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Schönborn L, Pavord S, Chen VMY, Pai M, Gwarzo DH, Buttery J, Munoz FM, Tran H, Greinacher A, Law B. Thrombosis with thrombocytopenia syndrome (TTS) and vaccine-induced immune thrombocytopenia and thrombosis (VITT): Brighton Collaboration case definitions and guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2024; 42:1799-1811. [PMID: 38302339 DOI: 10.1016/j.vaccine.2024.01.045] [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: 12/12/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
This is a revision of the online November 2021 Brighton thrombosis with thrombocytopenia syndrome (TTS) case definition and a new Brighton Collaboration case definition for vaccine-induced immune thrombocytopenia and thrombosis (VITT). These case definitions are intended for use in clinical trials and post-licensure pharmacovigilance activities to facilitate safety data comparability across multiple settings. They are not intended to guide clinical management. The case definitions were developed by a group of subject matter and Brighton Collaboration process experts as part of the Coalition for Epidemic Preparedness Innovations (CEPI)-funded Safety Platform for Evaluation of vACcines (SPEAC). The case definitions, each with defined levels of diagnostic certainty, are based on relevant published evidence and expert consensus and are accompanied by specific guidelines for TTS and VITT data collection and analysis. The document underwent peer review by a reference group of vaccine safety stakeholders and haematology experts to ensure case definition useability, applicability and scientific integrity.
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Affiliation(s)
- Linda Schönborn
- University Medicine Greifswald, Institute for Transfusion Medicine, Greifswald, Germany.
| | - Sue Pavord
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Vivien Mun Yee Chen
- Department of Haematology, Concord Repatriation General Hospital and NSW Health Pathology, Concord, NSW, Australia; ANZAC Research Institute, Concord, NSW, Australia; Sydney Medical School, University of Sydney, Concord, NSW, Australia.
| | - Menaka Pai
- Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada.
| | - Dalha Haliru Gwarzo
- Institution: Bayero University, Kano, Nigeria; Aminu Kano Teaching Hospital, Kano, Nigeria.
| | - Jim Buttery
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
| | - Flor M Munoz
- Department of Pediatrics, Division of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
| | - Huyen Tran
- Clinical Haematology Department, Monash University, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Andreas Greinacher
- University Medicine Greifswald, Institute for Transfusion Medicine, Greifswald, Germany.
| | - Barbara Law
- SPEAC, Brighton Collaboration, Independent Consultant, Stratford, Ontario, Canada.
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Tran HA, Deng L, Wood N, Choi P, Singleton S, Clarke L, Khanlari S, Maitland-Scott I, Bird R, Brown S, Manoharan B, Tan CW, Gold M, Hissaria P, Melody S, Chunilal S SD, Buttery J, Clothier H, Crawford NW, Phuong L, Pepperell D, Effler P, Parker C, Carter N, Macartney K, McStea M, Miller T, Nissen M, Larter C, Kay E, Chen VM. The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 40:100894. [PMID: 37701717 PMCID: PMC10494168 DOI: 10.1016/j.lanwpc.2023.100894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023]
Abstract
Background Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. We report the clinicopathological features of TTS following ChAdOx1-S vaccination and summarise the case outcomes in Australia. Methods In this cohort study, patients diagnosed with TTS in Australia between 23 March and 31 December 2021 were identified according to predefined criteria. Cases were included if they met the Therapeutic Goods Administration (TGA) probable and confirmed case definitions and were reclassified using Centres for Disease Control and Prevention (CDC) definition for analysis. Data were collected on patient baseline characteristics, clinicopathological features, risk factors, treatment and outcomes. Findings A total of 170 TTS cases were identified, with most occurring after the first dose (87%) of ChAdOx1-S. The median time to symptom onset after vaccination and symptom onset to admission was 11 and 2 days respectively. The median age of cases was 66 years (interquartile range 55-74). All except two patients received therapeutic anticoagulation and 66% received intravenous immunoglobulin. Overall, 85.3% of cases were discharged home after a median hospitalisation of 6 days, 9.4% required ongoing rehabilitation and 5.3% died. Eight deaths were related to TTS, with another dying from an unrelated condition while receiving treatment for TTS. Deaths occurred more commonly in those classified as Tier 1 according to the CDC definition and were associated with more severe thrombocytopenia and disease-related haemorrhage. Interpretation TTS, while rare, can be severe and have catastrophic outcomes in some individuals. In Australia, the mortality rate was low compared to that reported in other high-income countries. Almost all received therapeutic anticoagulation with no bleeding complications and were successfully discharged. This emphasises the importance of community education and an established pathway for early recognition, diagnosis and treatment of TTS. Funding Australian Commonwealth Department of Health and Aged Care. H.A Tran, N. Wood, J. Buttery, N.W. Crawford, S.D. Chunilal, V.M. Chen are supported by Medical Research Future Funds (MRFF) grant ID 2015305.
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Affiliation(s)
- Huyen A. Tran
- The Alfred Hospital, Melbourne, Victoria, Australia
- Monash Medical Centre, Clayton, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Lucy Deng
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Philip Choi
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sally Singleton
- ACT Health Directorate, Canberra, Australian Capital Territory, Australia
| | - Lisa Clarke
- Department of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Transfusion Policy and Education, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Sarah Khanlari
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | | | - Robert Bird
- Division of Cancer Services, Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Scott Brown
- Queensland Health, Brisbane, Queensland, Australia
| | - Bavahuna Manoharan
- Queensland Health, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Chee Wee Tan
- Royal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
- University of Adelaide, South Australia, Australia
| | - Michael Gold
- Department of Allergy and Clinical Immunology, Women's and Children's Health Network, Adelaide, South Australia, Australia
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Pravin Hissaria
- Royal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
- University of Adelaide, South Australia, Australia
| | - Shannon Melody
- Public Health Services, Tasmania Department of Health, Hobart, Tasmania, Australia
| | - Sanjeev D. Chunilal S
- Monash Medical Centre, Clayton, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Jim Buttery
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Hazel Clothier
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Health Analytics, Melbourne Children's Centre, Parkville, Victoria, Australia
| | - Nigel W. Crawford
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Linny Phuong
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | | | - Paul Effler
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Claire Parker
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Nicola Carter
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Megan McStea
- Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Todd Miller
- Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Michael Nissen
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Claire Larter
- Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Elspeth Kay
- Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Vivien M. Chen
- Department of Haematology and NSW Health Pathology, Concord Hospital Sydney, New South Wales, Australia
- ANZAC Research Institute, Sydney Local Health District, New South Wales, Australia
- Sydney Medical School, University of Sydney, New South Wales, Australia
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Chayachinda C, Watananirun K, Phatihattakorn C, Anuwutnavin S, Niyomnaitham S, Phongsamart W, Lapphra K, Wittawatmongkol O, Rungmaitree S, Jansarikit L, Boonnak K, Wongprompitak P, Senawong S, Upadhya A, Toh ZQ, Licciardi PV, Chokephaibulkit K. Immunogenicity and reactogenicity of heterologous COVID-19 vaccination in pregnant women. Hum Vaccin Immunother 2023; 19:2228670. [PMID: 37439770 PMCID: PMC10406153 DOI: 10.1080/21645515.2023.2228670] [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: 04/29/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
This open-labeled non-inferiority trial evaluated immunogenicity and reactogenicity of heterologous and homologous COVID-19 vaccination schedules in pregnant Thai women. 18-45-year-old pregnant women with no history of COVID-19 infection or vaccination and a gestational age of ≥12 weeks were randomized 1:1:1 into three two-dose primary series scheduled 4 weeks apart: BNT162b2-BNT162b2 (Group 1), ChAdOx1-BNT162b2 (Group 2), and CoronaVac-BNT162b2 (Group 3). Serum antibody responses, maternal and cord blood antibody levels at delivery, and adverse events (AEs) following vaccination until delivery were assessed. The 124 enrolled participants had a median age of 31 (interquartile range [IQR] 26.0-35.5) years and gestational age of 23.5 (IQR 18.0-30.0) weeks. No significant difference in anti-receptor binding domain (RBD) IgG were observed across arms at 2 weeks after the second dose. Neutralizing antibody geometric mean titers against the ancestral Wuhan strain were highest in Group 3 (258.22, 95% CI [187.53, 355.56]), followed by Groups 1 (187.47, 95% CI [135.15, 260.03]) and 2 (166.63, 95% CI [124.60, 222.84]). Cord blood anti-RBD IgG was correlated with, and equal to or higher than, maternal levels at delivery (r = 0.719, P < .001) and inversely correlated with elapsed time after the second vaccination (r = -0.366, P < .001). No significant difference in cord blood antibody levels between groups were observed. Local and systemic AEs were mild-to-moderate and more frequent in Group 2. Heterologous schedules of CoronaVac-BNT162b2 or ChAdOx1-BNT162b2 induced immunogenicity on-par with BNT162b2-BNT162b2 and may be considered as alternative schedules for primary series in pregnant women in mRNA-limited vaccine settings.
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Affiliation(s)
- Chenchit Chayachinda
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokwaroon Watananirun
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chayawat Phatihattakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sanitra Anuwutnavin
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suvimol Niyomnaitham
- Siriraj Institute of Clinical Research (SICRES), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanatpreeya Phongsamart
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Keswadee Lapphra
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orasri Wittawatmongkol
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supattra Rungmaitree
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Laddawan Jansarikit
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kobporn Boonnak
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patimaporn Wongprompitak
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sansnee Senawong
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Avishek Upadhya
- Department of Sciences, Mahidol University International College, Salaya, Nakhon Pathom, Thailand
| | - Zheng Quan Toh
- Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul V. Licciardi
- Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research (SICRES), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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