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Morciano C, Massari M, Cutillo M, Belleudi V, Trifirò G, Mores N, Sapigni E, Puccini A, Zanoni G, Zorzi M, Monaco G, Leoni O, Del Zotto S, Samez S, Mayer F, Marano G, Menniti Ippolito F, Da Cas R, Traversa G, Spila Alegiani S. Acute Appendicitis After COVID-19 Vaccines in Italy: A Self-Controlled Case Series Study. Drug Saf 2024:10.1007/s40264-024-01462-0. [PMID: 39068268 DOI: 10.1007/s40264-024-01462-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVE Cases of appendicitis were identified in the pivotal randomized clinical trial on BNT162b2 mRNA vaccine and reported from coronavirus disease 2019 (COVID-19) vaccine pharmacovigilance systems. Three cohort studies and two self-controlled case series (SCCS) studies evaluating the association between mRNA vaccines and appendicitis reported discordant results. To address this uncertainty, the present study examines in a large population, with a SCCS design, the association between mRNA (BNT162b2 and mRNA-1273) and, for the first time, viral vector (ChAdOx1-S and Ad26.COV2-S) COVID-19 vaccines and acute appendicitis. METHODS The SCCS study design was used to evaluate the association between COVID-19 vaccination and subsequent onset of acute appendicitis. The study was based on record linkage of health archives through TheShinISS application, a statistical tool that locally processes data from regional health care databases according to ad hoc, study-tailored and common data model. The study population included all vaccinated subjects ≥ 12 years old between 27 December 2020 and 30 September 2021. The acute appendicitis was identified through discharge diagnoses of hospital admissions or emergency department visits. Incident cases were defined as those who experienced a first event of acute appendicitis in the study period, excluding subjects with a diagnosis of appendicitis in the previous 5 years. Exposure was defined as the first or second dose of BNT162b2, mRNA-1273 and ChAdOx1-S and the single dose of Ad26.COV2-S. The risk interval was defined as 42 days from the first or second vaccination dose and divided into pre-specified risk subperiods; the reference period was the observation time outside the risk interval. Relative incidences (RI) and 95% confidence intervals (95% CI) were estimated with the SCCS method 'modified for event-dependent exposures', through unbiased estimating equations. The seasonal component was considered as a time-dependent covariate. RESULTS In the 42-day risk interval 1285 incident cases of acute appendicitis occurred: 727 cases after the first dose and 558 cases after the second dose. In the main analysis, no increased risks of acute appendicitis were observed in subjects vaccinated with BNT162b, mRNA-1273, ChAdOx1-S and Ad26.COV2-S. The subgroup analyses by sex showed an increased risk in the 14-27 day risk interval, in males after the first dose of mRNA-1273 (RI of 1.71; 95% CI 1.08-2.70, p = 0.02) and in females after the single dose of Ad26.COV2-S (RI of 4.40; 95% CI 1.29-15.01, p = 0.02). CONCLUSIONS There was no evidence of association of BNT162b, ChAdOx1-S, mRNA-1273 and Ad26.COV2-S with acute appendicitis in the general population. The results of the subgroup analyses by sex needs to be considered with caution. The multiplicity issue cannot be excluded being these hypotheses two of several hypotheses tested. In addition, relevant literature on the biological mechanism of the disease and evidence of similar effects with other vaccines or with the same vaccines are still lacking to provide strong support for a conclusion that there is an harmful effect in males and females with mRNA-1273 and Ad26.COV2-S.
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Affiliation(s)
- Cristina Morciano
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Marco Massari
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Maria Cutillo
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nadia Mores
- Institute of Pharmacology, Pharmacovigilance, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
| | - Ester Sapigni
- Hospital Assistance Service, General Directorate for Personal Care, Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Aurora Puccini
- Hospital Assistance Service, General Directorate for Personal Care, Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | | | - Manuel Zorzi
- Cancer Registry of Veneto, Azienda Zero, Padua, Italy
| | - Giuseppe Monaco
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Olivia Leoni
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | | | - Sarah Samez
- Regional Pharmacovigilance Centre, Trieste, Italy
| | - Flavia Mayer
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Giuseppe Marano
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | | | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Giuseppe Traversa
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Stefania Spila Alegiani
- National Centre for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy.
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Jambon‐Barbara C, Bernardeau C, Cracowski J, Khouri C. Understanding the variability of pharmaco-epidemiological studies assessing the risk of appendicitis with mRNA COVID-19 vaccines. Pharmacoepidemiol Drug Saf 2023; 32:87-90. [PMID: 36351883 PMCID: PMC9877887 DOI: 10.1002/pds.5560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Clement Jambon‐Barbara
- Pharmacovigilance DepartmentGrenoble Alpes University HospitalGrenobleFrance,Univ. Grenoble AlpesInserm U1300, HP2GrenobleFrance
| | - Claire Bernardeau
- Pharmacovigilance DepartmentGrenoble Alpes University HospitalGrenobleFrance,Univ. Grenoble AlpesInserm U1300, HP2GrenobleFrance
| | - Jean‐Luc Cracowski
- Pharmacovigilance DepartmentGrenoble Alpes University HospitalGrenobleFrance,Univ. Grenoble AlpesInserm U1300, HP2GrenobleFrance
| | - Charles Khouri
- Pharmacovigilance DepartmentGrenoble Alpes University HospitalGrenobleFrance,Univ. Grenoble AlpesInserm U1300, HP2GrenobleFrance,Univ. Grenoble AlpesInserm CIC1406, Grenoble Alpes University Hospital, F‐38000GrenobleFrance
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