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Melgarejo L, Caronna E, Rosell-Mirmi J, Elosua-Bayés I, Alpuente A, Torres-Ferrus M, Gallardo VJ, Pozo-Rosich P. Migraine worsening after COVID-19 and COVID-19 vaccination: Are we facing a nocebo effect? Eur J Neurol 2023; 30:3877-3885. [PMID: 37791410 DOI: 10.1111/ene.16058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND PURPOSE In clinical practice patients may report migraine worsening as a consequence of COVID-19 (either infection or vaccines), however, data in this area are lacking. We aimed to investigate the link between COVID-19 and COVID-19 vaccination with migraine worsening and its associated factors. METHODS An online survey was sent to migraine patients followed up in a Spanish Headache Clinic, collecting demographic data, and information regarding SARS-CoV-2 infection and vaccination. We asked patients if they had noticed worsening of their migraine after these events and assessed concerns about infection, vaccination and migraine worsening. We also extracted data from participants' own electronic diaries (e-diaries), including 1-month data before and after their reported infection and/or vaccination. We compared participants who self-reported migraine worsening since infection or vaccination with those who did not. RESULTS Of 550 participants, 44.9% (247/550) reported having had COVID-19 at least once and 83.3% (458/550) had been vaccinated. Sixty-one patients reported migraine worsening since COVID-19 and 52 since the vaccination. Among the risk factors for perceived migraine worsening in the two settings (infection and vaccination) was concern about migraine worsening itself (infection: odds ratio [OR] 2.498 [95% CI: 1.02-6.273], p = 0.046; vaccination: OR 17.3 [95% CI: confidence interval 5.3-68], p < 0.001). e-diary information was available for 136 of the 550 patients, 38.2% (52/136) for COVID-19 and 39.7% (54/136) for vaccination. We observed no significant difference in headache frequency 1 month before and after infection or vaccination, even when comparing patients with and without self-reported migraine worsening. CONCLUSIONS Our preliminary data point to a negligible role of the infection and vaccination on migraine worsening and to the possible presence of a nocebo effect in these settings, as a remarkable proportion of patients had a clear perception of migraine worsening.
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Affiliation(s)
- Laura Melgarejo
- Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Edoardo Caronna
- Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Rosell-Mirmi
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alicia Alpuente
- Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor J Gallardo
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Werner F, Zeschick N, Kühlein T, Steininger P, Überla K, Kaiser I, Sebastião M, Hueber S, Warkentin L. Patient-reported reactogenicity and safety of COVID-19 vaccinations vs. comparator vaccinations: a comparative observational cohort study. BMC Med 2023; 21:358. [PMID: 37726711 PMCID: PMC10510262 DOI: 10.1186/s12916-023-03064-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND In the course of the SARS-CoV-2 pandemic, multiple vaccines were developed. Little was known about reactogenicity and safety in comparison to established vaccines, e.g. influenza, pneumococcus, or herpes zoster. Therefore, the present study aimed to compare self-reported side effects in persons vaccinated against SARS-CoV-2 with the incidence of side effects in persons receiving one of the established vaccines. METHODS A longitudinal observational study was conducted over a total of 124 days using web-based surveys. Persons receiving either a vaccination against SARS-CoV-2 or one of the established vaccines (comparator group) were included. In the first questionnaire (short-term survey), 2 weeks after vaccination, mainly local and systemic complaints were evaluated. The long-term survey (42 days after vaccination) and follow-up survey (124 weeks after vaccination) focused on medical consultations for any reason. Multivariate analyses were conducted to determine the influence of the vaccine type (SARS-CoV-2 vs. comparator) and demographic factors. RESULTS In total, data from 16,636 participants were included. Self-reported reactogenicity was lowest in the comparator group (53.2%) and highest in the ChAdOx1 group (85.3%). Local reactions were reported most frequently after mRNA-1273 (73.9%) and systemic reactions mainly after vector-based vaccines (79.8%). Almost all SARS-CoV-2 vaccines showed increased odds of reporting local or systemic reactions. Approximately equal proportions of participants reported medical consultations. None in the comparator group suspected a link to vaccination, while this was true for just over one in 10 in the mRNA-1273 group. The multivariate analysis showed that people with SARS-CoV-2 vaccination were not more likely to report medical consultations; patients who had received a regimen with at least one ChAdOx1 were even less likely to report medical consultations. Younger age, female gender and higher comorbidity were mostly associated with higher odds of medical consultations. CONCLUSION The rate of adverse reactions after established vaccinations was roughly comparable to previous studies. Two weeks after vaccination, participants in the SARS-CoV-2 vaccination group reported more local and systemic local reactions than participants in the comparator group. In the further course, however, there were no higher odds of medical consultations in either of the two groups. Thus, altogether, we assume comparable safety. TRIAL REGISTRATION DRKS-ID DRKS00025881 and DRKS-ID DRKS00025373.
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Affiliation(s)
- Felix Werner
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, 91054, Germany.
| | - Nikoletta Zeschick
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, 91054, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, 91054, Germany
| | - Philipp Steininger
- Institute of Clinical and Molecular Virology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Schloßgarten 4, Erlangen, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Schloßgarten 4, Erlangen, Germany
| | - Isabelle Kaiser
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 6, Erlangen, Germany
| | - Maria Sebastião
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, 91054, Germany
| | - Susann Hueber
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, 91054, Germany
| | - Lisette Warkentin
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Universitätsstraße 29, Erlangen, 91054, Germany
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3
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Amanzio M, Cipriani GE, Mitsikostas DD. The nocebo phenomenon in the COVID-19 pandemic: a nocebodemic effect. Expert Rev Clin Pharmacol 2022; 15:1377-1382. [DOI: 10.1080/17512433.2022.2142115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Dimos D. Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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4
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Khouri C, Larabi A, Verger P, Gauna F, Cracowski JL, Ward J. Impact of Vaccine Hesitancy on Onset, Severity and Type of Self-reported Adverse Events: A French Cross-Sectional Survey. Drug Saf 2022; 45:1049-1056. [PMID: 35972651 PMCID: PMC9379877 DOI: 10.1007/s40264-022-01220-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
Introduction Little is known about the impact of mandatory vaccination on people who are reluctant to be vaccinated, despite the potential importance in terms of public health policy. Objective We aimed to explore the relationship between vaccine hesitancy and onset, severity and characteristics of self-reported adverse events. Methods We used a cross-sectional online survey conducted in 2021 among a representative sample of the French population aged 18 years and older (n = 1593). All reported adverse events were analyzed and categorized by trained experts in drug safety and pharmacovigilance. Multivariate binomial regressions on the onset of self-reported adverse events, vaccine hesitancy categories and predefined responders’ characteristics were performed. Results Overall, 590 (37.0%) participants reported at least one adverse event, with 121 (20.5%) considered it to be severe. Proportions of reported adverse events, ranging from 18% (in non-reluctant responders) to 65% (in very reluctant responders), and their severity, ranging from 5% (non-reluctant responders) to 41% (very reluctant responders), depended highly on attitudes toward vaccination. The adverse events profile remained similar between groups. In the multivariate regression model, beyond attitude toward vaccination, younger age and female gender were significantly associated with higher reporting of vaccine adverse events. Conclusions Our results suggest that vaccine hesitancy could be a major driver of patient-reported vaccine-related adverse events and their perceived severity. In this context, vaccinators must pay special attention to reluctant patients and inform them on the possible nocebo nature of these adverse events so as to prevent them. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01220-0.
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Affiliation(s)
- Charles Khouri
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France.
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France.
| | - Ayoub Larabi
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierre Verger
- VITROME (Aix Marseille Université, IRD, AP-HM, SSA), Marseille, France
- Observatoire régional de la santé PACA (ORS Paca), Aix-Marseille Université, Marseille, France
- Inserm, F-CRIN, I-REIVAC/COVIREIVAC, Paris, France
| | - Fatima Gauna
- Observatoire régional de la santé PACA (ORS Paca), Aix-Marseille Université, Marseille, France
| | - Jean-Luc Cracowski
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France
| | - Jeremy Ward
- VITROME (Aix Marseille Université, IRD, AP-HM, SSA), Marseille, France
- CERMES3 (INSERM, CNRS, EHESS, Université de Paris), Villejuif, France
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5
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Haas JW, Bender FL, Ballou S, Kelley JM, Wilhelm M, Miller FG, Rief W, Kaptchuk TJ. Frequency of Adverse Events in the Placebo Arms of COVID-19 Vaccine Trials: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2143955. [PMID: 35040967 PMCID: PMC8767431 DOI: 10.1001/jamanetworkopen.2021.43955] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/22/2021] [Indexed: 11/21/2022] Open
Abstract
Importance Adverse events (AEs) after placebo treatment are common in randomized clinical drug trials. Systematic evidence regarding these nocebo responses in vaccine trials is important for COVID-19 vaccination worldwide especially because concern about AEs is reported to be a reason for vaccination hesitancy. Objective To compare the frequencies of AEs reported in the placebo groups of COVID-19 vaccine trials with those reported in the vaccine groups. Data Sources For this systematic review and meta-analysis, the Medline (PubMed) and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched systematically using medical subheading terms and free-text keywords for trials of COVID-19 vaccines published up to July 14, 2021. Study Selection Randomized clinical trials of COVID-19 vaccines that investigated adults aged 16 years or older were selected if they assessed solicited AEs within 7 days of injection, included an inert placebo arm, and provided AE reports for both the vaccine and placebo groups separately. Full texts were reviewed for eligibility by 2 independent reviewers. Data Extraction and Synthesis Data extraction and quality assessment were performed independently by 2 reviewers, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and using the Cochrane risk-of-bias tool. Meta-analyses were based on random-effects models. Main Outcomes and Measures The primary outcomes were the proportions of placebo recipients reporting overall, systemic, and local (injection-site) AEs as well as logarithmic odds ratios (ORs) to evaluate group differences. Outcomes were tested for significance using z tests with 95% CIs. Results Twelve articles with AE reports for 45 380 participants (22 578 placebo recipients and 22 802 vaccine recipients) were analyzed. After the first dose, 35.2% (95% CI, 26.7%-43.7%) of placebo recipients experienced systemic AEs, with headache (19.3%; 95% CI, 13.6%-25.1%) and fatigue (16.7%; 95% CI, 9.8%-23.6%) being most common. After the second dose, 31.8% (95% CI, 28.7%-35.0%) of placebo recipients reported systemic AEs. The ratio between placebo and vaccine arms showed that nocebo responses accounted for 76.0% of systemic AEs after the first COVID-19 vaccine dose and for 51.8% after the second dose. Significantly more vaccine recipients reported AEs, but the group difference for systemic AEs was small after the first dose (OR, -0.47; 95% CI, -0.54 to -0.40; P < .001; standardized mean difference, -0.26; 95% CI, -0.30 to -0.22) and large after the second dose (OR, -1.36; 95% CI, -1.86 to -0.86; P < .001; standardized mean difference, -0.75; 95% CI, -1.03 to -0.47). Conclusions and Relevance In this systematic review and meta-analysis, significantly more AEs were reported in vaccine groups compared with placebo groups, but the rates of reported AEs in the placebo arms were still substantial. Public vaccination programs should consider these high rates of AEs in placebo arms.
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Affiliation(s)
- Julia W. Haas
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Friederike L. Bender
- Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Sarah Ballou
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - John M. Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Psychology, Endicott College, Beverly, Massachusetts
| | - Marcel Wilhelm
- Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | | | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Ted J. Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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6
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Garces KN, Cocores AN, Goadsby PJ, Monteith TS. Headache After Vaccination: An Update on Recent Clinical Trials and Real-World Reporting. Curr Pain Headache Rep 2022; 26:895-918. [PMID: 36418848 PMCID: PMC9685066 DOI: 10.1007/s11916-022-01094-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to characterize headache as a vaccine adverse event (VAE) in clinical trials. RECENT FINDINGS Of the recent phase III vaccine RCTs (non-COVID-19), 53 studies reported on headache (13 infectious agents). The median rate (interquartile range) of headache was 15.6% (IQR: 9.6-37.6%). Of these, 24.5% of the RCTs reported headache greater in the vaccine group compared to the placebo/control group. In the herpes zoster vaccination trials, headache was more common in all active groups: median rate 33.9% (IQR: 29.7-40.5%) as compared to placebo: median rate 17.7% (IQR: 15.4-23.8%). Influenza and HPV vaccination trials were the 2nd and 3rd most common to have headache as a VAE. Of the 6 widely distributed COVID-19 vaccinations, median rate of post-vaccination headache was 39% (IQR: 28-50%). Headache is a common VAE in vaccine trials. Standardized grading methods, predictors of persistence, and treatment regimens are warranted.
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Affiliation(s)
- Kimberly N. Garces
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
| | - Alexandra N. Cocores
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
| | - Peter J. Goadsby
- NIHR King’s Clinical Research Facility & Headache Group-Wolfson CARD, King’s College London, London, UK ,Department of Neurology, University of California, Los Angeles, Los Angeles, CA USA
| | - Teshamae S. Monteith
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
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Amanzio M, Mitsikostas DD, Giovannelli F, Bartoli M, Cipriani GE, Brown WA. Adverse events of active and placebo groups in SARS-CoV-2 vaccine randomized trials: A systematic review. LANCET REGIONAL HEALTH-EUROPE 2021; 12:100253. [PMID: 34729549 PMCID: PMC8553263 DOI: 10.1016/j.lanepe.2021.100253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background For safety assessment in clinical trials, adverse events (AEs) are reported for the drug under evaluation and compared with AEs in the placebo group. Little is known about the nature of the AEs associated with clinical trials of SARS-CoV-2 vaccines and the extent to which these can be traced to nocebo effects, where negative treatment-related expectations favor their occurrence. Methods In our systematic review, we compared the rates of solicited AEs in the active and placebo groups of SARS-CoV-2 vaccines approved by the Western pharmaceutical regulatory agencies.We implemented a search strategy to identify trial-III studies of SARS-CoV-2 vaccines through the PubMed database. We adopted the PRISMA Statement to perform the study selection and the data collection and identified three trial: two mRNA-based (37590 participants) and one adenovirus type (6736 participants). Findings Relative risks showed that the occurrence of AEs reported in the vaccine groups was higher compared with the placebo groups. The most frequently AEs in both groups were fatigue, headache, local pain, as injection site reactions, and myalgia. In particular, for first doses in placebo recipients, fatigue was reported in 29% and 27% in BNT162b2 and mRNA-1273 groups, respectively, and in 21% of Ad26.COV2.S participants. Headache was reported in 27% in both mRNA groups and in 24% of Ad26.COV2.S recipients. Myalgia was reported in 10% and 14% in mRNA groups (BNT162b2 and mRNA-1273, respectively) and in 13% of Ad26.COV2.S participants. Local pain was reported in 12% and 17% in mRNA groups (BNT162b2 and mRNA-1273, respectively), and in 17% of Ad26.COV2.S recipients. These AEs are more common in the younger population and in the first dose of placebo recipients of the mRNA vaccines. Interpretation Our results are in agreement with the expectancy theory of nocebo effects and suggest that the AEs associated with COVID-19 vaccines may be related to the nocebo effect. Funding Fondazione CRT - Cassa di Risparmio di Torino, IT (grant number 66346, "GAIA-MENTE" 2019).
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Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74 V. Sofia's Avenue, Athens 11528, Hellas, Greece
| | - Fabio Giovannelli
- Section of Psychology - Department of Neuroscience, Psychology, Drug Research and Child's Health (NEUROFARBA), University of Florence, Via di San Salvi 12, 50135 Florence, Italy
| | - Massimo Bartoli
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | | | - Walter A Brown
- Department of Psychiatry and Human Behavior, Brown University, 69 Brown Street Providence, RI 02912, USA
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8
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Mitsikostas DD, Aravantinou-Fatorou K, Deligianni C, Kravvariti E, Korompoki E, Mylona M, Vryttia P, Papagiannopoulou G, Delicha EM, Dellis A, Tsivgoulis G, Dimopoulos MA, Amanzio M, Sfikakis PP. Nocebo-Prone Behavior Associated with SARS-CoV-2 Vaccine Hesitancy in Healthcare Workers. Vaccines (Basel) 2021; 9:vaccines9101179. [PMID: 34696287 PMCID: PMC8541064 DOI: 10.3390/vaccines9101179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 12/13/2022] Open
Abstract
Among healthcare workers (HCWs), SARS-CoV-2 vaccine hesitancy may be linked to a higher susceptibility to nocebo effects, i.e., adverse events (AEs) experienced after medical treatments due to negative expectations. To investigate this hypothesis a cross-sectional survey was performed with a self-completed questionnaire that included a tool (Q-No) for the identification of nocebo-prone individuals. A total of 1309 HCWs (67.2% women; 43.4% physicians; 28.4% nurses; 11.5% administrative staff; 16.6% other personnel) completed the questionnaires, among whom 237 (18.1%) had declined vaccination. Q-No scores were ≥15 in 325 participants (24.8%) suggesting nocebo-prone behavior. In a multivariate logistic regression model with Q-No score, age, gender, and occupation as independent variables, estimated odds ratios (ORs) of vaccination were 0.43 (i.e., less likely, p < 0.001) in participants with Q-No score ≥ 15 vs. Q-No score < 15, 0.58 in females vs. males (p = 0.013), and 4.7 (i.e., more likely) in physicians vs. other HCWs (p < 0.001), independent of age, which was not significantly associated with OR of vaccination. At least one adverse effect (AE) was reported by 67.5% of vaccinees, mostly local pain and flu-like symptoms. In a multivariate logistic regression model, with Q-No score, age, gender, and occupation as independent variables, estimated ORs of AE reporting were 2.0 in females vs. males (p < 0.001) and 1.47 in physicians vs. other HCWs (p = 0.017) independently of age and Q-No score, which were not significantly associated with OR of AE. These findings suggest that nocebo-prone behavior in HCWs is associated with SARS-CoV-2 vaccination hesitancy indicating a potential benefit of a campaign focused on nocebo-prone people.
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Affiliation(s)
- Dimos D. Mitsikostas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
- Correspondence: ; Tel./Fax: +30-2107289282
| | - Konstantina Aravantinou-Fatorou
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Christina Deligianni
- Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, 2600 Copenhagen, Denmark;
| | - Evrydiki Kravvariti
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Maria Mylona
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
| | - Pinelopi Vryttia
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Georgia Papagiannopoulou
- 2nd Neurology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (G.T.)
| | | | - Athanasios Dellis
- 2nd Surgery Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Georgios Tsivgoulis
- 2nd Neurology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (G.T.)
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Martina Amanzio
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy;
| | - Petros P. Sfikakis
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
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9
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Benedetti F, Amanzio M, Giovannelli F, Craigs-Brackhahn K, Shaibani A. Hypothalamic-Pituitary-Adrenal Activity in Adverse Events Reporting after Placebo Administration. Clin Pharmacol Ther 2021; 110:1349-1357. [PMID: 34365636 DOI: 10.1002/cpt.2388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/28/2021] [Indexed: 11/06/2022]
Abstract
Participants of clinical trials who receive a placebo treatment often report a variety of adverse events, sometimes called nocebo effects. The reason why these adverse events occur is not clear, and understanding the underlying mechanisms represents a challenge that is likely to improve the interpretation of clinical trials as well as medical practice. Here, we studied 192 healthy subjects who received placebo oxygen through a mask after reading (READ) or not reading (NO-READ) a list of possible adverse events of oxygen breathing: headache, chest pain, abdominal pain, and cough. The whole hypothalamus-pituitary-adrenal axis was assessed just before and right after placebo breathing by measuring the hypothalamic corticotropin-releasing hormone (CRH), pituitary adrenocorticotropic hormone (ACTH), and adrenal cortisol (COR). In addition, both state and trait anxiety were assessed. We found that 64.5% of the NO-READ group reported no adverse events, 30.2% had one, and only 5.2% had two adverse events. In contrast, only 20.8% of the READ group reported no adverse events, whereas 1, 2, 3, and 4 adverse events were reported with a frequency of 21.8%, 19.8%, 19.8%, and 17.7%, respectively. In addition, when the READ group reported three and four adverse events, CRH, ACTH, and COR were significantly increased compared to the NO-READ group, along with an increase in state anxiety scores. These data indicate that hypothalamic-pituitary-adrenal activity and state anxiety are increased in those subjects who report many adverse events after reading a list of adverse events, thus highlighting a possible neuroendocrine mechanism after placebo administration.
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Affiliation(s)
- Fabrizio Benedetti
- Neuroscience Department, University of Turin Medical School, Turin, Italy.,Medicine & Physiology of Hypoxia, Plateau Rosà, Switzerland
| | | | - Fabio Giovannelli
- Department of Neuroscience, Psychology, Drug Research and Child's Health, University of Florence, Florence, Italy
| | | | - Aziz Shaibani
- Nerve & Muscle Center of Texas, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
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Bartoli M, Canessa N, Cipriani GE, Cappa SF, Amanzio M. The Role of Neuropsychological Factors in Perceived Threat of SARS-CoV-2 in Healthy Ageing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5847. [PMID: 34072431 PMCID: PMC8198099 DOI: 10.3390/ijerph18115847] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic is known to increase older adults' vulnerability to adverse outcomes. Alongside increased physical frailty, anxiety symptoms associated with the risk of SARS-CoV-2 contagion appear to represent its most prominent 'sequelae'. The attentional and linguistic resources required for decoding virus-related information may also influence the perceived threat of contagion. However, the possible role of neuropsychogeriatric factors on the latter dimension has never been assessed in a longitudinal study on the older population. To fill this gap, 50 healthy cognitively preserved older adults underwent a neuropsychological and physical frailty assessment before the pandemic (T0). Subsequently, they agreed to be interviewed and re-assessed during the lockdown (T1) and immediately after it (T2) through a longitudinal one-year study. Perceived threat of SARS-CoV-2 at T2 was predicted both by baseline anxiety and frailty scores, and by decreased performance in information processing speed and language comprehension tests. While confirming the joint role of frailty and anxiety, a moderation/interaction model showed that each of them was sufficient, at its highest level, to support the maximum degree of perceived threat of contagion. The contribution of neuropsychological factors to perceived threat of SARS-CoV-2 highlights their importance of tailoring information campaigns addressed to older people.
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Affiliation(s)
- Massimo Bartoli
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.B.); (M.A.)
| | - Nicola Canessa
- ICoN Center, Scuola Universitaria Superiore IUSS, 27100 Pavia, Italy; (N.C.); (S.F.C.)
- Istituti Clinici Scientifici Maugeri IRCCS, Cognitive Neuroscience Laboratory of Pavia Institute, 27100 Pavia, Italy
| | | | - Stefano F. Cappa
- ICoN Center, Scuola Universitaria Superiore IUSS, 27100 Pavia, Italy; (N.C.); (S.F.C.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, 27100 Pavia, Italy
| | - Martina Amanzio
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.B.); (M.A.)
- European Innovation Partnership on Active and Healthy Ageing, 1049 Brussels, Belgium
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Lin CH. Nocebo effects from COVID-19 and vaccination Hesitancy: The question of to be or not to be vaccinated. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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