Vaccine hesitancy prospectively predicts nocebo side-effects following COVID-19 vaccination

Does health anxiety and vaccine concern predict self-reported adverse events following COVID-19 vaccination?-A Danish national cohort study

OBJECTIVES

The nocebo effect refers to an expectation of sickness that leads to sickness in the expectant. Studies have found COVID-19 vaccines to be associated with the nocebo effect. However, the literature in this field is sparse yet important with the continuation of booster vaccines.

STUDY DESIGN

National cohort study.

METHODS

This study used data from the Danish national cohort "BiCoVac", which contains self-reported information on both health anxiety and specific COVID-19 vaccine concern, as well as 19 systemic AEs following COVID-19 vaccination. Simple and multiple logistic regression was used to estimate the association between health anxiety and specific COVID-19 vaccine concern with having one or more systemic AEs following COVID-19 vaccination. Inverse probability weights were used to compensate for the initial dropout and loss to follow-up.

RESULTS

Of the 85,080 participants in the study, 4 % reported health anxiety, 30 % reported specific COVID-19 vaccine concern, and 26 % one or more systemic AEs following vaccination. After adjusting for covariates, participants with health anxiety had higher odds of reporting one or more systemic AEs following vaccination compared to those without (OR, 1·21 CI 95 % [1·10; 1·33]). For specific COVID-19 vaccine concern, the OR was 1·51 CI 95 % [1·45; 1·58].

CONCLUSIONS

Participants with specific COVID-19 vaccine concern had higher odds of reporting one or more systemic AEs following vaccination compared with those who had no specific COVID-19 vaccine concern. There might be a potential to reduce AEs, with positive framing of AEs and information about nocebo. Reporting of AEs was also associated with health anxiety, but to a lesser degree.

Examining the association of vaccine-related mindsets and post-vaccination antibody response, side effects, and affective outcomes

Background

Although vaccines are largely effective and safe, there is variability in post-vaccination experience regarding antibody response, side effects, and affective outcomes. Vaccine mindsets, specific beliefs about the vaccine, may be associated with post-vaccination experience. This is important since mindsets are malleable and may help decrease vaccine hesitancy and improve post-vaccination experience.

Methods

In a prospective study, we measured overall positive vaccine mindset and specific mindsets regarding efficacy, body response, and side effects. We tested whether vaccine mindsets before vaccination predicted neutralizing antibody response, side effects, vaccine-related stress, and affective outcomes (general stress, sadness, and happiness). Antibody response was assessed one month and six months after participants completed a SARS-CoV-2 vaccination series. Side effect experience and affective reactions were assessed daily on the vaccination day and the subsequent five days.

Results

There was no significant association between the aggregate vaccine mindset score and neutralizing antibody response; however, people with a more positive vaccine mindset reported fewer side effects, less same-day vaccine-related anxiety, and improved affective outcomes after vaccination. In secondary analyses, when specific mindsets were explored, the mindset that vaccine side effects are a sign of treatment efficacy predicted higher antibodies, but not side effects experience and vaccine-related anxiety. Vaccine efficacy and body-response mindsets predicted fewer side effects, vaccine-related anxiety, and improved affective outcomes after vaccination.

Conclusion

These findings underscore the potential of vaccine mindsets in enhancing the overall post-vaccination experience and, in some cases, increasing antibody response.

Unraveling the association between vaccine attitude, vaccine conspiracies and self-reported side effects following COVID-19 vaccination among nurses and physicians in Jordan

Background

The negative impact of vaccine conspiracies is linked with negative health behavior. The aim of the current study was to examine the association between attitudes toward booster COVID-19, influenza, and monkeypox (mpox) vaccinations with post-COVID-19 vaccine side effects, vaccine conspiracies, and attitude towards mandatory vaccination among nurses and physicians in Jordan.

Methods

A structured closed-ended questionnaire was used to collect data on demographics, COVID-19 history, COVID-19 vaccine type and doses received, self-reported side effects post-COVID-19 vaccination, acceptance of booster COVID-19, seasonal influenza, and mpox vaccinations, attitudes towards mandatory vaccination, and beliefs in vaccine conspiracies.

Results

The study sample comprised a total of 341 participants. Acceptance of yearly booster COVID-19 vaccination was expressed by 46.6% of the sample, while 73.3% accepted seasonal influenza vaccination, and only 37.0% accepted mpox vaccination. A higher frequency of self-reported side effects following the first COVID-19 vaccine dose was associated with embrace of vaccine conspiracies and vaccine type. For the second vaccine dose, a higher frequency of self-reported side effects was associated with the embrace of vaccine conspiracies, older age, and affiliation to private sector. In multinomial logistic regression analyses, the lower embrace of vaccine conspiracies was associated with lower odds of reporting side effects post-COVID-19 vaccination. The lower embrace of vaccine conspiracies and favorable attitude towards mandatory vaccination were associated with the willingness to get COVID-19, influenza, and mpox vaccinations.

Conclusion

The study findings highlighted the negative impact of embracing vaccine conspiracies on health-seeking behavior among nurses and physicians. The findings indicated that the willingness to get vaccinated was associated with lower endorsement of vaccine conspiracies. Additionally, the lower embrace of vaccine conspiracies was associated with a lower frequency of self-reported side effects following COVID-19 vaccination. These results emphasize the importance of addressing vaccine misinformation and promoting accurate information to ensure optimal vaccine uptake and public health outcomes.

Urticaria exacerbations and adverse reactions in patients with chronic urticaria receiving COVID-19 vaccination: Results of the UCARE COVAC-CU study

BACKGROUND

Concern about disease exacerbations and fear of reactions after coronavirus disease 2019 (COVID-19) vaccinations are common in chronic urticaria (CU) patients and may lead to vaccine hesitancy.

OBJECTIVE

We assessed the frequency and risk factors of CU exacerbation and adverse reactions in CU patients after COVID-19 vaccination.

METHODS

COVAC-CU is an international multicenter study of Urticaria Centers of Reference and Excellence (UCAREs) that retrospectively evaluated the effects of COVID-19 vaccination in CU patients aged ≥18 years and vaccinated with ≥1 dose of any COVID-19 vaccine. We evaluated CU exacerbations and severe allergic reactions as well as other adverse events associated with COVID-19 vaccinations and their association with various CU parameters.

RESULTS

Across 2769 COVID-19-vaccinated CU patients, most (90%) received at least 2 COVID-19 vaccine doses, and most patients received CU treatment and had well-controlled disease. The rate of COVID-19 vaccination-induced CU exacerbation was 9%. Of 223 patients with CU exacerbation after the first dose, 53.4% experienced recurrence of CU exacerbation after the second dose. CU exacerbation most often started <48 hours after vaccination (59.2%), lasted for a few weeks or less (70%), and was treated mainly with antihistamines (70.3%). Factors that increased the risk for COVID-19 vaccination-induced CU exacerbation included female sex, disease duration shorter than 24 months, having chronic spontaneous versus inducible urticaria, receipt of adenovirus viral vector vaccine, having nonsteroidal anti-inflammatory drug/aspirin intolerance, and having concerns about getting vaccinated; receiving omalizumab treatment and Latino/Hispanic ethnicity lowered the risk. First-dose vaccine-related adverse effects, most commonly local reactions, fever, fatigue, and muscle pain, were reported by 43.5% of CU patients. Seven patients reported severe allergic reactions.

CONCLUSIONS

COVID-19 vaccination leads to disease exacerbation in only a small number of CU patients and is generally well tolerated.

Neurological symptoms after COVID-19 vaccination: a report on the clinical presentation of the first 50 patients

OBJECTIVES

Neurological symptoms associated with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) vaccination were discovered in the context of billions of administered vaccine doses. The clinical manifestations often resemble post Coronavirus Disease 2019 (post-COVID-19) syndrome (PCS) features and may be considered as post-COVID-19 vaccine syndrome (PVS). Data regarding frequency, severity and pathophysiological mechanisms are scarce.

METHODS

We assessed routine clinical examinations in 50 patients reporting new-onset neurological symptoms after SARS-CoV-2 vaccination, including neurological examination, laboratory and electrophysiology tests, as well as self-report questionnaires measuring fatigue, depressive symptoms, anxiety, risk of somatic symptom disorder, and health-related quality of life. Patients were included when symptoms occurred after confirmed COVID-19 vaccination and without prior SARS-CoV-2 infection, and if no alternative diagnosis was found to explain the symptoms.

RESULTS

The most frequently reported symptoms were paraesthesia (56%), fatigue (46%) and cognitive impairment (36%). Neurological, routine laboratory, and electrophysiological examinations did not yield distinct pathological findings. Neuropsychological testing of a subgroup revealed deficits in attention, executive function and memory.

DISCUSSION

The spectrum of clinical manifestations post-vaccination poses a substantial overlap with PCS symptoms. As no pathological findings were obtained in routine diagnostics, uncertainty remains about the underlying pathophysiological mechanisms and requires further investigation beyond routine work-up.

Identifying and Managing Those at Risk for Vaccine-Related Allergy and Anaphylaxis

Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are uncommon events occurring in fewer than 1 in a million doses administered. These reactions are infrequently immunoglobulin E-mediated. Because they are unlikely to recur, a reaction to a single dose of a vaccine is rarely a contraindication to redosing. This narrative review article contextualizes the recent knowledge we have gained from the coronavirus 2019 (COVID-19) pandemic rollout of the new mRNA platform with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines within the much broader context of what is known about immediate reactions to other vaccinations of routine and global importance. We focus on what is known about evidence-based approaches to diagnosis and management and what is new in our understanding of mechanisms of immediate vaccine reactions. Specifically, we review the epidemiology of immediate hypersensitivity vaccine reactions, differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, including how to recognize immunization stress-related responses. In addition, we highlight what is known about mechanisms and review the rare but important contribution of excipient allergies and specifically when to consider testing for them as well as other key features that contribute to safe evaluation and management.

Follow-Up of Side Effects throughout the Entire Course of Coronavirus Vaccination

Vaccines are considered the best protective means against coronavirus infection. There is increasing interest in reporting the side effects of vaccines, especially for individuals younger than 18 years old. Accordingly, this analytical cohort study aims to report on the side effects of adult and young individuals who received vaccination within 24 h, 72 h, 5 days, and 1 week through the entire course of vaccination (ECoV). A validated online survey was used to collect information. In total, 1069 individuals were completely followed. Most individuals received the Pfizer vaccine (59.6%). Most individuals had received two doses (69.4%). Very strong and statistically significant associations with side effects (p < 0.05, Phi (Φ) > 0.25) throughout the ECoV were reported for the type of vaccine and female gender. Non-smokers reported weak statistically significant associations. Fatigue and localized pain were the most commonly reported side effect, with onset within 24 h and duration of less than 72 h. The prevalence of reported side effects was statistically significantly higher among young individuals (<18 years old) than among adults (X2 (1) =7.6, p = 0.006. Phi φ = 0.11).