plus influenza, 5.5% Moderna bivalent booster plus influenza). The median age of patients was 66 years, and 90.9% (50/55) of reports involved a description of cytopenias or thrombosis. Notably, 3 potential cases of ITP and 1 case of VITT were identified. In one of the first safety analyses of the new SARS-CoV-2 booster vaccines, we identified few adverse hematologic events (1.05 per 1,000,000 doses), most of which could not be definitively attributed to vaccination. However, three reports of possible ITP and one report of possible VITT highlight the need for continued safety monitoring of these vaccines as their use expands and new formulations are authorized.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, 55 Park Street, New Haven, CT, 06520, USA.
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian D Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern, Dallas, TX, USA
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35
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Beltrami Moreira M, Bussel JB, Lee EJ. SARS-CoV-2 Vaccination: Long-Term Follow-Up of Pre-existing and De Novo Immune Thrombocytopenia. Thromb Haemost 2023; 123:482-486. [PMID: 36539200 DOI: 10.1055/a-2002-1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Marina Beltrami Moreira
- Division of Hematology and Medical Oncology, New York Presbyterian Hospital - Weill Cornell Medicine, New York, New York, United States
| | - James B Bussel
- Division of Hematology and Medical Oncology, New York Presbyterian Hospital - Weill Cornell Medicine, New York, New York, United States.,Division of Pediatric Hematology/Oncology, New York Presbyterian Hospital - Weill Cornell, New York, New York, United States
| | - Eun Ju Lee
- Division of Hematology and Medical Oncology, New York Presbyterian Hospital - Weill Cornell Medicine, New York, New York, United States
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36
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Issakov G, Tzur Y, Friedman T, Tzur T. Abnormal Uterine Bleeding Among COVID-19 Vaccinated and Recovered Women: a National Survey. Reprod Sci 2023; 30:713-721. [PMID: 35986194 PMCID: PMC9390105 DOI: 10.1007/s43032-022-01062-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
The objective of this research was to characterize menstrual changes including amount, duration, and frequency among COVID-19 vaccinated and infected women. We conducted an online nationwide questionnaire survey on premenopausal, non-pregnant women over 18 years of age in Israel, querying about any changes in their menstrual patterns after COVID-19 vaccination or infection. In total, 10,319 women responded, of which 7904 met the inclusion criteria. Changes in menstrual patterns following COVID-19 vaccination or infection were reported in 3689/7476 (49.3%) women compared with 202/428 (47.2%) women, respectively, (P = .387). The most commonly described menstrual disturbance was excessive bleeding (heavy, prolonged, or intermenstrual) in both the vaccinated and infected groups, (80.6% versus 81.4%, respectively, P = .720). Among women who experienced abnormal uterine bleeding (AUB), in most cases (61.1%), it occurred between the vaccination and the ensuing menstrual period. Menstrual disturbances were similar in type among the vaccinated and infected women. In conclusion, AUB emerged as a side effect of the BNT162b2 vaccine and a symptom of the COVID-19 infection and was characterized mainly by excessive bleeding. Although the precise incidence could not be determined in this study, the type of bleeding disorder as well as the characterization of risk factors including increasing age and a baseline menstrual pattern of prolonged, frequent, and heavy menses are well defined. The incidence and the long-term consequences of the BNT162b2 vaccine on uterine bleeding warrant further investigation.
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Affiliation(s)
- Gal Issakov
- Obstetrics Gynecology and IVF Department, Laniado Medical Center, Netanya, Israel.
- Adelson Medical School, Ariel University, Ariel, Israel.
| | - Yossi Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Friedman
- Obstetrics Gynecology and IVF Department, Laniado Medical Center, Netanya, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Tamar Tzur
- Adelson Medical School, Ariel University, Ariel, Israel
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Shishido AA, Barnes AH, Narayanan S, Chua JV. COVID-19 Vaccines-All You Want to Know. Semin Respir Crit Care Med 2023; 44:143-172. [PMID: 36646092 DOI: 10.1055/s-0042-1759779] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has led to an unprecedented public health crisis. The collective global response has led to production of multiple safe and effective vaccines utilizing novel platforms to combat the virus that have propelled the field of vaccinology forward. Significant challenges to universal vaccine effectiveness remain, including immune evasion by SARS-CoV-2 variants, waning of immune response, inadequate knowledge of correlates of protection, and dosing in special populations. This review serves as a detailed evaluation of the development of the current SARS-CoV-2 vaccines, their effectiveness, and challenges to their deployment as a preventive tool.
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Affiliation(s)
- Akira A Shishido
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia
| | - Ashley H Barnes
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shivakumar Narayanan
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joel V Chua
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
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38
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Abrams CS, Barnes GD. SARS-CoV-2 Vaccination-Induced Thrombotic Thrombocytopenia: A Rare but Serious Immunologic Complication. Annu Rev Med 2023; 74:65-74. [PMID: 35850494 DOI: 10.1146/annurev-med-043021-015237] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Billions of individuals worldwide have benefited from the unprecedented large-scale rollout of COVID-19 vaccines. Given the sheer number of people that have received these vaccines, it is not surprising that rare side effects are reported that were not previously detected in the phase III vaccine trials. This review addresses one rare complication called SARS-CoV-2 vaccination-induced thrombotic thrombocytopenia (VITT). It occurs in approximately 1/50,000 to 1/100,000 recipients of the adenovirus vector-based COVID-19 vaccines made by AstraZeneca-Oxford or Johnson & Johnson. Information on VITT syndrome was disseminated quickly via social media and publications after it was first discovered. Initial observations associating VITT with specific patient populations, thrombus locations, and outcomes associated with heparin therapy have since been refined with additional clinical experience. In this review, we discuss what is currently known about the incidence, pathophysiology, diagnosis, and treatment of VITT.
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Affiliation(s)
- Charles S Abrams
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA;
| | - Geoffrey D Barnes
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA;
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39
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Spiliopoulou P, Janse van Rensburg HJ, Avery L, Kulasingam V, Razak A, Bedard P, Hansen A, Chruscinski A, Wang B, Kulikova M, Chen R, Speers V, Nguyen A, Lee J, Coburn B, Spreafico A, Siu LL. Longitudinal efficacy and toxicity of SARS-CoV-2 vaccination in cancer patients treated with immunotherapy. Cell Death Dis 2023; 14:49. [PMID: 36670100 PMCID: PMC9853486 DOI: 10.1038/s41419-022-05548-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/17/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023]
Abstract
Despite more than 2 years having elapsed since the onset of SARS-CoV-2 pandemic, a level of hesitation around increased SARS-CoV-2 vaccine toxicity in cancer patients receiving immunotherapy (IO) remains. This hesitation stems from the idea that IO agents could elicit an overwhelming immune stimulation post vaccination and therefore increase the risk of vaccine-related toxicity. The aim of our study was to explore serological responses to SARS-CoV-2 vaccination in patients treated with IO and describe the level of immune stimulation using parameters such as blood cytokines, autoantibody levels and immune related adverse events (irAEs) post vaccination. Fifty-one evaluable patients were enrolled in this longitudinal study. Absolute levels and neutralization potential of anti-SARS-CoV-2 antibodies were not significantly different in the IO group compared to non-IO. Chemotherapy adversely affected seroconversion when compared to IO and/or targeted treatment. Following vaccination, the prevalence of grade ≥2 irAEs in patients treated with IO was not higher than the usual reported IO toxicity. We report, for the first time, that anti-SARS-CoV-2 vaccination, elicited the generation of five autoantibodies. The significantly increased autoantibodies were IgM autoantibodies against beta-2 glycoprotein (p = 0.02), myeloperoxidase (p = 0.03), nucleosome (p = 0.041), SPLUNC2 (p < 0.001) and IgG autoantibody against Myosin Heavy Chain 6 (MYH6) (p < 0.001). Overall, comprehensive analysis of a small cohort showed that co-administration of SARS-CoV-2 vaccine and IO is not associated with increased irAEs. Nevertheless, the detection of autoantibodies post anti-SARS-CoV-2 vaccination warrants further investigation (NCT03702309).
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Affiliation(s)
| | | | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Vathany Kulasingam
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Albiruni Razak
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philippe Bedard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Aaron Hansen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrzej Chruscinski
- Mutli-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Ben Wang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Maria Kulikova
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Rachel Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Vanessa Speers
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alisa Nguyen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jasmine Lee
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Bryan Coburn
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Anna Spreafico
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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Hromić-Jahjefendić A, Barh D, Uversky V, Aljabali AA, Tambuwala MM, Alzahrani KJ, Alzahrani FM, Alshammeri S, Lundstrom K. Can COVID-19 Vaccines Induce Premature Non-Communicable Diseases: Where Are We Heading to? Vaccines (Basel) 2023; 11:vaccines11020208. [PMID: 36851087 PMCID: PMC9960675 DOI: 10.3390/vaccines11020208] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
According to the WHO, as of January 2023, more than 850 million cases and over 6.6 million deaths from COVID-19 have been reported worldwide. Currently, the death rate has been reduced due to the decreased pathogenicity of new SARS-CoV-2 variants, but the major factor in the reduced death rates is the administration of more than 12.8 billion vaccine doses globally. While the COVID-19 vaccines are saving lives, serious side effects have been reported after vaccinations for several premature non-communicable diseases (NCDs). However, the reported adverse events are low in number. The scientific community must investigate the entire spectrum of COVID-19-vaccine-induced complications so that necessary safety measures can be taken, and current vaccines can be re-engineered to avoid or minimize their side effects. We describe in depth severe adverse events for premature metabolic, mental, and neurological disorders; cardiovascular, renal, and autoimmune diseases, and reproductive health issues detected after COVID-19 vaccinations and whether these are causal or incidental. In any case, it has become clear that the benefits of vaccinations outweigh the risks by a large margin. However, pre-existing conditions in vaccinated individuals need to be taken into account in the prevention and treatment of adverse events.
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Affiliation(s)
- Altijana Hromić-Jahjefendić
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina
| | - Debmalya Barh
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, India
- Correspondence: (D.B.); (K.L.)
| | - Vladimir Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer's Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Alaa A. Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid 21163, Jordan
| | - Murtaza M. Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln LN6 7TS, UK
| | - Khalid J. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Fuad M. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Saleh Alshammeri
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Kenneth Lundstrom
- PanTherapeutics, Route de Lavaux 49, CH1095 Lutry, Switzerland
- Correspondence: (D.B.); (K.L.)
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Osibogun AO, Shuaib FM, Adeyeye CM, Onajole AT, Ejembi CL, Banwat ME, Wright KO, Mohammed A, Adeleye OA, Yahya SJ, Ifeadike CO, Elemuwa UU, Bassey BE, Oluwole EO, Erinoso OA. Cohort event monitoring for safety signal detection in adult individuals 18 years and above after immunisation with coronavirus disease 2019 vaccines in Nigeria. Niger Postgrad Med J 2023; 30:18-24. [PMID: 36814159 DOI: 10.4103/npmj.npmj_299_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Introduction In Nigeria, immunisation with coronavirus disease 2019 (COVID-19) vaccines commenced in March 2021. COVISHIELD from AstraZeneca (AZ), a viral vector vaccine, was the brand administered in the first phase of vaccinations for pre-determined eligible adults 18 years and above. As more brands of COVID-19 vaccines have been introduced in Nigeria, identifying effective and safe vaccine brands is essential to pharmacovigilance and public health. The current study assessed the safety of the AZ-AZD1222 (ChAdOx1) COVID-19 vaccine in adults during the first phase of the vaccination exercise in Nigeria. Methodology We conducted a descriptive analysis of safety data from selected vaccination sites across six states in Nigeria between June 2021 and September 2021. Respondents were monitored over 3 months for local and systemic reactions, as well as hospitalisation and mortality. Measures obtained from respondents include age, sex, pre-existing comorbidity, local and systemic reactions to vaccines, timing onset of reactions, hospitalisation and mortality. Bivariate and multivariable regression models were used to assess factors associated with vaccine reactogenicity. Results A total of 1284 individuals were enrolled in the cohort study from the six selected states (Anambra, Borno, Edo, Katsina, Lagos and Plateau) representing the geopolitical zones of Nigeria. A total of 675 individuals or 52.6% of enrolees reported non-serious adverse effects, and only one individual or 0.08% reported a serious adverse event following immunisation in the first 7 days after vaccination. None of the enrolled participants reported adverse events requiring hospitalisation. The most common self-reported symptoms amongst vaccine recipients were tenderness at the injection site 20.9% and fever 20.3%. A majority of symptoms (55.5%) occurred on or before the 3rd day after vaccination. Multivariable logistic regression model showed that age 60 years or above (vs. 18-24 years) was significantly associated with a lower likelihood of a vaccine-related symptomatic reaction (adjusted odds ratio: 0.35; 95% confidence interval: 0.20-0.61). There was no reported mortality amongst all the enrolled and followed-up vaccine recipients. Conclusion Our findings suggest that the safety profile of the AZ vaccine is acceptable, and the observed symptoms were mild and mostly within the first 3 days following vaccination. Vaccine recipients will benefit from counselling about potential transient reactions, and improving public awareness can potentially encourage the uptake of vaccines and reduce the spread of the COVID-19 pandemic.
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Affiliation(s)
- Akinsanya O Osibogun
- Department of Community Health and Primary Care, College of Medicine University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Ikeja, Nigeria
| | - Faisal Mohammed Shuaib
- National Primary Health Care Development Agency, Office of the Executive Director, Abuja, Nigeria
| | | | - Adebayo Temitayo Onajole
- Department of Community Health and Primary Care, College of Medicine University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Ikeja, Nigeria
| | - Clara Ladi Ejembi
- Department of Community Medicine, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Mathilda Edmund Banwat
- Department of Community Health, University of Jos, Nigeria/Jos University Teaching Hospital, Jos, Nigeria
| | - Kikelomo Ololade Wright
- Department of Community Health and Primary Care, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Abdullahi Mohammed
- Department of Pathology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Omokhoa Adedayo Adeleye
- Department of Public Health and Community Medicine, University of Benin/University of Benin Teaching Hospital, Benin City, Nigeria
| | - Shuaib Jauro Yahya
- Department of Community Health, University of Maiduguri/University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | | | | | - Bassey Ekposen Bassey
- National Primary Health Care Development Agency, Office of the Executive Director, Abuja, Nigeria
| | - Esther O Oluwole
- Department of Community Health and Primary Care, College of Medicine University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Ikeja, Nigeria
| | - Olufemi Akinwunmi Erinoso
- Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, Lagos, Nigeria; Division of Socio-behavioral Health/Health Policy, University of Nevada, Reno, USA
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Siraj EA, Yayehrad AT, Yilma Z, Getahun T, Melaku MS, Bizuneh GK, Kifle ZD, Yimenu DK. Post COVID-19 Vaccination Side Effects and Associated Factors Among Vaccinated Clients in Bahir Dar City, Ethiopia. SAGE Open Nurs 2023; 9:23779608231172358. [PMID: 37139168 PMCID: PMC10150424 DOI: 10.1177/23779608231172358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/25/2023] [Accepted: 04/10/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The lack of local side effect profiles for vaccines could hinder vaccination uptake. Since all COVID-19 vaccines are brand-new medications, it is crucial to keep track of any safety related concern. Objective This study is aimed to investigate post-vaccination side effects of COVID-19 vaccines and associated factors in Bahir Dar city. Method An institutional-based cross-sectional study was conducted among vaccinated clients. A simple random and a systematic random sampling method were used to select the health facilities and the participants, respectively. Bi-variable and multivariable binary logistic regression analyses were executed with odds ratio at 95% confidence intervals at p < .05. Results A total of 72(17.4%) participants reported at least one side effect following vaccination. The proportion prevalence was higher after the first dose than that of the second dose and the difference was also found to be statistically significant. In the multivariable logistic regression analysis female participants (AOR = 3.39, 95% CI = 1.53, 7.52), participants with a history of regular medication use (AOR = 3.34, 95% CI = 1.52, 7.33), participants aged 55 and above (AOR = 2.93, 95% CI = 1.23, 7.01), and participants who had taken only the first dose (AOR = 14.81, 95% CI = 6.40, 34.31) were more likely to develop side effects for COVID 19 vaccination compared to their counterparts. Conclusion A significant number (17.4%) of participants reported at least one side effect following vaccination. Sex, medication, occupation, age, and type of vaccination dose were factors statistically associated with the reported side effects.
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Affiliation(s)
- Ebrahim Abdela Siraj
- Department of Pharmacy, College of
Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashagrachew Tewabe Yayehrad
- Department of Pharmacy, College of
Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Ashagrachew Tewabe Yayehrad; Department of
Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir
Dar, PO Box: 79, Ethiopia.
| | - Zewdu Yilma
- Department of Pharmacy, College of
Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tamyalew Getahun
- Addis Alem Primary Hospital, Amhara
Regional Health Beuro, Bahir Dar, Ethiopia
| | - Mequannent Sharew Melaku
- Department of Health Informatics,
Institute of Public Health, College of Medicine and Health Sciences, University of
Gondar, Gondar, Ethiopia
| | - Gizachew Kassahun Bizuneh
- Department of Pharmacognosy, School of
Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar,
Ethiopia
| | - Zemene Demelash Kifle
- Department of Pharmacology, School of
Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar,
Ethiopia
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Kaicker S, Martinko K, Bussel JB. Effects of COVID-19 vaccination on platelet counts and bleeding in children, adolescents, and young adults with immune thrombocytopenia. Pediatr Blood Cancer 2023; 70:e30051. [PMID: 36317671 PMCID: PMC9878097 DOI: 10.1002/pbc.30051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
Abstract
Coronavirus disease 2019 (COVID-19) vaccines rarely cause de novo immune thrombocytopenia (ITP) but may worsen preexisting ITP in adults. Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines impact platelet counts and bleeding in children, adolescents, and young adults (C-AYA) with preexisting ITP is unknown. We report here the very limited effect of COVID-19 vaccination on platelet counts and bleeding in a single-center series of 2 C-AYA with ITP. No patient experienced worsening bleeding and only one child had a significant decrease in platelet count which improved spontaneously to her baseline without intervention. SARS-CoV2 vaccination was safe in C-AYA with ITP in this small cohort.
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Affiliation(s)
- Shipra Kaicker
- Department of Pediatrics, Division of Hematology/OncologyWeill Cornell MedicineNew YorkUSA
| | - Kirsten Martinko
- Department of Pediatrics, Division of Hematology/OncologyWeill Cornell MedicineNew YorkUSA
| | - James B. Bussel
- Department of Pediatrics, Division of Hematology/OncologyWeill Cornell MedicineNew YorkUSA
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Muacevic A, Adler JR, Baig I, Modi V. Moderna COVID-19 Vaccine: A New Player in Vaccine-Induced Thrombosis Without Thrombocytopenia. Cureus 2023; 15:e34015. [PMID: 36824535 PMCID: PMC9941030 DOI: 10.7759/cureus.34015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 01/22/2023] Open
Abstract
This is a case of a 31-year-old male with no past medical history who developed extensive pulmonary embolism (PE) and deep venous thrombosis (DVT) three days after receiving the second dose of the Moderna vaccine. The patient presented with left calf swelling and mild shortness of breath, with no fever or hemodynamic instability. Doppler ultrasound of the left lower extremity showed thrombus in the common femoral, superior, mid-, and distal femoral, popliteal, and posterior tibial veins. Chest CT angiography (CTA) visualized extensive pulmonary emboli in the bilateral main pulmonary, lobar, and segmental arteries. Comprehensive hypercoagulable workup was unrevealing. The leading diagnosis was postulated as vaccine-induced thrombosis (VIT). Due to the diagnosis of bilateral sub-massive PE, the patient was initiated on enoxaparin and continued on direct-acting oral anticoagulation for at least one year. Our report showcases a plausible link between the Moderna vaccine and thrombosis due to the extensive and unprovoked nature of DVT/PE in this patient with a negative hypercoagulable workup. Although the mechanisms behind the messenger ribonucleic acid (mRNA) and double-stranded deoxyribonucleic acid (dsDNA) vaccines vary, the possibility of vaccine-induced thrombosis (VIT) after the Moderna vaccine is highly probable. Vaccine-induced thrombosis should be considered in a patient presenting with unprovoked thrombosis after the Moderna COVID-19 vaccine, and further research needs to be conducted to ascertain the correlation. However, these findings should not dissuade the use of the Moderna vaccine given its proven benefits.
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Qasim H, Rahhal A, Husain A, Alammora A, Alsa’ed K, Alsayed AAM, Faiyoumi B, Maen AbuAfifeh L, Abu-Tineh M, Alshurafa A, Yassin MA. Immune Thrombocytopenia Relapse in Patients Who Received mRNA COVID-19 Vaccines. J Blood Med 2023; 14:295-302. [PMID: 37082002 PMCID: PMC10112532 DOI: 10.2147/jbm.s396026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 04/22/2023] Open
Abstract
Background Immune thrombocytopenia (ITP) is a blood disorder in which antibodies coating platelets cause platelet destruction in the spleen with a resultant low platelet count and an increased tendency for bleeding. Coronavirus disease 2019 (COVID-19) is an illness caused by SARS-CoV-2. Though pneumonia and respiratory failure are major causes of morbidity and mortality, multisystemic complications were identified, including hematological ones. Several ITP relapse cases post-mRNA SARS-CoV-2 vaccines have been reported, and different pathophysiological theories have been proposed. Purpose The objective of this study is to identify the causal relationship between mRNA COVID-19 vaccines and ITP relapse, to highlight the longer-term effect of these vaccines on the platelet count more than 6 months after receiving the vaccine, and to identify if there is a statistical difference between Comirnaty and Spikevax vaccines on ITP relapse rate. Patients and Methods In this retrospective study, 67 patients with known ITP were followed before and after receiving the mRNA COVID-19 vaccine. The follow-up parameters included platelet counts when available and bleeding symptoms. All patients were adults over 18 years old, with no other identified causes of thrombocytopenia. Forty-seven patients received the Comirnaty vaccine, and 20 patients received the Spikevax vaccine. Results Data analysis showed 6% ITP relapse in the first 3 months, and a 10% relapse rate 3-6 months after receiving one of the mRNA COVID-19 vaccines, with no statically significant difference between the two vaccines. Conclusion mRNA COVID-19 vaccines increase the risk of ITP relapse and can lead to a prolonged reduction in platelet count in a proportion of ITP patients, with no statistically significant difference between Comirnaty and Spikevax vaccines.
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Affiliation(s)
- Hana Qasim
- Hematology-Oncology Department, National Centre for Cancer Care & Research, Doha, Qatar
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- Correspondence: Hana Qasim; Khaled Alsa’ed, Email ;
| | - Alaa Rahhal
- MSc Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Husain
- Infectious Disease Department, Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Khaled Alsa’ed
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Baha Faiyoumi
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammad Abu-Tineh
- Hematology-Oncology Department, National Centre for Cancer Care & Research, Doha, Qatar
| | - Awni Alshurafa
- Hematology-Oncology Department, National Centre for Cancer Care & Research, Doha, Qatar
| | - Mohamed A Yassin
- Hematology-Oncology Department, National Centre for Cancer Care & Research, Doha, Qatar
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Al-Samkari H. COVID-19 vaccination and immune thrombocytopenia: Cause for vigilance, but not panic. Res Pract Thromb Haemost 2023; 7:100039. [PMID: 36820404 PMCID: PMC9930930 DOI: 10.1016/j.rpth.2023.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 02/17/2023] Open
Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Choi PYI, Hsu D, Tran HA, Tan CW, Enjeti A, Chen VMY, Merriman E, Yong AS, Simpson J, Gardiner E, Cherbuin N, Curnow J, Pepperell D, Bird R. Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients. Res Pract Thromb Haemost 2023; 7:100009. [PMID: 36531670 PMCID: PMC9744687 DOI: 10.1016/j.rpth.2022.100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 01/12/2023] Open
Abstract
Background Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. After index case fatalities, there was concern among patients both with and without a prior history of ITP in Australia. Objectives To describe treatment outcomes of ITP after COVID-19 vaccination and compare relapsed vs historical pre-COVID-19 ITP cohorts. Methods We collected ITP cases in Australia within 6 weeks of receiving any COVID-19 vaccination as part of primary vaccination (up to October 17, 2021). Second, we reviewed platelet charts in a historical ITP cohort to determine whether platelet variability was distinct from relapsed ITP after vaccination. Results We report on 50 patients (37 de novo, 13 relapsed ITP) vaccinated from March 22, 2021, to October 17, 2021. Although there was 1 fatality, bleeding was otherwise mostly minor: (70% WHO bleeding grade <2). De novo ITP was more likely after AstraZeneca ChAdOx1 nCoV-19 (89%) than Pfizer BNT162b2 (11%). Most patients responded quickly (median, 4 days; complete response, 40 of 45 [89%]). In the historical cohort, only 6 of 47 patients exhibited platelet variability (>50% decrease and platelets <100 × 109/L), but median platelet nadir was significantly higher than vaccination relapse (27 vs 6 × 109/L, P =.005). Conclusion ITP was more frequently reported after AstraZeneca ChAdOx1 nCoV-19 than Pfizer BNT162b2 vaccination. Standard ITP treatments remain highly effective for de novo and relapsed ITP (96%). Although thrombocytopenia can be severe after vaccination, bleeding is usually mild. Despite some sampling bias, our data do not support a change in treatment strategies for patients with ITP after vaccination.
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Affiliation(s)
- Philip Young-Ill Choi
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Correspondence Philip Choi, Haematology Department, Canberra Region Cancer Centre, Level 5, Building 19, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia. @philbaggins
| | - Danny Hsu
- Liverpool Hospital (New South Wales Health Pathology), Liverpool, NSW, Australia
- University of New South Wales, Australia
| | | | - Chee Wee Tan
- Royal Adelaide Hospital, South Australia Pathology, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Anoop Enjeti
- Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | | | - Eileen Merriman
- Waitemata District Health Board, Department of Haematology, New Zealand
| | - Agnes S.M. Yong
- Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Jock Simpson
- Port Macquarie Base Hospital, New South Wales, Australia
| | - Elizabeth Gardiner
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jennifer Curnow
- Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Dominic Pepperell
- Fiona Stanley Hospital (PathWest), Murdoch, Western Australia, Australia
| | - Robert Bird
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Konstantinov K, Dolladille C, Gillet B, Alexandre J, Aouba A, Deshayes S, Repesse Y. Drug-associated acquired hemophilia A: an analysis based on 185 cases from the WHO pharmacovigilance database. Haemophilia 2023; 29:186-192. [PMID: 36367755 DOI: 10.1111/hae.14692] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Acquired hemophilia A (AHA) is a rare autoimmune hemorrhagic disease occurring in several underlying conditions. Drug-associated AHA (D-AHA) is poorly addressed nowadays. AIM This work aims to identify and characterize which drugs are associated with AHA using the WHO global database of reported potential effects of medicinal products (VigiBase). METHODS First, we realized a disproportionality analysis using the information component (IC) to identify D-AHA in VigiBase. IC compares observed- and expected-values in order to find associations between drugs and adverse drug reactions (ADRs) using disproportionate Bayesian reporting. IC025 is the lower end of a 95% credibility interval for the IC. Then, we collected cases of drugs significantly associated with AHA from July 2004 to November 2021. RESULTS 14 drugs with IC025 > 0 were identified representing a total of 185 cases. D-AHA occurred more frequently in men (59%) than women (41%). The median (min-max) age at onset was 75 years (8-98). The median [Q1-Q3] time to onset of D-AHA from the start of the suspected drug was 30 days [9.5-73.75] and 10% of cases resulted in a fatality. The drugs associated with the highest IC025 (IC025 > 2) were Clopidogrel, Alemtuzumab, Omalizumab. This study retrieved for the first time three usually used drugs (3/14) that exhibit a significant pharmacovigilance signal for D-AHA. CONCLUSION This worldwide pharmaco-epidemiologic study updates the list of the drugs associated with AHA. The clinician should be aware of these possible severe ADR, which might require larger epidemiological and pathophysiologic studies.
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Affiliation(s)
| | - Charles Dolladille
- UNICAEN, EA4650 SEILIRM, CHU de Caen Normandie, Normandie University, Caen, France.,Department of Pharmacology, CHU de Caen Normandie, Caen, France
| | | | - Joachim Alexandre
- UNICAEN, EA4650 SEILIRM, CHU de Caen Normandie, Normandie University, Caen, France.,Department of Pharmacology, CHU de Caen Normandie, Caen, France
| | - Achille Aouba
- Department of Internal Medicine, UNICAEN, CHU de Caen Normandie, Normandie University, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, UNICAEN, CHU de Caen Normandie, Normandie University, Caen, France
| | - Yohann Repesse
- Haematology Laboratory, CHU Caen Normandie, Caen, France.,Unicaen, Inserm, Physiopathology and Imaging of Neurological Disorders (PhIND), Normandie University, Caen, France
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Neutropenia Secondary to SARS-Cov2 Vaccination in Post-Hematopoietic Stem Cell Transplant (HSCT) Patients. Mediterr J Hematol Infect Dis 2023; 15:e2023014. [PMID: 36908872 PMCID: PMC10000821 DOI: 10.4084/mjhid.2023.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023] Open
Abstract
SARS-Cov2 s, caused a high mortality in patients with some degree of immunosuppression, like those that receive a hematopoietic progenitor transplant. Since December 2020, several vaccines have been developed having been key in decreasing complications and mortality in this group of patients. Different articles have described the presence of thrombopenia related to the administration of vaccines, however, there are few data on the occurrence of neutropenia as a side effect after administration. We present several cases of neutropenia (defined as absolute neutrophil count (ANC) less than 2,000/mm3), after vaccination in hematopoietic progenitor transplant (HPT) recipients performed in our center during 2021.
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50
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Ruzicka M, Wurm S, Lindner L, Dreyling M, von Bergwelt-Baildon M, Boeck S, Giessen-Jung C, Milani V, Stemmler JH, Subklewe M, Weigert O, Spiekermann K. Treatment, outcome and re-vaccination of patients with SARS-CoV-2 vaccine-associated immune thrombocytopenia. Infection 2023; 51:231-238. [PMID: 36195695 PMCID: PMC9531644 DOI: 10.1007/s15010-022-01909-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Following the emergency use authorization of BNT162b2 by the Food and Drug administration (FDA) in early December 2020, mRNA- and vector-based vaccines became an important means of reducing the spread and mortality of the COVID-19 pandemic. The European Medicines Agency labelled immune thrombocytopenia (ITP) as a rare adverse reaction of unknown frequency after vector-, but not mRNA-vaccination. Here, we report on the long-term outcome of 6 patients who were diagnosed with de-novo, vaccine-associated ITP (VA-ITP), and on the outcome of subsequent SARS-CoV-2 re-vaccinations. METHODS Patients were included after presenting to our emergency department. Therapy was applied according to ITP guidelines. Follow-up data were obtained from outpatient departments. Both mRNA- or vector-based vaccines were each used in 3 cases, respectively. RESULTS In all patients, the onset of symptoms occurred after the 1st dose of vaccine was applied. 5 patients required treatment, 3 of them 2nd line therapy. All patients showed a complete response eventually. After up to 359 days of follow-up, 2 patients were still under 2nd line therapy with thrombopoietin receptor agonists. 5 patients have been re-vaccinated with up to 3 consecutive doses of SARS-CoV-2 vaccines, 4 of them showing stable platelet counts hereafter. CONCLUSION Thrombocytopenia after COVID-19 vaccination should trigger a diagnostic workup to exclude vaccine-induced immune thrombotic thrombocytopenia (VITT) and, if confirmed, VA-ITP should be treated according to current ITP guidelines. Re-vaccination of patients seems feasible under close monitoring of blood counts and using a vaccine that differs from the one triggering the initial episode of VA-ITP.
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Affiliation(s)
- Michael Ruzicka
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Sonja Wurm
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany ,Division of Hematology, Medical University of Graz, Graz, Austria
| | - Lars Lindner
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | | | - Stefan Boeck
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Clemens Giessen-Jung
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Valeria Milani
- Facharztzentrum Fürstenfeldbruck, Fürstenfeldbruck, Germany
| | - Joachim H. Stemmler
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Oliver Weigert
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Karsten Spiekermann
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
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