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Shahri MS, Sadeghi S, Hazegh Fetratjoo D, Hosseini H, Amin Ghobadi M, Afshani SM, Mirhassani R, Gohari K, Havasi F, Abdolghaffari A, Hedayatjoo B, Ghanei M. Immunogenicity and safety evaluation of a newly manufactured recombinant Baculovirus-Expressed quadrivalent influenza vaccine in adults 18 years old and Above: An Open-Label, phase III extension study. Int Immunopharmacol 2024; 136:112214. [PMID: 38823176 DOI: 10.1016/j.intimp.2024.112214] [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: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 06/03/2024]
Abstract
In the face of global health threats, there is a growing demand for vaccines that can be manufactured on a large scale within compressed timeline. This study responds to this imperative by delving into the evaluation of FluGuard, a novel recombinant influenza vaccine developed by Nivad Pharmed Salamat Company in Iran. Positioned as a phase 3 extension, the research aimed to evaluate the safety and immunogenicity of FluGuard in volunteers aged 18 and above. The study was conducted as a single-center, open-label clinical trial. All eligible volunteers received FluGuard (2021-2022 Formula) on day 0. Safety assessments occurred at days 1, 4, 7, 14, 28 and 42 post-vaccination. Immunogenicity was measured through seroconversion, seroprotection, and geometric mean titer fold increase in subgroups of 250 volunteers. Among the 4,260 volunteers were screened and assessed for eligibility, 1000 were enrolled. At day 28 post-vaccination, seroconversion rates for A/H1N1, A/H3N2, B/Yamagata, B/Victoria were 53.4 % [95 %CI: 46.7-60], 57.7 % [95 %CI: 51.1-64.3], 54.3 % [95 %CI: 47.7-60.9], and 36.2 % [95 %CI: 29.8-42.6], respectively in volunteers 18 years and above. The most common solicited adverse events were pain at the injection site, malaise, and headache. No suspected unexpected adverse events and adverse events of special interest occurred during the study period. Our findings suggested that FluGuard® exhibits a desirable safety profile and provides sufficient immunogenicity against influenza virus types A and B. However, extended studies are warranted to assess the long-term protective efficacy. Trial Registration: The study protocol was accepted by Iranian registry of clinical trial; https://www.irct.ir; IRCT20201104049265N2.
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Affiliation(s)
| | - Setayesh Sadeghi
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamed Hosseini
- Clinical Trial Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Reihaneh Mirhassani
- Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran; Nivad Pharmed Salamat, Biotechnology Research Center, Tehran, Iran
| | - Kimiya Gohari
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Forugh Havasi
- Nivad Pharmed Salamat, Biotechnology Research Center, Tehran, Iran; Department of Chemistry, Faculty of Sciences, University of Kurdistan, Sanandaj, Iran
| | - Amirhossein Abdolghaffari
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Gastrointestinal Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | | | - Mostafa Ghanei
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Kitano T, Dudley MZ, Engineer L, Thompson DA, Salmon DA. The authors reply to Kurita et al and Lataster. Am J Epidemiol 2024; 193:932-934. [PMID: 38115177 DOI: 10.1093/aje/kwad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/07/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Taito Kitano
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Nara Prefecture General Medical Center, Nara 6308054, Japan
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Lilly Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - David A Thompson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
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Dreyfus J, Munnangi S, Bengtsson C, Correia B, Figueiredo R, Stark JH, Zawora M, Riddle MS, Maguire JD, Jiang Q, Ianos C, Naredo Turrado J, Svanström H, Bailey S, DeKoven M. Background incidence rates of health outcomes in populations at risk for Lyme disease using US administrative claims data. Vaccine 2024; 42:1094-1107. [PMID: 38262807 DOI: 10.1016/j.vaccine.2024.01.037] [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: 10/06/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Background incidence rates (IRs) of health outcomes in Lyme disease endemic regions are useful to contextualize events reported during Lyme disease vaccine clinical trials or post-marketing. The objective of this study was to estimate and compare IRs of health outcomes in Lyme disease endemic versus non-endemic regions in the US during pre-COVID and COVID era timeframes. METHODS IQVIA PharMetrics® Plus commercial claims database was used to estimate IRs of 64 outcomes relevant to vaccine safety monitoring in the US during January 1, 2017-December 31, 2019 and January 1, 2020-December 31, 2021. Analyses included all individuals aged ≥ 2 years with ≥ 1 year of continuous enrollment. Outcomes were defined by International Classification of Diseases Clinical Modification, 10th Revision (ICD-10-CM) diagnosis codes. IRs and 95 % confidence intervals (CIs) were calculated for each outcome and compared between endemic vs. non-endemic regions, and pre-COVID vs. COVID era using IR ratios (IRR). RESULTS The study population included 8.7 million (M) in endemic and 27.8 M in non-endemic regions. Mean age and sex were similar in endemic and non-endemic regions. In both study periods, the IRs were statistically higher in endemic regions for anaphylaxis, meningoencephalitis, myocarditis/pericarditis, and rash (including erythema migrans) as compared with non-endemic regions. Conversely, significantly lower IRs were observed in endemic regions for acute kidney injury, disseminated intravascular coagulation, heart failure, myelitis, myopathies, and systemic lupus erythematosus in both study periods. Most outcomes were statistically less frequent during the COVID-era. CONCLUSION This study identified potential differences between Lyme endemic and non-endemic regions of the US in background IRs of health conditions during pre-COVID and COVID era timeframes to inform Lyme disease vaccine safety monitoring. These regional and temporal differences in background IRs should be considered when contextualizing possible safety signals in clinical trials and post-marketing of a vaccine targeted at Lyme disease prevention.
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Affiliation(s)
| | | | | | | | | | - James H Stark
- Vaccines, Antivirals, and Evidence Generation, Medical Affairs, Pfizer Biopharma Group, Cambridge, MA, USA
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Clothier HJ, Shetty AN, Mesfin Y, Mackie M, Pearce C, Buttery JP. What would have happened anyway? Population data source considerations when estimating background incident rates of adverse events following immunisation to inform vaccine safety. Vaccine 2024; 42:1108-1115. [PMID: 38262811 DOI: 10.1016/j.vaccine.2024.01.025] [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: 11/15/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Understanding background incident rates of adverse events following immunisation (AEFI) is essential to rapidly detect, evaluate, respond to, and communicate about vaccine safety concerns, especially for new vaccines. Creating estimates based on geographic specific population level data is increasingly important, as new AEFI presentations will be subject to the same local influences of population demography, exposures, health system variations and level of health care sought. METHODS We conducted a retrospective cohort analysis of hospital admissions, emergency department presentations and general practice consultations from 2015 to 2019-before introduction of COVID-19, Mpox or Shingrix vaccination-to estimate background incident rates for 37 conditions considered potential AEFI of special interest (AESI). Background incident rates per 100,000 population were calculated and presented as cases expected to occur coincidentally 1 day, 1 week and 6 weeks post-vaccination, by life-stage age-groups and presenting healthcare setting. We then assessed the proportional contribution of each data source to inform each AESI background rate estimate. RESULTS 16,437,156 episodes of the 37 AESI were identified. Hospital admissions predominantly informed 19 (51%) of AESI, including exclusively ADEM and CVST; 8 AESI (22%) by primary care, and 10 (27%) a mix. Four AESI (allergic urticaria, Bell's palsy, erythema multiform and sudden death) were better informed by emergency presentations than admissions, but conversely 11 AESI (30%) were not captured in ICD-10 coded emergency presentations at all. CONCLUSIONS Emergent safety concerns are inevitable in population-wide implementation of new vaccines, therefore understanding local background rates aids both safety signal detection as well as maintaining public confidence in vaccination. Hospital and primary care data sources can be interrogated to inform expected background incident rates of adverse events that may occur following vaccination. However, it is necessary to understand which data-source provides best intelligence according to nature of condition and presenting healthcare setting.
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Affiliation(s)
- Hazel J Clothier
- Health Informatics, Centre for Health Analytics, Melbourne Children's Campus, 50 Flemington Road, Parkville, Victoria, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Melbourne School of Population & Global Health, University of Melbourne, Grattan Street, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, Victoria, Australia.
| | - Aishwarya N Shetty
- Health Informatics, Centre for Health Analytics, Melbourne Children's Campus, 50 Flemington Road, Parkville, Victoria, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.
| | - Yonatan Mesfin
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia
| | - Michael Mackie
- Victorian Agency for Health Information, Victorian Government Department of Health, 50 Lonsdale Street, Melbourne, Victoria, Australia.
| | | | - Jim P Buttery
- Health Informatics, Centre for Health Analytics, Melbourne Children's Campus, 50 Flemington Road, Parkville, Victoria, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, Victoria, Australia; Department of General Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia.
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Salmon DA, Chen RT, Black S, Sharfstein J. Lessons learned from COVID-19, H1N1, and routine vaccine pharmacovigilance in the United States: a path to a more robust vaccine safety program. Expert Opin Drug Saf 2024; 23:161-175. [PMID: 38343204 DOI: 10.1080/14740338.2024.2305707] [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: 08/23/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Vaccine pharmacovigilance is an essential component of vaccine safety programs. Vaccine pharmacovigilance refers to detecting uncommon adverse events following immunization (AEFI), determining whether they are due to the vaccine or are only a coincidence, and, for those AEFI considered related to vaccination, characterizing them further. When AEFI are due to vaccination, it is important to characterize the attributable risk and ascertain the biological mechanism causing the adverse reaction to inform efforts to prevent or mitigate the risk. A robust post-authorization safety system is necessary for vaccine decision-making, clinical recommendations, vaccine compensation, and vaccine communication and confidence. AREAS COVERED This paper describes the key characteristics of vaccine pharmacovigilance programs, reviews US vaccine pharmacovigilance for routine vaccination programs, COVID-19, and H1N1, and makes recommendations for improving future vaccine safety systems. EXPERT OPINION The key characteristics of vaccine pharmacovigilance programs include passive surveillance, active surveillance, clinical investigation and special studies, and causality assessment. Recent examples illustrate the strengths of US pharmacovigilance systems, including systems for passive and active surveillance, as well as areas for improvement, including study of pathogenesis, consistent funding, and leadership. We make recommendations that would, if implemented, further strengthen the vaccine safety system for future routine and pandemic immunizations.
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Affiliation(s)
- Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert T Chen
- Brighton Collaboration, A program of the Task Force for Global Health, Decatur, GA, USA
| | - Steve Black
- Global Vaccine Data Network, Auckland, New Zealand
| | - Joshua Sharfstein
- Department of Health, Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bu F, Schuemie MJ, Nishimura A, Smith LH, Kostka K, Falconer T, McLeggon JA, Ryan PB, Hripcsak G, Suchard MA. Bayesian safety surveillance with adaptive bias correction. Stat Med 2024; 43:395-418. [PMID: 38010062 DOI: 10.1002/sim.9968] [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: 05/23/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Postmarket safety surveillance is an integral part of mass vaccination programs. Typically relying on sequential analysis of real-world health data as they accrue, safety surveillance is challenged by sequential multiple testing and by biases induced by residual confounding in observational data. The current standard approach based on the maximized sequential probability ratio test (MaxSPRT) fails to satisfactorily address these practical challenges and it remains a rigid framework that requires prespecification of the surveillance schedule. We develop an alternative Bayesian surveillance procedure that addresses both aforementioned challenges using a more flexible framework. To mitigate bias, we jointly analyze a large set of negative control outcomes that are adverse events with no known association with the vaccines in order to inform an empirical bias distribution, which we then incorporate into estimating the effect of vaccine exposure on the adverse event of interest through a Bayesian hierarchical model. To address multiple testing and improve on flexibility, at each analysis timepoint, we update a posterior probability in favor of the alternative hypothesis that vaccination induces higher risks of adverse events, and then use it for sequential detection of safety signals. Through an empirical evaluation using six US observational healthcare databases covering more than 360 million patients, we benchmark the proposed procedure against MaxSPRT on testing errors and estimation accuracy, under two epidemiological designs, the historical comparator and the self-controlled case series. We demonstrate that our procedure substantially reduces Type 1 error rates, maintains high statistical power and fast signal detection, and provides considerably more accurate estimation than MaxSPRT. Given the extensiveness of the empirical study which yields more than 7 million sets of results, we present all results in a public R ShinyApp. As an effort to promote open science, we provide full implementation of our method in the open-source R package EvidenceSynthesis.
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Affiliation(s)
- Fan Bu
- Department of Biostatistics, University of California, Los Angeles, California, USA
- Department of Biostatistics, University of Michigan-Ann Arbor, Ann Arbor, Michigan, USA
| | - Martijn J Schuemie
- Department of Biostatistics, University of California, Los Angeles, California, USA
- Janssen Research and Development, Raritan, New Jersey, USA
| | - Akihiko Nishimura
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Louisa H Smith
- Department of Health Sciences, Northeastern University, Portland, Maine, USA
- The OHDSI Center at the Roux Institute, Northeastern University, Portland, Maine, USA
| | - Kristin Kostka
- The OHDSI Center at the Roux Institute, Northeastern University, Portland, Maine, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Jody-Ann McLeggon
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Patrick B Ryan
- Janssen Research and Development, Raritan, New Jersey, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Marc A Suchard
- Department of Biostatistics, University of California, Los Angeles, California, USA
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Song Y, Zheng X, Fang Y, Liu S, Liu K, Zhu J, Wu X. Current status of Guillain-Barré syndrome (GBS) in China: a 10-year comprehensive overview. Rev Neurosci 2023; 34:869-897. [PMID: 37145885 DOI: 10.1515/revneuro-2023-0024] [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: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy; a disease involving the peripheral nervous system which is the most common cause of acute flaccid paralysis worldwide. So far, it is still lack of a comprehensive overview and understanding of the national epidemiological, clinical characteristics, and the risk factors of GBS in China, as well as differences between China and other countries and regions in these respects. With the global outbreak of the coronavirus disease 2019 (COVID-19), an epidemiological or phenotypic association between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and GBS has attracted great attention. In this review, we outlined the current clinical data of GBS in China by retrieving literature, extracting and synthesizing the data of GBS in China from 2010 to 2021. Besides, we compared the characteristics of epidemiology, preceding events and clinical profiles of GBS between China and other countries and regions. Furthermore, in addition to conventional intravenous immunoglobulin (IVIG) and plasma exchange (PE) therapy, the potential therapeutic effects with novel medications in GBS, such as complement inhibitors, etc., have become the research focus in treatments. We found that epidemiological and clinical findings of GBS in China are approximately consistent with those in the International GBS Outcome Study (IGOS) cohort. We provided an overall picture of the present clinical status of GBS in China and summarized the global research progress of GBS, aiming to further understand the characteristics of GBS and improve the future work of GBS worldwide, especially in countries with the middle and low incomes.
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Affiliation(s)
- Yanna Song
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, 510000 Guangzhou, China
| | - Xiaoxiao Zheng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Yong Fang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Shan Liu
- The Second Hospital of Jilin University, Jilin University, Ziqiang Street 218, 130022 Changchun, China
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, 17177 Solna, Stockholm, Sweden
| | - Xiujuan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
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Makadia R, Shoaibi A, Rao GA, Ostropolets A, Rijnbeek PR, Voss EA, Duarte-Salles T, Ramírez-Anguita JM, Mayer MA, Maljković F, Denaxas S, Nyberg F, Papez V, Sena AG, Alshammari TM, Lai LYH, Haynes K, Suchard MA, Hripcsak G, Ryan PB. Evaluating the impact of alternative phenotype definitions on incidence rates across a global data network. JAMIA Open 2023; 6:ooad096. [PMID: 38028730 PMCID: PMC10662662 DOI: 10.1093/jamiaopen/ooad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/25/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Developing accurate phenotype definitions is critical in obtaining reliable and reproducible background rates in safety research. This study aims to illustrate the differences in background incidence rates by comparing definitions for a given outcome. Materials and Methods We used 16 data sources to systematically generate and evaluate outcomes for 13 adverse events and their overall background rates. We examined the effect of different modifications (inpatient setting, standardization of code set, and code set changes) to the computable phenotype on background incidence rates. Results Rate ratios (RRs) of the incidence rates from each computable phenotype definition varied across outcomes, with inpatient restriction showing the highest variation from 1 to 11.93. Standardization of code set RRs ranges from 1 to 1.64, and code set changes range from 1 to 2.52. Discussion The modification that has the highest impact is requiring inpatient place of service, leading to at least a 2-fold higher incidence rate in the base definition. Standardization showed almost no change when using source code variations. The strength of the effect in the inpatient restriction is highly dependent on the outcome. Changing definitions from broad to narrow showed the most variability by age/gender/database across phenotypes and less than a 2-fold increase in rate compared to the base definition. Conclusion Characterization of outcomes across a network of databases yields insights into sensitivity and specificity trade-offs when definitions are altered. Outcomes should be thoroughly evaluated prior to use for background rates for their plausibility for use across a global network.
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Affiliation(s)
- Rupa Makadia
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Azza Shoaibi
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Gowtham A Rao
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Anna Ostropolets
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10027, United States
| | - Peter R Rijnbeek
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Erica A Voss
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Talita Duarte-Salles
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 08007, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Barcelona, 08003, Spain
| | - Miguel A Mayer
- Management Control Department, Parc de Salut Mar (PSMAR), Barcelona, 08007, Spain
| | - Filip Maljković
- Research and Development, Heliant d.o.o, Belgrade, 11000, Serbia
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, NW1 2DA, United Kingdom
- British Heart Foundation Data Science Centre, HDR, London, NW1 2DA, United Kingdom
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
| | - Vaclav Papez
- Institute of Health Informatics, University College London, London, NW1 2DA, United Kingdom
| | - Anthony G Sena
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Thamir M Alshammari
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh, 11942, Saudi Arabia
| | - Lana Y H Lai
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Kevin Haynes
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Marc A Suchard
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA 90025, United States
| | - George Hripcsak
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10027, United States
| | - Patrick B Ryan
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10027, United States
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Gubernot D, Menis M, Whitaker B. Background rates for severe cutaneous reactions in the US: Contextual support for safety assessment of COVID-19 vaccines and novel biologics. Vaccine 2023; 41:6922-6929. [PMID: 37891051 DOI: 10.1016/j.vaccine.2023.10.025] [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: 04/19/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
The global COVID-19 public health crisis has resulted in extraordinary collaboration to expeditiously develop vaccines and therapeutics. The safety of these biologics is closely monitored by the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Novel products may have limited safety data, and although serious medical outcomes associated with vaccination are rare, knowledge of background incidence rates of medical conditions in the US population puts reported adverse events (AEs) in perspective for further study. Although relatively minor vaccination skin reactions are common, rare instances of severe delayed hypersensitivity reactions such as erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome may occur. To aid in the assessment of these events, we performed a literature search in PubMed and Web of Science on the background incidence of EM, SJS, SJS/TEN, and TEN in the US population and on published reports of these conditions occurring post-vaccination. The US background annual incidence rates per million individuals of all ages ranged from 5.3 to 63.0 for SJS, from 0.4 to 5.0 for TEN, and from 0.8 to 1.6 for SJS/TEN. Since these conditions may overlap, some studies reported rates for EM/SJS/TEN combined, however we did not find studies with exclusive EM incidence rates. The published literature, including studies of reports submitted to the FDA/CDC Vaccine Adverse Event Reporting System (VAERS), describes post-vaccination EM, SJS, SJS/TEN and/or TEN as rare occurrences. The vaccines most frequently associated with these conditions were measles, mumps, and rubella; diphtheria, tetanus, and pertussis; and varicella. The majority of VAERS reports of EM, SJS, SJS/TEN, or TEN occurred in children within 30 days of vaccination. This review summarizes background rates of these disorders in the general population and published AEs among vaccine recipients, to support safety surveillance of COVID-19 vaccines and other biologics.
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Affiliation(s)
- Diane Gubernot
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Mikhail Menis
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Barbee Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
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10
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Cullen LA, Grange Z, Antal K, Waugh L, Alsina MS, Gibbons CL, MacDonald LE, Robertson C, Cameron JC, Stockton D, O'Leary MC. COVID-19 vaccine safety in Scotland - background rates of adverse events of special interest. Public Health 2023; 224:1-7. [PMID: 37688806 DOI: 10.1016/j.puhe.2023.08.006] [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: 02/08/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES Mass COVID-19 vaccination commenced in December 2020 in Scotland. Monitoring vaccine safety relies on accurate background incidence rates (IRs) for health outcomes potentially associated with vaccination. This study aimed to quantify IRs in Scotland of adverse events of special interest (AESI) potentially associated with COVID-19 vaccination. STUDY DESIGN AND METHODS IRs and 95% confidence intervals (CIs) for 36 AESI were calculated retrospectively for the pre-COVID-19 pandemic period (01 January 2015-31 December 2019) and the COVID-19 pandemic period (01 April 2020-30 November 2020), with age-sex stratification, and separately by calendar month and year. Incident cases were determined using International Classification of Diseases-10th Revision (ICD-10)-coded hospitalisations. RESULTS Prepandemic population-wide IRs ranged from 0.4 (0.3-0.5 CIs) cases per 100,000 person-years (PYRS) for neuromyelitis optica to 478.4 (475.8-481.0 CIs) cases per 100,000 PYRS for acute renal failure. Pandemic population-wide IRs ranged from 0.3 (0.2-0.5 CIs) cases per 100,000 PYRS for Kawasaki disease to 483.4 (473.2-493.7 CIs) cases per 100,000 PYRS for acute coronary syndrome. All AESI IRs varied by age and sex. Ten AESI (acute coronary syndrome, acute myocardial infarction, angina pectoris, heart failure, multiple sclerosis, polyneuropathies and peripheral neuropathies, respiratory failure, rheumatoid arthritis and polyarthritis, seizures and vasculitis) had lower pandemic than prepandemic period IRs overall. Only deep vein thrombosis and pulmonary embolism had a higher pandemic IR. CONCLUSION Lower pandemic IRs likely resulted from reduced health-seeking behaviours and healthcare provision. Higher IRs may be associated with SARS-CoV-2 infections. AESI IRs will facilitate future vaccine safety studies in Scotland.
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Affiliation(s)
- L A Cullen
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - Z Grange
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - K Antal
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - L Waugh
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - M S Alsina
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - C L Gibbons
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | | | - C Robertson
- University of Strathclyde and Public Health Scotland, Glasgow, UK.
| | - J C Cameron
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - D Stockton
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - M C O'Leary
- Public Health Scotland, Glasgow, Edinburgh, UK.
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11
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Asturias EJ, Excler JL, Ackland J, Cavaleri M, Fulurija A, Long R, McCulloch M, Sriskandan S, Sun W, Zühlke L, Kim JH, Dale JB, Steer AC. Safety of Streptococcus pyogenes Vaccines: Anticipating and Overcoming Challenges for Clinical Trials and Post-Marketing Monitoring. Clin Infect Dis 2023; 77:917-924. [PMID: 37232372 PMCID: PMC10506775 DOI: 10.1093/cid/ciad311] [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: 02/26/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023] Open
Abstract
Streptococcus pyogenes (Strep A) infections result in a vastly underestimated burden of acute and chronic disease globally. The Strep A Vaccine Global Consortium's (SAVAC's) mission is to accelerate the development of safe, effective, and affordable S. pyogenes vaccines. The safety of vaccine recipients is of paramount importance. A single S. pyogenes vaccine clinical trial conducted in the 1960s raised important safety concerns. A SAVAC Safety Working Group was established to review the safety assessment methodology and results of more recent early-phase clinical trials and to consider future challenges for vaccine safety assessments across all phases of vaccine development. No clinical or biological safety signals were detected in any of these early-phase trials in the modern era. Improvements in vaccine safety assessments need further consideration, particularly for pediatric clinical trials, large-scale efficacy trials, and preparation for post-marketing pharmacovigilance.
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Affiliation(s)
- Edwin J Asturias
- Colorado School of Public Health, University of Colorado, Aurora Colorado, USA
- Children’s Hospital, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jean-Louis Excler
- Director General’s Office, International Vaccine Institute, Seoul, Republic of Korea
| | | | - Marco Cavaleri
- Anti-Infectives and Vaccines, European Medicines Agency, Amsterdam, The Netherlands
| | - Alma Fulurija
- Group A Streptococcal and Rheumatic Heart Disease Team, Telethon Kids Institute, Perth, Australia
| | - Raj Long
- Safety and pharmacovigilance, Bill & Melinda Gates Foundation, London, United Kingdom
| | - Mignon McCulloch
- Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | | | | | - Liesl Zühlke
- South African Medical Research Council, Parowvallei, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics, Institute of Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jerome H Kim
- Director General’s Office, International Vaccine Institute, Seoul, Republic of Korea
- College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - James B Dale
- College of Medicine, University of Tennessee Health Science Center, Memphis Tennessee, USA
| | - Andrew C Steer
- Infection and Immunity Theme, Tropical Diseases Research Group, Murdoch Children's Research Institute, Parkville Victoria, Australia
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12
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Halsey N, Evans S, Santosham M, Hacker A, Edwards KM, Chandler RE, Dudley MZ, Dekker CL, Al-Abri S, Arora N, Buttery J, Dodoo A, Eskola J, Heininger U, Jee Y, Khuri N, Obaro S, Orenstein W, Pitisuttithum P, Safadi M, Whitney CG, Black S. Considerations for unblinding individual study participants during vaccine trials. Vaccine 2023; 41:3399-3402. [PMID: 37121805 DOI: 10.1016/j.vaccine.2023.04.033] [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: 12/17/2022] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
Premature unblinding of individual participants is rarely reported in publications, but such unblinding can disrupt vaccine trials by causing worry and drop-out of other participants or "pseudo unblinding," in which participants or investigators over-interpret certain symptoms as being related to receiving an investigational product. This review summarizes appropriate reasons for unblinding in vaccine trials. Regulatory guidance could be improved by distinguishing guidance for vaccine trials from drug trials, with the recognition that unblinding individual participants in vaccine studies is rarely needed for management of adverse events following immunization.
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Affiliation(s)
- Neal Halsey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.
| | - Stephen Evans
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Adam Hacker
- Coalition for Epidemic Preparedness Innovations, Norway
| | | | | | - Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | | | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Narendra Arora
- Executive Director of The INCLEN Trust International, India
| | | | | | - Juhani Eskola
- National Institute for Health and Wellfare, Helsinki, Finland
| | | | | | | | - Stephen Obaro
- University of Nebraska Medical Center, United States
| | | | | | | | | | - Steve Black
- Global Vaccine Data Network, Auckland, New Zealand
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13
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Pillsbury A, Phillips A, Deng L, Quinn H, Macartney K, Gidding H. Background incidence rates of selected adverse events of special interest (AESI) to monitor the safety of COVID-19 vaccines. Vaccine 2023; 41:3422-3428. [PMID: 37088604 PMCID: PMC10110935 DOI: 10.1016/j.vaccine.2023.04.041] [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: 08/04/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Determining background rates of medical conditions identified as adverse events of special interest (AESI) that may occur following COVID-19 vaccination is important for contextualising and investigating potential vaccine safety signals. METHODS We conducted a retrospective population-based cohort study using linked emergency department, hospitalisation and death data for 2017 and 2018 from Australia's most populous state, New South Wales. Incident cases of select neurological conditions, arterial or venous thromboembolic conditions, secondary thrombocytopenia, myocarditis/pericarditis, and unique events of anaphylaxis and generalised convulsions were identified using internationally agreed upon diagnostic (ICD-10) codes. State-specific rates per 100,000 person-years were calculated, with further stratification by age group and sex where clinically relevant to the condition, and the number of expected cases nationally in one and 6 weeks was estimated. RESULTS Background rates of selected neurological conditions were low with the exception of generalised convulsions for which 1,599-1,872 cases were estimated nationally in a 1-week period in the absence of vaccination. Using a narrow case definition, rates of Guillain-Barré Syndrome (3.9 per 100,000 person-years) were higher than international rates reported elsewhere. Thromboembolic and cerebral venous sinus thrombosis event rates increased with age. Myocarditis occurred more commonly in males, and was highest in males aged 18-24 years, with an estimated 1-4 cases expected nationally in a 1-week period. CONCLUSIONS Using routinely collected linked healthcare data provides localised estimates of background rates of new onset or periodic AESI which enables rapid estimation of observed-versus-expected rates of events reported following COVID-19 vaccination. This Australian-specific analysis contributes AESI background rates which can be compared with those from other countries to enhance understanding of geographic variability in the frequency of specific AESI in the absence of vaccination, and can be utilised for signal detection during program implementation.
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Affiliation(s)
- Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia.
| | - Anastasia Phillips
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia.
| | - Lucy Deng
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia.
| | - Helen Quinn
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia.
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia.
| | - Heather Gidding
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Northern Clinical School, St Leonards, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; School of Population Health, UNSW Medicine, University of NSW, Sydney, NSW, Australia.
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14
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Schuemie MJ, Bu F, Nishimura A, Suchard MA. Adjusting for both sequential testing and systematic error in safety surveillance using observational data: Empirical calibration and MaxSPRT. Stat Med 2023; 42:619-631. [PMID: 36642826 PMCID: PMC10107810 DOI: 10.1002/sim.9631] [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: 07/08/2022] [Revised: 09/30/2022] [Accepted: 12/08/2022] [Indexed: 01/17/2023]
Abstract
Post-approval safety surveillance of medical products using observational healthcare data can help identify safety issues beyond those found in pre-approval trials. When testing sequentially as data accrue, maximum sequential probability ratio testing (MaxSPRT) is a common approach to maintaining nominal type 1 error. However, the true type 1 error may still deviate from the specified one because of systematic error due to the observational nature of the analysis. This systematic error may persist even after controlling for known confounders. Here we propose to address this issue by combing MaxSPRT with empirical calibration. In empirical calibration, we assume uncertainty about the systematic error in our analysis, the source of uncertainty commonly overlooked in practice. We infer a probability distribution of systematic error by relying on a large set of negative controls: exposure-outcome pairs where no causal effect is believed to exist. Integrating this distribution into our test statistics has previously been shown to restore type 1 error to nominal. Here we show how we can calibrate the critical value central to MaxSPRT. We evaluate this novel approach using simulations and real electronic health records, using H1N1 vaccinations during the 2009-2010 season as an example. Results show that combining empirical calibration with MaxSPRT restores nominal type 1 error. In our real-world example, adjusting for systematic error using empirical calibration has a larger impact than, and hence is just as essential as, adjusting for sequential testing using MaxSPRT. We recommend performing both, using the method described here.
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Affiliation(s)
- Martijn J Schuemie
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey.,Department of Biostatistics, University of California, Los Angeles, California
| | - Fan Bu
- Department of Biostatistics, University of California, Los Angeles, California.,Department of Human Genetics, University of California, Los Angeles, California
| | - Akihiko Nishimura
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Marc A Suchard
- Department of Biostatistics, University of California, Los Angeles, California.,Department of Human Genetics, University of California, Los Angeles, California.,VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, Utah, USA
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15
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Budigan Ni H, de Broucker G, Patenaude BN, Dudley MZ, Hampton LM, Salmon DA. Economic impact of vaccine safety incident in Ukraine: The economic case for safety system investment. Vaccine 2023; 41:219-225. [PMID: 36435704 DOI: 10.1016/j.vaccine.2022.11.004] [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: 09/04/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vaccine confidence and coverage decreased following a death temporally but not causally related to measles vaccination in Ukraine in 2008. Large measles outbreaks including international exportations followed. Herein we characterize this experience including associated costs. METHODS Mixed-methods were used to characterize this vaccine safety incident and quantify health and economic costs. Qualitative interviews illuminate the incident, social climate, and corruption that influenced vaccine confidence in Ukraine. A literature review explored attitudes toward vaccines in the USSR and post-independence Ukraine. Infectious disease incidence was examined before and after the vaccine safety incident. An economic analysis estimated associated healthcare costs, including prevention and outbreak control measures, additional vaccination activities due to failure of the 2008 campaign, treatment costs for new cases domestically and foreign exportation, and productivity loss from treatment time and mortality for new cases. FINDINGS Vaccine hesitancy and distrust in government and public health programs due to corruption existed in Ukraine before the vaccine safety incident. The mishandling of the 2008 incident catalyzed the decline of vaccine confidence and prompted poor procurement decisions, leading to a drop in infant vaccination coverage, increased domestic measles cases, and exportation of measles. The estimated cost of this incident was approximately $140 million from 2008 to 2018. INTERPRETATION Absent a rapid and credible vaccine safety response, a coincidental death following immunization resulted in major outbreaks of measles with substantial economic costs. Adequate investments in a post-licensure safety system may help avoid similar future incidents.
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Affiliation(s)
- Haley Budigan Ni
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Office of Health Equity, California Department of Public Health, 850 Marina Bay Pkwy, Unit F175, Richmond, CA 94804, USA
| | - Gatien de Broucker
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Bryan N Patenaude
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Lee M Hampton
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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16
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Willame C, Dodd C, Durán CE, Elbers RJHJ, Gini R, Bartolini C, Paoletti O, Wang L, Ehrenstein V, Kahlert J, Haug U, Schink T, Diez-Domingo J, Mira-Iglesias A, Carreras JJ, Vergara-Hernández C, Giaquinto C, Barbieri E, Stona L, Huerta C, Martín-Pérez M, García-Poza P, de Burgos A, Martínez-González M, Bryant V, Villalobos F, Pallejà-Millán M, Aragón M, Carreras JJ, Souverein P, Thurin NH, Weibel D, Klungel OH, Sturkenboom MCJM. Background rates of 41 adverse events of special interest for COVID-19 vaccines in 10 European healthcare databases - an ACCESS cohort study. Vaccine 2023; 41:251-262. [PMID: 36446653 PMCID: PMC9678835 DOI: 10.1016/j.vaccine.2022.11.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In May 2020, the ACCESS (The vACCine covid-19 monitoring readinESS) project was launched to prepare real-world monitoring of COVID-19 vaccines. Within this project, this study aimed to generate background incidence rates of 41 adverse events of special interest (AESI) to contextualize potential safety signals detected following administration of COVID-19 vaccines. METHODS A dynamic cohort study was conducted using a distributed data network of 10 healthcare databases from 7 European countries (Italy, Spain, Denmark, The Netherlands, Germany, France and United Kingdom) over the period 2017 to 2020. A common protocol (EUPAS37273), common data model, and common analytics programs were applied for syntactic, semantic and analytical harmonization. Incidence rates (IR) for each AESI and each database were calculated by age and sex by dividing the number of incident cases by the total person-time at risk. Age-standardized rates were pooled using random effect models according to the provenance of the events. FINDINGS A total number of 63,456,074 individuals were included in the study, contributing to 211.7 million person-years. A clear age pattern was observed for most AESIs, rates also varied by provenance of disease diagnosis (primary care, specialist care). Thrombosis with thrombocytopenia rates were extremely low ranging from 0.06 to 4.53/100,000 person-years for cerebral venous sinus thrombosis (CVST) with thrombocytopenia (TP) and mixed venous and arterial thrombosis with TP, respectively. INTERPRETATION Given the nature of the AESIs and the setting (general practitioners or hospital-based databases or both), background rates from databases that show the highest level of completeness (primary care and specialist care) should be preferred, others can be used for sensitivity. The study was designed to ensure representativeness to the European population and generalizability of the background incidence rates. FUNDING The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2018/28/PE.
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Affiliation(s)
- C Willame
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - C Dodd
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - CE Durán
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - RJHJ Elbers
- Department of Data science & Biostatistic, Data manegement, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - R Gini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - C Bartolini
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - O Paoletti
- Agenzia regionale di sanità della Toscana, via Pietro Dazzi 1, 55100 Florence, Italy
| | - L Wang
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - U Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Faculty of Human and Health Sciences, University of Bremen, Germany
| | - T Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, 28359 Bremen, Germany
| | - J Diez-Domingo
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - A Mira-Iglesias
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Vergara-Hernández
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - E Barbieri
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - L Stona
- Fondazione Penta ONLUS, Corso Stati Uniti 4, 35127 Padova, Italy
| | - C Huerta
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - M Martín-Pérez
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - P García-Poza
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - A de Burgos
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - M Martínez-González
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - V Bryant
- Pharmacoepidemiology and Pharmacovigilance Division, Medicines for Human Use Department, Spanish Agency for Medicines and Medical Devices (AEMPS), Calle Campezo 1, 28022 Madrid, Spain
| | - F Villalobos
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Pallejà-Millán
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43202 Reus, Spain
| | - M Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - JJ Carreras
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO – Public Health), Avenida Cataluña, 21, 46020 Valencia, Spain
| | - P Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - NH Thurin
- INSERM CIC-P1401, Bordeaux PharmacoEpi, Univ. Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
| | - D Weibel
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands
| | - OH Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands
| | - MCJM Sturkenboom
- Department of Datascience & Biostatistics, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands,Corresponding author at: Department Datascience & Biostatistics Univerisity Medical Center Utrecht, Heidelberglaan 100, The Netherlands
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17
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Oosterhuis I, Scholl J, van Puijenbroek E, Kant A, van Hunsel F. Optimizing Safety Surveillance for COVID-19 Vaccines at the National Pharmacovigilance Centre Lareb: One Year of COVID-19 Vaccine Experience. Drug Saf 2023; 46:65-75. [PMID: 36350465 PMCID: PMC9645343 DOI: 10.1007/s40264-022-01253-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Due to the COVID-19 vaccination campaign, national pharmacovigilance (PV) centres had to deal with high volumes of Individual Case Safety Reports (ICSRs) that needed to be processed and assessed in a short time span. This necessitated the development of a dedicated system to enable near real-time vaccine safety monitoring at the Dutch PV Centre Lareb. OBJECTIVES To describe infrastructure, processes and Adverse Events Following Immunisation (AEFIs) reported for vaccine safety monitoring of COVID-19 vaccines during a large-scale vaccination campaign in the Netherlands. METHODS A COVID-19 tailored vaccine web-based reporting form collected information on the vaccine administered, AEFIs and other (medical) information. A fully automated process for ICSRs enabled the handling of the majority of common and known reported AEFIs. All other ICSRs were triaged daily and processed separately. There were daily signal detection meetings and weekly reports for batch analysis. RESULTS In 2021, Lareb received 184,411 ICSRs, a reporting rate of 0.67% for vaccines given in the Netherlands. 887,954 AEFIs were reported, mostly well-known, nonserious AEFIs; 2.4% were serious and 0.3% were fatal. 33.1% of all ICSRs were processed fully automatically. Based on the daily triage, 4.2% were flagged as 'high priority'; 62.7% as 'low-priority'. Twenty-seven signals and news stories about the COVID-19 vaccines were disseminated. CONCLUSIONS Due to automatic processing of well-known AEFIs, daily triage and signal detection meetings, 99.9% of the ICSRs were processed within the compliance timeframe to Eudravigilance, and signal detection was performed during a large-scale vaccination campaign. These experiences may serve as a blueprint for future mass vaccination programs.
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Affiliation(s)
- Ingrid Oosterhuis
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH ’s-Hertogenbosch, The Netherlands
| | - Joep Scholl
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH ’s-Hertogenbosch, The Netherlands
| | - Eugène van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH ’s-Hertogenbosch, The Netherlands ,PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Agnes Kant
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH ’s-Hertogenbosch, The Netherlands
| | - Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH ’s-Hertogenbosch, The Netherlands
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18
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Buttery JP, Clothier H. Information systems for vaccine safety surveillance. Hum Vaccin Immunother 2022; 18:2100173. [PMID: 36162040 DOI: 10.1080/21645515.2022.2100173] [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: 12/15/2022] Open
Abstract
Immunization implementation in the community relies upon post-licensure vaccine safety surveillance to maintain safe vaccination programs and to detect rare AEFI not observed in clinical trials. The increasing availability of electronic health-care related data and correspondence from both health-related providers and internet-based media has revolutionized health-care information. Many and varied forms of health information related to adverse event following immunization (AEFI) are potentially suitable for vaccine safety surveillance. The utilization of these media ranges from more efficient use of electronic spontaneous reporting, automated solicited surveillance methods, screening various electronic health record types, and the utilization of natural language processing techniques to scan enormous amounts of internet-based data for AEFI mentions. Each of these surveillance types have advantages and disadvantages and are often complementary to each other. Most are "hypothesis generating," detecting potential safety signals, where some, such as vaccine safety datalinking, may also serve as "hypothesis testing" to help verify and investigate those potential signals.
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Affiliation(s)
- Jim P Buttery
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Centre for Health Analytics, Melbourne, Australia.,Health Informatics Group and SAEFVIC, Murdoch Children's Research Institute, Melbourne, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia
| | - Hazel Clothier
- Centre for Health Analytics, Melbourne, Australia.,Health Informatics Group and SAEFVIC, Murdoch Children's Research Institute, Melbourne, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia
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19
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Rudolph A, Mitchell J, Barrett J, Sköld H, Taavola H, Erlanson N, Melgarejo-González C, Yue QY. Global safety monitoring of COVID-19 vaccines: how pharmacovigilance rose to the challenge. Ther Adv Drug Saf 2022; 13:20420986221118972. [PMID: 36052399 PMCID: PMC9424876 DOI: 10.1177/20420986221118972] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Pharmacovigilance (PV) came suddenly into the spotlight when several new
vaccines, developed as a response to the COVID-19 pandemic, received emergency
authorisation and were rolled out on a large scale in late 2020. The vaccines
underwent stringent clinical trials and evaluation from regulatory authorities,
but with the use of novel technology and an anticipated rapid and vast
deployment of the vaccines, the importance of a well-functioning international
post marketing safety surveillance system was stressed. International PV
stakeholders were faced with several challenges due to the extent of the global
vaccination campaign. The unprecedented volume of reports of suspected adverse
events following immunization has led to the development and use of new tools.
Furthermore, the collaboration between various PV stakeholders was encouraged
and strengthened. PV rose to the challenges posed by the currently ongoing
global COVID-19 vaccination campaign and successful adaptations were made in a
short period of time. However, the pandemic has not ended yet, the vaccination
campaign is far from being completed, and further challenges are anticipated.
Advances made during the pandemic will be important to strengthen PV in future
and ensure to advance medicines’ safety together.
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Affiliation(s)
- Annette Rudolph
- WHO CC, Signal Management, Uppsala Monitoring Centre, Bredgränd 7B, Uppsala 753 20, Sweden
| | - Joseph Mitchell
- WHO CC, Signal Management, Uppsala Monitoring Centre, Uppsala, Sweden
| | - Jim Barrett
- Research, Data Science, Uppsala Monitoring Centre, Uppsala, Sweden
| | - Helena Sköld
- Operations, PV Portfolio, Uppsala Monitoring Centre, Uppsala, Sweden
| | - Henric Taavola
- Research, Data Science, Uppsala Monitoring Centre, Uppsala, Sweden
| | - Nils Erlanson
- Research, Data Science, Uppsala Monitoring Centre, Uppsala, Sweden
| | | | - Qun-Ying Yue
- WHO CC, Signal Management, Uppsala Monitoring Centre, Uppsala, Sweden
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20
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Schuemie MJ, Arshad F, Pratt N, Nyberg F, Alshammari TM, Hripcsak G, Ryan P, Prieto-Alhambra D, Lai LYH, Li X, Fortin S, Minty E, Suchard MA. Vaccine Safety Surveillance Using Routinely Collected Healthcare Data-An Empirical Evaluation of Epidemiological Designs. Front Pharmacol 2022; 13:893484. [PMID: 35873596 PMCID: PMC9299244 DOI: 10.3389/fphar.2022.893484] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Routinely collected healthcare data such as administrative claims and electronic health records (EHR) can complement clinical trials and spontaneous reports to detect previously unknown risks of vaccines, but uncertainty remains about the behavior of alternative epidemiologic designs to detect and declare a true risk early. Methods: Using three claims and one EHR database, we evaluate several variants of the case-control, comparative cohort, historical comparator, and self-controlled designs against historical vaccinations using real negative control outcomes (outcomes with no evidence to suggest that they could be caused by the vaccines) and simulated positive control outcomes. Results: Most methods show large type 1 error, often identifying false positive signals. The cohort method appears either positively or negatively biased, depending on the choice of comparator index date. Empirical calibration using effect-size estimates for negative control outcomes can bring type 1 error closer to nominal, often at the cost of increasing type 2 error. After calibration, the self-controlled case series (SCCS) design most rapidly detects small true effect sizes, while the historical comparator performs well for strong effects. Conclusion: When applying any method for vaccine safety surveillance we recommend considering the potential for systematic error, especially due to confounding, which for many designs appears to be substantial. Adjusting for age and sex alone is likely not sufficient to address differences between vaccinated and unvaccinated, and for the cohort method the choice of index date is important for the comparability of the groups. Analysis of negative control outcomes allows both quantification of the systematic error and, if desired, subsequent empirical calibration to restore type 1 error to its nominal value. In order to detect weaker signals, one may have to accept a higher type 1 error.
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Affiliation(s)
- Martijn J. Schuemie
- Observational Health Data Sciences and Informatics, New York, NY, United States,Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States,Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States,*Correspondence: Martijn J. Schuemie,
| | - Faaizah Arshad
- Observational Health Data Sciences and Informatics, New York, NY, United States,Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thamir M Alshammari
- College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh, Saudi Arabia
| | - George Hripcsak
- Observational Health Data Sciences and Informatics, New York, NY, United States,Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Patrick Ryan
- Observational Health Data Sciences and Informatics, New York, NY, United States,Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States,Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Lana Y. H. Lai
- O’Brien Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Xintong Li
- Division of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Stephen Fortin
- Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States
| | - Evan Minty
- O’Brien Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marc A. Suchard
- Observational Health Data Sciences and Informatics, New York, NY, United States,Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States,Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, United States
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21
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Burn E, Li X, Kostka K, Stewart HM, Reich C, Seager S, Duarte‐Salles T, Fernandez‐Bertolin S, Aragón M, Reyes C, Martinez‐Hernandez E, Marti E, Delmestri A, Verhamme K, Rijnbeek P, Horban S, Morales DR, Prieto‐Alhambra D. Background rates of five thrombosis with thrombocytopenia syndromes of special interest for COVID-19 vaccine safety surveillance: Incidence between 2017 and 2019 and patient profiles from 38.6 million people in six European countries. Pharmacoepidemiol Drug Saf 2022; 31:495-510. [PMID: 35191114 PMCID: PMC9088543 DOI: 10.1002/pds.5419] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 01/22/2023]
Abstract
AbstractBackgroundThrombosis with thrombocytopenia syndrome (TTS) has been reported among individuals vaccinated with adenovirus‐vectored COVID‐19 vaccines. In this study, we describe the background incidence of non‐vaccine induced TTS in six European countries.MethodsElectronic medical records from France, the Netherlands, Italy, Germany, Spain, and the United Kingdom informed the study. Incidence rates of cerebral venous sinus thrombosis (CVST), splanchnic vein thrombosis (SVT), deep vein thrombosis (DVT), pulmonary embolism (PE), and myocardial infarction or ischemic stroke, all with concurrent thrombocytopenia, were estimated among the general population of persons in a database between 2017 and 2019. A range of additional potential adverse events of special interest for COVID‐19 vaccinations were also studied in a similar manner.FindingsA total of 38 611 617 individuals were included. Background rates ranged from 1.0 (95% CI: 0.7–1.4) to 8.5 (7.4–9.9) per 100 000 person‐years for DVT with thrombocytopenia, from 0.5 (0.3–0.6) to 20.8 (18.9–22.8) for PE with thrombocytopenia, from 0.1 (0.0–0.1) to 2.5 (2.2–2.7) for SVT with thrombocytopenia, and from 1.0 (0.8–1.2) to 43.4 (40.7–46.3) for myocardial infarction or ischemic stroke with thrombocytopenia. CVST with thrombocytopenia was only identified in one database, with incidence rate of 0.1 (0.1–0.2) per 100 000 person‐years. The incidence of non‐vaccine induced TTS increased with age, and was typically greater among those with more comorbidities and greater medication use than the general population. It was also more often seen in men than women. A large proportion of those affected were seen to have been taking antithrombotic and anticoagulant therapies prior to their event.InterpretationAlthough rates vary across databases, non‐vaccine induced TTS has consistently been seen to be a very rare event among the general population. While still remaining very rare, rates were typically higher among older individuals, and those affected were also seen to generally be male and have more comorbidities and greater medication use than the general population.
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Affiliation(s)
- Edward Burn
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS)University of OxfordOxfordUK
| | - Xintong Li
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS)University of OxfordOxfordUK
| | - Kristin Kostka
- Real World Solutions, IQVIACambridgeMassachusettsUSA
- The OHDSI Center at The Roux InstituteNortheastern UniversityPortlandMaineUSA
| | | | | | - Sarah Seager
- Real World Solutions, IQVIACambridgeMassachusettsUSA
| | - Talita Duarte‐Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
| | - Sergio Fernandez‐Bertolin
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
| | - María Aragón
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
| | | | - Edelmira Marti
- Hemostasis and Thrombosis Unit, Hematology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain
| | - Antonella Delmestri
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS)University of OxfordOxfordUK
| | - Katia Verhamme
- Department of Medical InformaticsErasmus University Medical CenterRotterdamThe Netherlands
| | - Peter Rijnbeek
- Department of Medical InformaticsErasmus University Medical CenterRotterdamThe Netherlands
| | - Scott Horban
- Division of Population Health and GenomicsUniversity of DundeeDundeeUK
| | - Daniel R. Morales
- Division of Population Health and GenomicsUniversity of DundeeDundeeUK
| | - Daniel Prieto‐Alhambra
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS)University of OxfordOxfordUK
- Department of Medical InformaticsErasmus University Medical CenterRotterdamThe Netherlands
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22
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Ostropolets A, Li X, Makadia R, Rao G, Rijnbeek PR, Duarte-Salles T, Sena AG, Shaoibi A, Suchard MA, Ryan PB, Prieto-Alhambra D, Hripcsak G. Factors Influencing Background Incidence Rate Calculation: Systematic Empirical Evaluation Across an International Network of Observational Databases. Front Pharmacol 2022; 13:814198. [PMID: 35559254 PMCID: PMC9087898 DOI: 10.3389/fphar.2022.814198] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/17/2022] [Indexed: 01/01/2023] Open
Abstract
Objective: Background incidence rates are routinely used in safety studies to evaluate an association of an exposure and outcome. Systematic research on sensitivity of rates to the choice of the study parameters is lacking. Materials and Methods: We used 12 data sources to systematically examine the influence of age, race, sex, database, time-at-risk, season and year, prior observation and clean window on incidence rates using 15 adverse events of special interest for COVID-19 vaccines as an example. For binary comparisons we calculated incidence rate ratios and performed random-effect meta-analysis. Results: We observed a wide variation of background rates that goes well beyond age and database effects previously observed. While rates vary up to a factor of 1,000 across age groups, even after adjusting for age and sex, the study showed residual bias due to the other parameters. Rates were highly influenced by the choice of anchoring (e.g., health visit, vaccination, or arbitrary date) for the time-at-risk start. Anchoring on a healthcare encounter yielded higher incidence comparing to a random date, especially for short time-at-risk. Incidence rates were highly influenced by the choice of the database (varying by up to a factor of 100), clean window choice and time-at-risk duration, and less so by secular or seasonal trends. Conclusion: Comparing background to observed rates requires appropriate adjustment and careful time-at-risk start and duration choice. Results should be interpreted in the context of study parameter choices.
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Affiliation(s)
| | - Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, United States
| | - Gowtham Rao
- Janssen Research and Development, Titusville, NJ, United States
| | - Peter R. Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Talita Duarte-Salles
- Fundacio Institut Universitari per a la Recerca a L’Atencio Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Anthony G. Sena
- Janssen Research and Development, Titusville, NJ, United States
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Azza Shaoibi
- Janssen Research and Development, Titusville, NJ, United States
| | - Marc A. Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Patrick B. Ryan
- Columbia University Medical Center, New York, NY, United States
- Janssen Research and Development, Titusville, NJ, United States
| | | | - George Hripcsak
- Columbia University Medical Center, New York, NY, United States
- New York-Presbyterian Hospital, New York, NY, United States
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23
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Thorpe A, Fagerlin A, Drews FA, Butler J, Stevens V, Riddoch MS, Scherer LD. Communications to Promote Interest and Confidence in COVID-19 Vaccines. Am J Health Promot 2022; 36:976-986. [PMID: 35411819 PMCID: PMC9008475 DOI: 10.1177/08901171221082904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Communicating about COVID-19 vaccine side effects and efficacy is crucial for promoting transparency and informed decision-making, but there is limited evidence on how to do so effectively. DESIGN A within-subjects experiment. SETTING Online survey from January 21 to February 6, 2021. SUBJECTS 596 US Veterans and 447 non-Veterans. INTERVENTION 5 messages about COVID-19 vaccine side effects and 4 messages about COVID-19 vaccine efficacy. MEASURES COVID-19 vaccine interest (1 = "I definitely do NOT want the vaccine" to 7 = "I definitely WANT the vaccine" with the midpoint 4 = "Unsure"). Confidence about COVID-19 vaccine efficacy (1= "Not at all confident," 2 = "Slightly confident," 3 = "Somewhat confident," 4 = "Moderately confident," 5 = "Extremely confident"). RESULTS Compared to providing information about side effects alone (M = 5.62 [1.87]), messages with additional information on the benefits of vaccination (M = 5.77 [1.82], P < .001, dz = .25), reframing the likelihood of side effects (M = 5.74 [1.84], P < .001, dz = .23), and emphasizing that post-vaccine symptoms indicate the vaccine is working (M = 5.72 [1.84], P < .001, dz = .17) increased vaccine interest. Compared to a vaccine efficacy message containing verbal uncertainty and an efficacy range (M = 3.97 [1.25]), messages conveying verbal certainty with an efficacy range (M = 4.00 [1.24], P = .042, dz=.08), verbal uncertainty focused on the upper efficacy limit (M = 4.03 [1.26], P < .001, dz = .13), and communicating the point estimate with certainty (M = 4.02 [1.25], P < .001, dz = .11) increased confidence. Overall, Veteran respondents were more interested (MVeterans = 5.87 [1.72] vs MNonVeterans = 5.45 [2.00], P < .001, d = .22) and confident (MVeterans = 4.13 [1.19] vs MNonVeterans = 3.84 [1.32], P < .001, d = .23) about COVID-19 vaccines than non-Veterans. CONCLUSIONS These strategies can be implemented in large-scale communications (e.g., webpages, social media, and leaflets/posters) and can help guide healthcare professionals when discussing vaccinations in clinics to promote interest and confidence in COVID-19 vaccines.
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Affiliation(s)
- Alistair Thorpe
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA
| | - Angela Fagerlin
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA.,Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Frank A Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA.,University of Utah College of Social and Behavioral Science, Salt Lake City, UT, USA
| | - Jorie Butler
- University of Colorado School of Medicine, Aurora, CO, USA.,VA Denver Center for Innovation, Denver, CO, USA
| | - Vanessa Stevens
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA.,Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
| | - Marian S Riddoch
- University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA
| | - Laura D Scherer
- University of Colorado School of Medicine, Aurora, CO, USA.,VA Denver Center for Innovation, Denver, CO, USA
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24
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Lai LY, Arshad F, Areia C, Alshammari TM, Alghoul H, Casajust P, Li X, Dawoud D, Nyberg F, Pratt N, Hripcsak G, Suchard MA, Prieto-Alhambra D, Ryan P, Schuemie MJ. Current Approaches to Vaccine Safety Using Observational Data: A Rationale for the EUMAEUS (Evaluating Use of Methods for Adverse Events Under Surveillance-for Vaccines) Study Design. Front Pharmacol 2022; 13:837632. [PMID: 35392566 PMCID: PMC8980923 DOI: 10.3389/fphar.2022.837632] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 12/28/2022] Open
Abstract
Post-marketing vaccine safety surveillance aims to detect adverse events following immunization in a population. Whether certain methods of surveillance are more precise and unbiased in generating safety signals is unclear. Here, we synthesized information from existing literature to provide an overview of the strengths, weaknesses, and clinical applications of epidemiologic and analytical methods used in vaccine monitoring, focusing on cohort, case-control and self-controlled designs. These designs are proposed to be evaluated in the EUMAEUS (Evaluating Use of Methods for Adverse Event Under Surveillance-for vaccines) study because of their widespread use and potential utility. Over the past decades, there have been an increasing number of epidemiological study designs used for vaccine safety surveillance. While traditional cohort and case-control study designs remain widely used, newer, novel designs such as the self-controlled case series and self-controlled risk intervals have been developed. Each study design comes with its strengths and limitations, and the most appropriate study design will depend on availability of resources, access to records, number and distribution of cases, and availability of population coverage data. Several assumptions have to be made while using the various study designs, and while the goal is to mitigate any biases, violations of these assumptions are often still present to varying degrees. In our review, we discussed some of the potential biases (i.e., selection bias, misclassification bias and confounding bias), and ways to mitigate them. While the types of epidemiological study designs are well established, a comprehensive comparison of the analytical aspects (including method evaluation and performance metrics) of these study designs are relatively less well studied. We summarized the literature, reporting on two simulation studies, which compared the detection time, empirical power, error rate and risk estimate bias across the above-mentioned study designs. While these simulation studies provided insights on the analytic performance of each of the study designs, its applicability to real-world data remains unclear. To bridge that gap, we provided the rationale of the EUMAEUS study, with a brief description of the study design; and how the use of real-world multi-database networks can provide insights into better methods evaluation and vaccine safety surveillance.
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Affiliation(s)
- Lana Yh Lai
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Faaizah Arshad
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Paula Casajust
- Real-World Evidence, Trial Form Support, Barcelona, Spain
| | - Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Dalia Dawoud
- Faculty of Pharmacy, Cairo University, Giza, Egypt
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicole Pratt
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Marc A Suchard
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Dani Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom.,Health Data Sciences, Medical Informatics, Erasmus Medical Center University, Rotterdam, Netherlands
| | - Patrick Ryan
- Department of Biomedical Informatics, Columbia University, New York, NY, United States.,Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States
| | - Martijn J Schuemie
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States.,Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States
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Nasreen S, Calzavara A, Buchan SA, Thampi N, Johnson C, Wilson SE, Kwong JC. Background incidence rates of adverse events of special interest related to COVID-19 vaccines in Ontario, Canada, 2015 to 2020, to inform COVID-19 vaccine safety surveillance. Vaccine 2022; 40:3305-3312. [PMID: 35527057 PMCID: PMC9042732 DOI: 10.1016/j.vaccine.2022.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
Background Background incidence rates are critical in pharmacovigilance to facilitate identification of vaccine safety signals. We estimated background incidence rates of 11 adverse events of special interest related to COVID-19 vaccines in Ontario, Canada. Methods We conducted a population-based retrospective observational study using linked health administrative databases for hospitalizations and emergency department visits among Ontario residents. We estimated incidence rates of Bell’s palsy, idiopathic thrombocytopenia, febrile convulsions, acute disseminated encephalomyelitis, myocarditis, pericarditis, Kawasaki disease, Guillain-Barré syndrome, transverse myelitis, acute myocardial infarction, and anaphylaxis during five pre-pandemic years (2015–2019) and 2020. Results The average annual population was 14 million across all age groups with 51% female. The pre-pandemic mean annual rates per 100,000 population during 2015–2019 were 191 for acute myocardial infarction, 43.9 for idiopathic thrombocytopenia, 28.8 for anaphylaxis, 27.8 for Bell’s palsy, 25.0 for febrile convulsions, 22.8 for acute disseminated encephalomyelitis, 11.3 for myocarditis/pericarditis, 8.7 for pericarditis, 2.9 for myocarditis, 2.0 for Kawasaki disease, 1.9 for Guillain-Barré syndrome, and 1.7 for transverse myelitis. Females had higher rates of acute disseminated encephalomyelitis, transverse myelitis and anaphylaxis while males had higher rates of myocarditis, pericarditis, and Guillain-Barré syndrome. Bell’s palsy, acute disseminated encephalomyelitis, and Guillain-Barré syndrome increased with age. The mean rates of myocarditis and/or pericarditis increased with age up to 79 years; males had higher rates than females: from 12 to 59 years for myocarditis and ≥12 years for pericarditis. Febrile convulsions and Kawasaki disease were predominantly childhood diseases and generally decreased with age. Conclusions Our estimated background rates will permit estimating numbers of expected events for these conditions and facilitate detection of potential safety signals following COVID-19 vaccination.
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Tebaa A, Benkirane R, Alj L, Cherkaoui I, Soulaymani-Bencheikh R. Monitoring the safety of influenza A/H1N1 pandemic and seasonal vaccines in Morocco. Ther Adv Vaccines Immunother 2022; 10:25151355221088157. [PMID: 35372783 PMCID: PMC8968976 DOI: 10.1177/25151355221088157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A vaccination campaign against pandemic influenza A/H1N1 was implemented in Morocco between November 2009 and April 2010. Overall, 705,883 subjects were vaccinated by Pandemrix, Arepanrix, and Panenza. The adverse events following immunization (AEFIs) data comparison was made with the 2014/2015 seasonal influenza vaccination campaign that was specifically investigated. Aim: To evaluate the safety of the 2009 pandemic influenza A/H1N1 vaccine and to compare it to that of 2014 seasonal influenza vaccine. Methods: During the pandemic vaccination campaign, the Morocco Pharmacovigilance Centre reinforced passive AEFI surveillance with an active and prospective monitoring programme of 1000 immunized people over 6 months at 10 randomly selected vaccination centres. For the 2014/2015 seasonal vaccination campaign, AEFI data were collected from spontaneous notifications. Results: Active monitoring of 2009 pandemic collected 771 AEFI reports, corresponding to an AEFI incidence rate of 77.1% with vaccination by either Pandemrix or Arepanrix vaccine in 95% of cases. Reported AEFI were most frequently local (37.7%), general (29.5%), and neurological reactions (20.3%). Most of the AEFI (95.5%) were observed during the first 48 hours after vaccination, and the remainder within 2 weeks. None of the reported AEFI were serious case. The highest rate of notification was documented for health professionals, followed by patients with diabetes or chronic respiratory diseases. Concerning passive surveillance, the AEFI notification rate was significantly higher for the 2009/2010 pandemic vaccine (3.1 vs 1.2 per 10,000). However, there was no significant difference between pandemic and seasonal vaccination with regards to the serious adverse events (SAE) notification rate (0.3 vs 0.2 per 10,000). Conclusion: Data analysis indicates that the vaccines used against 2009 pandemic influenza in Morocco have a satisfactory safety profile, similar to the seasonal influenza vaccine with the exception of local reactions as observed previously in other countries.
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Affiliation(s)
- Amina Tebaa
- Centre Anti Poison et de Pharmacovigilance du Maroc (CAPM), Ministry of Health, Rue Lamfedel Cherkaoui, Rabat Instituts, Madinate Al Irfane, B.P. 6671, Rabat 10100, Morocco
| | - Raja Benkirane
- Ecole Nationale de Santé Publique (ENSP), Ministry of Health, Rabat, Morocco
| | - Loubna Alj
- Centre Anti Poison et de Pharmacovigilance du Maroc (CAPM), Ministry of Health, Rabat, Morocco
| | - Imad Cherkaoui
- Direction de l’Epidemiologie et de Lutte contre les Maladies (DELM), Ministry of Health, Rabat, Morocco
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Wang F, Wang D, Wang Y, Li C, Zheng Y, Guo Z, Liu P, Zhang Y, Wang W, Wang Y, Hou H. Population-Based Incidence of Guillain-Barré Syndrome During Mass Immunization With Viral Vaccines: A Pooled Analysis. Front Immunol 2022; 13:782198. [PMID: 35185881 PMCID: PMC8850251 DOI: 10.3389/fimmu.2022.782198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/14/2022] [Indexed: 01/22/2023] Open
Abstract
Misunderstanding temporal coincidence of adverse events during mass vaccination and invalid assessment of possible safety concerns have negative effects on immunization programs, leading to low immunization coverage. We conducted this systematic review and meta-analysis to identify the incidence rates of GBS that are temporally associated with viral vaccine administration but might not be attributable to the vaccines. By literature search in Embase and PubMed, we included 48 publications and 2,110,441,600 participants. The pooled incidence rate of GBS was 3.09 per million persons (95% confidence interval [CI]: 2.67 to 3.51) within six weeks of vaccination, equally 2.47 per 100,000 person-year (95%CI: 2.14 to 2.81). Subgroup analyses illustrated that the pooled rates were 2.77 per million persons (95%CI: 2.47 to 3.07) for individuals who received the influenza vaccine and 2.44 per million persons (95%CI: 0.97 to 3.91) for human papillomavirus (HPV) vaccines, respectively. Our findings evidence the GBS-associated safety of virus vaccines. We present a reference for the evaluation of post-vaccination GBS rates in mass immunization campaigns, including the SARS-CoV-2 vaccine.
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Affiliation(s)
- Fengge Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Donglan Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yingjie Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Cancan Li
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yulu Zheng
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Zheng Guo
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Pengcheng Liu
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yichun Zhang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Wei Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China.,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Haifeng Hou
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China.,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
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Wan MM, Lee A, Kapadia R, Hahn C. Case Series of Guillain-Barré Syndrome After the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) Vaccine. Neurol Clin Pract 2022; 12:149-153. [PMID: 35747886 PMCID: PMC9208400 DOI: 10.1212/cpj.0000000000001148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022]
Abstract
AbstractPurposeof Review: Vaccination has been associated with Guillain-Barre Syndrome (GBS). Amidst a global vaccination campaign to stop the spread of COVID-19, fears of GBS can contribute to vaccine-hesitancy. We describe three cases of GBS in Calgary, Canada presenting within 2 weeks of receiving the ChAdOx1 nCoV-19 (COVISHIELD) Oxford-AstraZeneca vaccination and review the available literature.Recent Findings:All three patients presented to hospital in Calgary, Alberta, Canada within a one-month time frame with GBS. Their clinical courses ranged from mild to severe impairment, all requiring immunomodulatory treatment.Summary:There is currently little evidence to support a causal relationship between vaccination and GBS. Furthermore, there is limited evidence to support recurrent GBS in patients with GBS temporally associated with vaccination. Neurologists should approach discussions with patients regarding GBS after vaccination carefully, so as not to misrepresent this relationship, and to educate patients that the risk of COVID-19 infection outweighs the small individual risk of a vaccine-associated adverse event.
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Affiliation(s)
- Miranda Mengyuan Wan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Angela Lee
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Ronak Kapadia
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Christopher Hahn
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Barišić N, Turudić D, Marić LS, Tešović G. Vaccination in pediatric acquired inflammatory immune-mediated neuromuscular disorders. Eur J Paediatr Neurol 2022; 36:159-176. [PMID: 34998097 DOI: 10.1016/j.ejpn.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2021] [Accepted: 12/18/2021] [Indexed: 11/26/2022]
Abstract
AIM To analyse literature data on vaccine related induction, worsening of the disease and disease reccurrences as well as vaccine safety and efficacy among pediatric patients with acquired inflammatory immune-mediated neuromuscular disorders (NMD). METHODS Medline, Pub Med and Scopus database search from 1975 to 2020 focused on pediatric age was conducted including peer reviews, meta analyses and epidemiological studies on vaccination and Guillain-Barré syndrome (GBS), Bell's palsy, optic neuritis (ON), myasthenia gravis (MG), chronic inflammatory demyelinating polyneuropathy (CIDP) and immune-mediated inflammatory myopathy (IM). RESULTS AND CONCLUSION s: There are no strong evidence supporting relationship between vaccination with different pediatric vaccines and development of first episodes or reccurrences of GBS, Bell's palsy, optic neuritis (ON), juvenile MG, CIDP, and IM. The vaccination and revaccination with inactivated vaccines is considered safe in children with medical history of GBS, Bell's palsy, ON, MG and IM. Caution when immunization against influenza, quadrivalent conjugated meningococcal vaccine (MCV4) and pneumococcal disease and avoiding tetanus toxoid immunization in CIDP patients is suggested. Patients with immune mediated acquired NMD should be vaccinated with live vaccines before the initiation of immunosupressive treatment. Immunosuppressed patients with low protective antibody titers should be considered for revaccination.
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Affiliation(s)
- Nina Barišić
- Department of Pediatrics, Clinical Medical Centre, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia.
| | - Daniel Turudić
- Department of Pediatrics, Clinical Medical Centre, Zagreb, Croatia
| | - Lorna Stemberger Marić
- University of Zagreb, School of Medicine, Zagreb, Croatia; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Goran Tešović
- University of Zagreb, School of Medicine, Zagreb, Croatia; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
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30
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Abara WE, Gee J, Delorey M, Tun Y, Mu Y, Shay DK, Shimabukuro T. Expected Rates of Select Adverse Events following Immunization for COVID-19 Vaccine Safety Monitoring. J Infect Dis 2021; 225:1569-1574. [PMID: 34958099 PMCID: PMC8755334 DOI: 10.1093/infdis/jiab628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Using meta-analytic methods, we calculated expected rates of 21 potential adverse events of special interest (AESI) that would occur following COVID-19 vaccination within 1-, 7-, and 42-day intervals without causal associations. Based on these expected rates, if 10,000,000 persons are vaccinated, 0.5, 3.7, and 22.5 Guillain-Barre syndrome cases; 0.3, 2.4, and 14.3 myopericarditis cases; and 236.5, 1655.5, and 9932.8 all-cause deaths would occur coincidentally within 1, 7, and 42 days post-vaccination, respectively. Expected rates of potential AESI can contextualize events associated temporally with immunization, aid in safety signal detection, guide COVID-19 vaccine health communications, and inform COVID-19 vaccine benefit-risk assessments.
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Affiliation(s)
- Winston E Abara
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention Atlanta, Georgia United States
| | - Julianne Gee
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention Atlanta, Georgia United States
| | - Mark Delorey
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention Atlanta, Georgia United States
| | - Ye Tun
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention Atlanta, Georgia United States
| | - Yi Mu
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention Atlanta, Georgia United States
| | - David K Shay
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention Atlanta, Georgia United States
| | - Tom Shimabukuro
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention Atlanta, Georgia United States
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31
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Nasreen S, Calzavara AJ, Sundaram ME, MacDonald SE, Righolt CH, Pai M, Field TS, Zhou LW, Wilson SE, Kwong JC. Background incidence rates of hospitalisations and emergency department visits for thromboembolic and coagulation disorders in Ontario, Canada for COVID-19 vaccine safety assessment: a population-based retrospective observational study. BMJ Open 2021; 11:e052019. [PMID: 34921078 PMCID: PMC8685534 DOI: 10.1136/bmjopen-2021-052019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The objective of this study was to estimate background rates of selected thromboembolic and coagulation disorders in Ontario, Canada. DESIGN Population-based retrospective observational study using linked health administrative databases. Records of hospitalisations and emergency department visits were searched to identify cases using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada diagnostic codes. PARTICIPANTS All Ontario residents. PRIMARY OUTCOME MEASURES Incidence rates of ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, deep vein thrombosis, pulmonary embolism, idiopathic thrombocytopaenia, disseminated intravascular coagulation and cerebral venous thrombosis during five prepandemic years (2015-2019) and 2020. RESULTS The average annual population was 14 million with 51% female. The mean annual rates per 100 000 population during 2015-2019 were 127.1 (95% CI 126.2 to 127.9) for ischaemic stroke, 22.0 (95% CI 21.6 to 22.3) for intracerebral haemorrhage, 9.4 (95% CI 9.2 to 9.7) for subarachnoid haemorrhage, 86.8 (95% CI 86.1 to 87.5) for deep vein thrombosis, 63.7 (95% CI 63.1 to 64.3) for pulmonary embolism, 6.1 (95% CI 5.9 to 6.3) for idiopathic thrombocytopaenia, 1.6 (95% CI 1.5 to 1.7) for disseminated intravascular coagulation, and 1.5 (95% CI 1.4 to 1.6) for cerebral venous thrombosis. Rates were lower in 2020 than during the prepandemic years for ischaemic stroke, deep vein thrombosis and idiopathic thrombocytopaenia. Rates were generally consistent over time, except for pulmonary embolism, which increased from 57.1 to 68.5 per 100 000 between 2015 and 2019. Rates were higher for females than males for subarachnoid haemorrhage, pulmonary embolism and cerebral venous thrombosis, and vice versa for ischaemic stroke and intracerebral haemorrhage. Rates increased with age for most of these conditions, but idiopathic thrombocytopaenia demonstrated a bimodal distribution with incidence peaks at 0-19 years and ≥60 years. CONCLUSIONS Our estimated background rates help contextualise observed events of these potential adverse events of special interest and to detect potential safety signals related to COVID-19 vaccines.
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Affiliation(s)
- Sharifa Nasreen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Maria E Sundaram
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Menaka Pai
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Thalia S Field
- Division of Neurology, The University of British Columbia, Vancouver, Columbia, Canada
| | - Lily W Zhou
- Division of Neurology, The University of British Columbia, Vancouver, Columbia, Canada
- Stanford Stroke Center, Palo Alto, California, USA
| | - Sarah E Wilson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Immunization and vaccine-preventable diseases, Public Health Ontario, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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32
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Li X, Lai LYH, Ostropolets A, Arshad F, Tan EH, Casajust P, Alshammari TM, Duarte-Salles T, Minty EP, Areia C, Pratt N, Ryan PB, Hripcsak G, Suchard MA, Schuemie MJ, Prieto-Alhambra D. Bias, Precision and Timeliness of Historical (Background) Rate Comparison Methods for Vaccine Safety Monitoring: An Empirical Multi-Database Analysis. Front Pharmacol 2021; 12:773875. [PMID: 34899334 PMCID: PMC8652333 DOI: 10.3389/fphar.2021.773875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Using real-world data and past vaccination data, we conducted a large-scale experiment to quantify bias, precision and timeliness of different study designs to estimate historical background (expected) compared to post-vaccination (observed) rates of safety events for several vaccines. We used negative (not causally related) and positive control outcomes. The latter were synthetically generated true safety signals with incident rate ratios ranging from 1.5 to 4. Observed vs. expected analysis using within-database historical background rates is a sensitive but unspecific method for the identification of potential vaccine safety signals. Despite good discrimination, most analyses showed a tendency to overestimate risks, with 20%-100% type 1 error, but low (0% to 20%) type 2 error in the large databases included in our study. Efforts to improve the comparability of background and post-vaccine rates, including age-sex adjustment and anchoring background rates around a visit, reduced type 1 error and improved precision but residual systematic error persisted. Additionally, empirical calibration dramatically reduced type 1 to nominal but came at the cost of increasing type 2 error.
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Affiliation(s)
- Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Lana YH Lai
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Faaizah Arshad
- Department of Biostatistics, University of California, Los Angeles, California, United States
| | - Eng Hooi Tan
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Paula Casajust
- Real-World Evidence, Trial Form Support, Barcelona, Spain
| | | | - Talita Duarte-Salles
- Institut Universitari D’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Evan P. Minty
- O'Brien Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, SA, Australia
| | - Patrick B. Ryan
- Observational Health Data Sciences and Informatics, New York, NY, United States
- Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
- Medical Informatics Services, NewYork-Presbyterian Hospital, NewYork, NY, United States
| | - Marc A. Suchard
- Department of Biostatistics, University of California, Los Angeles, California, United States
- Observational Health Data Sciences and Informatics, New York, NY, United States
| | - Martijn J. Schuemie
- Department of Biostatistics, University of California, Los Angeles, California, United States
- Observational Health Data Sciences and Informatics, New York, NY, United States
- Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
- Health Data Sciences, Medical Informatics, Erasmus Medical Center University, Rotterdam, Netherlands
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Analysis of medical services provided to patients with peripheral facial palsy in Korea: a descriptive, cross-sectional study of the health insurance review and assessment service national patient sample database. BMC Health Serv Res 2021; 21:1178. [PMID: 34715858 PMCID: PMC8555159 DOI: 10.1186/s12913-021-07078-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background This cross-sectional, retrospective, observational study analyzed the demographics of patients with peripheral facial palsy in South Korea and their use of healthcare services. Methods The 2016 Korean Health Insurance Review and Assessment National Patient Sample dataset was used; a total of 4790 patients, diagnosed with facial palsy, who had used healthcare services at least once between January 2016 and December 2016 were included, and data on the use of medical services, hospitalizations, sociodemographic factors, treatments, and medications were analyzed. Results Overall, 326 patients per 100,000 individuals used healthcare services at least once because of peripheral facial palsy in 2016, with higher numbers for women and those aged 50–59 years. The percentage of patients who used Korean traditional medicine (KM), Western medicine (WM), and both KM and WM was 54.4, 23.3, and 22.3%, respectively. Users of both WM and KM had higher per capita medical costs, more visits, and longer treatment durations. Physiotherapy was the most frequent WM treatment (44.4%), and “examinations” was the costliest (24.7%) category. “Procedures” was both the most frequent and costliest KM category (99.9 and 57.3%, respectively). “Continuous intravenous injections” (8.6%) and “superficial heat therapy” (8.3%) were the most frequent WM treatments, while acupuncture accounted for 98% of all KM treatments. Conclusions This study analyzed the demographic characteristics and medical service use of patients with peripheral facial palsy in detail. These results can be used as basic information to improve clinical and policy strategies for the management and treatment of peripheral facial palsy. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07078-9.
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Pan X, Lv H, Chen F, Wang Y, Liang H, Shen L, Chen Y, Hu Y. Analysis of adverse events following immunization in Zhejiang, China, 2019: a retrospective cross-sectional study based on the passive surveillance system. Hum Vaccin Immunother 2021; 17:3823-3830. [PMID: 34170800 DOI: 10.1080/21645515.2021.1939621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objectives: This study summarizes passive surveillance data for adverse events following immunization (AEFI) in Zhejiang province.Methods: The AEFI reports and number of doses on all vaccines used were extracted from the national AEFI surveillance system and the immunization information system of Zhejiang province (ZJIIS). Reporting rates of AEFI were calculated by age, city, severity of AEFI, categories of AEFI, vaccine types, and reaction categories.Results: A total of 13,079 AEFI records were reported and 23,091,401 vaccine doses were administered, with a reporting rate of 56.64/100,000 doses for AEFI. The highest reporting rate of AEFI was observed among the infants <1 year of age (108.61/100,000 doses) and the lowest rate was observed among recipients aged ≥60 years. Most of the AEFI reports were vaccine product-related reactions (48.81/100,000 doses), and the lowest was vaccination errors (0.02/100,000 doses). The most frequently reported individual vaccine was DTP and Hib combined vaccine, with a reporting rate of 426.62/100,000 doses. The most frequently reported AEFI was fever/redness/induration (48.82/100,000 doses).Conclusion: Our findings illustrated the high level of vaccine safety since the majority of those reported were not serious, or coincidentally associated with vaccination. Furthermore, the national AEFI surveillance system should be continuously used as a surveillance tool for monitoring of AEFI.
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Affiliation(s)
- Xuejiao Pan
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Huakun Lv
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Fuxing Chen
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Ying Wang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Hui Liang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Linzhi Shen
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Yaping Chen
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Yu Hu
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
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Brazete C, Aguiar A, Furtado I, Duarte R. Thrombotic events and COVID-19 vaccines. Int J Tuberc Lung Dis 2021; 25:701-707. [PMID: 34802491 PMCID: PMC8412105 DOI: 10.5588/ijtld.21.0298] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
COVID-19 vaccines are considered promising agents in the control of the pandemic. Although their safety was assessed in randomised clinical trials, severe adverse events (AEs) have been reported after large-scale administration. This study aims to evaluate thromboembolic AEs reported after vaccination in a real-world context and how they led to the interruption of vaccination campaigns. We also review the benefits and risks of the vaccines approved in the European Union and provide recommendations. A review of the literature was performed using Medline/PubMed electronic database as well as institutional and pharmacovigilance official reports. Our findings show that vaccine-induced prothrombotic immune thrombocytopenia has been suggested as a very rare AE associated with viral vector vaccines. Unusual thrombotic events combined with moderate-to-severe thrombocytopenia were reported mainly in women under 60 years of age. As safety signals emerged, Vaxzevria and Janssen´s COVID-19 vaccine campaigns have been paused while investigations proceed. On the other hand, the number of deep vein thrombosis and pulmonary embolism reports have not increased. Post-marketing surveillance indicated that mRNA vaccines are safe and should continue to be used. The thrombotic events report rate is not increased in people over 60 years. As they are at greater risk for COVID-19 complications and death, no vaccine restrictions are recommended in this group. Risk factors for vaccine-induced prothrombotic immune thrombocytopenia should be established so that evidence-based decisions can be made. Systematic monitoring of COVID-19 vaccine safety is essential to ensure that the benefits of vaccination outweigh the risks.
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Affiliation(s)
- C Brazete
- Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal, Unidade de Saúde Pública do Alto Minho, Viana do Castelo, Portugal
| | - A Aguiar
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - I Furtado
- Serviço de Infeciologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - R Duarte
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal, Unidade de Investigação Clínica da Administração Regional de Saúde do Norte, Porto, Portugal, Departamento de Ciências da Saúde Pública, Ciências Forenses e Educação Médica, Universidade do Porto, Porto, Portugal, Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Sobue T, Fukuda H, Matsumoto T, Lee B, Ito S, Iwata S. The background occurrence of selected clinical conditions prior to the start of an extensive national vaccination program in Japan. PLoS One 2021; 16:e0256379. [PMID: 34437567 PMCID: PMC8389412 DOI: 10.1371/journal.pone.0256379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/04/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused by SARS-CoV-2 has now affected tens of millions of people globally. It is the hope that vaccines against SARS-CoV-2 will deliver a comprehensive solution to this global pandemic; however, this will require extensive national vaccination programs. Ultimately, clinical conditions and even sudden unexplained death will occur around the time of vaccination, thus a distinction needs to be made between events that are causally related to the vaccine or temporally related to vaccination. This study aimed to estimate the background occurrence of 43 clinical conditions in the Japanese population. METHODS A retrospective cohort study was conducted from 2013 to 2019 using data from two large healthcare claims databases (MDV and JMDC) in Japan. The estimated number of new cases and incidence were calculated based on the actual number of new cases identified in the databases. The PubMed and Ichushi-web databases, as well as grey literature such as guidelines and government statistics, were also searched to identify any publications related to incidence of these conditions in Japan. RESULTS AND CONCLUSION The estimates of the number of total cases and incidence were similar for the MDV and JMDC databases for some diseases. In addition, some estimates were similar to those in the scientific literature. For example, from the MDV and JMDC databases, estimates of incidence of confirmed Bell's palsy in 2019 were 41.7 and 47.9 cases per 100,000 population per year, respectively. These estimates were of the same order from the scientific publication. Determining whether clinical conditions occurring around the time of vaccination are causally or only temporally related to vaccination will be critical for public health decision makers as well as for the general public. Comparison of background occurrence at the population level may provide some additional objective evidence for the evaluation of temporality or causality.
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Affiliation(s)
- Tomotaka Sobue
- Division of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University, Fukuoka, Japan
| | - Tetsuya Matsumoto
- Department of Infectious Diseases, International University of Health and Welfare, Narita, Japan
| | - Bennett Lee
- Vaccine Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Shuhei Ito
- Vaccine Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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Clothier HJ, Mesfin YM, Strange S, Buttery JP. Background rates of hospital transfer and death in Australian aged care facilities: estimates to assist interpretation of rates after COVID-19 vaccination. Med J Aust 2021; 215:180-181. [PMID: 34268767 PMCID: PMC8447446 DOI: 10.5694/mja2.51170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Hazel J Clothier
- SAEFVIC, Murdoch Children's Research Institute, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | - Yonatan M Mesfin
- Royal Children's Hospital, Melbourne, VIC.,Centre for Child Health Informatics, University of Melbourne, Melbourne, VIC
| | | | - Jim P Buttery
- SAEFVIC, Murdoch Children's Research Institute, Melbourne, VIC.,Centre for Child Health Informatics, University of Melbourne, Melbourne, VIC
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38
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Li X, Ostropolets A, Makadia R, Shoaibi A, Rao G, Sena AG, Martinez-Hernandez E, Delmestri A, Verhamme K, Rijnbeek PR, Duarte-Salles T, Suchard MA, Ryan PB, Hripcsak G, Prieto-Alhambra D. Characterising the background incidence rates of adverse events of special interest for covid-19 vaccines in eight countries: multinational network cohort study. BMJ 2021; 373:n1435. [PMID: 35727911 PMCID: PMC8193077 DOI: 10.1136/bmj.n1435] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To quantify the background incidence rates of 15 prespecified adverse events of special interest (AESIs) associated with covid-19 vaccines. DESIGN Multinational network cohort study. SETTING Electronic health records and health claims data from eight countries: Australia, France, Germany, Japan, the Netherlands, Spain, the United Kingdom, and the United States, mapped to a common data model. PARTICIPANTS 126 661 070 people observed for at least 365 days before 1 January 2017, 2018, or 2019 from 13 databases. MAIN OUTCOME MEASURES Events of interests were 15 prespecified AESIs (non-haemorrhagic and haemorrhagic stroke, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, anaphylaxis, Bell's palsy, myocarditis or pericarditis, narcolepsy, appendicitis, immune thrombocytopenia, disseminated intravascular coagulation, encephalomyelitis (including acute disseminated encephalomyelitis), Guillain-Barré syndrome, and transverse myelitis). Incidence rates of AESIs were stratified by age, sex, and database. Rates were pooled across databases using random effects meta-analyses and classified according to the frequency categories of the Council for International Organizations of Medical Sciences. RESULTS Background rates varied greatly between databases. Deep vein thrombosis ranged from 387 (95% confidence interval 370 to 404) per 100 000 person years in UK CPRD GOLD data to 1443 (1416 to 1470) per 100 000 person years in US IBM MarketScan Multi-State Medicaid data among women aged 65 to 74 years. Some AESIs increased with age. For example, myocardial infarction rates in men increased from 28 (27 to 29) per 100 000 person years among those aged 18-34 years to 1400 (1374 to 1427) per 100 000 person years in those older than 85 years in US Optum electronic health record data. Other AESIs were more common in young people. For example, rates of anaphylaxis among boys and men were 78 (75 to 80) per 100 000 person years in those aged 6-17 years and 8 (6 to 10) per 100 000 person years in those older than 85 years in Optum electronic health record data. Meta-analytic estimates of AESI rates were classified according to age and sex. CONCLUSION This study found large variations in the observed rates of AESIs by age group and sex, showing the need for stratification or standardisation before using background rates for safety surveillance. Considerable population level heterogeneity in AESI rates was found between databases.
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Affiliation(s)
- Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Gowtham Rao
- Janssen Research and Development, Titusville, NJ, USA
| | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Bio-Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg, Gent, Belgium
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Talita Duarte-Salles
- Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Marc A Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, USA
| | - Patrick B Ryan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
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Liu Z, Meng R, Yang Y, Li K, Yin Z, Ren J, Shen C, Feng Z, Zhan S. Active Vaccine Safety Surveillance: Global Trends and Challenges in China. HEALTH DATA SCIENCE 2021; 2021:9851067. [PMID: 38487501 PMCID: PMC10880162 DOI: 10.34133/2021/9851067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/03/2021] [Indexed: 03/17/2024]
Abstract
Importance. The great success in vaccine-preventable diseases has been accompanied by vaccine safety concerns. This has caused vaccine hesitancy to be the top 10 in threats to global health. The comprehensive understanding of adverse events following immunization should be entirely based on clinical trials and postapproval surveillance. It has increasingly been recognized worldwide that the active surveillance of vaccine safety should be an essential part of immunization programs due to its complementary advantages to passive surveillance and clinical trials.Highlights. In the present study, the framework of vaccine safety surveillance was summarized to illustrate the importance of active surveillance and address vaccine hesitancy or safety concerns. Then, the global progress of active surveillance systems was reviewed, mainly focusing on population-based or hospital-based active surveillance. With these successful paradigms, the practical and reliable ways to create robust and similar systems in China were discussed and presented from the perspective of available databases, methodology challenges, policy supports, and ethical considerations.Conclusion. In the inevitable trend of the global vaccine safety ecosystem, the establishment of an active surveillance system for vaccine safety in China is urgent and feasible. This process can be accelerated with the consensus and cooperation of regulatory departments, research institutions, and data owners.
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Affiliation(s)
- Zhike Liu
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Ruogu Meng
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Yu Yang
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Keli Li
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingtian Ren
- Center for Drug Reevaluation, National Medical Products Administration, BeijingChina
| | - Chuanyong Shen
- Center for Drug Reevaluation, National Medical Products Administration, BeijingChina
| | - Zijian Feng
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
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U.S. Population-Based background incidence rates of medical conditions for use in safety assessment of COVID-19 vaccines. Vaccine 2021; 39:3666-3677. [PMID: 34088506 PMCID: PMC8118666 DOI: 10.1016/j.vaccine.2021.05.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has had a devastating impact on global health, and has resulted in an unprecedented, international collaborative effort to develop vaccines to control the outbreak, protect human lives, and avoid further social and economic disruption. Mass vaccination campaigns are underway in multiple countries and are expected worldwide once more vaccine becomes available. Some early candidate vaccines use novel platforms, such as mRNA encapsulated in lipid nanoparticles, and relatively new platforms, such as replication-deficient viral vectors. While these new vaccine platforms hold promise, limited safety data in humans are available. Serious health outcomes linked to vaccinations are rare, and some outcomes may occur incidentally in the vaccinated population. Knowledge of background incidence rates of these medical conditions is a critical component of vaccine safety monitoring to aid in the assessment of adverse events temporally associated with vaccination and to put these events into context with what would be expected due to chance alone. A list of 22 potential adverse events of special interest (AESI), including neurologic, autoimmune, and cardiovascular disorders, was compiled by subject matter experts at the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention. The most recently available U.S. background rates for these medical conditions, overall and by age, sex, and race/ethnicity (when available), were sourced from reported statistics (data published by medical panels/ associations or federal government reports), and literature reviews in PubMed. This review provides estimates of background incidence rates for medical conditions that may be monitored or studied as AESI during safety surveillance and research for COVID-19 vaccines and other new vaccines.
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41
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Chiesa M, Decima R, Bertinat A, Poggi L, Hackembruch H, Montenegro C, Chiparelli H, Vázquez C. Incidence of Guillain-Barré syndrome in an Uruguayan population. A prospective cohort study. J Peripher Nerv Syst 2021; 26:209-215. [PMID: 33945181 DOI: 10.1111/jns.12450] [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: 12/29/2020] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
Guillain-Barre syndrome (GBS) is an acute autoimmune peripheral inflammatory neuropathy and the most frequent cause of non-poliovirus acute flaccid paralysis worldwide. Background annual GBS incidence rates (IRs) in Latin America (LA) varies from 0.40 to 2.12/100000 persons per year. We performed a prospective population-based epidemiological study to determine the incidence and clinical profile of GBS in the most densely populated regions in Uruguay. The incidence of GBS in the population living in Montevideo and Canelones was studied in the period between June 01, 2018 and May 31, 2020. Patients older than 16 years of age diagnosed with GBS were prospectively enrolled. The mean global annual IR in the Uruguayan population was 1.7/100000 persons (95% CI 1.25-2.25). The highest rate was observed in the 65 to 74 age group among men (5.25/100000 per year) and in the 55 to 64 age group among women (2/100.000 per year). The mean age was 53.9 ± 19.5, years, without difference by sex (53.5 women, 54.5 men). The in-hospital mortality rate was 5.8%. A total of 51 patients were diagnosed with GBS: 42 (82%) had typical GBS, 5 (10%) Miller-Fisher syndrome (MFS), 3 (7%) a bilateral facial nerve palsy, 1 patient had a GBS-MFS overlap (2.3%). This is the first population-based GBS incidence study in LA using a prospective design. Our IR can be a useful tool in establishing the background rate to examine future disease trends caused by the introduction of new viruses or vaccines in Uruguay.
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Affiliation(s)
- Mercedes Chiesa
- Department of Neurology, Assistant of Neurophysiology, Hospital de Clínicas, Montevideo, Uruguay
| | - Rodrigo Decima
- Department of Neurology, Neurology resident, Hospital de Clínicas, Montevideo, Uruguay
| | | | - Luciana Poggi
- Medical doctor, Hospital de Clínicas, Montevideo, Uruguay
| | - Heber Hackembruch
- Department of Neurology, Adjunct-Professor of Neurophysiology, Hospital de Clínicas, Montevideo, Uruguay
| | - Cecilia Montenegro
- Adjunct Professor of Immunology in the Laboratory of Hospital de Clínicas, Montevideo, Uruguay
| | - Hector Chiparelli
- Virologist doctor, Director of the virology department of the public health laboratory
| | - Cristina Vázquez
- Department of Neurology, Clinical Professor of Neurology, Hospital de Clínicas, Montevideo, Uruguay
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42
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Li X, Ostropolets A, Makadia R, Shaoibi A, Rao G, Sena AG, Martinez-Hernandez E, Delmestri A, Verhamme K, Rijnbeek PR, Duarte-Salles T, Suchard M, Ryan P, Hripcsak G, Prieto-Alhambra D. Characterizing the incidence of adverse events of special interest for COVID-19 vaccines across eight countries: a multinational network cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.25.21254315. [PMID: 33791732 PMCID: PMC8010764 DOI: 10.1101/2021.03.25.21254315] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND As large-scale immunization programs against COVID-19 proceed around the world, safety signals will emerge that need rapid evaluation. We report population-based, age- and sex-specific background incidence rates of potential adverse events of special interest (AESI) in eight countries using thirteen databases. METHODS This multi-national network cohort study included eight electronic medical record and five administrative claims databases from Australia, France, Germany, Japan, Netherlands, Spain, the United Kingdom, and the United States, mapped to a common data model. People observed for at least 365 days before 1 January 2017, 2018, or 2019 were included. We based study outcomes on lists published by regulators: acute myocardial infarction, anaphylaxis, appendicitis, Bell's palsy, deep vein thrombosis, disseminated intravascular coagulation, encephalomyelitis, Guillain-Barre syndrome, hemorrhagic and non-hemorrhagic stroke, immune thrombocytopenia, myocarditis/pericarditis, narcolepsy, pulmonary embolism, and transverse myelitis. We calculated incidence rates stratified by age, sex, and database. We pooled rates across databases using random effects meta-analyses. We classified meta-analytic estimates into Council of International Organizations of Medical Sciences categories: very common, common, uncommon, rare, or very rare. FINDINGS We analysed 126,661,070 people. Rates varied greatly between databases and by age and sex. Some AESI (e.g., myocardial infarction, Guillain-Barre syndrome) increased with age, while others (e.g., anaphylaxis, appendicitis) were more common in young people. As a result, AESI were classified differently according to age. For example, myocardial infarction was very rare in children, rare in women aged 35-54 years, uncommon in men and women aged 55-84 years, and common in those aged ≥85 years. INTERPRETATION We report robust baseline rates of prioritised AESI across 13 databases. Age, sex, and variation between databases should be considered if background AESI rates are compared to event rates observed with COVID-19 vaccines.
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Affiliation(s)
- Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | - Azza Shaoibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Gowtham Rao
- Janssen Research and Development, Titusville, NJ, USA
| | - Anthony G. Sena
- Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Antonella Delmestri
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Talita Duarte-Salles
- Fundacio Institut Universitari per a la recerca a l’Atencio Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Marc Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
| | - Patrick Ryan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hendrickson BA, Wang W, Ball G, Bennett D, Bhattacharyya A, Fries M, Kuebler J, Kurek R, McShea C, Tremmel L. Aggregate Safety Assessment Planning for the Drug Development Life-Cycle. Ther Innov Regul Sci 2021; 55:717-732. [PMID: 33755928 DOI: 10.1007/s43441-021-00271-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The Program Safety Analysis Plan (PSAP) was proposed previously as a tool to proactively plan for integrated analyses of product safety data. Building on the PSAP and taking into consideration the evolving regulatory landscape, the Drug Information Association-American Statistical Association (DIA-ASA) Interdisciplinary Safety Evaluation scientific working group herein proposes the Aggregate Safety Assessment Plan (ASAP) process. The ASAP evolves over a product's life-cycle and promotes interdisciplinary, systematic safety planning as well as ongoing data review and characterization of the emerging product safety profile. Objectives include alignment on the safety topics of interest, identification of safety knowledge gaps, planning for aggregate safety evaluation of the clinical trial data and preparing for safety communications. The ASAP seeks to tailor the analyses for a drug development program while standardizing the analyses across studies within the program. The document is intended to be modular and flexible in nature, depending on the program complexity, phase of development and existing sponsor processes. Implementation of the ASAP process will facilitate early safety signal detection, improve characterization of product risks, harmonize safety messaging, and inform program decision-making.
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Affiliation(s)
| | - William Wang
- Clinical Safety Statistics, Biostatistics and Research Decision Sciences, Merck Research Laboratories, North Wales, PA, USA
| | - Greg Ball
- Clinical Safety Statistics, Biostatistics and Research Decision Sciences, Merck Research Laboratories, Rahway, NJ, USA
| | - Dimitri Bennett
- Takeda Pharmaceutical Company Ltd., Cambridge, MA, USA.,Perelman School of Medicine, Adjunct, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Michael Fries
- Quantitative Clinical Sciences and Reporting, CSL Behring, King of Prussia, PA, USA
| | - Juergen Kuebler
- QSciCon, Quantitative Scientific Consulting, Marburg, Germany
| | - Raffael Kurek
- Early Oncology Clinical Group, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Cynthia McShea
- Statistical Sciences and Innovation, UCB BioSciences, Inc., Raleigh, NC, USA
| | - Lothar Tremmel
- Quantitative Clinical Sciences and Reporting, CSL Behring, King of Prussia, PA, USA
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Black SB, Law B, Chen RT, Dekker CL, Sturkenboom M, Huang WT, Gurwith M, Poland G. The critical role of background rates of possible adverse events in the assessment of COVID-19 vaccine safety. Vaccine 2021; 39:2712-2718. [PMID: 33846042 PMCID: PMC7936550 DOI: 10.1016/j.vaccine.2021.03.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
Beginning in December of 2019, a novel coronavirus, SARS-CoV-2, emerged in China and is now a global pandemic with extensive morbidity and mortality. With the emergence of this threat, an unprecedented effort to develop vaccines against this virus began. As vaccines are now being introduced globally, we face the prospect of millions of people being vaccinated with multiple types of vaccines many of which use new vaccine platforms. Since medical events happen without vaccines, it will be important to know at what rate events occur in the background so that when adverse events are identified one has a frame of reference with which to compare the rates of these events so as to make an initial assessment as to whether there is a potential safety concern or not. Background rates vary over time, by geography, by sex, socioeconomic status and by age group. Here we describe two key steps for post-introduction safety evaluation of COVID-19 vaccines: Defining a dynamic list of Adverse Events of Special Interest (AESI) and establishing background rates for these AESI. We use multiple examples to illustrate use of rates and caveats for their use. In addition we discuss tools available from the Brighton Collaboration that facilitate case evaluation and understanding of AESI.
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Affiliation(s)
- Steven B Black
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA.
| | - Barbara Law
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Robert T Chen
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Cornelia L Dekker
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | | | - Wan-Ting Huang
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Marc Gurwith
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
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Willame C, Dodd C, van der Aa L, Picelli G, Emborg HD, Kahlert J, Gini R, Huerta C, Martín-Merino E, McGee C, de Lusignan S, Roberto G, Villa M, Weibel D, Titievsky L, Sturkenboom MCJM. Incidence Rates of Autoimmune Diseases in European Healthcare Databases: A Contribution of the ADVANCE Project. Drug Saf 2021; 44:383-395. [PMID: 33462778 PMCID: PMC7892524 DOI: 10.1007/s40264-020-01031-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The public-private ADVANCE collaboration developed and tested a system to generate evidence on vaccine benefits and risks using European electronic healthcare databases. In the safety of vaccines, background incidence rates are key to allow proper monitoring and assessment. The goals of this study were to compute age-, sex-, and calendar-year stratified incidence rates of nine autoimmune diseases in seven European healthcare databases from four countries and to assess validity by comparing with published data. METHODS Event rates were calculated for the following outcomes: acute disseminated encephalomyelitis, Bell's palsy, Guillain-Barré syndrome, immune thrombocytopenia purpura, Kawasaki disease, optic neuritis, narcolepsy, systemic lupus erythematosus, and transverse myelitis. Cases were identified by diagnosis codes. Participating organizations/databases originated from Denmark, Italy, Spain, and the UK. The source population comprised all persons registered, with at least 1 year of data prior to the study start, or follow-up from birth. Stratified incidence rates were computed per database over the period 2003 to 2014. RESULTS Between 2003 and 2014, 148,947 incident cases of nine autoimmune diseases were identified. Crude incidence rates were highest for Bell's palsy [23.8/100,000 person-years (PYs), 95% confidence interval (CI) 23.6-24.1] and lowest for Kawasaki disease (0.7/100,000 PYs, 95% CI 0.6-0.7). Specific patterns were observed by sex, age, calendar time, and data sources. Rates were comparable with published estimates. CONCLUSION A range of autoimmune events could be identified in the ADVANCE system. Estimation of rates indicated consistency across selected European healthcare databases, as well as consistency with US published data.
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Affiliation(s)
- Corinne Willame
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
| | - Caitlin Dodd
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Lieke van der Aa
- Sciensano, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Gino Picelli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (Pedianet), Padua, Italy
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Johnny Kahlert
- Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus, Denmark
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Consuelo Huerta
- Spanish Agency of Medicines and Medical Devices-AEMPS, Madrid, Spain
| | | | - Chris McGee
- University of Surrey, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London, UK
| | - Simon de Lusignan
- University of Surrey, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London, UK
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | | | - Daniel Weibel
- VACCINE.GRID, Basel, Switzerland
- Erasmus University Medical Center, PO Box 2014, 3000 CA, Rotterdam, The Netherlands
| | | | - Miriam C J M Sturkenboom
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- VACCINE.GRID, Basel, Switzerland
- P-95, Koning Leopold III laan 1 3001, Heverlee, Leuven, Belgium
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Krubiner CB, Faden RR, Karron RA, Little MO, Lyerly AD, Abramson JS, Beigi RH, Cravioto AR, Durbin AP, Gellin BG, Gupta SB, Kaslow DC, Kochhar S, Luna F, Saenz C, Sheffield JS, Tindana PO. Pregnant women & vaccines against emerging epidemic threats: Ethics guidance for preparedness, research, and response. Vaccine 2021; 39:85-120. [PMID: 31060949 PMCID: PMC7735377 DOI: 10.1016/j.vaccine.2019.01.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/07/2019] [Indexed: 12/22/2022]
Abstract
Zika virus, influenza, and Ebola have called attention to the ways in which infectious disease outbreaks can severely - and at times uniquely - affect the health interests of pregnant women and their offspring. These examples also highlight the critical need to proactively consider pregnant women and their offspring in vaccine research and response efforts to combat emerging and re-emerging infectious diseases. Historically, pregnant women and their offspring have been largely excluded from research agendas and investment strategies for vaccines against epidemic threats, which in turn can lead to exclusion from future vaccine campaigns amidst outbreaks. This state of affairs is profoundly unjust to pregnant women and their offspring, and deeply problematic from the standpoint of public health. To ensure that the needs of pregnant women and their offspring are fairly addressed, new approaches to public health preparedness, vaccine research and development, and vaccine delivery are required. This Guidance offers 22 concrete recommendations that provide a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance was developed by the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group - a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy - in consultation with a variety of external experts and stakeholders.
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Affiliation(s)
- Carleigh B Krubiner
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD, USA.
| | - Ruth R Faden
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth A Karron
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Margaret O Little
- Kennedy Institute of Ethics, Georgetown University, Washington, D.C., USA
| | - Anne D Lyerly
- University of North Carolina Center for Bioethics, Chapel Hill, NC, USA
| | - Jon S Abramson
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Richard H Beigi
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Anna P Durbin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | - Carla Saenz
- Pan American Health Organization, Washington, D.C., USA
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Tavares-Da-Silva F, Mahaux O, Van Holle L, Haguinet F, Seifert H, Stegmann JU. Post-Marketing Safety Surveillance for the Adjuvanted Recombinant Zoster Vaccine: Methodology. Drug Saf 2020; 43:1223-1234. [PMID: 32862397 PMCID: PMC7686206 DOI: 10.1007/s40264-020-00989-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A diligent, systematic, regular review of aggregate safety data is essential, particularly early after vaccine introduction, as this is when safety signals not identified during clinical development may emerge. In October 2017, the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommended the adjuvanted recombinant zoster vaccine (RZV; Shingrix, GSK) as the preferred vaccine for preventing herpes zoster (HZ) and related complications in immunocompetent adults aged ≥ 50 years. Subsequently, GSK experienced an unprecedented high demand for RZV. In this methodology paper, we summarize the enhanced measures undertaken to assess RZV safety during its early post-marketing experience in the USA, Canada and Germany. In addition to the routine signal-detection methods already in place for all vaccines, GSK established tailored and enhanced safety monitoring for RZV based on aggregate data of spontaneous reports and manufacturing data. Proactive, near real-time detection and evaluation of signals was a key objective. A dedicated in-house signal-detection tool customized for RZV was employed on a weekly (rather than the routine monthly) basis, allowing for a centralized, more frequent review of data on a single web-based platform. We also identified the background incidence rates of preselected medical events of interest in the first countries to introduce RZV (USA, Canada and Germany) to perform observed-to-expected analyses. This approach may offer a solution to the challenges associated with the assessment and monitoring of vaccine safety in an efficient and timely manner in the context of high vaccine uptake.
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Affiliation(s)
| | | | - Lionel Van Holle
- GSK, Avenue Fleming 20, 1300 Wavre, Belgium
- Present Address: UCB Pharma, 1420 Braine-l’Alleud, Belgium
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Abstract
Vaccines against COVID-19 are being developed at speeds not previously achieved. With this unprecedented effort comes challenges for post-marketing safety monitoring and challenges for vaccine safety communication. To deploy these new vaccines fast across diverse populations, it is vital that robust pharmacovigilance and active surveillance systems are in place. Not all countries have the capability or resources to undertake adequate surveillance and will rely on data from those who can. The tools exist to assess COVID-19 vaccines as they are deployed such as surveillance systems, administrative data and case definitions for adverse events of special interest. However, stitching these all together and using them effectively requires investment and collaboration. This paper provides a high-level overview of some of the facets of modern vaccine safety assessment and how they are, or can be, applied to COVID-19 vaccines.
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Salmon DA, Dudley MZ. It is time to get serious about vaccine confidence. Lancet 2020; 396:870-871. [PMID: 32919522 DOI: 10.1016/s0140-6736(20)31603-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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