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Karimi-Shahrbabak E, Di Chiara C, Farrar DS, Abu Fadaleh SM, Peresin J, Low B, Avelar-Rodriguez D, Orkin J, Science M, Piché-Renaud PP, Morris SK. COVID-19 vaccine acceptance and uptake among caregivers of children aged 5-11 years in Ontario, Canada: A cross-sectional survey. Vaccine 2024; 42:3974-3980. [PMID: 38772834 DOI: 10.1016/j.vaccine.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/25/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Although COVID-19 vaccine safety in 5-11-year-old children has been documented, half of Ontarian children this age remain unvaccinated. This study aimed to assess caregivers' vaccine acceptance for 5-11-year-old children and identify factors associated with vaccine non-acceptance. METHODS A multi-language self-administered survey was sent to caregivers of 5-11-year-old children through schools and community health centers within the Greater Toronto Area from April-July 2022. Sociodemographic characteristics and immunization behaviours were collected for caregivers, their 5-11-year-old children, and any older siblings. The primary outcome, COVID-19 vaccine acceptance, was previous uptake of COVID-19 vaccine or caregiver intent to vaccinate for their 5-11-year-old child. Data were analyzed using descriptive statistics and multivariable logistic regression. RESULTS In total, 807 caregivers were included in analysis. Although 93 % of caregivers had received two doses of COVID-19 vaccine, 77 % had a 5-11-year-old child who received at least one dose of vaccine. Caregivers age was associated with vaccine acceptance (vs. < 40 years; adjusted odds ratio [aOR] 2.1, 95 % confidence interval [CI] 1.4-3.1 for ages 40-49; aOR 2.8, 95 % CI 1.1-7.1 for ages ≥50 years). Immunization factors associated with vaccine acceptance included caregiver COVID-19 vaccination (aOR 38.1 vs. unvaccinated caregivers; 95 % CI 15.8-92.3), older siblings COVID-19 vaccination (aOR 49.2 vs. unvaccinated siblings; 95 % CI 18.3-132.3), and recent influenza vaccination for the child (aOR 6.9 vs. no influenza vaccine; 95 % CI 4.6-10.5). Among 189 caregivers with unvaccinated 5-11-year-old children, the most common reasons for non-acceptance were concerns about long-term side effects (59 %), lack of experience vaccinating children (41 %), and concerns that vaccines were developed too quickly (39 %). CONCLUSION Acceptance of COVID-19 vaccination for 5-11-year-old children were associated with caregiver vaccine behaviors and sociodemographic factors. These findings highlight groups of caregivers that can be targeted for educational interventions and concerns that may be addressed to increase vaccine confidence.
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Affiliation(s)
- Elahe Karimi-Shahrbabak
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Costanza Di Chiara
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada; Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada.
| | - Daniel S Farrar
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Sarah M Abu Fadaleh
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Joelle Peresin
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Brooke Low
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - David Avelar-Rodriguez
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada.
| | - Julia Orkin
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada.
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada.
| | - Pierre-Philippe Piché-Renaud
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada.
| | - Shaun K Morris
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada; Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Division of Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, 155 College Street, Toronto, ON M5T 3M7, Canada.
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Alami A, Villeneuve PJ, Farrell PJ, Mattison D, Farhat N, Haddad N, Wilson K, Gravel CA, Crispo JAG, Perez-Lloret S, Krewski D. Myocarditis and Pericarditis Post-mRNA COVID-19 Vaccination: Insights from a Pharmacovigilance Perspective. J Clin Med 2023; 12:4971. [PMID: 37568373 PMCID: PMC10419493 DOI: 10.3390/jcm12154971] [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: 06/10/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Concerns remain regarding the rare cardiovascular adverse events, myocarditis and pericarditis (myo/pericarditis), particularly in younger individuals following mRNA COVID-19 vaccination. Our study aimed to comprehensively assess potential safety signals related to these cardiac events following the primary and booster doses, with a specific focus on younger populations, including children as young as 6 months of age. Using the Vaccine Adverse Events Reporting System (VAERS), the United States national passive surveillance system, we conducted a retrospective pharmacovigilance study analyzing spontaneous reports of myo/pericarditis. We employed both frequentist and Bayesian methods and conducted subgroup analyses by age, sex, and vaccine dose. We observed a higher reporting rate of myo/pericarditis following the primary vaccine series, particularly in males and mainly after the second dose. However, booster doses demonstrated a lower number of reported cases, with no significant signals detected after the fourth or fifth doses. In children and young adults, we observed notable age and sex differences in the reporting of myo/pericarditis cases. Males in the 12-17 and 18-24-year-old age groups had the highest number of cases, with significant signals for both males and females after the second dose. We also identified an increased reporting for a spectrum of cardiovascular symptoms such as chest pain and dyspnea, which increased with age, and were reported more frequently than myo/pericarditis. The present study identified signals of myo/pericarditis and related cardiovascular symptoms after mRNA COVID-19 vaccination, especially among children and adolescents. These findings underline the importance for continued vaccine surveillance and the need for further studies to confirm these results and to determine their clinical implications in public health decision-making, especially for younger populations.
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Affiliation(s)
- Abdallah Alami
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Paul J. Villeneuve
- Department of Neuroscience, Faculty of Science, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Patrick J. Farrell
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
| | - Donald Mattison
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Nawal Farhat
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
| | - Nisrine Haddad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Christopher A. Gravel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1Y7, Canada
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - James A. G. Crispo
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Division of Human Sciences, NOSM University, Sudbury, ON P3E2C6, Canada
| | - Santiago Perez-Lloret
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires C1033AAJ, Argentina
- Observatorio de Salud Pública, Pontificia Universidad Católica Argentina, Buenos Aires C1107AAZ, Argentina
- Department of Physiology, Faculty of Medicine, University of Buenos Aires, Buenos Aires C1121ABG, Argentina
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
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Guo BQ, Li HB, Yang LQ. Incidence of myopericarditis after mRNA COVID-19 vaccination: A meta-analysis with focus on adolescents aged 12-17 years. Vaccine 2023; 41:4067-4080. [PMID: 37246067 PMCID: PMC10201323 DOI: 10.1016/j.vaccine.2023.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The incidence of myopericarditis after mRNA COVID-19 vaccination among adolescents aged 12-17 years remains unknown. Therefore, we conducted a study to pool the incidence of myopericarditis following COVID-19 vaccination in this age group. METHODS We did a meta-analysis by searching 4 electronic databases until February 6, 2023. The following main keywords were used: "COVID-19", "vaccines", "myocarditis", "pericarditis", and "myopericarditis". Observational studies reporting on adolescents aged 12-17 years who had myopericarditis in temporal relation to receiving mRNA COVID-19 vaccines were included. The pooled incidence of myopericarditis and 95 % confidence interval (CI) were calculated using a single-group meta-analysis. RESULTS Fifteen studies were included. The pooled incidences of myopericarditis after mRNA COVID-19 vaccination among adolescents aged 12-17 years were 43.5 (95 % CI, 30.8-61.6) cases per million vaccine doses for both BNT162b2 and mRNA-1273 (39 628 242 doses; 14 studies), and 41.8 (29.4-59.4) cases for BNT162b2 alone (38 756 553 doses; 13 studies). Myopericarditis was more common among males (66.0 [40.5-107.7] cases) than females (10.1 [6.0-17.0] cases) and among those receiving the second dose (60.4 [37.6-96.9] cases) than those receiving the first dose (16.6 [8.7-31.9] cases). The incidences of myopericarditis did not differ significantly when grouped by age, type of myopericarditis, country, and World Health Organization region. None of the incidences of myopericarditis pooled in the current study were higher than those after smallpox vaccinations and non-COVID-19 vaccinations, and all of them were significantly lower than those in adolescents aged 12-17 years after COVID-19 infection. CONCLUSIONS The incidences of myopericarditis after mRNA COVID-19 vaccination among adolescents aged 12-17 years were very rare; they were not higher than other important reference incidences. These findings provide an important context for health policy makers and parents with vaccination hesitancy to weight the risks and benefits of mRNA COVID-19 vaccination among adolescents aged 12-17 years.
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Affiliation(s)
- Bao-Qiang Guo
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan 453003, China.
| | - Hong-Bin Li
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan 453003, China
| | - Li-Qiang Yang
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan 453003, China
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Karemingi C, Georgiyeva K, Santiesteban E, Sciarra J, Kumar H. Anesthetic Management of Suspected COVID-19 Vaccination Pericarditis/Myocarditis Scheduled for a Pericardial Window: A Case Report and Literature Review. Cureus 2023; 15:e39222. [PMID: 37337497 PMCID: PMC10276972 DOI: 10.7759/cureus.39222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
The unique challenges posed by the COVID vaccination continue to affect multiple healthcare specialties. Although short-term studies have shown that COVID-19 vaccines are both safe and effective, reports of side effects continue to emerge. Cardiovascular side effects such as myo-pericardial inflammation are of particular interest to the fields of cardiology, anesthesiology, and surgery. Myocarditis and pericarditis necessitate diagnostic and therapeutic procedures such as transesophageal echocardiography (TEE) and pericardial window surgery. Intraoperative monitoring of clinical status and heart rhythm and careful adjustments to anesthetic management are required to ensure successful outcomes. This case report follows a 50-year-old male with a known history of pericardial effusion post-COVID vaccination who presented to the emergency department with shortness of breath and chest pain, necessitating further management. We examine the importance of TEE in preventing unnecessary pericardial window procedures and shed light on the importance of careful patient monitoring and management in promoting successful outcomes from an anesthesiology perspective.
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Affiliation(s)
- Cecilia Karemingi
- Anesthesiology, Larkin Community Hospital, South Miami, USA
- Anesthesiology, University of Rochester, Rochester, USA
| | - Kateryna Georgiyeva
- Internal Medicine, Memorial Healthcare System, Pembroke Pines, USA
- Anesthesiology, Larkin Community Hospital, South Miami, USA
| | | | - John Sciarra
- Anesthesiology, Larkin Community Hospital, South Miami, USA
| | - Harendra Kumar
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
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Piché‐Renaud P, Morris SK, Top KA. A narrative review of vaccine pharmacovigilance during mass vaccination campaigns: Focus on myocarditis and pericarditis after COVID-19 mRNA vaccination. Br J Clin Pharmacol 2022; 89:967-981. [PMID: 36480113 PMCID: PMC9878271 DOI: 10.1111/bcp.15625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccines have had a tremendous impact on reducing the burden of infectious diseases; however, they have the potential to cause adverse events following immunization (AEFIs). Prelicensure clinical trials are limited in their ability to detect rare AEFIs that may occur in less than one per thousand individuals. While postmarketing surveillance systems have shown COVID-19 mRNA vaccines to be safe, they led to the identification of rare cases of myocarditis and pericarditis after COVID-19 vaccination that were not initially detected in clinical trials. In this narrative review, we highlight concepts of vaccine pharmacovigilance during mass vaccination campaigns and compare the approaches used in the context of myocarditis and pericarditis following COVID-19 vaccination to historical examples. We describe mechanisms of passive and active surveillance, their strengths and limitations, and how they interacted to identify and characterize the safety signal of myocarditis and pericarditis after COVID-19 mRNA vaccination. Articles were synthesized from a PubMed search using relevant keywords for articles published on vaccine surveillance systems and myocarditis and pericarditis after COVID-19 vaccination, as well as the authors' collections of relevant publications and grey literature reports. The global experience around the identification and monitoring of myocarditis and pericarditis after COVID-19 mRNA vaccination has provided important lessons for vaccine safety surveillance and highlighted its importance in maintaining public trust in mass vaccination programmes in a pandemic context.
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Affiliation(s)
| | - Shaun K. Morris
- Division of Infectious DiseasesThe Hospital for Sick ChildrenTorontoOntarioCanada,Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of Pediatrics, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Clinical Public Health, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Karina A. Top
- Department of PediatricsDalhousie University and Canadian Center for Vaccinology, IWK Health CentreHalifaxNova ScotiaCanada
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Ferraresi A, Isidoro C. Will Omics Biotechnologies Save Us from Future Pandemics? Lessons from COVID-19 for Vaccinomics and Adversomics. Biomedicines 2022; 11:52. [PMID: 36672560 PMCID: PMC9855897 DOI: 10.3390/biomedicines11010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
The COVID-19 pandemic had cross-cutting impacts on planetary health, quotidian life, and society. Mass vaccination with the current gene-based vaccines has helped control the pandemic but unfortunately it has not shown effectiveness in preventing the spread of the virus. In addition, not all individuals respond to these vaccines, while others develop adverse reactions that cannot be neglected. It is also a fact that some individuals are more susceptible to infection while others develop effective immunization post-infection. We note here that the person-to-person and population variations in vaccine efficacy and side effects have been studied in the field of vaccinomics long before the COVID-19 pandemic. Additionally, the field of adversomics examines the mechanisms of individual differences in the side effects of health interventions. In this review, we discuss the potential of a multi-omics approach for comprehensive profiling of the benefit/risk ratios of vaccines. Vaccinomics and adversomics stand to benefit planetary health and contribute to the prevention of future pandemics in the 21st century by offering precision guidance to clinical trials as well as promoting precision use of vaccines in ways that proactively respond to individual and population differences in their efficacy and safety. This vision of pandemic prevention based on personalized instead of mass vaccination also calls for equity in access to precision vaccines and diagnostics that support a vision and practice of vaccinomics and adversomics in planetary health.
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Affiliation(s)
| | - Ciro Isidoro
- Laboratory of Molecular Pathology, Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
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