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du Preez HN, Lin J, Maguire GEM, Aldous C, Kruger HG. COVID-19 vaccine adverse events: Evaluating the pathophysiology with an emphasis on sulfur metabolism and endotheliopathy. Eur J Clin Invest 2024:e14296. [PMID: 39118373 DOI: 10.1111/eci.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024]
Abstract
In this narrative review, we assess the pathophysiology of severe adverse events that presented after vaccination with DNA and mRNA vaccines against COVID-19. The focus is on the perspective of an undersulfated and degraded glycocalyx, considering its impact on immunomodulation, inflammatory responses, coagulation and oxidative stress. The paper explores various factors that lead to glutathione and inorganic sulfate depletion and their subsequent effect on glycocalyx sulfation and other metabolites, including hormones. Components of COVID-19 vaccines, such as DNA and mRNA material, spike protein antigen and lipid nanoparticles, are involved in possible cytotoxic effects. The common thread connecting these adverse events is endotheliopathy or glycocalyx degradation, caused by depleted glutathione and inorganic sulfate levels, shear stress from circulating nanoparticles, aggregation and formation of protein coronas; leading to imbalanced immune responses and chronic release of pro-inflammatory cytokines, ultimately resulting in oxidative stress and systemic inflammatory response syndrome. By understanding the underlying pathophysiology of severe adverse events, better treatment options can be explored.
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Affiliation(s)
- Heidi N du Preez
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Johnson Lin
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Glenn E M Maguire
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
- School of Chemistry and Physics, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hendrik G Kruger
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
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Mazzeffi M, Miller D, Garneau A, Sheeran J, Kleiman A, Mehta SH, Tiouririne M. Cesarean Delivery Outcomes for Patients with Coronavirus Disease-2019 in the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01857-2. [PMID: 37938434 DOI: 10.1007/s40615-023-01857-2] [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: 08/07/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Coronavirus disease-2019 (COVID-19) may have increased morbidity and mortality in patients having Cesarean delivery (CD) in the USA. METHODS We performed a retrospective cohort study of patients who had CD in 2020 using the national inpatient sample. After stratification by COVID-19 status, demographics, comorbidities, complications, mortality, and costs were compared. RESULTS There were 31,444,222 hospitalizations in the USA in 2020 with a mortality rate of 2.8%. Among these, 1,453,945 patients had COVID-19 and mortality was 13.2%. There were 1,108,755 patients who had CD and 15,550 had COVID-19. Patients with COVID-19 more frequently had Medicaid and were Hispanic. Patients with COVID-19 had more comorbidities including chronic hypertension, diabetes mellitus, pre-eclampsia, and eclampsia. Mortality in CD patients with COVID-19 was 30 in 10,000 patients, while for non-COVID-19 patients, it was 1 in 10,000 patients, P < 0.001. The crude odds ratio for mortality in COVID-19 patients was 32.1 (95% confidence interval = 22.9 to 44.7), P < 0.001 and the adjusted odds ratio was 29.3 (95% confidence interval = 20.7 to 41.4), P < 0.001. CONCLUSIONS CD patients with COVID-19 had 30-fold higher mortality before widespread vaccination was available with Hispanic and Medicaid patients disproportionately impacted. Potential explanations for this disparity include reduced access to personal protective equipment (e.g., masks) and testing, as well as socio-economic factors. Further research is needed to understand the factors that contributed to disparities in infection and clinical outcomes among obstetric patients during the COVID-19 pandemic. In future pandemics, enhanced efforts will be needed to protect economically disadvantaged women who are pregnant.
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Affiliation(s)
- Michael Mazzeffi
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, 22908, USA.
| | - David Miller
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ashley Garneau
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, 22908, USA
| | - Jessica Sheeran
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, 22908, USA
| | - Amanda Kleiman
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, 22908, USA
| | - Sachin H Mehta
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, 22908, USA
| | - Mohamed Tiouririne
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, 22908, USA
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Gwak E, Kim T, Shin JY, Choi NK, Han S, Lee JY, Choe YJ, Choe SA. Effectiveness and Safety of COVID-19 Vaccination During Preconceptional and Preclinical Pregnancy Period: A National Population Study. J Korean Med Sci 2023; 38:e314. [PMID: 37873626 PMCID: PMC10593595 DOI: 10.3346/jkms.2023.38.e314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/15/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND We aimed to assess the risk of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and early abortive outcomes after the association between coronavirus disease 2019 (COVID-19) vaccination during the preconceptional period and preclinical pregnancy, which are likely to be inadvertent vaccination. METHODS We used data from the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service cohort from December 2020 to December 2021. The vaccinated pregnant women were matched to unvaccinated pregnant controls at a 1:4 ratio. The risks of SARS-CoV-2 infection and intensive care unit (ICU) admission within 14 days of infection were analyzed to assess its effectiveness. For safety measures, the adjusted relative risks (aRRs) of early abortive outcomes for the first COVID-19 vaccination during the preconceptional and preclinical periods were calculated considering covariates. We compared the risk of early abortion between mRNA and viral vector vaccines. RESULTS The overall COVID-19 vaccination rates during the preconceptional period and preclinical pregnancy were 3.1% (6,662/215,211) and 2.6% (5,702/215,211), respectively. The cumulative incidence of ICU admission within 14 days of SARS-CoV-2 infection was 6/100,000 in the unvaccinated group, whereas there were no ICU admissions in the vaccinated groups. The risks of early abortive outcomes were not significantly different between the preconceptional vaccination group and the unvaccinated group (aRR, 1.04; 95% confidence interval [CI],0.99-1.10) or between preclinical pregnancy vaccination and their matched controls (1.02; 95% CI, 0.96-1.08). mRNA and viral vector vaccines have shown similar risks for early abortive outcomes and miscarriages. CONCLUSION Our findings have provided compelling evidence regarding the effectiveness and safety of COVID-19 vaccination prior to and during early pregnancy. Further research is required to extend the safety and efficacy profiles of COVID-19 vaccines to pregnant women and their babies.
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Affiliation(s)
- Eunseon Gwak
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Taemi Kim
- Department of Public Health, Korea University, Seoul, Korea
| | - Ju-Young Shin
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Korea
| | - Seungbong Han
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Department of Obstetrics & Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
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Sotoodeh Ghorbani S, Taherpour N, Rahimi E, Farhadi Babadi K, Feyzi R, Hashemi Nazari SS. Effectiveness, Immunogenicity and Safety of COVID-19 Vaccination in Pregnant Women: A Rapid Review Study. Med J Islam Repub Iran 2023; 37:72. [PMID: 37600627 PMCID: PMC10436674 DOI: 10.47176/mjiri.37.72] [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: 10/23/2022] [Indexed: 08/22/2023] Open
Abstract
Background Pregnant women infected with the coronavirus disease 2019 (COVID-19) are at risk for adverse pregnancy outcomes, and the only real preventive strategy against COVID-19 is mass vaccination. This study aimed to examine the effectiveness, immunogenicity, and safety of Covid-19 vaccination in pregnant women. Methods A combination of search terms was performed by 2 researchers independently in the Web of Science, PubMed, and Scopus databases, the World Health Organization website, and the US Centers for Disease Control (CDC) website up to February 2022. After the selection of eligible studies, the review process, description, and summarization of the selected studies were performed by the research team. Results Finally, 22 articles were included in this study. Evidence supports the safety of COVID-19 vaccination during pregnancy. There is no risk of transmitting COVID-19 to infants during lactation. In addition, antibodies made by vaccination can protect infants through breast milk. Conclusion The scientific community believes that being vaccinated as soon as possible is the best course of action because there is no evidence to suggest that the COVID-19 vaccine poses a risk to expectant or nursing women.
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Affiliation(s)
- Sahar Sotoodeh Ghorbani
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
| | - Niloufar Taherpour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
| | - Elham Rahimi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
| | - Kosar Farhadi Babadi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
| | - Rezvan Feyzi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
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Zare M, Mirahmadizadeh A, Akbari M, Moradian MJ. Comparison of in-hospital mortality of COVID-19 between pregnant and non-pregnant women infected with SARS-CoV-2: a historical cohort study. J Perinat Med 2023; 51:269-276. [PMID: 35254012 DOI: 10.1515/jpm-2022-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to compare pregnant and non-pregnant women infected with SARS-CoV-2 disease (COVID-19) in terms of in-hospital mortality. METHODS This historical cohort study was conducted on hospitalized women of reproductive ages (15-49 years) infected with SARS-CoV-2 in Fars province, Iran during 15 March 2019-10 May 2021. RESULTS Out of the 5,322 patients, 330 were pregnant. The fatality rate of SARS-CoV-2 was 1.2% amongst pregnant women and 3.5% amongst non-pregnant ones. Pregnant and non-pregnant women reported the same history of smoking, opium use, previous COVID-19 infection, vaccination against SARS-CoV-2, and COVID-19 symptoms (p>0.05 for all). However, the pregnant women were younger and had fewer underlying diseases (p<0.001 for both). The results revealed no significant difference between the two groups regarding in-hospital clinical manifestations including the number of days after the onset of COVID-19 symptoms, mechanical ventilation, and long involvement (cRR; 95% CI=0.99 (0.96-1.02), 1.18 (0.72-2.02), and 0.95 (0.88-1.02), respectively). Nonetheless, Intensive Care Unit (ICU) admission was significantly higher in pregnant women (cRR; 95% CI=2.37(1.85-3.02)). After adjusting for age, history of underlying diseases, and ICU admission, pregnant women showed lower in-hospital mortality due to COVID-19 compared to non-pregnant women (aRR; 95% CI=0.32 (0.12-0.87)). CONCLUSIONS Based on the current study findings, pregnant women showed lower in-hospital mortality due to COVID-19 compared to non-pregnant ones. Nevertheless, they should follow the same recommendations as non-pregnant women, avoiding exposure to the virus and receiving medical treatment and vaccination. Further studies are recommended to address the follow-up of recovered pregnant women, their babies, and puerperium.
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Affiliation(s)
- Marjan Zare
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Akbari
- Health Affairs, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Moradian
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Karrow NA, Shandilya UK, Pelech S, Wagter-Lesperance L, McLeod D, Bridle B, Mallard BA. Correction: Karrow et al. Maternal COVID-19 Vaccination and Its Potential Impact on Fetal and Neonatal Development. Vaccines 2021, 9, 1351. Vaccines (Basel) 2022; 10:vaccines10111925. [PMID: 36423074 PMCID: PMC9697509 DOI: 10.3390/vaccines10111925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
In the original publication [...].
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Affiliation(s)
- Niel A. Karrow
- Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
- Correspondence:
| | - Umesh K. Shandilya
- Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Steven Pelech
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | | | - Deanna McLeod
- Kaleidoscope Strategic Inc., Toronto, ON M6R 1E7, Canada
| | - Byram Bridle
- Department of Pathobiology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Bonnie A. Mallard
- Department of Pathobiology, University of Guelph, Guelph, ON N1G 2W1, Canada
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