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Wu JJ, Hauben M, Younus M. Current Approaches in Postapproval Vaccine Safety Studies Using Real-World Data: A Systematic Review of Published Literature. Clin Ther 2024; 46:555-564. [PMID: 39142925 DOI: 10.1016/j.clinthera.2024.06.005] [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: 12/04/2023] [Revised: 05/06/2024] [Accepted: 06/05/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Well-designed observational postmarketing studies using real-world data (RWD) are critical in supporting an evidence base and bolstering public confidence in vaccine safety. This systematic review presents current research methodologies in vaccine safety research in postapproval settings, technological advancements contributing to research resources and capabilities, and their major strengths and limitations. METHODS A comprehensive search was conducted using PubMed to identify relevant articles published from January 1, 2019, to December 31, 2022. Eligible studies were summarized overall by study design and other study characteristics (eg, country, vaccine studied, types of data source, and study population). An in-depth review of select studies representative of conventional or new designs, analytical approaches, or data collection methods was conducted to summarize current methods in vaccine safety research. FINDINGS Out of 977 articles screened for inclusion, 135 were reviewed. The review shows that recent advancements in scientific methods, digital technology, and analytic approaches have significantly contributed to postapproval vaccine safety studies using RWD. "Near real-time surveillance" using large datasets (via collaborative or distributed databases) has been used to facilitate rapid signal detection that complements passive surveillance. There was increasing appreciation for self-controlled case-only designs (self-controlled case series and self-controlled risk interval) to assess acute-onset safety outcomes, artificial intelligence, and natural language processing to improve outcome accuracy and study timeliness and emerging artificial intelligence-based analysis to capture adverse events from social media platforms. IMPLICATIONS Continued development in the area of vaccine safety research methodologies using RWD is warranted. The future of successful vaccine safety research, especially evaluation of rare safety events, is likely to comprise digital technologies including linking RWD networks, machine learning, and advanced analytic methods to generate rapid and robust real-world safety information.
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Affiliation(s)
- Juan Joanne Wu
- Safety Surveillance Research, Worldwide Medical and Safety, Pfizer Inc, New York, NY
| | - Manfred Hauben
- Department of Family and Community Medicine, New York Medical College, Valhalla, NY and Truliant Consulting, Baltimore, Maryland
| | - Muhammad Younus
- Safety Surveillance Research, Worldwide Medical and Safety, Pfizer Inc, New York, NY.
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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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Elsaid M, Nune A, Brakat AM, Anand A, Alashwah M, Maher A, Lama N, Peñamante CAC. Immune thrombocytopenic purpura after influenza vaccine administration; a systematic review and meta-analysis. Trop Dis Travel Med Vaccines 2023; 9:22. [PMID: 38001495 PMCID: PMC10675976 DOI: 10.1186/s40794-023-00206-9] [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: 05/18/2023] [Accepted: 09/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The American Society of Haematology defines immune thrombocytopenic purpura (ITP) as a common hematologic disorder characterized by a transient or long-term decrease in platelet counts (< 100 × 109/L.), purpura, and haemorrhagic episodes caused by antiplatelet autoantibodies, with the exclusion of other clinical conditions. We aimed to systematically determine the incidence of ITP in adults and children following influenza vaccination, the duration between vaccination and the occurrence of ITP, and to identify predictors of ITP after the vaccine. METHODS We searched PubMed, Cochrane Library, Google Scholar, Web of Science, Scopus, and Science Direct. We included primary studies that assessed the occurrence of immune thrombocytopenia in individuals who had received any influenza vaccine (primary or booster dose), regardless of the dosage, preparation, time of administration, or age of the participants. We excluded studies that were (a) Narrative, scoping, and umbrella reviews ;(b) studies with no accessible full text, abstract-only studies, or (c) Overlapping or unreliable data. The risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) tool. We categorized studies for qualitative analysis based on study design. Descriptive statistics were used to summarize quantitative data, including the incidence of ITP after influenza vaccination. RESULTS Out of 729 articles retrieved from the database search, we included 24 studies. All patients identified and included in this systematic review presented with immune thrombocytopenia, determined by their platelet count. The period between vaccination and the occurrence of ITP ranged from (2:35 days). The mean duration was 13.5 days. The analysis revealed a statistically significant incidence rate ratio (IRR) = 1.85,95% CI [1.03-3.32] of ITP occurrence after 42 days. CONCLUSIONS Influenza-associated ITP is uncommon, self-limiting, non-life-threatening, and curable. None of the patients reported having severe adverse events or death. Further studies are required to confirm the exact incidence of the ITP to better understand the pathophysiology of ITP development post-influenza vaccination.
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Affiliation(s)
- Mohamed Elsaid
- Faculty of Medicine, Misr University for Science and Technology, 6th of October, Giza, Egypt.
- Medical Research Platform, Giza, Egypt.
| | - Arvind Nune
- Department of Rheumatology and General Medicine, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Aml M Brakat
- Faculty of Medicine, Zagazig University, Ash Sharqia Governorate, Egypt
- Medical Research Platform, Giza, Egypt
| | - Ayush Anand
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
- Medical Research Platform, Giza, Egypt
| | - Mahmoud Alashwah
- Faculty of Medicine, Cairo University, Cairo, Egypt
- Medical Research Platform, Giza, Egypt
| | - Ahmed Maher
- Faculty of Medicine, Al-Azhar University, New-Damietta, Egypt
- Medical Research Platform, Giza, Egypt
| | - Nitu Lama
- Dr. M. V. Shetty College of Physiotherapy, Rajiv Gandhi University of Health Sciences, Mangaluru, India
- Medical Research Platform, Giza, Egypt
| | - Criselle Angeline C Peñamante
- Department of Clinical Epidemiology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
- Department of Psychology, College of Science, University of Santo Tomas, Manila, Philippines
- Medical Research Platform, Giza, Egypt
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Yokomichi H, Mochizuki M, Horiuchi S, Kushima M, Shinohara R, Kojima R, Ooka T, Akiyama Y, Miyake K, Otawa S, Yamagata Z. Association of influenza vaccination or influenza virus infection history with subsequent infection risk among children: The Japan Environment and Children's Study (JECS). Prev Med 2023; 173:107599. [PMID: 37391036 DOI: 10.1016/j.ypmed.2023.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
We measured the association between history of influenza vaccination by age 2 years and influenza virus (IFV) infection at ages 3 and 4 years by relative risk reduction. We also examined the association between history of IFV infection by age 2 years and recurrent IFV infection at age 3 years. This study included 73,666 children from a large Japanese birth cohort. Among children vaccinated never, once or twice when aged under 2 years, 16.0%, 10.8% and 11.3%, respectively, had been infected with IFV by age 3 years, and 19.2%, 14.5% and 16.0%, respectively, by age 4 years. Compared with no history of influenza vaccination, vaccination at ages 1 and/or 2 years reduced the risk of IFV infection at age 3 by 30%-32% and at age 4 by 17%-24%. The relative risk of recurrent IFV infection at ages 3 and 4 years increased in proportion to the number of prior infections by age 2. One-season-prior influenza vaccination history reduced the IFV infection risk at age 3 years by 25%-42%. Influenza vaccination most effectively protected children at age 3 who lacked older sibling(s) and did not attend nursery school. One-season-prior IFV infection increased the relative risk of recurrent infection at age 3 years (1.72-3.33). In conclusion, influenza vaccination-induced protection may partly extend to the next season. Owing to the relative risk reduction by influenza vaccination and the increased relative risk of IFV infection from prior-season infection, annual influenza vaccination is recommended.
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Affiliation(s)
- Hiroshi Yokomichi
- Department of Epidemiology and Environmental Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Mie Mochizuki
- Department of Paediatrics, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Sayaka Horiuchi
- Department of Epidemiology and Environmental Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Megumi Kushima
- Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Ryoji Shinohara
- Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Reiji Kojima
- Department of Health Sciences, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Tadao Ooka
- Department of Health Sciences, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Yuka Akiyama
- Department of Health Sciences, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Kunio Miyake
- Department of Epidemiology and Environmental Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Sanae Otawa
- Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Zentaro Yamagata
- Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan; Department of Health Sciences, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
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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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Küster O, Schmohl J, Greiner J, Storz MA. Severe immune thrombocytopenia following diphtheria, tetanus, pertussis and polio vaccination in a 36-year-old Caucasian woman: a case report. Eur J Med Res 2022; 27:63. [PMID: 35505368 PMCID: PMC9062629 DOI: 10.1186/s40001-022-00686-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 04/11/2022] [Indexed: 12/29/2022] Open
Abstract
Background Immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by low platelet counts and increased bleeding risk. The disease may be induced by other disorders, including malignancies, autoimmune diseases, infectious agents or drugs. However, ITP has also been described following vaccinations, such as the measles–mumps–rubella vaccination. In rare cases, ITP may occur in children who received a DTaP-IP (diphtheria, tetanus, acellular pertussis vaccine and inactivated poliovirus) vaccine. Hereinafter, we report the first well-documented cases of ITP in an adult patient in the temporal context of a DTaP-IP vaccination. Case presentation This case report attempts to capture the life-threatening picture of a 36-year-old otherwise healthy Caucasian woman with newly diagnosed severe immune thrombocytopenia in the temporal context of a DTaP-IP vaccination. Four days after receiving the vaccine, the women presented to her primary care physician with malaise, fever and recurrent epistaxis. Clinical examination revealed oral petechiae, ecchymoses, and non-palpable petechiae on both legs. The patient was immediately referred to a local hematology unit where she developed hematuria and an intestinal bleeding (WHO Bleeding Grade III) requiring multiple transfusions. After receiving oral corticosteroids and intravenous immunoglobulins, her platelets gradually recovered. Common causes of secondary ITP were ruled out by laboratory investigations, bone marrow and peripheral blood examinations. This raises the possibility of a (secondary) vaccination-associated thrombocytopenia. To the best of our knowledge, this is the first well-documented case of a DTaP-IP vaccination-related ITP in an adult patient in the English literature. Conclusion Although a causal connection between both entities may not be established, we would like to raise awareness in clinicians that ITP following DTaP-IP vaccinations is potentially not limited to children, but may also occur in adults. Users of DTaP-IP booster vaccines should be alert of the possibility of such adverse reactions. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00686-z.
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Affiliation(s)
- Onno Küster
- MVZ Dillmannstraße, Dillmannstraße 19, 70193, Stuttgart, Baden-Württemberg, Germany
| | - Jörg Schmohl
- Department of Internal Medicine, Diakonie Hospital Stuttgart, 70176, Stuttgart, Germany
| | - Jochen Greiner
- Department of Internal Medicine, Diakonie Hospital Stuttgart, 70176, Stuttgart, Germany
| | - Maximilian Andreas Storz
- Department of Internal Medicine II, Center for Complementary Medicine, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
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Favorable prognosis of vaccine-associated immune thrombocytopenia in children is correlated with young age at vaccination: Retrospective survey of a nationwide disease registry. Int J Hematol 2021; 115:114-122. [PMID: 34626332 DOI: 10.1007/s12185-021-03230-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Childhood vaccine-associated immune thrombocytopenia (ITP) has a mostly favorable prognosis. To identify factors associated with prognosis, a retrospective survey was conducted with children with ITP who were registered in the Japanese Society of Pediatric Hematology/Oncology registry from 2008 to 2011. A total of 477 patients were categorized into four groups by event preceding ITP onset: vaccine-precedence (VP; n = 43), vaccine/infection-precedence (VIP; n = 34), infection-precedence (IP; n = 162), and no vaccine/infection-precedence (NVI; n = 238). Compared to IP and NVI, VP and VIP were significantly younger at diagnosis, with the age distribution peaking at infancy, and more frequently had favorable prognosis. Time to platelet recovery to 100 × 103/µL was significantly faster for VP and VIP than NVI. Multivariate Cox regression analysis with sex, age at diagnosis, infection-precedence, and vaccine-precedence as variables revealed age < 36 months (HR 0.992, 95% CI 0.989-0.995; p < 0.001) and male sex (HR 0.770, 95% CI 0.623-0.952; p = 0.015) as associated factors, but not infection-precedence (p = 0.149) or vaccine-precedence (p = 0.650). In subgroup analysis in patients < 36 months, age at diagnosis (p < 0.001) was the only associated factor. Favorable prognosis of childhood vaccine-associated ITP is correlated with young age at vaccination, but not with vaccination itself.
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Akiyama H, Kakiuchi S, Rikitake J, Matsuba H, Sekinada D, Kozuki Y, Iwata N. Immune thrombocytopenia associated with Pfizer-BioNTech's BNT162b2 mRNA COVID-19 vaccine. IDCases 2021; 25:e01245. [PMID: 34381692 PMCID: PMC8336989 DOI: 10.1016/j.idcr.2021.e01245] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/07/2023] Open
Abstract
The recent global pandemic of coronavirus disease 2019 (COVID-19) has led to vaccination in many parts of the world for herd immunity, and as vaccination has progressed, several rare adverse events have been reported. Immune thrombocytopenia (ITP) has been reported to be one of the rare adverse events caused by vaccination with MMR (measles-mumps-rubella) vaccine and influenza vaccine. In addition, ITP has been reported to occur in a small number of cases associated with the COVID-19 messenger ribonucleic acid (mRNA) vaccine. However, there are few reports on the details of the treatment and clinical course; optimal treatment has not yet been established. We report the case of a 20-year-old woman who developed ITP after receiving Pfizer-BioNTech's BNT162b2 vaccine. She had generalized subcutaneous hemorrhage, 14 days after vaccination. At the time of our visit, she had marked thrombocytopenia and intraoral bleeding; she was diagnosed with ITP. Treatment with oral steroids was started and the platelet count promptly improved after 4 days of treatment. Since the response to treatment was very good, we tapered off the steroids. As these vaccines will be increasingly used in the future, it is important to recognize ITP as a possible adverse event.
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Affiliation(s)
- Hiroaki Akiyama
- Department of Hematology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashi-Yodogawa-ku, Osaka, Japan
| | - Seiji Kakiuchi
- Department of Hematology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashi-Yodogawa-ku, Osaka, Japan
| | - Junpei Rikitake
- Department of Hematology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashi-Yodogawa-ku, Osaka, Japan
| | - Hiroyuki Matsuba
- Department of Hematology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashi-Yodogawa-ku, Osaka, Japan
| | - Daisuke Sekinada
- Department of Hematology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashi-Yodogawa-ku, Osaka, Japan
| | - Yoko Kozuki
- Department of Hematology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashi-Yodogawa-ku, Osaka, Japan
| | - Nobuko Iwata
- Department of Hematology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashi-Yodogawa-ku, Osaka, Japan
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Helms JM, Ansteatt KT, Roberts JC, Kamatam S, Foong KS, Labayog JMS, Tarantino MD. Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine. J Blood Med 2021; 12:221-224. [PMID: 33854395 PMCID: PMC8040692 DOI: 10.2147/jbm.s307047] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
The rollout of the SARS-CoV-2 vaccine is underway, and millions have already been vaccinated. At least 25 reports of "immune thrombocytopenia" (ITP) or "thrombocytopenia" following the Moderna or Pfizer vaccine have been added to the Vaccine Adverse Event Reporting System (VAERS) in the US. ITP is a rare but known complication of several vaccinations. SARS-CoV-2 vaccine is new, with a novel mechanism of action, and understanding the epidemiology, clinical manifestations, treatment success and natural history of post-vaccination thrombocytopenia is evolving. We report a 74-year-old man who developed refractory thrombocytopenia within one day of receiving the Moderna SARS-CoV-2 vaccine. Several hours after vaccination, he developed significant epistaxis and cutaneous purpura. Severe thrombocytopenia was documented the following day, and he developed extremity weakness and encephalopathy with facial muscle weakness. Over a 14-day period, thrombocytopenia was treated first with high dose dexamethasone, intravenous immunoglobulin, platelet transfusions, rituximab, plasma exchange (for presumed acute inflammatory demyelinating polyneuropathy (AIDP)), and four daily doses of the thrombopoietin receptor agonist (TPO-RA) eltrombopag (Promacta™), without a platelet response. Three days later, he received the TPO-RA romiplostim (Nplate™). Five days later, his platelet count began to rise and by post-vaccination day 25, his platelet count was in the normal range. Thrombocytopenia was refractory to frontline and second-line treatment. The eventual rise in his platelet count suggests that one or both TPO-RAs may have impacted platelet recovery. Possibly, but less likely given the temporality, the drug-induced thrombocytopenia was subsiding. The aggressive use of immunosuppressive treatment may jeopardize the intended purpose of the SARS-CoV-2 vaccine, and earlier use of non-immunosuppressive second-line treatment for vaccine-related severe thrombocytopenia, such as with TPO-RAs, should be considered. While it is imperative to continue the global vaccination program, vigilance to the occurrence of post-vaccination severe thrombocytopenia is warranted.
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Affiliation(s)
- Jackie M Helms
- The Bleeding and Clotting Disorders Institute, Peoria, IL, USA
| | | | - Jonathan C Roberts
- The Bleeding and Clotting Disorders Institute, Peoria, IL, USA
- Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA
| | - Sravani Kamatam
- Department of Medicine, Saint Francis Medical Center, Peoria, IL, USA
| | - Kap Sum Foong
- Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA
- Department of Medicine, Saint Francis Medical Center, Peoria, IL, USA
| | - Jo-mel S Labayog
- Department of Medicine, OSF Sacred Heart Medical Center, Danville, IL, USA
| | - Michael D Tarantino
- The Bleeding and Clotting Disorders Institute, Peoria, IL, USA
- Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA
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Yokomichi H, Mochizuki M, Yamagata Z. Encouraging Cross-Disciplinary Collaboration and Innovation in Epidemiology in Japan. Front Public Health 2021; 9:641882. [PMID: 33869131 PMCID: PMC8044351 DOI: 10.3389/fpubh.2021.641882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Scientific innovation is often achieved through the intersection of ideas from different fields. However, barriers prevent non-epidemiologists from cultivating interests in epidemiology or undertaking epidemiologic work. In this study, we evaluated changes in the diversity of research topics in an epidemiologic journal over time. We aimed to understand how epidemiologists and non-epidemiologists communicate about epidemiologic data and how this impacts innovation in the field. Methods: We categorized the topics of articles published in the Journal of Epidemiology during the early and late 2010s based on their titles. We calculated the Shannon-Weaver diversity index (H') to measure changes in the diversity of topics addressed by published articles. Results: Comparing 2011-2013 with 2017-2019, there was no significant change in the diversity of article topics (H' = 4.25 and 4.21, respectively) published in the Journal of Epidemiology. Conclusion: To encourage healthcare providers and public administrators to conduct or comment on epidemiologic studies, epidemiologists should present their findings in easily understood language with appropriate and relevant statistical indicators and useful illustrations. Bringing experience from other specialties into epidemiology may yield new findings from epidemiologic data because of the exposure of non-epidemiologists to different values, workplaces, and occupations. Collaboration among professionals from varied backgrounds and with varied occupational experiences may help to promote scientific innovation by broadening perspectives. In addition, a range of professional experiences may enable individuals to solve difficult research questions more easily by themselves.
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Affiliation(s)
- Hiroshi Yokomichi
- Department of Health Sciences, University of Yamanashi, Yamanashi, Japan
| | - Mie Mochizuki
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, University of Yamanashi, Yamanashi, Japan
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Effectiveness of influenza vaccination in infants and toddlers with and without prior infection history: The Japan Environment and Children's Study. Vaccine 2021; 39:1800-1804. [PMID: 33685777 DOI: 10.1016/j.vaccine.2021.02.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 01/26/2023]
Abstract
We calculated the Poisson-regression-adjusted relative risk (RR) of new influenza infection by vaccination, prior infection, and vaccination after prior infection in a large Japanese birth cohort, using data from ≤89,253 children aged 6 months to 3 years. The effectiveness of risk reduction (1 - RR) by vaccination at ages 1.5-3 years was 21%-31%. The RR of new infection after prior infection vs. no prior infection was 2.58-19.3 at age 1-3 years. An analysis of the 1 - RR data stratified by having at least one senior sibling and/or attending nursery school revealed that vaccination reduced the RR by 22%-40%. The 1 - RR of new infection was 21% in 3-year-old children who were vaccinated after prior infection. All these findings are statistically significant. The results consistently indicate that, regardless of having at least one senior sibling, attending nursery school, and/or being previously infected with influenza, infants and toddlers will benefit from influenza vaccination.
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