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Stone CA, Garvey LH, Nasser S, Lever C, Triggiani M, Parente R, Phillips EJ. Identifying and Managing Those at Risk for Vaccine-Related Allergy and Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2008-2022. [PMID: 37182566 DOI: 10.1016/j.jaip.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are uncommon events occurring in fewer than 1 in a million doses administered. These reactions are infrequently immunoglobulin E-mediated. Because they are unlikely to recur, a reaction to a single dose of a vaccine is rarely a contraindication to redosing. This narrative review article contextualizes the recent knowledge we have gained from the coronavirus 2019 (COVID-19) pandemic rollout of the new mRNA platform with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines within the much broader context of what is known about immediate reactions to other vaccinations of routine and global importance. We focus on what is known about evidence-based approaches to diagnosis and management and what is new in our understanding of mechanisms of immediate vaccine reactions. Specifically, we review the epidemiology of immediate hypersensitivity vaccine reactions, differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, including how to recognize immunization stress-related responses. In addition, we highlight what is known about mechanisms and review the rare but important contribution of excipient allergies and specifically when to consider testing for them as well as other key features that contribute to safe evaluation and management.
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Affiliation(s)
- Cosby A Stone
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shuaib Nasser
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charley Lever
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Elizabeth J Phillips
- Department of Dermatology, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Perth, Western Australia.
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Vaz M, D'Silva C, Krishna B, Ramachandran P, D'Souza MC, Mendonca L, Raman P. Understanding the Challenges of Intensive Care Staff in Communicating With Patients and Patients' Families During the COVID-19 Crisis: A Qualitative Exploration. Cureus 2023; 15:e40961. [PMID: 37503489 PMCID: PMC10369211 DOI: 10.7759/cureus.40961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/29/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) isolation protocols in India restricted family members of COVID-19 patients from visiting them in hospitals and in intensive care units, especially during the peak of the pandemic. This along with the elaborate personal protective equipment (PPE) created challenges for intensivists and nurses in COVID ICUs in effectively communicating with patients and patients' families, especially in shared decision-making processes. Methods This article is the outcome of a qualitative study using in-depth one-on-one interviews with 10 intensivists and four intensive care nurses in two teaching hospitals in Bengaluru, South India. Each participant, purposively selected till data saturation was reached, had spent extensive periods of time in a COVID ICU during both COVID-19 waves in 2020 and 2021. A framework of descriptive phenomenology led to the design of the study in which varied experiences and insights of participants were captured using an interview guide to understand their lived reality. The interviews were conducted online or in person between July 2021 and October 2021 and were audio recorded and transcribed verbatim. Coding of transcripts using the NVivo 12 (Burlington, MA: QSR International Pty Ltd) software helped with the thematic analysis. This was guided by interpretive phenomenological methods that derived meaning from participants' life experiences. Results Four themes involving challenges in effective communication in the COVID ICU emerged as follows: physical barriers, emotional and mental stressors, infrastructural challenges, and ethical and moral dilemmas. Sub-themes included personal protective equipment as a barrier, reduced energy levels, and isolation of family from patients under the domain of physical challenges; fears of the unknown, handling death of patients in isolation, and the frustrations of families were challenges under the emotional and mental domain. Infrastructural/systemic challenges included poor connectivity and insufficient mobile phones, and the absence of rules to handle interruptions. Privacy breaches, taking consent over the phone, end-of-life discussions, and medico-legal risks emerged as the subthemes under the domain of ethical and moral challenges. A mobile phone communication policy specifying usage times and operating methods, a mandatory communication and counseling training module for intensivists and intensive care nurses, and a set of protocols for highly restrictive, intensive care units in pandemic situations were recommendations and lessons learned. Conclusions The lack of face-to-face interactions was a serious barrier to communication between ICU staff and patients and their caregivers. It had a bearing on trust levels and had emotional and ethical consequences for healthcare teams to handle. Opportunities for self-care, venting of anxiety and distress, and opportunities to celebrate and reward special efforts and cooperation between consultants, residents, nurses, and technicians in stressful environments like a pandemic ICU were important to sustain empathy and keep care and communication humane.
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Affiliation(s)
- Manjulika Vaz
- Health Humanities, St. John's Research Institute, St. John's Medical College, Bangalore, IND
| | - Carol D'Silva
- Critical Care Medicine, St. John's Medical College Hospital, Bangalore, IND
| | - Bhuvana Krishna
- Critical Care Medicine, St. John's Medical College Hospital, Bangalore, IND
| | - Priya Ramachandran
- Pulmonary and Critical Care Medicine, St. John's Medical College Hospital, Bangalore, IND
| | - Moses C D'Souza
- Anesthesiology and Critical Care Medicine, St. John's Medical College Hospital, Bangalore, IND
| | - Lavina Mendonca
- Nursing, St. John's Medical College Hospital, Bangalore, IND
| | - Padmalatha Raman
- Anesthesiology and Critical Care Medicine, Prakriya Hospitals, Bangalore, IND
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Kravvariti E, Kasdagli MI, Diomatari KM, Mouratidou P, Daskalakis K, Mitsikostas DD, Sfikakis PP, Yavropoulou MP. Meta-analysis of placebo-arm dropouts in osteoporosis randomized-controlled trials and implications for nocebo-associated discontinuation of anti-osteoporotic drugs in clinical practice. Osteoporos Int 2023; 34:585-598. [PMID: 36596944 DOI: 10.1007/s00198-022-06658-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023]
Abstract
UNLABELLED Dropout from placebo arms in randomized-controlled trials is a surrogate for nocebo responses, resulting from patients' negative expectations to treatment. Among 16,460 placebo-treated patients in oral anti-osteoporotic drug trials, nocebo dropouts were 8% on average, being higher in older patients. This implies that nocebo may contribute to the osteoporosis treatment gap in clinical practice. PURPOSE Osteoporosis is a common disease requiring long-term treatment. Despite the availability of effective anti-osteoporotic drugs, adherence to treatment is low. Nocebo, a behavior mostly related to the negative expectations to a certain treatment, decreases adherence and negatively affects treatment outcomes and health-related care costs in chronic diseases. Since in double-blind placebo-controlled randomized trials any unfavorable outcome leading to discontinuation in placebo arms is considered as nocebo, we aimed to investigate the size of nocebo response in patients participating in osteoporosis trials. METHODS We searched MEDLINE, EMBASE, SCOPUS, and Cochrane databases for dropouts due to reported adverse events in the placebo arms (nocebo dropouts) in all double-blind trials investigating anti-osteoporotic drugs published between January 1993 and March 2022. Only data on bisphosphonates and selective estrogen receptor modulators (SERMs) were analyzed (Prospero registration number CRD42020212843). RESULTS Data from 44 trials were extracted. In 16,460 placebo-treated patients, the pooled nocebo-dropout was 8% both for bisphosphonates (average: 0.08; range 0.01-0.27; 95%CI 0.06-0.10) and SERMs (average: 0.08; range 0.03-0.15; 95%CI 0.05-0.13). Nocebo-dropouts were higher in bisphosphonate trials enrolling individuals ≥ 65 years (11%) (n = 18) compared to trials enrolling younger individuals (6%) (n = 18) (average: 0.11; 95%CI 0.08-0.13 vs. average: 0.06; 95%CI 0.05-0.08, respectively, p = 0.001). Participants' sex, dosing-intervals, publication year, or severity of osteoporosis had no impact on the nocebo-dropouts. CONCLUSION Almost 1 in 10 osteoporosis patients receiving placebo in trials of bisphosphonates and SERMs experiences AEs leading to dropout, implying that nocebo contributes to treatment-discontinuation in clinical practice. Efforts to identify and minimize nocebo, especially in older patients, are warranted.
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Affiliation(s)
- Evrydiki Kravvariti
- 1st Propaedeutic and Internal Medicine Clinic, Joint Academic Rheumatology Program, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece.
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece.
| | - Maria-Iosifina Kasdagli
- Department of Hygiene and Epidemiology, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Konstantina Maria Diomatari
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Pelagia Mouratidou
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Kosmas Daskalakis
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 85, Örebro, Sweden
| | - Dimos D Mitsikostas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 11528, Athens, Greece
| | - Petros P Sfikakis
- 1st Propaedeutic and Internal Medicine Clinic, Joint Academic Rheumatology Program, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Maria P Yavropoulou
- Endocrinology Unit, 1st Department of Propaedeutic and Internal Medicine, School of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece
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Amanzio M, Cipriani GE, Mitsikostas DD. The nocebo phenomenon in the COVID-19 pandemic: a nocebodemic effect. Expert Rev Clin Pharmacol 2022; 15:1377-1382. [DOI: 10.1080/17512433.2022.2142115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Dimos D. Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Azzolini E, Canziani LM, Voza A, Desai A, Pepys J, De Santis M, Ceribelli A, Pozzi C, Turato M, Badalamenti S, Germagnoli L, Mantovani A, Rescigno M, Selmi C. Short-Term Adverse Events and Antibody Response to the BNT162b2 SARS-CoV-2 Vaccine in 4156 Health Care Professionals. Vaccines (Basel) 2022; 10:439. [PMID: 35335071 PMCID: PMC8950377 DOI: 10.3390/vaccines10030439] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
Short-term adverse events are common following the BNT162b2 vaccine for SARS-Cov-2 and have been possibly associated with IgG response. We aimed to determine the incidence of adverse reactions to the vaccine and the impact on IgG response. Our study included 4156 health-care professionals who received two doses of the BNT162b2 vaccine 21 days apart and obtained 6113 online questionnaires inquiring about adverse events. The serum response was tested in 2765 subjects 10 days after the second dose. Adverse events, most frequently a local reaction at the site of injection, were reported by 39% of subjects. Multivariate analysis showed that female sex (odds ratio—OR—1.95; 95% confidence interval—CI—1.74−2.19; p < 0.001), younger age (OR 0.98 per year, p < 0.001), second dose of vaccine (OR 1.36, p < 0.001), and previous COVID-19 infection (OR 1.41, p < 0.001) were independently associated with adverse events. IgG response was significantly higher in subjects with adverse events (1110 AU/mL—IQR 345-1630 vs. 386 AU/mL, IQR 261-1350, p < 0.0001), and the association was more pronounced in subjects experiencing myalgia, fever, and lymphadenopathy. We demonstrate that a more pronounced IgG response is associated with specific adverse events, and these are commonly reported by health care professionals after the BNT162b2 vaccine for SARS-Cov-2.
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Affiliation(s)
- Elena Azzolini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Lorenzo Maria Canziani
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Antonio Desai
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Jack Pepys
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Angela Ceribelli
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Chiara Pozzi
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Massimo Turato
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Salvatore Badalamenti
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Luca Germagnoli
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Alberto Mantovani
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
- The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Maria Rescigno
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (E.A.); (A.V.); (A.D.); (J.P.); (M.D.S.); (A.C.); (A.M.); (M.R.)
- IRCCS Humanitas Clinical Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy; (L.M.C.); (C.P.); (M.T.); (S.B.); (L.G.)
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Fragoulis GE, Bournia VK, Mavrea E, Evangelatos G, Fragiadaki K, Karamanakos A, Kravariti E, Laskari K, Panopoulos S, Pappa M, Mitsikostas DD, Tektonidou MG, Vassilopoulos D, Sfikakis PP. COVID-19 vaccine safety and nocebo-prone associated hesitancy in patients with systemic rheumatic diseases: a cross-sectional study. Rheumatol Int 2022; 42:31-39. [PMID: 34739573 PMCID: PMC8569844 DOI: 10.1007/s00296-021-05039-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/22/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe the rate and type of adverse effects (AEs) and the frequency of disease flares after COVID-19 vaccination and to assess the reasons for vaccination hesitancy (non-vaccination) in SRD patients. METHODS Telephone interviews were conducted of SRD patients consecutively enrolled (15/06/2021-1/7/2021). Participants were asked about the type of AEs and disease flare after vaccination. Reasons for vaccination hesitancy were recorded. Univariate and mutivariable analyses examined associations of demographic, clinical and other features, with occurrence of AEs, disease flare and non-vaccination. For the latter, association with negative vaccination behaviour (not influenza vaccinated for the last 2 years) and nocebo-prone behaviour (denoting AEs attributed to negative expectations [Q-No questionnaire]) was also tested. RESULTS 561 out of 580 contacted patients were included in the study. 441/561 (78.6%) patients were vaccinated [90% (Pfizer, Moderna), 10% (Astra-Zeneca)]. AEs were reported by 148/441 (33.6%), with rates being comparable between the three vaccines. AEs were more common in females and those with chronic obstructive pulmonary disease [OR, 95% CI; females: 2.23 (1.30-3.83); COPD: 3.31 (1.24-8.83)]. Disease flare was reported in 9/441 (2%) patients. For those unvaccinated, fear that the vaccine would be harmful (53.3%), could cause disease flare (24.2%) and/or could cause thrombosis (21.7%) were the main reasons to do so. Multivariable analysis identified as independent variables for non-vaccination: nocebo-prone behaviour (OR; 95% CI, 3.88; 1.76-8.55), negative vaccination behaviour (6.56; 3.21-13.42) and previous COVID-19 infection (2.83; 1.13-7.05). Higher educational status was protective (0.49; 0.26-0.92). CONCLUSION No new safety signals for COVID-19 vaccination were observed. Vaccination campaign should target SRD patients with nocebo-prone and negative influenza vaccination behaviour.
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Affiliation(s)
- George E. Fragoulis
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Vassiliki-Kalliopi Bournia
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Eugenia Mavrea
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, Hippokration General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Kalliopi Fragiadaki
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Anastasios Karamanakos
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Eyrydiki Kravariti
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Katerina Laskari
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Stylianos Panopoulos
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Maria Pappa
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Dimos D. Mitsikostas
- 1st Neurology Department, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G. Tektonidou
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, Hippokration General Hospital, Athens, Greece
| | - Petros P. Sfikakis
- Joint Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Athens School of Medicine, National and Kapodistrian University, Mikras Asias 75 str, 11527 Athens, Greece
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Vaccination Hesitancy among Health-Care-Workers in Academic Hospitals Is Associated with a 12-Fold Increase in the Risk of COVID-19 Infection: A Nine-Month Greek Cohort Study. Viruses 2021; 14:v14010026. [PMID: 35062230 PMCID: PMC8779273 DOI: 10.3390/v14010026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 01/02/2023] Open
Abstract
Health-Care-Workers (HCWs) are considered at high risk for SARS-CoV-2 infection. We sought to compare rates and severity of Coronavirus disease 2019 (COVID-19) among vaccinated and unvaccinated HCWs conducting a retrospective cohort study in two tertiary Academic Hospitals, namely Laiko and Attikon, in Athens, Greece. Vaccinated by BNT162b2 Pfizer-BioNTech COVID-19 mRNA vaccine and unvaccinated HCWs were included and data were collected between 1 January 2021 and 15 September 2021. Overall, 2921 of 3219 HCWs without a history of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection were fully vaccinated during the study period (90.7% at each Hospital). Demographic characteristics were comparable between 102/2921 (3.5%) vaccinated and 88/298 (29.5%) unvaccinated HCWs with COVID-19, although age and occupation differed significantly. None were in need of hospital admission in the vaccinated Group, whereas in the unvaccinated Group 4/88 (4.5%) were hospitalized and one (1.1%) died. Multivariable logistic regression analysis revealed that lack of vaccination was an independent risk factor for COVID-19 with an odds ratio 11.54 (95% CI: 10.75-12.40). Vaccination hesitancy among HCWs resulted to highly increased COVID-19 rates; almost one in three unvaccinated HCWs was SARS-CoV-2 infected during the 9-month period. The absolute need of vaccination of HCWs, including boosting dose, is highlighted. Evidence should be used appropriately to overcome any hesitancy.
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