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Lim SY, Jung YM, Kim Y, Kim G, Jeon J, Chin B, Kim MK. Adverse Reactions After Intradermal Vaccination With JYNNEOS for Mpox in Korea. J Korean Med Sci 2024; 39:e100. [PMID: 38442725 PMCID: PMC10911936 DOI: 10.3346/jkms.2024.39.e100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
In response to the Mpox domestic epidemic, South Korea initiated a nationwide vaccination program in May 2023, administering a 0.1 mL intradermal dose of JYNNEOS (Modified Vaccinia Ankara vaccine, Bavarian Nordic) to a high-risk group. To investigate the adverse reactions after intradermal JYNNEOS vaccination, an anonymous online survey was conducted at the National Medical Center from May 22 to July 31, 2023. Overall, 142 individuals responded. Over 80% of the respondents reported local reactions of predominantly mild severity. The predominant local reactions were pruritus, redness, and swelling; their incidence rates after the first dose were 66.2%, 48.1%, and 49.4%, respectively; the corresponding rates after the second dose were 69.2%, 60.6%, and 53.8%. Fewer respondents reported systemic symptoms. The most common systemic symptom was fatigue, the incidence rates of which after the first and second doses were 37.7% and 24.6%, respectively. Overall, the intradermally administered JYNNEOS vaccine appeared well tolerated.
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Affiliation(s)
- So Yun Lim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yu Mi Jung
- Infectious Diseases Response Team, National Medical Center, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Gayeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Jaehyun Jeon
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Min-Kyung Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea.
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Lu H, Li F, Yang Y, Zhao D. Case report of severe pneumothorax due to lung cancer treated with anlotinib. J Int Med Res 2023; 51:3000605231208923. [PMID: 37976276 PMCID: PMC10657525 DOI: 10.1177/03000605231208923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
Anlotinib is a tyrosine kinase inhibitor that targets the vascular endothelial growth factor receptor for the treatment of lung cancer. Pneumothorax is a rare complication of anlotinib treatment. Here, the case of a male patient in his early seventies, with lung cancer combined with emphysema, who developed a pneumothorax during treatment with anlotinib, is described. The patient was admitted to hospital mainly for dyspnoea and was diagnosed with pneumothorax after digital radiography of the chest. The patient's symptoms improved significantly after closed chest drainage, and a repeat chest digital radiography showed a more resolved pneumothorax. The patient had no previous history of pneumothorax. After discontinuation of anlotinib, the latest follow-up chest computed tomography assessment in August 2023 showed no recurrence of pneumothorax, thus, the pneumothorax is presumed to have been associated with anlotinib in this patient. In addition, the authors speculate that emphysema may be a cause of pneumothorax in patients with lung cancer receiving anlotinib treatment. Therefore, clinicians should be alert to the risk of pneumothorax occurrence in patients with emphysema combined with lung cancer who are treated with anlotinib.
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Affiliation(s)
| | | | - Yong Yang
- Department of Medical Oncology, Lixin County People's Hospital, Bozhou City, Anhui Province, China
| | - Dong Zhao
- Department of Medical Oncology, Lixin County People's Hospital, Bozhou City, Anhui Province, China
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Yang Q, Lyu J, Gui Y, Yu S, Chen J, Zhang H, Liu S. Prurigo Nodularis onset during secukinumab treatment of psoriasis: a case report. Allergy Asthma Clin Immunol 2023; 19:59. [PMID: 37408052 DOI: 10.1186/s13223-023-00811-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/11/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Secukinumab has been approved by the U.S. FDA and the European Medicines Agency for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis with the documented adverse effects. Here we reported in one case that a new symptom, Prurigo Nodularis (PN), developed during the programmed dosing of secukinumab. CASE INTRODUCTION A 22-years-old male with a 6-month history of severe plaque psoriasis vulgaris was presented to the dermatology clinic two weeks after the fifth serial weekly doses of secukinumab, for the reason of the outbreaks of multiple erythematous papules and pruritus nodules on the trunk and extremities. Physical examination showed that psoriatic rash were under effective control with the previous targeted therapy of secukinumab for plaque psoriasis vulgaris, but new dermatologic condition was spotted with multiple edematous red firm papules on the trunk and extremities, in the form of soy or hemispherical nodules, red in color, firm to touch, with some ulcerated crusts visible at tops, but negative Auspitz sign. Pathological examination confirmed these papules as PN. CONCLUSION This case report is shared to inform clinicians about an unannounced adverse effect of the secukinumab in the treatment of psoriasis, and it is recommended that patients be carefully informed of the possible risk of PN before starting treatment.
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Affiliation(s)
- Qingqing Yang
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Anhui, Hefei, 230032, China
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Anhui, 230032, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, 230032, China
| | - Jiajie Lyu
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Anhui, Hefei, 230032, China
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Anhui, 230032, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, 230032, China
| | - Yu Gui
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Anhui, Hefei, 230032, China
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Anhui, 230032, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, 230032, China
| | - Shuling Yu
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Anhui, Hefei, 230032, China
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Anhui, 230032, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, 230032, China
| | - Jiajie Chen
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Anhui, Hefei, 230032, China
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Anhui, 230032, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, 230032, China
| | - Haoxue Zhang
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Anhui, Hefei, 230032, China
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Anhui, 230032, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, 230032, China
| | - Shengxiu Liu
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Anhui, Hefei, 230032, China.
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Anhui, 230032, Hefei, China.
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, 230032, China.
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Kiernan EA, Carpenter JE, Dunkley CA, Moran TP, Rothstein LS, Silver E, Salehi M, Koch DD, Morgan BW, Murray BP. Elevated methemoglobin levels in patients treated with hydroxocobalamin: a case series and in-vitro analysis. Clin Toxicol (Phila) 2022; 60:1012-1018. [PMID: 35549585 DOI: 10.1080/15563650.2022.2072315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Historically, the first step in treating cyanide (CN-) toxicity utilized antidotes to induce methemoglobinemia. This is concerning in patients who are already hypoxemic or have elevated carboxyhemoglobin. Hydroxocobalamin (OHCbl) is now the first-line antidote for CN- toxicity and is not known to induce methemoglobinemia. We observed elevated methemoglobin (MetHb) levels in several patients treated with OHCbl and sought to investigate the incidence of MetHb formation following administration of OHCbl. METHODS Chart review: A single-center, retrospective case series of patients who received 5 or 10 g of hydroxocobalamin from 01/01/2011 through 04/30/2019. Data was analyzed using descriptive statistics. In-vitro study: Discarded blood was separated into whole blood and plasma samples. OHCbl and normal saline was added to reach 0×, 1×, 2×, and 4× peak therapeutic concentrations and analyzed at times 0, 2, and 4 h after administration. RESULTS Chart review: Twenty-seven cases of OHCbl administration were identified. The median age was 53 years (IQR 38 - 64) and 20 (74.1%) were male. Exposure to a house fire or smoke inhalation was the reason for OHCbl administration in 21 (77.8%) patients. Five (18.5%) patients received 10 g of OHCbl while the rest received 5 g. Six (22.2%) patients developed methemoglobinemia, all after 5 g OHCbl administration; four had been exposed to fire and smoke, two received the medication for severe acidosis of unknown etiology not related to fire or smoke. The median peak level was 7.1% (IQR 2.2 - 16.4%) at a median time of 11.4 h post-administration. Two patients received methylene blue (MB), neither responded. Death occurred in 17 (63%) cases. In-vitro study: We observed a dose dependent elevation in total hemoglobin but did not detect any increase in MetHb. CONCLUSION We observed a noteworthy temporal association between the formation of methemoglobinemia and the administration of hydroxocobalamin. This does not appear to be an artifact of the CO-oximeters. This could have profound implications for patients who are already hypoxemic or have impaired oxygen carrying capacity from carboxyhemoglobin.
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Affiliation(s)
| | | | | | - Tim P Moran
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Maryam Salehi
- Emory University School of Medicine, Atlanta, GA, USA
| | - David D Koch
- Emory University School of Medicine, Atlanta, GA, USA
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Oh TH, Woo SH, Hong S, Lee C, Lee WJ, Jeong SK. Clinical Features of Patients Presenting to the Emergency Department With Cardiovascular Adverse Reactions After COVID-19 mRNA Vaccination. J Korean Med Sci 2022; 37:e73. [PMID: 35257528 PMCID: PMC8901880 DOI: 10.3346/jkms.2022.37.e73] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Since the implementation of the nationwide coronavirus disease 2019 (COVID-19) vaccination campaign, emergency departments (EDs) have had an increasing number of patients reporting postvaccination cardiovascular adverse effects. We investigated the clinical features of patients who visited the ED for cardiovascular adverse reactions after COVID-19 mRNA vaccination. METHODS We conducted a retrospective observational study in two EDs. Patients with cardiovascular adverse reactions after COVID-19 mRNA vaccination who visited EDs between June 1, 2021, and October 15, 2021, were selected. The clinical data of these patients were collected by reviewing medical records. RESULTS Among 683 patients, 426 (62.4%) were female. The number of patients in their 20s was the highest (38.9% of males, 28.2% of females) (P < 0.001). More patients visited the ED for adverse reactions following the first vaccine dose than following the second dose (67.6% vs. 32.2%). Chief complaints were chest pain/discomfort (74.4%), dyspnea (14.3%) and palpitation (11.3%). The final diagnosis was a nonspecific cause (63.1%), and 663 (97.1%) patients were discharged from the ED. The admission rate was higher in males than in females (3.9% vs. 1.9%). Myocarditis was diagnosed in four males, who showed mild clinical progression and were discharged within 5 hospital days. CONCLUSION Most patients who visited the ED with cardiovascular adverse reactions were discharged from the ED, but some were admitted for other medical diseases as well as adverse vaccine reactions. Therefore, further surveillance and a differential diagnosis of cardiovascular adverse events after COVID-19 mRNA vaccination should be considered by emergency physicians.
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Affiliation(s)
- Tae Hoon Oh
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sungyoup Hong
- Department of Emergency Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Carol Lee
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Woon Jeong Lee
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Si Kyoung Jeong
- Department of Emergency Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
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Lee YW, Lim SY, Lee JH, Lim JS, Kim M, Kwon S, Joo J, Kwak SH, Kim EO, Jung J, Kwon HS, Kim TB, Kim SH, Bae S. Adverse Reactions of the Second Dose of the BNT162b2 mRNA COVID-19 Vaccine in Healthcare Workers in Korea. J Korean Med Sci 2021; 36:e153. [PMID: 34060261 PMCID: PMC8167406 DOI: 10.3346/jkms.2021.36.e153] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/11/2021] [Indexed: 01/14/2023] Open
Abstract
We conducted a prospective, mobile-based survey on the self-reported adverse reactions in healthcare workers (HCWs) who received both doses of the BNT162b2 mRNA vaccine. Of the 342 HCWs who completed the two-dose vaccination, 265 (77.5%) responded to the survey at least once. Overall, the rates of adverse reactions were higher after the second dose compared with the first dose (89.1% vs. 80.1%, P = 0.006). The most common systemic reactions were muscle ache (69.1%), fatigue (65.7%), headache (48.7%), chills (44.2%), and fever (32.1%), and were notably more common after the second dose vaccine as well. We also noted a sex difference in which the frequency of adverse reactions after the second dose of the vaccine was significantly higher in females, which was not observed after the first dose. The rates of adverse reactions were lower in older age groups, and the rates and severities of the adverse reactions decreased during the 3-day period following vaccination.
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Affiliation(s)
- Yun Woo Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yun Lim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seo Lim
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miseo Kim
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seonhee Kwon
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiyeon Joo
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Hee Kwak
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Bae S, Lee YW, Lim SY, Lee JH, Lim JS, Lee S, Park S, Kim SK, Lim YJ, Kim EO, Jung J, Kwon HS, Kim TB, Kim SH. Adverse Reactions Following the First Dose of ChAdOx1 nCoV-19 Vaccine and BNT162b2 Vaccine for Healthcare Workers in South Korea. J Korean Med Sci 2021; 36:e115. [PMID: 33942579 PMCID: PMC8093607 DOI: 10.3346/jkms.2021.36.e115] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/11/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We performed a prospective survey on the adverse reactions following the first dose of two types of vaccines against coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs) in South Korea. METHODS HCWs at a tertiary referral hospital in Seoul, South Korea, received a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) or an mRNA-based vaccine (BNT162b2) between March 5 and March 26, 2021. The HCWs were asked to report adverse reactions through a mobile self-report questionnaire for three days after vaccination. RESULTS A total of 7,625 HCWs received the first dose of ChAdOx1 or BNT162b2 vaccine during the study period. Of them, 5,866 (76.9%) HCWs (ChAdOx1, n = 5,589 [95.3%]; BNT162b2, n = 277 [4.7%]) participated at least once in the survey, of whom 77% were female and 86% were younger than 50 years. The overall adverse reaction rate was 93% in the ChAdOx1 group and 80% in the BNT162b2 group (P < 0.001). Both local and systemic reactions were more commonly reported in the ChAdOx1 group, and the difference was larger in systemic reactions such as fever and fatigue. In the ChAdOx1 group, the incidence of adverse reactions was significantly higher in females and those in the younger age groups, while the BNT162b2 group showed such difference according to age. CONCLUSION In our prospective survey, vaccine-associated adverse reactions were more commonly reported in the ChAdOx1 group than in the BNT162b2 group. Females and younger age groups experienced vaccine-associated adverse reactions more frequently.
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Affiliation(s)
- Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Woo Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yun Lim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seo Lim
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sojeong Lee
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soyeon Park
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Kyung Kim
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ju Lim
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Abstract
BACKGROUND A national immunization program (NIP) to prevent disease and reduce mortality from vaccine preventable diseases (VPD) is very important. METHODS We analyzed only the anaphylaxis cases that occurred between 2001 and 2016 that Korea Centers for Disease Control and Prevention (KCDC) determined had a definite causal relationship with a vaccine. The clinical symptoms were assessed according to the Brighton Collaboration case definition (BCCD) level. RESULTS During the period, there were 13 cases of vaccine-related anaphylaxis. The median age was 9 years (range, 1 month to 59 years). The incidence of anaphylaxis per million doses was 0.090 in 2005, 0.079 in 2012, 0.071 in 2013, 0.188 in 2015, and 0.036 in 2016. Of those cases, 23.1% were influenza vaccines, and 76.9% were BCCD level 2. Epinephrine was used in 46.2%. CONCLUSION Vaccine-related anaphylaxis seems to have been very rare in the past, but health care professionals must always be aware of anaphylaxis.
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Affiliation(s)
- Eui Jeong Roh
- Department of Pediatrics, Sun General Hospital, Daejeon, Korea
| | - Mi Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Korea
| | - Kun Baek Song
- Department of Pediatrics, Chungnam National University, College of Medicine, Daejeon, Korea
| | - Yeon Kyeong Lee
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Min Kyung Kim
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Tae Eun Kim
- Division of Vaccine-Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University, College of Medicine, Daejeon, Korea.
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Hayashi PH, Fontana RJ, Chalasani NP, Stolz AA, Talwalker JA, Navarro VJ, Lee WM, Davern TJ, Kleiner DE, Gu J, Hoofnagle JH. Under-reporting and Poor Adherence to Monitoring Guidelines for Severe Cases of Isoniazid Hepatotoxicity. Clin Gastroenterol Hepatol 2015; 13:1676-82.e1. [PMID: 25724701 PMCID: PMC4653068 DOI: 10.1016/j.cgh.2015.02.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/15/2015] [Accepted: 02/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Isoniazid is a leading cause of liver injury but it is not clear how many cases are reported or how many clinicians and patients adhere to American Thoracic Society (ATS) guidelines. We collected data on cases of isoniazid hepatotoxicity and assessed adherence to ATS guidelines and reports to the Centers for Disease Control's (CDC) isoniazid severe adverse events program. METHODS We analyzed Drug-Induced Liver Injury Network (DILIN) cases considered definite, highly likely, or probable for isoniazid injury from 2004 through 2013. We assessed the delays in isoniazid discontinuance according to ATS criteria and hepatotoxicity severity by Severity Index Score. We checked reporting to the CDC by matching cases based on age, latency, indication, reporting period, and comorbidities. RESULTS Isoniazid was the second most commonly reported agent in the DILIN, with 69 cases; 60 of these met inclusion criteria. The median age of cases was 49 years (range, 4-68 y), 70% were female, 97% had latent tuberculosis, and 62% were hospitalized. Patients took a median of 9 days to stop taking isoniazid (range, 0-99 days). Thirty-three cases (55%) continued taking isoniazid for more than 7 days after the ATS criteria for stopping were met. Twenty-four cases (40%) continued isoniazid for more than 14 days after meeting criteria for stopping. A delay in stopping was associated with more severe injury (P < .05). Of 13 patients who died or underwent liver transplantation, 9 (70%) continued taking isoniazid for more than 7 days after meeting criteria for stopping. Only 1 of 25 cases of isoniazid hepatotoxicity eligible for reporting to the CDC was reported. CONCLUSIONS Poor adherence to ATS guidelines is common in cases of hepatotoxicity and is associated with more severe outcomes including hospitalization, death, and liver transplantation. Isoniazid continues to be a leading cause of DILI in the United States, and its hepatotoxicity is under-reported significantly.
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Affiliation(s)
- Paul H. Hayashi
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC
| | | | - Naga P. Chalasani
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN
| | - Andrew A. Stolz
- Division of Gastroenterology, University of Southern California, Los Angeles, CA
| | | | - Victor J. Navarro
- Division of Gastroenterology, Einstein Healthcare Network & University of Pennsylvania, Philadelphia, PA
| | - William M. Lee
- Division of Gastroenterology, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Timothy J. Davern
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA
| | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jiezhun Gu
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Jay H. Hoofnagle
- Liver Disease Research Branch, Division of Digestive Diseases & Nutrition, National Institute of Diabetes & Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Sherwani AMK, Zulkifle M, Rehmatulla. A Pilot Trial of Jawarish Amla as Adjuvant to Anti-Tubercular Treatment Drugs for Control of Adverse Reactions in DOTS Regime in Pulmonary TB. J IMA 2013; 44:jima-44-1-09988. [PMID: 23864996 PMCID: PMC3708637 DOI: 10.5915/44-1-9988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 03/08/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES One of the greatest challenges of health care systems at the dawn of the 21st century is tuberculosis (TB). Drug resistant strains of TB are becoming a global public health risk. These strains commonly appear due to faulty therapies. Patients frequently stop treatment due to the toxicity of anti-tubercular treatment (ATT) drugs. Amla (Emblica officinalis) is a well-known Unani single drug. Jawarish amla is a Unani compound formulation which is commonly used to administer amla. This study tested the efficacy of Jawarish amla as an adjuvant to ATT drugs in reducing their side effects. METHODOLOGY Half of forty eligible pulmonary tuberculosis patients were randomly assigned to Test (Group B) and the other half to Control (Group A). Six grams of Jawarish amla twice daily was administered to the test group, and the same dosage of placebo was administered to control group along with directly observed treatment, short course chemotherapy (DOTS) for 60 days. Fisher exact test and paired t-test were applied for efficacy evaluation. Grading of symptoms was done to assess the toxicity of ATT and outcome of the adjuvant. RESULTS AND DISCUSSION Significant improvements were observed in almost all subjective and objective parameters. The exceptions were serum creatine and serum uric acid, which showed non-significant slight elevations within normal limits. CONCLUSION Jawarish amla was ascertained to be safe and effective adjuvant of DOTS in combating the adverse effects of ATT drugs.
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