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Pasi R, Babu TA, Kallidoss VK. Efficacy of oral mefenamic acid versus paracetamol as a prophylactic analgesic for needle pain in children receiving vaccination: a three-arm, parallel, triple-blind, placebo-controlled MAP VaC randomized controlled trial. Ther Adv Vaccines Immunother 2023; 11:25151355231216122. [PMID: 38077267 PMCID: PMC10702398 DOI: 10.1177/25151355231216122] [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: 05/26/2023] [Accepted: 10/11/2023] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Needle pain due to routine vaccination is an important factor contributing to low vaccine adherence and immunization coverage. Prophylactic oral analgesics can address this important issue of needle pain related to vaccination. Paracetamol and mefenamic acid are commonly used nonsteroidal anti-inflammatory drugs for pain relief, but there is little published literature on whether the same can be used for needle pain related to vaccination. OBJECTIVES This study was planned to compare the efficacy of oral mefenamic acid and paracetamol over placebo as a prophylactic analgesic during vaccination and prophylactic antipyretic during the post-vaccination period. DESIGNS Three-arm, triple-blind, randomized controlled trial. METHODS This study was conducted at the outpatient department of a tertiary-level medical college in South India from January 2021 to June 2022. In this three-arm interventional trial, each arm had either a single dose of placebo or mefenamic acid (4 mg/kg/dose) or paracetamol (10 mg/kg/dose). These medicines were administered orally 30 min before vaccination to reduce needle pain. MAIN OUTCOME AND MEASURES Outcome was measured with the change of FLACC (Face, Leg, Activity, Cry, Consolability) scoring at the time of vaccination, subsequently at 15 and 30 min of vaccination in all three groups. Appearance of fever, grade of fever, and need for antipyretics 24 h after vaccination were also noted. RESULTS There was a significant difference in FLACC scores at the time of administration (p = 0.010) and at 15 min (p = 0.014) with mefenamic acid compared to placebo. Although the paracetamol group showed a difference when compared to the placebo, it was not significant at the time of administration (p = 0.401), at 15 min (p = 0.451), or 30 min (p = 0.892) post-vaccination. The appearance of fever, grade of fever, and use of antipyretic up to 24 h post-vaccination had no significant difference among any of the three groups. CONCLUSION Mefenamic acid was more potent than placebo for pre-vaccination pain prophylaxis in children. There was no difference in the appearance of fever and its grade among the three groups. The promising results from this trial warrant further large-scale studies to recommend a single oral dose of mefenamic acid to tackle needle pain related to vaccination in children to improve vaccine adherence and coverage. TRIAL REGISTRATION CTRI (Clinical trials registry-India) (CTRI/2021/01/030239). [Date of Commencement: 13 Jan 2021, Date of last recruitment: 30 June 2022 (now closed for new participants)].
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Affiliation(s)
- Rachna Pasi
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Thirunavukkarasu Arun Babu
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
| | - Vinoth Kumar Kallidoss
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
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2
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Ricci E, Glavasc A, Morandini B, Grassi MC, La Torre G. The Effectiveness of Paracetamol to Reduce the Post-Vaccination SARS-CoV-2 Adverse Effects in an Italian Vaccination Center. Vaccines (Basel) 2023; 11:1493. [PMID: 37766169 PMCID: PMC10534772 DOI: 10.3390/vaccines11091493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The arrival of specific vaccines was crucial for the eradication of COVID-19. Despite the security of the vaccination, the administration of COVID-19 mRNA vaccines often causes systemic side effects for a short time after the injection, such as headache, fatigue, fever, muscle pain and nausea. These side effects can limit the adherence to COVID-19 vaccines administration, especially in healthcare workers. This study aims to analyze the impact of the prophylactic use of paracetamol to reduce the post-vaccination Comirnaty/Pfizer adverse effects. The study took place at the San Giovanni Battista Hospital in Rome and included all hospital employees who received two doses of Pfizer-BioNTech. The vaccination health personnel recommended the preventive intake of 1 g of paracetamol before the inoculation of the vaccine and then every 6 h in the first 24 h. Information was collected through forms and subsequent telephone recall. A total of 403 volunteers were involved in the study, with 391 of them receiving two doses and twelve individuals only one dose of the vaccine. The main results demonstrated that the prophylactic therapy influenced the lower onset of asthenia in the first and second doses. However, there were no significant differences between the two groups in terms of fever, headache and localized pain. Paracetamol had a good impact on the side effect of COVID-19 vaccination, reducing asthenia in both doses and mitigating the total of symptoms during the second vaccination.
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Affiliation(s)
- Eleonora Ricci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Anamaria Glavasc
- San Giovanni Battista Hospital, 00148 Roma, Italy; (A.G.); (B.M.)
| | | | - Maria Caterina Grassi
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, 00185 Rome, Italy;
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
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3
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Abitbol V, Sohn WY, Horn M, Safadi MAP. Safety and immunogenicity of co-administered meningococcal serogroup B (4CMenB) vaccine: A literature review. Hum Vaccin Immunother 2023; 19:2245705. [PMID: 37642229 PMCID: PMC10467517 DOI: 10.1080/21645515.2023.2245705] [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: 05/05/2023] [Revised: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
The four-component meningococcal serogroup B vaccine (4CMenB) is indicated for the prevention of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup B. Co-administering 4CMenB with other vaccines may improve vaccine uptake provided that the safety and immunogenicity of either are not affected. Published literature on the immunogenicity and reactogenicity of 4CMenB co-administered with other routine childhood and adulthood vaccines was reviewed. From 282 publications identified, data were collated from 10 clinical studies, 3 real-world studies, and 3 reviews. The evidence showed that 4CMenB co-administration is not associated with significant safety concerns or clinically relevant immunological interferences. The increased reactogenicity (e.g., fever) associated with 4CMenB co-administration can be adequately managed with prophylactic paracetamol in children. Thus, 4CMenB co-administration has the potential to maximize vaccine coverage and improve protection against IMD globally.
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Affiliation(s)
| | | | | | - Marco Aurelio P. Safadi
- Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
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4
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Zempsky W, Bell J, Mossali VM, Kachroo P, Siddiqui K. Common Selfcare Indications of Pain Medications in Children. Paediatr Drugs 2023; 25:321-341. [PMID: 36928608 PMCID: PMC10019440 DOI: 10.1007/s40272-023-00562-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
Pain has a multifaceted impact on individuals worldwide, affecting their physical functioning, emotional well-being, and quality of life. Children (age < 18 years) have a high prevalence of conditions associated with pain, such as toothache, headache, earache, sore throat, and respiratory tract infections, many of which may be accompanied by fever. Globally, the pharmacologic treatment of pain in pediatric patients is limited largely to nonopioid analgesics, and dosing must account for differences in age, weight, metabolism, and risk of adverse effects. This narrative review summarizes the findings of a literature search on the pediatric indications, dosing approaches, dosing guidelines, and pharmacokinetics of paracetamol and ibuprofen, which are common pain medications available globally for self-care use in children. The review also discusses the risks and benefits associated with these agents. The current roles of paracetamol and ibuprofen in the symptomatic management of coronavirus disease 2019 (COVID-19) infection and in the management of post-COVID-19 immunization symptoms in children are also discussed. Therefore, while a very large amount of data over several decades is available for paracetamol and ibuprofen, an urgent need exists for well-designed studies of these medications for the management of pain and fever in pediatric patients with COVID-19 to ensure optimal relief with minimal toxicity.
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Affiliation(s)
- William Zempsky
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, 06106, USA. .,University of Connecticut School of Medicine, Farmington, CT, USA.
| | - John Bell
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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5
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CALABRÒ GIOVANNAELISA, VITALE FRANCESCO, RIZZO CATERINA, PUGLIESE ANDREA, BOCCALINI SARA, BECHINI ANGELA, PANATTO DONATELLA, AMICIZIA DANIELA, DOMNICH ALEXANDER, AMODIO EMANUELE, COSTANTINO CLAUDIO, DI PIETRO MARIALUISA, SALVATI CRISTINA, D’AMBROSIO FLORIANA, ORSINI FRANCESCA, MAIDA ADA, DOMINICI ANNA, CLEMENTE DANIA, CECCI MARINA, PELLACCHIA ANDREA, DI SERAFINO FRANCESCA, BAKKER KEVIN, MALIK TUFAILMOHAMMAD, SHAROMI OLUWASEUN, BELLUZZO MIRIAM, LEONFORTE FRANCESCO, ZAGRA LUIGI, LA GATTA EMANUELE, PETRELLA LUIGI, BONANNI PAOLO, DE WAURE CHIARA. [The new 15-valent pneumococcal conjugate vaccine for the prevention of S. pneumoniae infections in pediatric age: a Health Technology Assessment]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E1-E160. [PMID: 37655211 PMCID: PMC10468156 DOI: 10.15167/2421-4248/jpmh2023.64.1s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
- VIHTALI (Value In Health Technology and Academy for Leadership & Innovation), Spin-off dell’Università Cattolica del Sacro Cuore, Roma, Italia
| | - FRANCESCO VITALE
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - CATERINA RIZZO
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italia
| | - ANDREA PUGLIESE
- Dipartimento di Matematica, Università di Trento, Trento, Italia
| | - SARA BOCCALINI
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - ANGELA BECHINI
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - DONATELLA PANATTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
- Centro Interuniversitario di Ricerca sull’Influenza e le altre Infezioni Trasmissibili (CIRI-IT), Genova, Italia
| | - DANIELA AMICIZIA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
- Centro Interuniversitario di Ricerca sull’Influenza e le altre Infezioni Trasmissibili (CIRI-IT), Genova, Italia
| | | | - EMANUELE AMODIO
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - CLAUDIO COSTANTINO
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - MARIA LUISA DI PIETRO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - CRISTINA SALVATI
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - FLORIANA D’AMBROSIO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - FRANCESCA ORSINI
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Roma, Italia
| | - ADA MAIDA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - ANNA DOMINICI
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
| | - DANIA CLEMENTE
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
| | - MARINA CECCI
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
| | - ANDREA PELLACCHIA
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
| | - FRANCESCA DI SERAFINO
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italia
| | - KEVIN BAKKER
- Health Economic and Decision Sciences (HEDS), Biostatistics & Research Decision Sciences (BARDS), Merck Research Laboratories, West Point, Pennsylvania
| | - TUFAIL MOHAMMAD MALIK
- Health Economic and Decision Sciences (HEDS), Biostatistics & Research Decision Sciences (BARDS), Merck Research Laboratories, West Point, Pennsylvania
| | - OLUWASEUN SHAROMI
- Health Economic and Decision Sciences (HEDS), Biostatistics & Research Decision Sciences (BARDS), Merck Research Laboratories, West Point, Pennsylvania
| | - MIRIAM BELLUZZO
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - FRANCESCO LEONFORTE
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - LUIGI ZAGRA
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - EMANUELE LA GATTA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - LUIGI PETRELLA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - CHIARA DE WAURE
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
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6
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Bessede A, Marabelle A, Guégan JP, Danlos FX, Cousin S, Peyraud F, Chaput N, Spalato M, Roubaud G, Cabart M, Khettab M, Chaibi A, Rey C, Nafia I, Mahon FX, Soria JC, Italiano A. Impact of acetaminophen on the efficacy of immunotherapy in cancer patients. Ann Oncol 2022; 33:909-915. [PMID: 35654248 DOI: 10.1016/j.annonc.2022.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acetaminophen (APAP) use has been associated with blunted vaccine immune responses. This study aimed to assess APAP impact on immunotherapy efficacy in patients with cancer. PATIENTS AND METHODS Exposure to APAP was assessed by plasma analysis and was correlated with clinical outcome in three independent cohorts of patients with advanced cancer who were treated with immune checkpoint blockers (ICB). APAP immunomodulatory effects were evaluated on a pre-clinical tumor model and on human peripheral blood mononuclear cells (PBMCs) from healthy donors. RESULTS Detectable plasma APAP levels at treatment onset was associated with a significantly worse clinical outcome in ICB-treated cancer patients, independently of other prognostic factors. APAP significantly reduced ICB efficacy in the pre-clinical MC38 model, as well as the production of PD1 blockade-related interferon-γ secretion by human PBMCs. Moreover, reduction of ICB efficacy in vivo was associated with significantly increased tumor infiltration by regulatory T cells (Tregs). Administration of APAP over 24 h induced a significant expansion of peripheral Tregs in healthy individuals. In addition, interleukin-10, a crucial mediator of Treg-induced immune suppression, was significantly upregulated upon treatment with ICB in cancer patients taking APAP. CONCLUSION This study provides strong pre-clinical and clinical evidence of the role of APAP as a potential suppressor of antitumor immunity. Hence, APAP should be used with caution in patients treated with ICB.
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Affiliation(s)
- A Bessede
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - A Marabelle
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - J P Guégan
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - F X Danlos
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - S Cousin
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - F Peyraud
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - N Chaput
- Laboratory of Immunomonitoring in Oncology, Gustave Roussy Cancer Campus, CNRS-UMS 3655 and INSERM-US23, Villejuif, France; Faculty of Pharmacy, University Paris-Saclay, Chatenay-Malabry, France; Laboratory of Genetic Instability and Oncogenesis, UMR CNRS 8200, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - M Spalato
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - G Roubaud
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - M Cabart
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - M Khettab
- Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - A Chaibi
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - C Rey
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - I Nafia
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - F X Mahon
- Department of Medicine, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - J C Soria
- Department of Medicine, Gustave Roussy, Villejuif, France
| | - A Italiano
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France; Department of Medicine, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France.
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7
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Use of analgesics/antipyretics in the management of symptoms associated with COVID-19 vaccination. NPJ Vaccines 2022; 7:31. [PMID: 35236842 PMCID: PMC8891349 DOI: 10.1038/s41541-022-00453-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/31/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 vaccines are effective and important to control the ongoing pandemic, but vaccine reactogenicity may contribute to poor uptake. Analgesics or antipyretic medications are often used to alleviate vaccine side effects, but their effect on immunogenicity remains uncertain. Few studies have assessed the effect of analgesics/antipyretics on vaccine immunogenicity and reactogenicity. Some studies revealed changes in certain immune response parameters post-vaccination when analgesics/antipyretics were used either prophylactically or therapeutically. Still, there is no evidence that these changes impact vaccine efficacy. Specific data on the impact of analgesic/antipyretic medications on immunogenicity of COVID-19 vaccines are limited. However, available data from clinical trials of licensed vaccines, along with recommendations from public health bodies around the world, should provide reassurance to both healthcare professionals and vaccine recipients that short-term use of analgesics/antipyretics at non-prescription doses is unlikely to affect vaccine-induced immunity.
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