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Caplanusi I, Szmigiel A, van der Elst M, Schougaard Christiansen ML, Thirstrup S, Zaccaria C, Cappelli B, Genov G, Straus S. The Role of the European Medicines Agency in the Safety Monitoring of COVID-19 Vaccines and Future Directions in Enhancing Vaccine Safety Globally. Drug Saf 2024; 47:405-418. [PMID: 38396269 PMCID: PMC11018685 DOI: 10.1007/s40264-024-01405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
The European Union (EU) regulatory network was at the forefront of the safety monitoring of COVID-19 vaccines during the pandemic. An unprecedented number of case reports of suspected adverse reactions after vaccination called for huge efforts for the assessment of this safety information, to ensure that any possible risks were detected and managed as early as possible, while ruling out coincidental but temporally related adverse health outcomes. We describe the role of the European Medicines Agency alongside the EU regulatory network in the safety monitoring of the COVID-19 vaccines, and provide an insight into challenges, particularities and outcomes of the scientific assessment and regulatory decisions in the complex, dynamic international environment of the pandemic. We discuss the flexible procedural tools that were used to ensure an expedited scientific assessment of safety issues, and subsequent updates of the product information (i.e., labelling) when available evidence (e.g., spontaneous reports, findings from observational studies and/or scientific literature) suggested that causal association is at least a reasonable possibility. The safety monitoring was accompanied by enhanced transparency measures, proactive communication, and easy access to information, which played a key role in public reassurance. The pandemic has been a powerful booster for worldwide collaboration, exchange of information and work-sharing. The safety monitoring of COVID-19 vaccines continues, and the lessons learned will be applied in future safety reviews, as well as future health emergencies.
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Affiliation(s)
- Irina Caplanusi
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
| | - Agnieszka Szmigiel
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Menno van der Elst
- Medicines Evaluation Board, Utrecht, The Netherlands
- Pharmacovigilance Risk Assessment Committee, Amsterdam, The Netherlands
| | | | - Steffen Thirstrup
- Chief Medical Officer, European Medicines Agency, Amsterdam, The Netherlands
| | - Cosimo Zaccaria
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Bénédicte Cappelli
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Georgy Genov
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Sabine Straus
- Medicines Evaluation Board, Utrecht, The Netherlands
- Pharmacovigilance Risk Assessment Committee, Amsterdam, The Netherlands
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2
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Mercadé-Besora N, Li X, Kolde R, Trinh NT, Sanchez-Santos MT, Man WY, Roel E, Reyes C, Delmestri A, Nordeng HME, Uusküla A, Duarte-Salles T, Prats C, Prieto-Alhambra D, Jödicke AM, Català M. The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications. Heart 2024; 110:635-643. [PMID: 38471729 DOI: 10.1136/heartjnl-2023-323483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/13/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To study the association between COVID-19 vaccination and the risk of post-COVID-19 cardiac and thromboembolic complications. METHODS We conducted a staggered cohort study based on national vaccination campaigns using electronic health records from the UK, Spain and Estonia. Vaccine rollout was grouped into four stages with predefined enrolment periods. Each stage included all individuals eligible for vaccination, with no previous SARS-CoV-2 infection or COVID-19 vaccine at the start date. Vaccination status was used as a time-varying exposure. Outcomes included heart failure (HF), venous thromboembolism (VTE) and arterial thrombosis/thromboembolism (ATE) recorded in four time windows after SARS-CoV-2 infection: 0-30, 31-90, 91-180 and 181-365 days. Propensity score overlap weighting and empirical calibration were used to minimise observed and unobserved confounding, respectively.Fine-Gray models estimated subdistribution hazard ratios (sHR). Random effect meta-analyses were conducted across staggered cohorts and databases. RESULTS The study included 10.17 million vaccinated and 10.39 million unvaccinated people. Vaccination was associated with reduced risks of acute (30-day) and post-acute COVID-19 VTE, ATE and HF: for example, meta-analytic sHR of 0.22 (95% CI 0.17 to 0.29), 0.53 (0.44 to 0.63) and 0.45 (0.38 to 0.53), respectively, for 0-30 days after SARS-CoV-2 infection, while in the 91-180 days sHR were 0.53 (0.40 to 0.70), 0.72 (0.58 to 0.88) and 0.61 (0.51 to 0.73), respectively. CONCLUSIONS COVID-19 vaccination reduced the risk of post-COVID-19 cardiac and thromboembolic outcomes. These effects were more pronounced for acute COVID-19 outcomes, consistent with known reductions in disease severity following breakthrough versus unvaccinated SARS-CoV-2 infection.
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Affiliation(s)
- Núria Mercadé-Besora
- Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), IDIAP Jordi Gol, Barcelona, Catalunya, Spain
| | - Xintong Li
- Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Nhung Th Trinh
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Maria T Sanchez-Santos
- Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Wai Yi Man
- Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Elena Roel
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), IDIAP Jordi Gol, Barcelona, Catalunya, Spain
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), IDIAP Jordi Gol, Barcelona, Catalunya, Spain
| | - Antonella Delmestri
- Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Hedvig M E Nordeng
- School of Pharmacy, University of Oslo, Oslo, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), IDIAP Jordi Gol, Barcelona, Catalunya, Spain
- Department of Medical Informatics, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, Netherlands
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, Netherlands
| | - Annika M Jödicke
- Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Martí Català
- Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
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3
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Lataster R. How the adverse effect counting window affected vaccine safety calculations in randomised trials of COVID-19 vaccines. J Eval Clin Pract 2024; 30:453-458. [PMID: 38234278 DOI: 10.1111/jep.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/05/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Raphael Lataster
- Centre for Continuing Education, The University of Sydney, Sydney, New South Wales, Australia
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Razzaque MS. Can adverse cardiac events of the COVID-19 vaccine exacerbate preexisting diseases? Expert Rev Anti Infect Ther 2024; 22:131-137. [PMID: 38284355 DOI: 10.1080/14787210.2024.2311837] [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: 07/31/2023] [Accepted: 01/25/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION SARS-CoV-2 infection and COVID-19 vaccination can both lead to serious cardiac conditions such as myocarditis, arrhythmia, acute myocardial infarction, and coagulopathy. Further studies are needed to better understand the risks and benefits of COVID-19 vaccination, and to determine the best course of action for individuals with preexisting heart conditions. AREAS COVERED The current knowledge and challenges in understanding vaccine-associated heart issues concerning the COVID-19 pandemic are briefly summarized, highlighting similar cardiac conditions caused by either SARS-CoV-2 infection or COVID-19 vaccination and the potential clinical impacts. EXPERT OPINION The short-term risks of severe cardiovascular side effects following COVID-19 vaccination are relatively low. However, further studies are needed to determine whether adverse vaccination events outweigh the long-term benefits in specific groups of individuals. Since cardiac inflammation, blood pressure dysregulation, coagulopathy, acute myocardial infarction, or arrhythmia could be the consequences of either SARS-CoV-2 infection or COVID-19 vaccination, clinical questions should be asked whether the COVID-19 vaccine worsens the condition in persons with preexisting heart diseases. It is important to carefully assess the potential risks and benefits of COVID-19 vaccination, especially for individuals with preexisting heart conditions, and to continue monitoring and studying the long-term effects of vaccination on cardiovascular health.
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Affiliation(s)
- Mohammed S Razzaque
- Professor of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
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Amer SA, Al-Zahrani A, Imam EA, Ishteiwy EM, Djelleb IF, Abdullh LR, Ballaj D, Amer YA, El-Sokkary RH, Elshabrawy AM, Eskander G, Shah J, Raza ML, ALsafa AMAA, Ali HT, Fawzy HM. Exploring the reported adverse effects of COVID-19 vaccines among vaccinated Arab populations: a multi-national survey study. Sci Rep 2024; 14:4785. [PMID: 38413637 PMCID: PMC10899622 DOI: 10.1038/s41598-024-54886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/17/2024] [Indexed: 02/29/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been a major challenge worldwide for the past years with high morbidity and mortality rates. While vaccination was the cornerstone to control the pandemic and disease spread, concerns regarding safety and adverse events (AEs) have been raised lately. A cross-sectional study was conducted between January 1st and January 22nd, 2022, in six Arabic countries namely Saudi Arabia, Egypt, Syria, Libya, Iraq, and Algeria. We utilized a self-administered questionnaire validated in Arabic which encompassed two main parts. The first was regarding sociodemographic data while the second was about COVID-19 vaccination history, types, doses, and experienced AEs. A multistage sampling was employed in each country, involving the random selection of three governorates from each country, followed by the selection of one urban area and one rural area from each governorate. We included the responses of 1564 participants. The most common AEs after the first and second doses were local AEs (67.9% and 46.6%, respectively) followed by bone pain and myalgia (37.6% and 31.8%, respectively). After the third dose, the most common AEs were local AEs (45.7%) and fever (32.4%). Johnson and Johnson, Sputnik Light, and Moderna vaccines showed the highest frequency of AEs. Factors associated with AEs after the first dose included an increase in age (aOR of 61-75 years compared to the 12-18 years group: 2.60, 95% CI: 1.59-4.25, p = 0.001) and male gender (OR: 0.72, 95% CI: 0.63-0.82, p < 0.001). The cumulative post-vaccination COVID-19 disease was reported with Sinovac (16.1%), Sinopharm (15.8%), and Johnson and Johnson (14.9) vaccines. History of pre-vaccination SARS-CoV-2 infection significantly increases the risk of post-vaccination COVID-19 after the first, second, and booster doses (OR: 3.09, CI: 1.9-5.07, p < 0.0001; OR: 2.56, CI: 1.89-3.47, p < 0.0001; and OR: 2.94, CI: 1.6-5.39, p = 0.0005 respectively). In conclusion, AEs were common among our participants, especially local AEs. Further extensive studies are needed to generate more generalizable data regarding the safety of different vaccines.
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Affiliation(s)
- Samar A Amer
- Department of Public Health and Community Medicine, Faculty of Medicine, Zagzig University, Zagazig, Egypt.
- Membership at the Royal Colleague of General Practitioners [INT], London, UK.
- Department of Mental Health Primary Care, Nova University, Lisbon, Portugal.
| | - Ali Al-Zahrani
- Research and Innovation Group, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Esraa A Imam
- Department of Family Medicine, Faculty of Medicine, MOH, Riyadh, Saudi Arabia
| | - Ehab M Ishteiwy
- Internship Year at Albayda Medical Center (AMC), Omar-Almukhtar University, Albayad, Libya
| | - Ines F Djelleb
- Faculty of Medicine, Badji Mokhtar, 23000, Annaba, Algeria
| | - Lina R Abdullh
- Department of Dermatology, Faculty of Medicine, University of Baghdad, Baghdad, Iraq
| | - Dana Ballaj
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Youmna A Amer
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Zagzig University, Zagazig, Egypt
| | - Rehab H El-Sokkary
- Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Arafa M Elshabrawy
- Endocrinology and Diabetes Division, Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Georgette Eskander
- Department of Biochemistry, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | | | | | | | - Hebatallah M Fawzy
- Lecturer of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Choi K, Park SJ, Han S, Mun Y, Lee DY, Chang DJ, Kim S, Yoo S, Woo SJ, Park KH, Suh HS. Patient-Centered Economic Burden of Exudative Age-Related Macular Degeneration: Retrospective Cohort Study. JMIR Public Health Surveill 2023; 9:e49852. [PMID: 38064251 PMCID: PMC10746973 DOI: 10.2196/49852] [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: 06/12/2023] [Revised: 09/01/2023] [Accepted: 10/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Exudative age-related macular degeneration (AMD), one of the leading causes of blindness, requires expensive drugs such as anti-vascular endothelial growth factor (VEGF) agents. The long-term regular use of effective but expensive drugs causes an economic burden for patients with exudative AMD. However, there are no studies on the long-term patient-centered economic burden of exudative AMD after reimbursement of anti-VEGFs. OBJECTIVE This study aimed to evaluate the patient-centered economic burden of exudative AMD for 2 years, including nonreimbursement and out-of-pocket costs, compared with nonexudative AMD using the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). METHODS This retrospective cohort study was conducted using the OMOP CDM, which included 2,006,478 patients who visited Seoul National University Bundang Hospital from June 2003 to July 2019. We defined the exudative AMD group as patients aged >50 years with a diagnosis of exudative AMD and a prescription for anti-VEGFs or verteporfin. The control group was defined as patients aged >50 years without a diagnosis of exudative AMD or a prescription for anti-VEGFs or verteporfin. To adjust for selection bias, controls were matched by propensity scores using regularized logistic regression with a Laplace prior. We measured any medical cost occurring in the hospital as the economic burden of exudative AMD during a 2-year follow-up period using 4 categories: total medical cost, reimbursement cost, nonreimbursement cost, and out-of-pocket cost. To estimate the average cost by adjusting the confounding variable and overcoming the positive skewness of costs, we used an exponential conditional model with a generalized linear model. RESULTS We identified 931 patients with exudative AMD and matched 783 (84.1%) with 2918 patients with nonexudative AMD. In the exponential conditional model, the total medical, reimbursement, nonreimbursement, and out-of-pocket incremental costs were estimated at US $3426, US $3130, US $366, and US $561, respectively, in the first year and US $1829, US $1461, US $373, and US $507, respectively, in the second year. All incremental costs in the exudative AMD group were 1.89 to 4.25 and 3.50 to 5.09 times higher in the first and second year, respectively, than those in the control group (P<.001 in all cases). CONCLUSIONS Exudative AMD had a significantly greater economic impact (P<.001) for 2 years on reimbursement, nonreimbursement, and out-of-pocket costs than nonexudative AMD after adjusting for baseline demographic and clinical characteristics using the OMOP CDM. Although economic policies could relieve the economic burden of patients with exudative AMD over time, the out-of-pocket cost of exudative AMD was still higher than that of nonexudative AMD for 2 years. Our findings support the need for expanding reimbursement strategies for patients with exudative AMD given the significant economic burden faced by patients with incurable and fatal diseases both in South Korea and worldwide.
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Affiliation(s)
- Kyungseon Choi
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sola Han
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Yongseok Mun
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Da Yun Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Jin Chang
- Department of Ophthalmology and Visual Science, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Kim
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hae Sun Suh
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation Through Science, Kyung Hee University, Seoul, Republic of Korea
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
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Dorgalaleh A, Shabannezhad A, Hassani S. COVID-19 vaccine-induced immune thrombotic thrombocytopenia: pathophysiology and diagnosis. Ann Hematol 2023:10.1007/s00277-023-05563-1. [PMID: 38030893 DOI: 10.1007/s00277-023-05563-1] [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: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Coronavirus disease-19 (COVID-19) vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but serious clinical condition with high mortality rate in apparently healthy individuals without noticeable risk factors. VITT typically arises due to the administration of vaccines that possess recombinant adenoviral vectors, including ChAdOx1 nCov-19 (AstraZeneca) and Ad26 COV2.S (Johnson & Johnson/Janssen). Thrombosis frequently occurs at atypical sites, such as the cerebral or splanchnic circulations, in this particular pathological state. Similar to heparin-induced thrombotic thrombocytopenia (HITT), it seems that the cause of VITT is the misdirection of anti-platelet factor 4 antibodies (anti-PF4 Abs), an ancient antimicrobial mechanism. Anti-PF4 Abs in patients with VITT activates the coagulation system, leading to thrombosis. This process occurs through the stimulation of platelets (Plts) and neutrophils and subsequently release of neutrophil extracellular traps (NETs). Due to the potentially fatal consequences of VITT, early diagnosis is mandatory. In addition to thrombocytopenia, thrombosis, and the presence of anti-PF4 Abs, the day of symptoms onset and the elevation of D-dimer are also required for definitive diagnosis of VITT. The absence of one or more criteria can result in the exclusion of definitive VITT and lead to the diagnosis of probable, possible, or unlikely VITT.
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Affiliation(s)
| | - Ashkan Shabannezhad
- Department of Hematology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Hassani
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Arak University of Medical Sciences, Arak, Iran.
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Bernardi FF, Mascolo A, Sarno M, Capoluongo N, Trama U, Ruggiero R, Sportiello L, Fusco GM, Bisogno M, Coscioni E, Iervolino A, Di Micco P, Capuano A, Perrella A. Thromboembolic Events after COVID-19 Vaccination: An Italian Retrospective Real-World Safety Study. Vaccines (Basel) 2023; 11:1575. [PMID: 37896978 PMCID: PMC10611339 DOI: 10.3390/vaccines11101575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Real-world safety studies can provide important evidence on the thromboembolic risk associated with COVID-19 vaccines, considering that millions of people have been already vaccinated against COVID-19. In this study, we aimed to estimate the incidence of thromboembolic events after COVID-19 vaccination and to compare the Oxford-AstraZeneca vaccine with other COVID-19 vaccines. METHODS We conducted a retrospective real-world safety study using data from two different data sources: the Italian Pharmacovigilance database (Rete Nazionale di Farmacovigilanza, RNF) and the Campania Region Health system (Sistema INFOrmativo saNità CampanIA, SINFONIA). From the start date of the COVID-19 vaccination campaign (27 December 2021) to 27 September 2022, information on COVID-19 vaccinations and thromboembolic events were extracted from the two databases. The reporting rate (RR) and its 95% confidence interval (95%CI) of thromboembolic events for 10,000 doses was calculated for each COVID-19 vaccine. Moreover, the odds of being vaccinated with the Oxford-AstraZeneca vaccine vs. the other COVID-19 vaccines in cases with thromboembolic events vs. controls without thromboembolic events were computed. RESULTS A total of 12,692,852 vaccine doses were administered in the Campania Region, of which 6,509,475 (51.28%) were in females and mostly related to the Pfizer-BioNtech vaccine (65.05%), followed by Moderna (24.31%), Oxford-AstraZeneca (9.71%), Janssen (0.91%), and Novavax (0.02%) vaccines. A total of 641 ICSRs with COVID-19 vaccines and vascular events were retrieved from the RNF for the Campania Region, of which 453 (70.67%) were in females. Most ICSRs reported the Pfizer-BioNtech vaccine (65.05%), followed by Oxford-AstraZeneca (9.71%), Moderna (24.31%), and Janssen (0.91%). A total of 2451 events were reported in the ICSRs (3.8 events for ICSRs), of which 292 were thromboembolic events. The higher RRs of thromboembolic events were found with the Oxford-AstraZeneca vaccine (RR: 4.62, 95%CI: 3.50-5.99) and Janssen vaccine (RR: 3.45, 95%CI: 0.94-8.82). Thromboembolic events were associated with a higher likelihood of exposure to the Oxford-AstraZeneca vaccine compared to Pfizer-BioNtech (OR: 6.06; 95%CI: 4.22-8.68) and Moderna vaccines (OR: 6.46; 95%CI: 4.00-10.80). CONCLUSION We observed a higher reporting of thromboembolic events with viral-vector-based vaccines (Oxford-AstraZeneca and Janssen) and an increased likelihood of being exposed to the Oxford-AstraZeneca vaccine compared to the mRNA vaccines (Pfizer-BioNtech and Moderna) among thromboembolic cases.
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Affiliation(s)
- Francesca Futura Bernardi
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Marina Sarno
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
| | - Nicolina Capoluongo
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
| | - Ugo Trama
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Giovanni Maria Fusco
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Massimo Bisogno
- Regional Special Office for Digital Transformation, Campania Region, 80100 Naples, Italy;
| | - Enrico Coscioni
- Division of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy;
| | - Anna Iervolino
- Directorate-General AORN Ospedali dei Colli, Campania Region, 80131 Naples, Italy;
| | - Pierpaolo Di Micco
- General Medicine, Santa Maria delle Grazie Hospital, ASL NA2 Nord, 80078 Pozzuoli, Italy;
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Alessandro Perrella
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
- Regional Observatory for Infectious Disease, Campania Region, 80131 Naples, Italy
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Ponnaiah M, Bhatnagar T, Abdulkader RS, Elumalai R, Surya J, Jeyashree K, Kumar MS, Govindaraju R, Thangaraj JWV, Aggarwal HK, Balan S, Baruah TD, Basu A, Bavaskar Y, Bhadoria AS, Bhalla A, Bhardwaj P, Bhat R, Chakravarty J, Chandy GM, Gupta BK, Kakkar R, Karnam AHF, Kataria S, Khambholja J, Kumar D, Kumar N, Lyngdoh M, Meena MS, Mehta K, Sheethal MP, Mukherjee S, Mundra A, Murugan A, Narayanan S, Nathan B, Ojah J, Patil P, Pawar S, Ruban ACP, Vadivelu R, Rana RK, Boopathy SN, Priya S, Sahoo SK, Shah A, Shameem M, Shanmugam K, Shivnitwar SK, Singhai A, Srivastava S, Sulgante S, Talukdar A, Verma A, Vohra R, Wani RT, Bathula B, Kumari G, Kumar DS, Narasimhan A, Krupa NC, Senguttuvan T, Surendran P, Tamilmani D, Turuk A, Kumar G, Murkherjee A, Aggarwal R, Murhekar MV. Factors associated with unexplained sudden deaths among adults aged 18-45 years in India - A multicentric matched case-control study. Indian J Med Res 2023; 158:351-362. [PMID: 37988028 DOI: 10.4103/ijmr.ijmr_2105_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND OBJECTIVES In view of anecdotal reports of sudden unexplained deaths in India's apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case-control study. METHODS This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1 st October 2021-31 st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI). RESULTS Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not. INTERPRETATION CONCLUSIONS COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death.
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Affiliation(s)
| | | | | | | | - Janani Surya
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Kathiresan Jeyashree
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Ranjithkumar Govindaraju
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Hari Krishan Aggarwal
- Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Suresh Balan
- Department of Community Medicine, Kanyakumari Government Medical College, Kanyakumari, Tamil Nadu, India
| | - Tridip Dutta Baruah
- Department of General Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ayan Basu
- Infectious Disease Department, Institute of Post-Graduate Medical Education & Research, West Bengal, India
| | - Yogita Bavaskar
- Department of Community Medicine, Government Medical College, Jalgaon, India
| | - Ajeet Singh Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Bhardwaj
- SPH and Community Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Rachana Bhat
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jaya Chakravarty
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Gina Maryann Chandy
- Department of Emergency Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Bal Kishan Gupta
- Department of Medicine, Sardar Patel Medical College, Bikaner, India
| | - Rakesh Kakkar
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Ali Hasan Faiz Karnam
- Department of Emergency and Critical Care Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sushila Kataria
- Department of Internal Medicine, Medanta, Gurugram, Haryana, India
| | - Janakkumar Khambholja
- Department of General Medicine, Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Dewesh Kumar
- Department of Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Nithin Kumar
- Department of Community Medicine, Manipal Academy of Higher Education, Manipal, India
- Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka, India
| | - Monaliza Lyngdoh
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, India
| | - M Selva Meena
- Department of Community Medicine, Government Medical College, Virudhunagar, Tamil Nadu, India
| | - Kedar Mehta
- Department of Community Medicine, GMERS Medical College, Vadodara, India
| | - M P Sheethal
- Department of Community Medicine, Adichunchanagiri Institute of Medical Sciences, Balagangadharanatha Nagara, Mandya, India
| | - Subhasis Mukherjee
- Department of Respiratory Medicine, College of Medicine & Sagore Dutta Hospital, West Bengal, India
| | - Anuj Mundra
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
| | - Arun Murugan
- Department of Community Medicine, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu, India
| | - Seetharaman Narayanan
- Department of Community Medicine, KMCH Institute of Health Sciences & Research, Coimbatore, Tamil Nadu, India
| | - Balamurugan Nathan
- Department of Emergency Medicine & Trauma, Jawaharlal Institute of Post Graduate Medical Education & Research, Puducherry, India
| | - Jutika Ojah
- Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India
| | - Pushpa Patil
- Department of Community Medicine, SDM College of Medical Science & Hospital, Dharwad, India
| | - Sunita Pawar
- Department of Community Medicine, Dr. Vasantrao Pawar Medical College, Hospital & Research Center, Nashik, India
| | - A Charles Pon Ruban
- Department of Community Medicine, Tirunelveli Medical College & Hospital, Tirunelveli, Tamil Nadu, India
| | - R Vadivelu
- Department of Cardiology, Velammal Medical College Hospital & Research Institute, Madurai, Tamil Nadu, India
| | - Rishabh Kumar Rana
- Department of PSM/Community Medicine, Shaheed Nirmal Mahato Medical College, Dhanbad, Jharkhand, India
| | - S Nagendra Boopathy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - S Priya
- Institute of Community Medicine, Madurai Medical College, Madurai, Tamil Nadu, India
| | - Saroj Kumar Sahoo
- Department of Trauma & Emergency (Division of Cardiology), All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arti Shah
- Department of Respiratory Medicine, SBKS MI&RC, Sumandeep Vidyapeeth, Pipariya, Vadodara, India
| | - Mohammad Shameem
- Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Karthikeyan Shanmugam
- Department of Community Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu, India
| | - Sachin K Shivnitwar
- Department of Medicine, Dnyandeo Yashwantrao Patil Medical College, Pune, Maharashtra, India
| | - Abhishek Singhai
- Department of Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Saurabh Srivastava
- Department of Medicine, Government Institute of Medical Sciences, Noida, India
| | - Sudheera Sulgante
- Department of Community Medicine, Bidar Institute of Medical Sciences, Bidar, India
| | - Arunansu Talukdar
- Department of Geriatric Medicine, Medical College Kolkata, West Bengal, India
| | - Alka Verma
- Department of Emergency, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajaat Vohra
- Department of Community Medicine, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India
| | - Rabbanie Tariq Wani
- Department of Community Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir
| | | | - Gayathri Kumari
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Divya Saravana Kumar
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Aishwariya Narasimhan
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - N C Krupa
- Division of Online Courses, Chennai, Tamil Nadu, India
| | | | - Parvathi Surendran
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Alka Turuk
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Gunjan Kumar
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Aparna Murkherjee
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Rakesh Aggarwal
- Department of Medical Gastroenterology, Jawaharlal Institute of Post Graduate Medical Education & Research, Puducherry, India
| | - Manoj Vasant Murhekar
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Rachman MJ, Kalanjati VP, Rimbun R, Khadijah F. Retinal Vein Occlusion Amongst People Vaccinated by mRNA- and Viral Vector- COVID-19 Vaccines: A Systematic Review. Clin Ophthalmol 2023; 17:2825-2842. [PMID: 37794952 PMCID: PMC10545804 DOI: 10.2147/opth.s426428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
Vaccines are highly effective in lowering the mortality due to COVID-19. Although several suspected adverse events or side effects after vaccination including retinal vein occlusion (RVO) have been reported. We conducted a systematic review using PRISMA methods to analyze the occurrence of RVO among people vaccinated by COVID-19 mRNA- vs viral vector- vaccines on 4 databases from 1-1-2021 to 31-12-2022 using specified MeSH terms. All included studies were assessed using JBI critical appraisal tools for eligibility. The final included studies are 31 studies (n=78 cases from 75 patients; 3 of these patients suffered twice). The median age of the patients was 61 years (28 to 96 years old) and most of them were female (52.00%). Thirty-nine patients received the mRNA vaccine (52.00%), while 36 patients received the viral vector vaccine (48.00%) before the event. The RVO diagnoses are based on physical examination confirmed by Fluorescein Angiography (FA), and/or Optical Coherence Tomography (OCT). The median time interval between vaccination and RVO was 6 days in the mRNA vaccine group and 4 days in the viral vector vaccine group. Central retinal vein occlusion (CRVO) and Branch Retinal Vein Occlusion (BRVO) were tied as the most common diagnosis in the mRNA vaccine group (20.51% and 20.51%), whilst in the viral vector vaccine group CRVO was the most common diagnosis (17.94%). Most of these cases had good outcomes with improved visual impairment in one or both eyes. From this review, we could not ascertain that the RVO occurs due to the type of COVID-19 vaccines because of the detailed data on the dosage and the history of illness of each patient. However, the awareness that the RVO could develop after COVID-19 vaccination must be taken into consideration, even though it is rare.
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Affiliation(s)
- Maria Jessica Rachman
- Master Program of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Faculty of Medicine, Universitas Ciputra, Surabaya, East Java, Indonesia
| | - Viskasari P Kalanjati
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Rimbun Rimbun
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Fira Khadijah
- Master Program of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
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11
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Raventós B, Fernández-Bertolín S, Aragón M, Voss EA, Blacketer C, Méndez-Boo L, Recalde M, Roel E, Pistillo A, Reyes C, van Sandijk S, Halvorsen L, Rijnbeek PR, Burn E, Duarte-Salles T. Transforming the Information System for Research in Primary Care (SIDIAP) in Catalonia to the OMOP Common Data Model and Its Use for COVID-19 Research. Clin Epidemiol 2023; 15:969-986. [PMID: 37724311 PMCID: PMC10505380 DOI: 10.2147/clep.s419481] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/03/2023] [Indexed: 09/20/2023] Open
Abstract
Purpose The primary aim of this work was to convert the Information System for Research in Primary Care (SIDIAP) from Catalonia, Spain, to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). Our second aim was to provide a descriptive analysis of COVID-19-related outcomes among the general population. Patients and Methods We mapped patient-level data from SIDIAP to the OMOP CDM and we performed more than 3,400 data quality checks to assess its readiness for research. We established a general population cohort as of the 1st March 2020 and identified outpatient COVID-19 diagnoses or tested positive for, hospitalised with, admitted to intensive care units (ICU) with, died with, or vaccinated against COVID-19 up to 30th June 2022. Results After verifying the high quality of the transformed dataset, we included 5,870,274 individuals in the general population cohort. Of those, 604,472 had either an outpatient COVID-19 diagnosis or positive test result, 58,991 had a hospitalisation, 5,642 had an ICU admission, and 11,233 died with COVID-19. A total of 4,584,515 received a COVID-19 vaccine. People who were hospitalised or died were more commonly older, male, and with more comorbidities. Those admitted to ICU with COVID-19 were generally younger and more often male than those hospitalised and those who died. Conclusion We successfully transformed SIDIAP to the OMOP CDM. From this dataset, a general population cohort of 5.9 million individuals was identified and their COVID-19-related outcomes over time were described. The transformed SIDIAP database is a valuable resource that can enable distributed network research in COVID-19 and beyond.
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Affiliation(s)
- Berta Raventós
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Sergio Fernández-Bertolín
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - María Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Erica A Voss
- Janssen Pharmaceutical Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Clair Blacketer
- Janssen Pharmaceutical Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Leonardo Méndez-Boo
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain
| | - Martina Recalde
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Elena Roel
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | | | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA
| | - Edward Burn
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
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Satapathy BS, Pattnaik G, Sahoo RN, Pattanaik S, Sarangi AK, Kandi V, Mishra S, Rabaan AA, Mohanty A, Sah R, Mohapatra RK. COVID-19 vaccines and their underbelly: Are we going the right way? Health Sci Rep 2023; 6:e1540. [PMID: 37670844 PMCID: PMC10475498 DOI: 10.1002/hsr2.1540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Background Historically, a critical aetiological agent of health concern stays till eternity after its discovery, so shall it be with the COVID-19 outbreak. It has transformed human life to a 'new normal' with huge tolls on the social, psychological, intellectual and financial spheres. Aim This perspective aimed to collate numerous reported COVID-19 vaccine-associated adverse events and the predisposing factors. It focussed on the efficacy of mix-n-match (cocktail) vaccines to effectively counter COVID-19 infection to facilitate future research and possible interventions. Material and Methods Databases like Scopus, Pubmed and the Web-of-science were searched for published literature on 'adverse events associated with COVID-19 vaccine'. The reports and updates from health agencies like the WHO and CDC were also considered for the purpose. The details with respect to the adverse events associated with COVID-19 vaccination and the predisposing factors were compiled to obtain insights and suggest possible future directions in vaccine research. Results India stood strong to manage its health resources in time and turned into a dominant global vaccine supplier at a time when healthcare infrastructure of many countries was still significantly challenged. Developing indigenous vaccines and the vaccination drive in India were its major achievements during the second and the subsequent COVID-19 waves. The fully indigenous Covaxin vaccine, primarily as an emergency intervention, was successfully rapidly launched. Similar such vaccines for emergency use were developed elsewhere as well. However, all of these reached the marketplace with a 'emergency use only' tag, without formal clinical trials and other associated formalities to validate and verify them as these would require much longer incubation time before they are available for human use. Discussion Many adverse events associated with either the first or the second/booster vaccination doses were reported. Evidently, these associated adverse events were considered as 'usually rare' or were often underreported. Without the additional financial or ethical burden on the vaccine companies, fortunately, the Phase IV (human) clinical trials of their manufactured vaccines are occurring by default as the human population receives these under the tag 'emergency use'. Thus, focused and collaborative strategies to unveil the molecular mechanisms in vaccine-related adverse events in a time-bound manner are suggested. Conclusion Reliable data particularly on the safety of children is lacking as majority of the current over-the-counter COVID-19 vaccines were for emergency use. Many of these were still in their Phase III and Phase IV trials. The need for a mutant-proof, next-gen COVID-19 vaccine in the face of vaccine-associated adverse events is opined.
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Affiliation(s)
- Bhabani Sankar Satapathy
- School of Pharmaceutical SciencesSiksha O Anusandhan Deemed to be UniversityBhubaneswarOdishaIndia
| | - Gurudutta Pattnaik
- School of Pharmaceutical SciencesCenturion University of Technology and ManagementAlluri NagarOdishaIndia
| | - Rudra Narayan Sahoo
- School of Pharmaceutical SciencesSiksha O Anusandhan Deemed to be UniversityBhubaneswarOdishaIndia
| | - Sovan Pattanaik
- School of Pharmaceutical SciencesSiksha O Anusandhan Deemed to be UniversityBhubaneswarOdishaIndia
| | - Ashish K. Sarangi
- Department of ChemistryCenturion University of Technology and ManagementAlluri NagarOdishaIndia
| | - Venkataramana Kandi
- Department of MicrobiologyPrathima Institute of Medical SciencesKarimnagarTelanganaIndia
| | - Snehasish Mishra
- School of BiotechnologyCampus‐11, KIIT Deemed‐to‐be‐UniversityBhubaneswarOdishaIndia
| | - Ali A. Rabaan
- Molecular Diagnostic LaboratoryJohns Hopkins Aramco HealthcareDhahranSaudi Arabia
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
- Department of Public Health and NutritionThe University of HaripurHaripurPakistan
| | - Aroop Mohanty
- Department of Clinical MicrobiologyAll India Institute of Medical SciencesGorakhpurUttar PradeshIndia
| | - Ranjit Sah
- Department of MicrobiologyTribhuvan University Teaching HospitalKathmanduNepal
- Department of MicrobiologyDr. D.Y Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil VidyapeethPuneIndia
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Joy M, Agrawal U, Fan X, Robertson C, Anand SN, Ordonez-Mena J, Byford R, Goudie R, Jamie G, Kar D, Williams J, Marsden GL, Tzortziou-Brown V, Sheikh SA, Hobbs FR, de Lusignan S. Thrombocytopenic, thromboembolic and haemorrhagic events following second dose with BNT162b2 and ChAdOx1: self-controlled case series analysis of the English national sentinel cohort. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100681. [PMID: 37671127 PMCID: PMC10477035 DOI: 10.1016/j.lanepe.2023.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/07/2023]
Abstract
Background Thrombosis associated with thrombocytopenia was a matter of concern post first and second doses of BNT162b2 and ChAdOx1 COVID-19 vaccines. Therefore, it is important to investigate the risk of thrombocytopenic, thromboembolic and haemorrhagic events following a second dose of BNT162b2 and ChAdOx1 COVID-19 vaccines. Methods We conducted a large-scale self-controlled case series analysis, using routine primary care data linked to hospital data, among 12.3 million individuals (16 years old and above) in England. We used the nationally representative Oxford-Royal College of General Practitioners (RCGP) sentinel network database with baseline and risk periods between 8th December 2020 and 11th June 2022. We included individuals who received two vaccine (primary) doses of the BNT162b2 mRNA (Pfizer-BioNTech) and two vaccine doses of ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines in our analyses. We carried out a self-controlled case series (SCCS) analysis for each outcome using a conditional Poisson regression model with an offset for the length of risk period. We reported the incidence rate ratios (IRRs) and 95% confidence intervals (CI) of thrombocytopenic, thromboembolic (including arterial and venous events) and haemorrhagic events, in the period of 0-27 days after receiving a second dose of BNT162b2 or ChAdOx1 vaccines compared to the baseline period (14 or more days prior to first dose, 28 or more days after the second dose and the time between 28 or more days after the first and 14 or more days prior to the second dose). We adjusted for a range of potential confounders, including age, sex, comorbidities and deprivation. Findings Between December 8, 2020 and February 11, 2022, 6,306,306 individuals were vaccinated with two doses of BNT162b2 and 6,046,785 individuals were vaccinated with two doses of ChAdOx1. Compared to the baseline, our analysis show no increased risk of venous thromboembolic events (VTE) for both BNT162b2 (IRR 0.71, 95% CI: 0.65-0.770) and ChAdOx1 (IRR 0.91, 95% CI: 0.84-0.98); and similarly there was no increased risk for cerebral venous sinus thrombosis (CVST) for both BNT162b2 (IRR 0.87, 95% CI: 0.41-1.85) and ChAdOx1 (IRR 1.73, 95% CI: 0.82-3.68). We additionally report no difference in IRR for pulmonary embolus, and deep vein thrombosis, thrombocytopenia, including idiopathic thrombocytopenic purpura (ITP), and haemorrhagic events post second dose for both BNT162b2. Interpretation Reassuringly, we found no associations between increased risk of thrombocytopenic, thromboembolic and haemorrhagic events post vaccination with second dose for either of these vaccines. Funding Data and Connectivity: COVID-19 Vaccines Pharmacovigilance study.
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Affiliation(s)
- Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Sneha N. Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Jose Ordonez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Rosalind Goudie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Gavin Jamie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | | | | | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Li JX, Wang YH, Bair H, Hsu SB, Chen C, Wei JCC, Lin CJ. Risk assessment of retinal vascular occlusion after COVID-19 vaccination. NPJ Vaccines 2023; 8:64. [PMID: 37130882 PMCID: PMC10153772 DOI: 10.1038/s41541-023-00661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/11/2023] [Indexed: 05/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccines are associated with several ocular manifestations. Emerging evidence has been reported; however, the causality between the two is debatable. We aimed to investigate the risk of retinal vascular occlusion after COVID-19 vaccination. This retrospective cohort study used the TriNetX global network and included individuals vaccinated with COVID-19 vaccines between January 2020 and December 2022. We excluded individuals with a history of retinal vascular occlusion or those who used any systemic medication that could potentially affect blood coagulation prior to vaccination. To compare the risk of retinal vascular occlusion, we employed multivariable-adjusted Cox proportional hazards models after performing a 1:1 propensity score matching between the vaccinated and unvaccinated cohorts. Individuals with COVID-19 vaccination had a higher risk of all forms of retinal vascular occlusion in 2 years after vaccination, with an overall hazard ratio of 2.19 (95% confidence interval 2.00-2.39). The cumulative incidence of retinal vascular occlusion was significantly higher in the vaccinated cohort compared to the unvaccinated cohort, 2 years and 12 weeks after vaccination. The risk of retinal vascular occlusion significantly increased during the first 2 weeks after vaccination and persisted for 12 weeks. Additionally, individuals with first and second dose of BNT162b2 and mRNA-1273 had significantly increased risk of retinal vascular occlusion 2 years following vaccination, while no disparity was detected between brand and dose of vaccines. This large multicenter study strengthens the findings of previous cases. Retinal vascular occlusion may not be a coincidental finding after COVID-19 vaccination.
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Affiliation(s)
- Jing-Xing Li
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Shu-Bai Hsu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung, Taiwan
- Institute of Optometry, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
| | - Chun-Ju Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.
- Department of Optometry, Asia University, Taichung, Taiwan.
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15
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Rzymski P. Guillain-Barré syndrome and COVID-19 vaccines: focus on adenoviral vectors. Front Immunol 2023; 14:1183258. [PMID: 37180147 PMCID: PMC10169623 DOI: 10.3389/fimmu.2023.1183258] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
COVID-19 vaccination is a life-saving intervention. However, it does not come up without a risk of rare adverse events, which frequency varies between vaccines developed using different technological platforms. The increased risk of Guillain-Barré syndrome (GBS) has been reported for selected adenoviral vector vaccines but not for other vaccine types, including more widely used mRNA preparations. Therefore, it is unlikely that GBS results from the cross-reactivity of antibodies against the SARS-CoV-2 spike protein generated after the COVID-19 vaccination. This paper outlines two hypotheses according to which increased risk of GBS following adenoviral vaccination is due to (1) generation of anti-vector antibodies that may cross-react with proteins involved in biological processes related to myelin and axons, or (2) neuroinvasion of selected adenovirus vectors to the peripheral nervous system, infection of neurons and subsequent inflammation and neuropathies. The rationale behind these hypotheses is outlined, advocating further epidemiological and experimental research to verify them. This is particularly important given the ongoing interest in using adenoviruses in developing vaccines against various infectious diseases and cancer immunotherapeutics.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznan, Poland
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16
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Hematological Questions in Personalized Management of COVID-19 Vaccination. J Pers Med 2023; 13:jpm13020259. [PMID: 36836493 PMCID: PMC9965747 DOI: 10.3390/jpm13020259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been causing a worldwide pandemic since 2019. Many vaccines have been manufactured and have shown promising results in reducing disease morbidity and mortality. However, a variety of vaccine-related adverse effects, including hematological events, have been reported, such as thromboembolic events, thrombocytopenia, and bleeding. Moreover, a new syndrome, vaccine-induced immune thrombotic thrombocytopenia, following vaccination against COVID-19 has been recognized. These hematologic side effects have also raised concerns about SARS-CoV-2 vaccination in patients with preexisting hematologic conditions. Patients with hematological tumors are at a higher risk of severe SARS-CoV-2 infection, and the efficacy and safety of vaccination in this group remain uncertain and have raised attention. In this review, we discuss the hematological events following COVID-19 vaccination and vaccination in patients with hematological disorders.
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17
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Lassanova M, Lassan S, Liskova S, Tesar T, Cicova M. Analysis of spontaneous reports of suspected adverse reactions after vaccination against COVID-19 in Slovakia. Front Pharmacol 2023; 14:1097890. [PMID: 36726587 PMCID: PMC9886282 DOI: 10.3389/fphar.2023.1097890] [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: 11/14/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Introduction: The COVID-19 pandemic has resulted in more than 6.5 million deaths worldwide yet. Vaccination against the SARS-CoV-2 virus is a reliable way out of the pandemic, however, vaccination rate reaches only 58% in the Slovak Republic. Concerns about the adverse reactions of vaccines are one of the reasons for the low vaccination rate. Objective: The aim of our analysis was to review reported suspicions of adverse reactions (ARs) of registered COVID-19 vaccines (Comirnaty, Vaxzevria, Spikevax), which State Institute for Drug Control received from healthcare professionals and patients in the period from 1 January 2021 to 31 May 2021. Methods: Data were collected from the State Institute for Drug Control database, a retrospective analysis was carried out focusing on trends in the number of all reports of suspicions of adverse reactions sent to the State Institute for Drug Control during the previously mentioned period. We analysed the Retrieved data were analysed with the usage of descriptive statistics and comparison to historical data on drug adverse reactions in Slovakia was performed. Results: During the evaluation period, 5,763 reported suspicions of adverse reactions were analysed, overall, there was a significant (p < 0.0001) increase in the number of reported adverse reactions fivefold. 93% of ARs (n = 5,346) were reported for COVID-19 vaccines. In comparison of the extentof all adverse reactions, there is clearly a statistically significant difference between all types of vaccines administered at that time (p ≤ 0.0001). No statistically significant difference (p ≤ 0.238) was identified between Spikevax and Comirnaty in the proportion of serious adverse reactions. However, a significantly higher (p ≤ 0.00001) proportion of reported suspicions of serious adverse reactions was observed after the administration of Vaxzevria. Conclusion: This is the first analysis conducted in Slovakia aimed to reported adverse reactions in relation to the administration of COVID-19 vaccines. The rate of spontaneously reported suspected adverse reactions has been insufficient in the past for a long time; during the period from January to May 2021 the reporting rate increased due active calls for adverse reactions reporting. In concordance with European data, Vaxzevria had a significantly higher ratio of reported suspicions of serious adverse reactions.
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Affiliation(s)
- Monika Lassanova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Stefan Lassan
- Department of Pneumology, Phthisiology and Functional Diagnostics, Slovak Medical University and Bratislava University Hospital, Bratislava, Slovakia,*Correspondence: Stefan Lassan, ; Tomas Tesar,
| | - Silvia Liskova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia,*Correspondence: Stefan Lassan, ; Tomas Tesar,
| | - Monika Cicova
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia,State Institute for Drug Control, Pharmacovigilance and Clinical Trial Section, Bratislava, Slovakia
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18
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Drapkina OM, Berns SA, Gorshkov AY, Ryzhakova LN, Zhdanova OV, Chaschin MG, Litinskaya OA. Reactogenicity of various COVID-19 vaccination regimens. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2022-3476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
During the spread of an increasing number of new variants of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2), it is extremely important not only to assess the immunogenicity and efficacy, butalso the safety of various combinations of vaccines. Excessive immune response and associated signs and symptoms may occur with varying frequency as expected from the use of vaccines.Aim. To compare the reactogenicity of various (heterologous and homologous) vaccination regimens in a prospective observational study.Material and methods. In individuals aged ≥18 years, in the absence of contraindications to vaccination, two types of vaccines were used at primary vaccination and revaccination: Gam-COVID-Vac and CoviVac: group I (n=97) — Gam-COVID-Vac at each stage of primary and booster vaccination ; group II (n=7) — Gam-COVID-Vck at each stage of primary vaccination, CoviVac at each stage of revaccination; group III (n=42) — CoviVac at each stage of primary vaccination, Gam-COVID-Vac at each stage of revaccination; group IV (n=38) — CoviVac at each stage of primary and secondary vaccination. In all participants, the dynamics of IgG to SARS-CoV-2 spike glycoprotein receptor-binding domain and T-cell immunity to SARS-CoV-2 were determined over time. To control the plasma hemostasis, the method of dynamic thrombophotometry was used. Local and systemic adverse events were assessed.Results. The number of vaccinated individuals with a rise in body temperature above 370 C after the 1st stage of revaccination was significantly (p<0,05) more in group I (37,5%) and group II (57,1%) compared with vaccinated persons of IV group. At the same time, after the 2nd stage of revaccination, in general, a smaller percentage of vaccinated persons with hyperthermia was noted. In group I, a higher percentage of persons (22,9%) complaining of the appearance of weakness after stage I of revaccination was noted compared to vaccinated persons of group IV — 5,2%. An increase in the fibrin clot growth rate was noted in group III at the stage of revaccination.Conclusion. The use of various revaccination schemes (homologous and heterologous) was not associated with the development of serious adverse events. The resulting local and systemic reactions were shortlived and did not require hospitalization. More pronounced systemic reactions were noted in the form of a short-term fever and weakness when using the Gam-COVID-Vac. No cases of arterial or venous thrombosis were registered during the follow-up period.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. A. Berns
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. Yu. Gorshkov
- National Medical Research Center for Therapy and Preventive Medicine
| | - L. N. Ryzhakova
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. V. Zhdanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. G. Chaschin
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. A. Litinskaya
- National Medical Research Center for Therapy and Preventive Medicine
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19
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St Clair LA, Chaulagain S, Klein SL, Benn CS, Flanagan KL. Sex-Differential and Non-specific Effects of Vaccines Over the Life Course. Curr Top Microbiol Immunol 2023; 441:225-251. [PMID: 37695431 PMCID: PMC10917449 DOI: 10.1007/978-3-031-35139-6_9] [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] [Indexed: 09/12/2023]
Abstract
Biological sex and age have profound effects on immune responses throughout the lifespan and impact vaccine acceptance, responses, and outcomes. Mounting evidence from epidemiological, clinical, and animal model studies show that males and females respond differentially to vaccination throughout the lifespan. Within age groups, females tend to produce greater vaccine-induced immune responses than males, with sex differences apparent across all age groups, but are most pronounced among reproductive aged individuals. Females report more adverse effects following vaccination than males. Females, especially among children under 5 years of age, also experience more non-specific effects of vaccination. Despite these known sex- and age-specific differences in vaccine-induced immune responses and outcomes, sex and age are often ignored in vaccine research. Herein, we review the known sex differences in the immunogenicity, effectiveness, reactogenicity, and non-specific effects of vaccination over the lifespan. Ways in which these data can be leveraged to improve vaccine research are described.
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Affiliation(s)
- Laura A St Clair
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabal Chaulagain
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Stabell Benn
- Institute of Clinical Research and Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Katie L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia.
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20
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Abbasi K. Health and climate crises will shape Sunak’s legacy. BMJ : BRITISH MEDICAL JOURNAL 2022. [DOI: 10.1136/bmj.o2565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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