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Mellinghoff SC, Robrecht S, Sprute R, Mayer L, Weskamm LM, Dahlke C, Gruell H, Teipel F, Schlößer HA, Siepmann K, Thelen M, Fink AM, Fischer K, Klein F, Addo MM, Kolovou A, Cornely OA, Eichhorst B, Hallek M, Langerbeins P. Hybrid immunity to SARS-CoV-2 in patients with chronic lymphocytic leukemia. Eur J Haematol 2024; 112:788-793. [PMID: 38311570 DOI: 10.1111/ejh.14170] [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: 10/24/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE Preventing severe COVID-19 remains a priority globally, particularly in the immunocompromised population. As shown in healthy individuals, immunity against SARS-CoV-2 can be yielded by previous infection, vaccination, or both (hybrid immunity). The objective of this observation study was to investigate hybrid immunity in patients with chronic lymphocytic leukemia (CLL). METHODS/RESULTS Blood samples of six patients with CLL were collected 55 days after fourth COVID-19 vaccination. All patients had a SARS-CoV-2 infection within 12 months before the second booster (fourth vaccination). SARS-CoV-2 spike receptor binding domain (RBD)-specific IgG antibodies were detectable in 6/6 (100.0%) CLL patients after four compared to 4/6 (66.7%) after three vaccinations. The median number of SARS-CoV-2 spike-specific T cells after repeated booster vaccination plus infection was 166 spot-forming cells (SFC) per million peripheral blood mononuclear cells. Overall, 5/5 (100%) studied patients showed a detectable increase in T cell activity. CONCLUSION Our data reveal an increase of cellular and humoral immune response in CLL patients after fourth COVID-19 vaccination combined with SARS-CoV-2 infection, even in those undergoing B cell-depleting treatment. Patients with prior vaccination failure now show a specific IgG response. Future research should explore the duration and effectiveness of hybrid immunity considering various factors like past infection and vaccination rates, types and numbers of doses, and emerging variants.
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Affiliation(s)
- Sibylle C Mellinghoff
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Leonie Mayer
- Department of Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Leonie M Weskamm
- Department of Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Christine Dahlke
- Department of Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Henning Gruell
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Finn Teipel
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hans A Schlößer
- Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Klara Siepmann
- Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Martin Thelen
- Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Florian Klein
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marylyn M Addo
- Department of Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Division of Infectious Diseases, First Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Androniki Kolovou
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Michael Hallek
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
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Björnsson ES. The Epidemiology of Newly Recognized Causes of Drug-Induced Liver Injury: An Update. Pharmaceuticals (Basel) 2024; 17:520. [PMID: 38675480 PMCID: PMC11053599 DOI: 10.3390/ph17040520] [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] [Received: 03/21/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
The incidence and prevalence of drug-induced liver injury appear to be increasing globally, for example, with the introduction of checkpoint inhibitors. Several reviews have been published in the last decade on the epidemiology of DILI, both among hospitalized patients and in the general population, as well as from retrospective and prospective studies on DILI. Most of these reviews have not focused on newly recognized agents that have recently changed the landscape of DILI. Apart from liver injury associated with antibiotics, oncological agents, particularly checkpoint inhibitors, are increasingly being recognized as causing liver injury. The type of liver injury associated with these agents is not idiosyncratic but rather an indirect type of injury. Furthermore, recently, COVID-19 vaccines and green tea extract have been found to lead to liver injury. Checkpoint inhibitors have revolutionized the treatment of many malignancies, such as malignant melanoma, lung cancer, and renal cancer. Via the activation of T cells, they can increase immune activity against malignant cells, but at the same time, they can decrease immune tolerance and therefore lead to immune-related adverse effects in many organs. The most common adverse effect in clinical practice is liver injury. A recent prospective study demonstrated an 8% frequency of DILI due to the use of checkpoint inhibitors among patients with malignant melanoma and renal cancer. This rate is much higher than observed with drugs, leading to idiosyncratic liver injury. Shortly after the implementation of the worldwide vaccination program against COVID-19, several case reports were published on suspected vaccination-induced autoimmune-like hepatitis occurring shortly after the vaccination. At first, these reports were met with skepticism, but currently, around 100 reports have been published, and cases of positive recurrence have been reported. The clinical, biochemical, immunological, and histological features are indistinguishable from classic autoimmune hepatitis (AIH). These reactions are very similar to drug-induced autoimmune-like hepatitis (DI-ALH) due to drugs such as nitrofurantoin, minocycline, and infliximab, which do not relapse after a short course of corticosteroids, which is the general rule in classic autoimmune hepatitis (AIH). Green tea extract has been found to be a well-documented cause of acute hepatocellular liver injury with jaundice. A strong HLA association has been reported, showing a high prevalence of HLA-B*35:01 among patients suffering from green tea-induced liver injury. Overall, 3% of patients recruited in the DILIN study were supplemented with green tea extract as one of the ingredients. In a prospective population-based study from Iceland, green tea was implicated in approximately 8% of patients with DILI.
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Affiliation(s)
- Einar Stefan Björnsson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The National University Hospital of Iceland, Faculty of Medicine, University of Iceland, Hringbraut, 101 Reykjavik, Iceland
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Bernstein M, Frintner M, Gao S, Gibbons T, Green N, Hildreth D, Lustig M, Stamps J, Turner J, Singer R, Singer R. Community-Academic Partnerships: Addressing Health Inequities Through Community-Engaged Service Learning. Health Promot Pract 2024; 25:5-7. [PMID: 36113088 DOI: 10.1177/15248399221102913] [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] [Indexed: 01/05/2024]
Abstract
In Chicago, Black men who have sex with men (MSM) and transgender and gender nonconforming (TGNC) individuals experience higher rates of HIV diagnoses. The Southside of Chicago has a thriving house ball culture powered by MSM and TGNC individuals who are disproportionately impacted by HIV. While this community has a history of facilitating health promotion at their events, gaps exist in community-empowered education specific to this community. Through partnership between nursing students from University of Illinois Chicago (UIC) and leaders from the Southside Health Advocacy Resource Partnership (SHARP) and the University of Chicago Center for HIV Elimination (CCHE), we aimed to reduce health disparities experienced by the Black MSM/TGNC community in Chicago. We promoted COVID-19 vaccinations and obtained funding for a community-led project to reduce HIV-related stigma. Our team consisted of two community leaders, seven students, and two professors. We met weekly during the development stages and detailed notes were maintained by students and updated with next steps. Four months of collaboration demonstrated how nursing coursework can facilitate community-academic partnership and yielded a COVID-19 viral vaccination promotion video, community administration of vaccines, and SHARP's procurement of funding to implement a project to reduce HIV-related stigma. Students learned the importance of community leaders' presence when bringing health care to communities. Community leaders learned to communicate population needs and best utilize students as a resource. Enriching nursing curriculum using an integrated service-learning format offers the opportunity for student development while simultaneously serving the community.
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Affiliation(s)
| | | | - Shuang Gao
- University of Illinois Chicago, Chicago, IL, USA
| | | | - Noel Green
- The University of Chicago, Chicago, IL, USA
- Southside Health Advocacy Resource Partnership, Chicago, IL, USA
| | | | | | - Jahari Stamps
- Southside Health Advocacy Resource Partnership, Chicago, IL, USA
| | - Julia Turner
- University of Illinois Chicago, Chicago, IL, USA
| | | | - Randi Singer
- University of Illinois Chicago, Chicago, IL, USA
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Wojturska W, Nowakowski J, Pilch W, Biernikowicz M, Korkosz M. Reactive arthritis after vaccination against SARS-CoV-2: A case series and a mini-review. Hum Vaccin Immunother 2023; 19:2173912. [PMID: 36746791 PMCID: PMC10026907 DOI: 10.1080/21645515.2023.2173912] [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] [Indexed: 02/08/2023] Open
Abstract
The rapid development of COVID-19 vaccines became essential for addressing the global pandemic. Reactive arthritis after vaccination has been a rare phenomenon. Here, we present a case series of three patients with joint inflammation possibly attributed to COVID-19 immunization (mRNA and live adenovirus vectored vaccine). Symptoms were alleviated using non-steroid anti-inflammatory drugs and glucocorticoids. After follow-up, the patients have not been diagnosed with any other rheumatic disease. Reactive arthritis after the COVID-19 vaccine is an unusual adverse effect and poses a negligible risk in comparison to the benefits of immunization, but it should be considered in differential diagnostics by a practicing rheumatologist who cares for patients with new-onset arthritis without apparent cause at the time of pandemic.
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Affiliation(s)
- Wiktoria Wojturska
- Students' Scientific Group of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Jarosław Nowakowski
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Weronika Pilch
- Students' Scientific Group of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Małgorzata Biernikowicz
- Students' Scientific Group of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Mariusz Korkosz
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
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Mohamed S, Chan CK, Tsang CW, Szeto SK, Fong AH, Chan JC, Wong CY. Case Report: Retinal Vasculitis in Two Adolescents After COVID-19 Vaccination. Ocul Immunol Inflamm 2023; 31:1245-1249. [PMID: 36228169 DOI: 10.1080/09273948.2022.2129694] [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: 05/11/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To report two cases of bilateral retinal vasculitis in adolescents following COVID-19 vaccination. STUDY DESIGN Case report. RESULTS We report the first two cases of retinal vasculitis in adolescents following COVID-19 vaccinations. Both patients received recent second-dose COVID-19 vaccinations (7 weeks and 4 weeks respectively), and presented with bilateral retinal vasculitis and vitritis. Investigations did not reveal other causes of retinal vasculitis. Both patients' retinal vasculitis settled with a short course of oral prednisolone. CONCLUSION Although rare, the temporal association between vaccination, bilateral eye involvement, and the absence of alternative infective or inflammatory causes, makes this a plausible etiology. mRNA vaccinations may cause an autoimmune reaction via host antigenic mimicry, and systemic vasculitis has previously been described. We believe that a short interval between COVID-19 vaccination doses might be a risk factor for the development of retinal vasculitis in adolescents, and clinicians should be aware to elicit vaccination history.
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Affiliation(s)
- Shaheeda Mohamed
- Hong Kong Eye Hospital, Kowloon, Hong Kong
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, Shatin, China
| | - Carmen Km Chan
- Hong Kong Eye Hospital, Kowloon, Hong Kong
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, Shatin, China
| | - Chi Wai Tsang
- Hong Kong Eye Hospital, Kowloon, Hong Kong
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, Shatin, China
| | - Simon Kh Szeto
- Hong Kong Eye Hospital, Kowloon, Hong Kong
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, Shatin, China
| | - Angie Hc Fong
- Hong Kong Eye Hospital, Kowloon, Hong Kong
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, Shatin, China
| | - Jason Ck Chan
- Hong Kong Eye Hospital, Kowloon, Hong Kong
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, Shatin, China
| | - Cherie Yk Wong
- Hong Kong Eye Hospital, Kowloon, Hong Kong
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, Shatin, China
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Fairchild R, Price M, Craig A, Dotters-Katz SK. Reliability and comprehensiveness of YouTube videos about the COVID-19 vaccine in pregnancy. Am J Infect Control 2023:S0196-6553(23)00521-7. [PMID: 37487971 DOI: 10.1016/j.ajic.2023.07.004] [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] [Received: 05/24/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Online information influences health care decisions and may contribute to vaccine hesitancy among pregnant individuals. We assessed the quality (reliability and comprehensiveness) of YouTube videos about COVID-19 vaccination in pregnancy. We systematically identified videos and recorded video information and quality. 137 videos were reviewed. Comments, likes, dislikes, duration, reliability, and content scores differed between sources. Videos were low quality overall, but videos produced by medical sources tended to be higher quality. Quality was positively correlated with duration, but not views.
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Affiliation(s)
| | - Meghan Price
- Johns Hopkins Department of Internal Medicine, Baltimore, MD, USA
| | - Amanda Craig
- Duke University Department of Obstetrics and Gynecology, Durham, NC, USA
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Sundaram SP, Devi NJ, Lyngdoh M, Medhi GK, Lynrah W. Vaccine Hesitancy and Factors Related to Vaccine Hesitancy in COVID-19 Vaccination among a Tribal Community of Meghalaya: A Mixed Methods Study. J Patient Exp 2023; 10:23743735231183673. [PMID: 37457232 PMCID: PMC10345914 DOI: 10.1177/23743735231183673] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Vaccine hesitancy should be dealt as an important issue as it carries both individual- and community-level risks; however, it lacks proper assessment in particular among the indigenous tribal population. A community-based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised in-depth interviews among the eligible residents and key informant interviews among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. A total of 113 [47.5% (95% confidence interval [CI]: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual-related, disease-related, vaccine-related, healthcare system and provider related and socio-cultural and religious. The main barriers for the likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumors, and socio-cultural and religious misbeliefs. Vaccine hesitancy is found to be considerably higher and it depends on complacency toward the vaccine, confidence in its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccines by reducing the barriers to the vaccine acceptance.
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Affiliation(s)
| | - Ningombam J Devi
- Department of Community Medicine, NEIGRIHMS, Shillong, Meghalaya, India
| | - Markordor Lyngdoh
- Department of Community Medicine, NEIGRIHMS, Shillong, Meghalaya, India
| | - Gajendra K Medhi
- Department of Community Medicine, NEIGRIHMS, Shillong, Meghalaya, India
| | - Wallambok Lynrah
- Department of Community Medicine, NEIGRIHMS, Shillong, Meghalaya, India
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Schillinger D, Cortez G, Lee M. The "Survival Pending Revolution" COVID-19 vaccination campaign: an example of critical communication theory in action. Front Public Health 2023; 11:1134104. [PMID: 37404275 PMCID: PMC10316422 DOI: 10.3389/fpubh.2023.1134104] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/21/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction We carried out a two-phase, qualitative evaluation of a novel public health campaign to promote COVID-19 vaccination among youth and young adults of color (YOC), called Survival Pending Revolution. The campaign, commissioned by California's Department of Public Health, was created by YOC spoken word artists, under the direction of the organization, Youth Speaks. Methods In phase 1, we describe the communication attributes of the campaign's nine video-poems, coded the content of the pieces, and applied thematic analysis to describe the themes conveyed. In phase 2, we carried out a comparative health communication study to assess the content's potential value. We exposed a sample of the target audience (YOC) to the content of Survival Pending Revolution and a widely viewed comparator campaign (The Conversation). Using a focus group, we solicited participants' views using a semi-structured approach. Using thematic analysis, we summarized the reactions that arose when participants reflected on the attributes of each campaign. Results Findings from phase 1 reveal how engaging YOC artists who embrace Youth Speaks' philosophy of harnessing "life as primary text" resulted in content that is aligned with critical communication theory, focusing on structural determinants of health, including themes of overcoming oppressive systems, health and social inequities, and medical discrimination and mistrust. Findings from phase 2 reveal that this arts-based campaign based on such critical communication theory, when compared to a more traditional campaign, promotes message salience, fosters emotional engagement, and provides a form of validation among historically oppressed groups such that they may be more open to, and potentially act on, the COVID-19 vaccination communications to which they are exposed. Discussion As an example of critical communication, the Survival Pending Revolution campaign encourages health-promoting behavioral decisions while calling out the structural determinants of health that shape risks of exposure and constrain free choice. Engaging uniquely gifted members of marginalized populations as creators and messengers of campaigns lead to content that is aligned with a critical communication approach, whose goal is to aid disparity populations in both resisting and navigating systems that continue to locate them on the margins of society. Our evaluation of this campaign suggests that it represents a promising formative and interventional approach to engendering trust in public health messaging and promoting health equity.
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Affiliation(s)
- Dean Schillinger
- Health Communications Research Program, University of California, San Francisco, San Francisco, CA, United States
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Abstract
PURPOSE Following the pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, different vaccines were developed and approved by the main medical authorities under emergency protocol regulations. Although highly effective and well-tolerated in most patients, vaccines can uncommonly cause ocular adverse effects. In this article, the current evidence related to vaccine-associated uveitis is reviewed. METHODS A literature review of uveitis post various SARS-CoV-2 vaccinations. RESULTS Uveitis was reported following various forms of vaccinations but was more commonly seen following the Pfizer mRNA vaccine which is the most used vaccination worldwide. In western countries, the most common uveitis is mild anterior uveitis, developing within a week of first or subsequent vaccination with good resolution following appropriate topical steroid therapy in most cases. Posterior uveitis and particularly Vogt-Koyanagi-Harada disease was more prevalent in Asia. Uveitis may develop among known uveitis patients and those with other autoimmune diseases. CONCLUSION Uveitis following Covid vaccinations is uncommon and has a good prognosis.
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Affiliation(s)
- Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Piergiorgio Neri
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Lerner College of Medicine, Case Western University, Cleveland, Ohio, USA
- College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Annabelle A Okada
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore
- Lee Kong Chian School of Medicine, Singapore
- Eye ACP Program, Duke NUS Medical School, Antimicrobials and Anti-infectives, Singapore Eye Research Institute, Singapore
| | - Ng Xin Le
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Shai Cohen
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Fischer
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Amy Coman
- University College Dublin Medical School, Dublin, Ireland
- Department of Ophthalmology, Royal Victoria Eye & Ear Hospital, Dublin, Ireland
| | - Dara Kilmartin
- University College Dublin Medical School, Dublin, Ireland
- Department of Ophthalmology, Royal Victoria Eye & Ear Hospital, Dublin, Ireland
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Mathur R. COVID-19 vaccination and fertility: fighting misinformation. Obstet Gynaecol Reprod Med 2023; 33:S1751-7214(23)00060-X. [PMID: 37363425 PMCID: PMC10080270 DOI: 10.1016/j.ogrm.2023.04.004] [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] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
The introduction of vaccination against COVID-19 was associated with widespread misinformation on social media concerning, among other things, the potential effect of the vaccine in reducing fertility and increasing the risk of miscarriage among recipients. Tackling misinformation requires an understanding of the context in which it spreads and careful use of the doctor's knowledge and communication skills. Research into ways of tackling disinformation is still at an early stage, but some measures that are likely to be effective include content moderation, misinformation labelling and improving the level of scientific discussion in public media. Health professionals have a duty to provide unbiased and accurate information, including through the use of social media. This requires the maintenance of empathy, trustworthiness and openness in the face of what may at times be malicious intent.
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Affiliation(s)
- Raj Mathur
- Consultant Gynaecologist, St Mary's Hospital, Manchester NHS Foundation Trust, UK. Conflicts of interest: RM is Chair of the British Fertility Society, which has published FAQs on the COVID-19 vaccine and fertility
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Abstract
The COVID-19 pandemic caused by the SARS-CoV-2 virus represents an unprecedented global health crisis. Safe and effective vaccines were rapidly developed and deployed that reduced COVID-19-related severe disease, hospitalization, and death. Patients with inflammatory bowel disease are not at increased risk of severe disease or death from COVID-19, and data from large cohorts of patients with inflammatory bowel disease demonstrate that COVID-19 vaccination is safe and effective. Ongoing research is clarifying the long-term impact of SARS-CoV-2 infection on patients with inflammatory bowel disease, long-term immune responses to COVID-19 vaccination, and optimal timing for repeated COVID-19 vaccination doses.
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Affiliation(s)
- Keith C Summa
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 1400, Chicago, IL 60611, USA
| | - Stephen B Hanauer
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 1400, Chicago, IL 60611, USA.
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12
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Donaldson L, Margolin E. Variant Guillain-Barre Syndrome Following SARS-CoV-2 Vaccination: Case Report and Review of the Literature. Can J Neurol Sci 2023; 50:138-40. [PMID: 35532270 DOI: 10.1017/cjn.2021.492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Mohammed A, Cortese B. "Spontaneous" Coronary Artery Dissection After SARS-CoV-2 Messenger RNA Vaccination. J Soc Cardiovasc Angiogr Interv 2022; 2:100551. [PMID: 36504691 PMCID: PMC9722217 DOI: 10.1016/j.jscai.2022.100551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ahmed Mohammed
- Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
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Havaldar AA, Prakash J, Kumar S, Sheshala K, Chennabasappa A, Thomas RR, Sushmitha EC, Khan MS, Kumar R, Kindo S, Singh R, Kartik M, Swamy AHM, Raj JM, Thomas T, Selvam S. Demographics and Clinical Characteristics of COVID-19-vaccinated Patients Admitted to ICU: A Multicenter Cohort Study from India (PostCoVac Study-COVID Group). Indian J Crit Care Med 2022; 26:1184-1191. [PMID: 36873595 PMCID: PMC9983652 DOI: 10.5005/jp-journals-10071-24349] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Emergency authorization and approval were given for the coronavirus disease-19 (COVID-19) vaccines. The efficacy reported after phase III trials were 70.4% and 78% for Covishield and Covaxin, respectively.In this study, we aim to analyze the risk factors, which were associated with mortality in critically ill COVID-19-vaccinated patients admitted into intensive care unit (ICU). Materials and methods This study was conducted from April 1, 2021 to December 31, 2021 across five centers in India. Patients who had received either one or two doses of any of the COVID vaccines and developed COVID-19 were included. The ICU mortality was a primary outcome. Results A total of 174 patients with COVID-19 illness were included in the study. The mean age was 57 years standard deviation (SD 15). Acute physiology, age and chronic health evaluation (APACHE II) score and the sequential organ failure assessment (SOFA) score were 14 (8-24.5) and 6 (4-8), respectively. Multiple variable logistic regression showed patients who have received a single dose [odds ratio (OR): 2.89, confidence interval (CI): 1.18, 7.08], neutrophil:lymphocyte (NL) ratio (OR: 1.07, CI: 1.02,1.11), and SOFA score (OR: 1.18, CI: 1.03,1.36) were associated with higher mortality. Conclusion The mortality in the vaccinated patients admitted to the ICU was 43.68% due to COVID illness. The mortality was lower in patients who had received two doses. How to cite this article Havaldar AA, Prakash J, Kumar S, Sheshala K, Chennabasappa A, Thomas RR et al. Demographics and Clinical Characteristics of COVID-19-vaccinated Patients Admitted to ICU: A Multicenter Cohort Study from India (PostCoVac Study-COVID Group). Indian J Crit Care Med 2022;26(11):1184-1191.
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Affiliation(s)
- Amarja Ashok Havaldar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Jay Prakash
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Sanjeev Kumar
- Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Kaladhar Sheshala
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | | | - Ria Rachel Thomas
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Ea Chinny Sushmitha
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Mohd Saif Khan
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Raman Kumar
- Department of Anaesthesiology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Srishti Kindo
- Department of Anaesthesiology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Ritu Singh
- Department of Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Munta Kartik
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | | | - John Michael Raj
- Department of Biostatistics, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Tinku Thomas
- Department of Biostatistics, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Sumithra Selvam
- Division of Epidemiology and Biostatistics, St John's Research Institute, Bengaluru, Karnataka, India
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15
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Ojha V, Nagulakonda S, Malhi AS, Mishra S, Jagia P. Advanced cardiac MRI to detect myocarditis after COVID-19 vaccination in a 22-year-old man. Acta Cardiol 2022; 77:855-856. [PMID: 35341465 DOI: 10.1080/00015385.2022.2054494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sravan Nagulakonda
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarindar Singh Malhi
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sundeep Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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16
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Thakar M, Bhattacharya S. Central retinal artery occlusion after vaccination with whole virion inactivated SARSCoV- 2 vaccine Covaxin. Indian J Ophthalmol 2022; 70:3716-3718. [PMID: 36190081 PMCID: PMC9789834 DOI: 10.4103/ijo.ijo_1148_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccinations have been associated with a higher risk of thromboembolic events. There have been no reports of central retinal artery occlusion (CRAO) after vaccination with the indigenously developed Covaxin, and worldwide, there has been only one such isolated case after administration of the AstraZeneca vaccine. We report a case of a 44-year-old healthy man who presented with sudden painless vision loss in his left eye 10 days after receiving Covaxin. His best-corrected visual acuity was minimal perception of light, with a relative afferent pupillary defect. Fundus examination revealed arterial attenuation and macular cherry red spot, suggesting an acute CRAO. Optical coherence tomography showed macular swelling and disorganization of the inner layers due to ischemic sequelae. Blood work was normal and cardiovascular examination was unremarkable. The patient was kept on follow-up. To our knowledge, this is the first case of an isolated CRAO after Covaxin administration, but further studies are needed to evaluate this potential association.
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Affiliation(s)
- Meenakshi Thakar
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Shruti Bhattacharya
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, Delhi, India,Correspondence to: Dr. Shruti Bhattacharya, Retina Clinic, Guru Nanak Eye Centre, Maharaja Ranjit Singh Marg, New Delhi - 110002, India. E-mail:
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De Marco G, Giryes S, Williams K, Alcorn N, Slade M, Fitton J, Nizam S, Smithson G, Iqbal K, Tran G, Pekarska K, Keen MUH, Solaiman M, Middleton E, Wood S, Buss R, Devine K, Marzo-Ortega H, Green M, McGonagle DG. A Large Cluster of New Onset Autoimmune Myositis in the Yorkshire Region Following SARS-CoV-2 Vaccination. Vaccines (Basel) 2022; 10:vaccines10081184. [PMID: 35893834 PMCID: PMC9331977 DOI: 10.3390/vaccines10081184] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The novel SARS-CoV-2 vaccines partially exploit intrinsic DNA or RNA adjuvanticity, with dysregulation in the metabolism of both these nucleic acids independently linked to triggering experimental autoimmune diseases, including lupus and myositis. Methods: Herein, we present 15 new onset autoimmune myositis temporally associated with SARS-CoV-2 RNA or DNA-based vaccines that occurred between February 2021 and April 2022. Musculoskeletal, pulmonary, cutaneous and cardiac manifestations, laboratory and imaging data were collected. Results: In total, 15 cases of new onset myositis (11 polymyositis/necrotizing/overlap myositis; 4 dermatomyositis) were identified in the Yorkshire region of approximately 5.6 million people, between February 2021 and April 2022 (10 females/5 men; mean age was 66.1 years; range 37–83). New onset disease occurred after first vaccination (5 cases), second vaccination (7 cases) or after the third dose (3 cases), which was often a different vaccine. Of the cases, 6 had systemic complications including skin (3 cases), lung (3 cases), heart (2 cases) and 10/15 had myositis associated autoantibodies. All but 1 case had good therapy responses. Adverse event following immunization (AEFI) could not be explained based on the underlying disease/co-morbidities. Conclusion: Compared with our usual regional Rheumatology clinical experience, a surprisingly large number of new onset myositis cases presented during the period of observation. Given that antigen release inevitably follows muscle injury and given the role of nucleic acid adjuvanticity in autoimmunity and muscle disease, further longitudinal studies are required to explore potential links between novel coronavirus vaccines and myositis in comparison with more traditional vaccine methods.
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Affiliation(s)
- Gabriele De Marco
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK; (G.D.M.); (K.D.); (H.M.-O.)
- Section of Experimental Rheumatology, The Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK;
| | - Sami Giryes
- Section of Experimental Rheumatology, The Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK;
| | - Katie Williams
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK; (K.W.); (N.A.); (M.S.); (J.F.)
| | - Nicola Alcorn
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK; (K.W.); (N.A.); (M.S.); (J.F.)
| | - Maria Slade
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK; (K.W.); (N.A.); (M.S.); (J.F.)
| | - John Fitton
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK; (K.W.); (N.A.); (M.S.); (J.F.)
| | - Sharmin Nizam
- Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK; (S.N.); (G.S.); (K.I.)
| | - Gayle Smithson
- Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK; (S.N.); (G.S.); (K.I.)
| | - Khizer Iqbal
- Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK; (S.N.); (G.S.); (K.I.)
| | - Gui Tran
- Harrogate and District NHS Foundation Trust, Harrogate HG2 7SX, UK; (G.T.); (K.P.); (M.G.)
| | - Katrina Pekarska
- Harrogate and District NHS Foundation Trust, Harrogate HG2 7SX, UK; (G.T.); (K.P.); (M.G.)
| | | | - Mohammad Solaiman
- Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK; (M.S.); (E.M.); (S.W.); (R.B.)
| | - Edward Middleton
- Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK; (M.S.); (E.M.); (S.W.); (R.B.)
| | - Samuel Wood
- Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK; (M.S.); (E.M.); (S.W.); (R.B.)
| | - Rihards Buss
- Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK; (M.S.); (E.M.); (S.W.); (R.B.)
| | - Kirsty Devine
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK; (G.D.M.); (K.D.); (H.M.-O.)
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK; (G.D.M.); (K.D.); (H.M.-O.)
- Section of Experimental Rheumatology, The Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK;
| | - Mike Green
- Harrogate and District NHS Foundation Trust, Harrogate HG2 7SX, UK; (G.T.); (K.P.); (M.G.)
| | - Dennis Gerald McGonagle
- Section of Experimental Rheumatology, The Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK;
- Correspondence:
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Hazra D, Nekkanti AC, Moorthy M, Prabhakar Abhilash KP. Three waves, three vaccines, three COVID-19 infections - Saga of a frontline health care worker during the pandemic. Indian J Med Microbiol 2022; 40:608-610. [PMID: 35868947 PMCID: PMC9296257 DOI: 10.1016/j.ijmmb.2022.07.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/05/2022] [Accepted: 07/06/2022] [Indexed: 11/05/2022]
Abstract
The COVID-19 pandemic affected millions around the globe, with front line healthcare workers (HCW) amongst the most vulnerable. The Emergency Department (ED) was the first line of care for all patients infected with the virus, making HCWs in the ED one of the most exposed populations during the pandemic. We highlight the case of a 35-year-old ED physician who developed COVID-19 infections on three separate instances during the peaks of each wave despite the usage of personal protective equipment and being triple vaccinated.
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Affiliation(s)
- Darpanarayan Hazra
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, 632004, India.
| | - Ankita Chowdary Nekkanti
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, 632004, India.
| | - Mahesh Moorthy
- Department of Clinical Virology, Christian Medical College and Hospital, Vellore, 632004, India.
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Stoll SE, Werner P, Wetsch WA, Dusse F, Bunck AC, Kochanek M, Popp F, Schmidt T, Bruns C, Böttiger BW. Transjugular intrahepatic portosystemic shunt, local thrombaspiration, and lysis for management of fulminant portomesenteric thrombosis and atraumatic splenic rupture due to vector-vaccine-induced thrombotic thrombocytopenia: a case report. J Med Case Rep 2022; 16:271. [PMID: 35821156 PMCID: PMC9274642 DOI: 10.1186/s13256-022-03464-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/17/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Recombinant adenoviral vector vaccines against severe acute respiratory syndrome coronavirus 2 have been observed to be associated with vaccine-induced immune thrombotic thrombocytopenia. Though vaccine-induced immune thrombotic thrombocytopenia is a rare complication after vaccination with recombinant adenoviral vector vaccines, it can lead to severe complications. In vaccine-induced immune thrombotic thrombocytopenia, the vector vaccine induces heparin-independent production of platelet factor 4 autoantibodies, resulting in platelet activation and aggregation. Therefore, patients suffering from vaccine-induced immune thrombotic thrombocytopenia particularly present with signs of arterial or venous thrombosis, often at atypical sites, but also signs of bleeding due to disseminated intravascular coagulation and severe thrombocytopenia. We describe herein a rare case of fulminant portomesenteric thrombosis and atraumatic splenic rupture due to vaccine-induced immune thrombotic thrombocytopenia. Case summary (main symptoms and therapeutic interventions) This case report presents the diagnosis and treatment of a healthy 29-year-old male Caucasian patient suffering from an extended portomesenteric thrombosis associated with atraumatic splenic rupture due to vaccine-induced immune thrombotic thrombocytopenia after the first dose of an adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2 [ChAdOx1 nCoV-19 (AZD1222)]. Therapeutic management of vaccine-induced immune thrombotic thrombocytopenia initially focused on systemic anticoagulation avoiding heparin and the application of steroids and intravenous immune globulins as per the recommendations of international societies of hematology and hemostaseology. Owing to the atraumatic splenic rupture and extended portomesenteric thrombosis, successful management of this case required splenectomy with additional placement of a transjugular intrahepatic portosystemic shunt to perform local thrombaspiration, plus repeated local lysis to reconstitute hepatopetal blood flow. Conclusion The complexity and wide spectrum of the clinical picture in patients suffering from vaccine-induced immune thrombotic thrombocytopenia demand an early interdisciplinary diagnostic and therapeutic approach. Severe cases of portomesenteric thrombosis in vaccine-induced immune thrombotic thrombocytopenia, refractory to conservative management, may require additional placement of a transjugular intrahepatic portosystemic shunt, thrombaspiration, thrombolysis, and surgical intervention for effective management.
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Affiliation(s)
- Sandra Emily Stoll
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Patrick Werner
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Wolfgang A Wetsch
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Felix Popp
- Department of General, Visceral, Tumor and Transplantation Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Tumor and Transplantation Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Christiane Bruns
- Department of General, Visceral, Tumor and Transplantation Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Campise M, Alfieri CM, Benedetti M, Perna A, Miglio R, Molinari P, Cervesato A, Giuliani S, Gandolfo MT, Regalia A, Cresseri D, Alagna L, Gori A, Castellano G. How Vaccinations Changed the Outcome of COVID-19 Infections in Kidney Transplant Patients: Single-Center Experience. Vaccines (Basel) 2022; 10. [PMID: 35891153 DOI: 10.3390/vaccines10070990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 12/04/2022] Open
Abstract
Kidney transplant recipients are a vulnerable population at risk of a life-threatening COVID-19 infection with an incidence of death four-times higher than in the general population. The availability of mRNA COVID-19 vaccines has dramatically changed the fate of this infection also within this fragile population. Transplanted patients have an impaired immunological response also to mRNA vaccines. In March 2021, however, we started a vaccination campaign. These preliminary results show that both the incidence of death and of hospitalization dropped from 13% to 2.4% and from 45% to 12.5% compared to the previous outbreaks reported by our group. In univariate analysis, two variables were associated with an increased risk of hospitalization: older age and dyspnea (p = 0.023, p < 0.0001, respectively). In multivariate analysis, dyspnea (p < 0.0001) and mycophenolate therapy (p = 0.003) were independently associated with the risk of hospitalization. The association was even stronger when the two variables were combined (p < 0.0001). Vaccinations did not reduce the incidence of COVID-19 infections among our transplanted patients, but provided certain protection that was associated with a significantly better outcome for this infection.
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21
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Sadeh B, Ugolini S, Pinzon OW, Potapov EV, Selzman CH, Bader F, Zuckermann AO, Gomez-Mesa JE, Shah KS, Alharethi R, Morejon-Barragan P, Hanff T, Goldraich LA, Farrero M, MacDonald PS, Drakos S, Mehra MR, Stehlik J. Medical decisions in organ donors and heart transplant candidates with history of COVID-19 infection: An international practice survey. Clin Transplant 2022; 36:e14733. [PMID: 35652422 PMCID: PMC9347846 DOI: 10.1111/ctr.14733] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/23/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
Background A growing proportion of transplant donors and recipients have a history of COVID‐19 infection. This study sought to characterize clinical practice after recipient or donor COVID‐19 infection. Methods An online survey was distributed to heart transplant clinicians through a professional society message board and social media. Responses were collected between September 29 and November 5, 2021. Results There were 222 health care professionals (68% transplant cardiologists, 22% transplant surgeons, 10% other) across diverse geographic regions who completed the survey. While there was significant variation in donor acceptance, as it relates to past and current COVID‐19 infection, the respondents were fairly cautious: 28% would not typically accept a donor with a history of COVID‐19 regardless of the infection course and > 80% would not accept donors who had evidence of myocardial dysfunction during past COVID‐19 infection, or who died of COVID‐19 or its complications. The timing of candidate reactivation on the waiting list after COVID‐19 infection also varied and often diverged from scenarios addressed by social guidelines. Eighty‐one percent of the respondents felt COVID‐19 vaccine should be mandatory before transplant, but this rate varied by geographic region. Conclusion Our results reflect evolving experience of the heart transplant field at a time of lack of high‐quality evidence. In the absence of longer‐term outcome data for donors and transplant candidates with history of COVID‐19 infection, clinicians remain cautious; however, this approach will likely need to be refined as an increasing proportion of the population will continue to be infected with COVID‐19.
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Affiliation(s)
- Ben Sadeh
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sharon Ugolini
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Omar Wever Pinzon
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Feras Bader
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | | | | | - Kevin S Shah
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rami Alharethi
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
| | - Paola Morejon-Barragan
- Heart Failure and Transplantation Unit, Cardiac Critical Care Unit, Clinica Guayaquil, Guayaquil, Ecuador
| | - Thomas Hanff
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Livia A Goldraich
- Heart Transplantation Unit, Cardiology Department, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marta Farrero
- Heart Failure Unit, Cardiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Peter S MacDonald
- Heart Failure and Transplant Unit, Cardiology Department, St Vincent's Hospital, Sydney, Australia
| | - Stavros Drakos
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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22
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Barrios Y, Franco A, Alava-Cruz C, Cuesta-Martin R, Camara C, Matheu V. Easy approach to detect cell immunity to COVID vaccines in common variable immunodeficiency patients. Allergol Immunopathol (Madr) 2022; 50:101-5. [PMID: 35527662 DOI: 10.15586/aei.v50i3.583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with primary antibody deficiencies, such as Common Variable Immunodeficiency (CVID), have some problems to assess immune response after coronavirus disease (COVID) vaccination. Cutaneous delayed-type hypersensitivity (DTH) has the potential to be used as a useful, simple, and cheaper tool to assess T-cell (T lymphocyte) function. METHODS Seventeen patients with CVID, a rare disease, received two doses of the mRNA-based Pfizer-BioNTech COVID-19 vaccine. Humoral Immune Response (HIR) was determined by measuring specific immunoglobulin G (IgG) antibodies, and Cellular Immune Response (CIR) was evaluated using an ex vivo interferon-gamma release assay (IGRA) and in vivo by DTH skin test. RESULTS Two weeks after the second dose of the vaccine, 12 out of 17 CVID patients have high optical density (OD) ratios of specific anti-spike protein (S) IgG whereas five patients were negative or low. Ex vivo CIR was considered positive in 14 out of 17 S1-stimulated patients. Unspecific stimulation was positive in all 17 patients showing no T-cell defect. A positive DTH skin test was observed in 16 CVID patients. The only patient with negative DTH also had negative ex vivo CIR. CONCLUSIONS The use of DTH to evaluate CIR was validated with an optimal correlation with the ex vivo CIR. The CIR after vaccination in patients with antibody deficiencies seems to have high precision and more sensitivity to antibodies-based methods in CVID. CLINICAL IMPLICATIONS There is a remarkable correlation between cutaneous DTH and ex vivo IGRA after COVID vaccination. A COVID-specific skin DTH test could be implemented in large populations. CAPSULE SUMMARY Cutaneous delayed-type hypersensitivity has the potential to be used as a useful, simple, and cheaper tool to assess T-cell functioning.
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Wisnivesky JP, Govindarajulu U, Bagiella E, Goswami R, Kale M, Campbell KN, Meliambro K, Chen Z, Aberg JA, Lin JJ. Association of Vaccination with the Persistence of Post-COVID Symptoms. J Gen Intern Med 2022; 37:1748-1753. [PMID: 35266128 PMCID: PMC8906626 DOI: 10.1007/s11606-022-07465-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 11/04/2021] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients who have had COVID-19 often report persistent symptoms after resolution of their acute illness. Recent reports suggest that vaccination may be associated with improvement in post-acute symptoms. We used data from a prospective cohort to assess differences in post-acute sequelae of COVID (PASC) among vaccinated vs. unvaccinated patients. METHODS We used data from a cohort of COVID-19 patients enrolled into a prospective registry established at a tertiary care health system in New York City. Participants underwent a baseline evaluation before COVID-19 vaccines were available and were followed 6 months later. We compared unadjusted and propensity score-adjusted baseline to 6-month change for several PASC-related symptoms and measures: anosmia, respiratory (cough, dyspnea, phlegm, wheezing), depression, anxiety, post-traumatic stress disorder (PTSD; COVID-19-related and other trauma), and quality-of-life domains among participants who received vs. those who did not receive COVID-19 vaccination. RESULTS The study included 453 COVID-19 patients with PASC, of which 324 (72%) were vaccinated between the baseline and 6-month visit. Unadjusted analyses did not show significant differences in the baseline to 6-month change in anosmia, respiratory symptoms, depression, anxiety, PTSD, or quality of life (p > 0.05 for all comparisons) among vaccinated vs. unvaccinated patients. Similar results were found in propensity-adjusted comparisons and in secondary analyses based on the number of vaccine doses received. CONCLUSIONS Our findings suggest that COVID vaccination is not associated with improvement in PASC. Additional studies are needed to better understand the mechanisms underlying PASC and to develop effective treatments.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Usha Govindarajulu
- Department of Population Health and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emilia Bagiella
- Department of Population Health and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruchir Goswami
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Minal Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kirk N Campbell
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Meliambro
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zijian Chen
- Division of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Abstract
Light chain (AL) amyloidosis is a potentially fatal disease of monoclonal plasma cells that leads to accumulation of light chain amyloid fibrils, organ damage, and the manifestations of clinical disease. Meanwhile, coronavirus disease 2019 (COVID-19) is a disease caused by infection with the severe acute respiratory syndrome coronavirus 2 virus, with the potential to cause severe systemic illness and death. There is significant overlap in the demographics and comorbidities observed in AL amyloidosis and those associated with highest risk for severe morbidity and mortality due to COVID-19. This overlap creates unique challenges in caring for patients with AL amyloidosis, which are further compounded by the immunosuppressive nature of anti-plasma cell therapies, the need for frequent clinical assessments, and the exclusion of AL amyloidosis patients from initial COVID-19 vaccine trials. Herein, we highlight many of the relevant concerns related to COVID-19 and the treatment of AL amyloidosis, summarize a general approach for AL amyloidosis management amidst the ongoing COVID-19 pandemic, and discuss current guidance about COVID-19 vaccination of patients with AL amyloidosis.
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Affiliation(s)
- Zachary D Crees
- School of Medicine, Division of Oncology, Washington University in St. Louis, Mo.
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25
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Fenoglio R, Lalloni S, Marchisio M, Oddone V, De Simone E, Del Vecchio G, Sciascia S, Roccatello D. New Onset Biopsy-Proven Nephropathies after COVID Vaccination. Am J Nephrol 2022; 53:325-330. [PMID: 35354140 PMCID: PMC9059008 DOI: 10.1159/000523962] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/03/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To date, almost 7 billion doses of the different types of vaccine against SARS-CoV-2 have been administered worldwide. Although the severity of new cases of SARS-CoV-2 has progressively decreased, and the pressure on national health systems has declined, the development of de novo glomerular injuries has been suggested. METHODS This study aimed to examine the patients who were hospitalized in our Unit between April and November 2021 and underwent renal biopsy for new-onset urinary abnormalities (UA) and/or renal impairment within 3 months of SARS-CoV-2 vaccination. RESULTS We identified 17 patients who developed UA and/or renal insufficiency within 3 months of vaccination. Minimal change disease was the most common disease in our cohort (5 patients, 29.4%) followed by acute tubulointerstitial nephritis (TIN; 3 patients, 17.6%), membranous nephropathy (3 patients, 17.6%), and rapidly progressive IgA nephropathy (2 patients, 11.8%). The other 4 patients had a diagnosis of membranoproliferative glomerulonephritis (1 patient), systemic lupus erythematosus (1 patient), ANCA-associated vasculitis (1 patient), and tip-variant focal segmental glomerulosclerosis (1 patient), respectively. Eight out of the 17 patients (47.1%) developed acute kidney injury. Two patients with acute TIN had to start hemodialysis that was discontinued after 1 and 2 months, respectively, due to the recovery of renal function. All patients underwent treatment with corticosteroids and/or immunosuppressants. DISCUSSION Although it is not possible to conclusively determine whether there is a causal relationship between SARS-CoV-2 vaccination and new-onset nephropathies, based on the appearance of UA and/or renal insufficiency shortly after vaccination, we hypothesize that the immune response to the COVID-19 vaccine may be a trigger of nephropathies. Therefore, our results highlight the need for pharmacovigilance. However, this report should not lead to vaccine hesitation during this pandemic as the benefits of vaccination strongly outweigh the potential risks.
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Affiliation(s)
- Roberta Fenoglio
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) including the Nephrology and Dialysis Unit, Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), Department of Clinical and Biological Sciences, San Giovanni Bosco Hub Hospital, University of Turin, Turin, Italy
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26
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Swift P, Bunn L. An analysis of Public Health England's vaccination data for care home workers immediately preceding a 'Roadmap out of COVID-19 Lockdown'. BJGP Open 2022; 6:BJGPO. [PMID: 35027351 DOI: 10.3399/BJGPO.2021.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
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27
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Bansal SB, Rana AS, Manhas N, Rana A. Post COVID Vaccination (COVAXIN™ -BB152 V) Pauci-immune Crescentic Glomerulonephritis. Indian J Nephrol 2022; 32:495-497. [PMID: 36568599 PMCID: PMC9775610 DOI: 10.4103/ijn.ijn_352_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/06/2021] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic is responsible for widespread morbidity and mortality. The vaccination against the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, the cause of the COVID-19 pandemic, is currently ongoing across the globe. Rapid vaccination is of paramount importance to mitigate this pandemic. Although considered safe in general, these vaccines have their share of rare adverse events. We report a case of antineutrophil cytoplasmic antibody (ANCA)-associated pauci-immune crescentic glomerulonephritis 15 days post 2nd dose of a killed COVID-19 (COVAXIN™ -BB152 V) vaccine. We hypothesize that vaccination triggered a systemic immune response in a susceptible patient to develop ANCA-associated vasculitis (AAV), leading to rapidly progressive glomerulonephritis (RPGN).
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Affiliation(s)
- Shyam B. Bansal
- Department of Nephrology and Renal Transplant Medicine, Medanta -The Medicity, Gurugram, India
| | - Abhyuday S. Rana
- Department of Nephrology and Renal Transplant Medicine, Medanta -The Medicity, Gurugram, India,Address for correspondence: Dr. Abhyuday S. Rana, Department of Nephrology and Renal Transplant Medicine, Medanta -The Medicity, Sector 38, Gurguram - 122001, Haryana, India. E-mail:
| | - Neha Manhas
- Department of Nephrology and Renal Transplant Medicine, Medanta -The Medicity, Gurugram, India
| | - Alka Rana
- Department of Pathology and Laboratory Medicine, Medanta -The Medicity, Gurugram, India
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28
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Li C, Douglas M, Zahidi R, Josiah Willock R, Caplan L, Baltrus P, Gillis E, Mack D, Gaglioti A. Racial and ethnic disparities in H1N1 vaccine uptake in Medicaid: Lessons learned for a COVID-19 vaccine rollout. Prev Med Rep 2021; 24:101588. [PMID: 34642618 PMCID: PMC8498984 DOI: 10.1016/j.pmedr.2021.101588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/07/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Racial and ethnic minorities in the US have been disproportionately affected by the COVID-19 pandemic and are at risk for disparities in COVID-19 vaccinations. The H1N1 flu vaccine experience provides lessons learned to address and prevent racial and ethnic disparities in COVID-19 vaccinations. We aim to identify racial/ethnic and geographic disparities in H1N1 vaccinations among Medicaid enrollees to inform equitable COVID-19 vaccination policies and strategies. Methods The study population included people under 65 who were continuously enrolled in Medicaid in 2009 and 2010 from 28 states and the District of Columbia. H1N1 vaccinations were identified from Medicaid outpatient claims. Vaccination rates were calculated for the overall sample and subpopulations by race/ethnicity and state. Results 3,708,894 (12.3%) Medicaid enrollees in the sample were vaccinated for H1N1 in 2009-2010. Race-specific vaccination rates ranged from 8.1% in American Indian/Alaska Native (AI/AN) to 19.8% in Asian/Pacific Islander Medicaid enrollees. NHB enrollees had lower vaccination rates than non-Hispanic White (NHW) enrollees in all states, with the exceptions of Maryland, Missouri, Ohio, and Washington. The largest disparity between NHB and NHW was in Pennsylvania (1.0% vs. 7.0%), while the largest absolute difference between NHB and NHW enrollees was in Georgia (17.4% vs. 30.7%). Conclusions Our study found huge variation in H1N1 vaccinations across states and racial/ethnic disparities in H1N1 vaccinations within states. In most states, NHB and AI/AN Medicaid enrollees had lower vaccination rates than Whites. Hispanic and Asian/Pacific Islander Medicaid enrollees in most states had higher vaccination rates than Whites.
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Affiliation(s)
- Chaohua Li
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
| | - Megan Douglas
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
| | - Rabab Zahidi
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
| | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
| | - Lee Caplan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
| | - Peter Baltrus
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
| | - Eric Gillis
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
| | - Dominic Mack
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
| | - Anne Gaglioti
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States.,Department of Family Medicine, Morehouse School of Medicine, 720 Westview Dr, SWAtlanta, GA 30310, United States
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29
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Hine AM, Grant-Kels JM, Feng H. The ethics of considering COVID vaccination status in the provision of dermatologic care. J Am Acad Dermatol 2021; 86:258-259. [PMID: 34610380 PMCID: PMC8517573 DOI: 10.1016/j.jaad.2021.09.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ashley M Hine
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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30
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Bobdey S, Kaushik SK, Menon AS. The conundrum of two-dose interval of ChAdOx1 nCOV-19 corona virus vaccine: Way ahead. Med J Armed Forces India 2021; 77:S250-S253. [PMID: 34334889 PMCID: PMC8313024 DOI: 10.1016/j.mjafi.2021.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/28/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Saurabh Bobdey
- Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S K Kaushik
- Professor & Head, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - A S Menon
- Professor & Head, Department of Internal Medicine, Armed Forces Medical College, Pune, India
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31
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Easdale S, Shea R, Ellis L, Bazin J, Davis K, Dallas F, Thistlethwayte E, Ethell M, Potter M, Arias C, Anthias C, Nicholson E. Serologic Responses following a Single Dose of SARS-Cov-2 Vaccination in Allogeneic Stem Cell Transplantation Recipients. Transplant Cell Ther 2021; 27:880.e1-880.e4. [PMID: 34293520 PMCID: PMC8288211 DOI: 10.1016/j.jtct.2021.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022]
Abstract
Immunocompromised individuals were not included in formal trials of SARS-CoV-2 mRNA vaccines. Subsequent studies in patients with hematologic malignancies and solid organ transplantation recipients suggest inferior responses to vaccination. We determined antibody responses to a single dose of vaccines in one of the most vulnerable patient groups, allogeneic hematopoietic cell transplantation (allo-HCT) recipients. Pfizer-BioNTech (PB) or AstraZeneca (AZ) SARS-CoV-2 vaccines were administered at least 3 months post-transplantation to 55 adult allo-HCT recipients. We found that older age and concurrent use of immunosuppressive medications were significantly associated with lack of antibody response to vaccination. Only 21% of patients on systemic immunosuppression mounted a response, compared with 58% of patients not on immunosuppression (P = .006). We also show that responses to the AZ vaccine may be superior to responses to the PB vaccine in this cohort. These findings highlight the need for novel immunogenic vaccine formulations and schedules in these highest-risk patients, as well as continued public healthy safety measures to protect the most vulnerable members of our society.
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Affiliation(s)
| | - Robyn Shea
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
| | - Lauren Ellis
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
| | - Jessica Bazin
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
| | - Kim Davis
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
| | - Fiona Dallas
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
| | | | - Mark Ethell
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
| | - Mike Potter
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
| | - Carlos Arias
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
| | - Chloe Anthias
- The Royal Marsden NHS Hospital, Sutton, United Kingdom
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32
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Thienemann F, Chakafana G, Piñeiro D, Pinto FJ, Perel P, Singh K, Eiselé JL, Prabhakaran D, Sliwa K. WHF Position Statement on COVID Vaccination. Glob Heart 2021; 16:29. [PMID: 34040942 DOI: 10.5334/gh.1027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The current COVID-19 pandemic has challenged health systems and communities globally. As such, several countries have embarked on national COVID-19 vaccination programmes in order to curb spread of the disease. However, at present, there isn't yet enough dosages to enable vaccination of the general population. Different vaccine prioritization strategies are thus being implemented in different communities in order to permit for a systematic vaccination of individuals. Here, on behalf of the World Heart Federation, we emphasize the need for individuals with Cardiovascular disease to be prioritized in national vaccine prioritization programmes as these are high risk individuals.
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Russo AG, Decarli A, Valsecchi MG. Strategy to identify priority groups for COVID-19 vaccination: A population based cohort study. Vaccine 2021; 39:2517-2525. [PMID: 33824037 PMCID: PMC7997303 DOI: 10.1016/j.vaccine.2021.03.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/17/2022]
Abstract
Background Evidence from COVID-19 outbreak shows that individuals with specific chronic diseases are at higher risk of severe prognosis after infection. Public health authorities are developing vaccination programmes with priorities that minimize the risk of mortality and severe events in individuals and communities. We propose an evidence-based strategy that targets the frailest subjects whose timely vaccination is likely to minimize future deaths and preserve the resilience of the health service by preventing infections. Methods The cohort includes 146,087 cases with COVID-19 diagnosed in 2020 in Milan (3.49 million inhabitants). Individual level data on 42 chronic diseases and vital status updated as of January 21, 2021, were available in administrative data. Analyses were performed in three sub-cohorts of age (16–64, 65–79 and 80+ years) and comorbidities affecting mortality were selected by means of LASSO cross-validated conditional logistic regression. Simplified models based on previous results identified high-risk categories worth targeting with highest priority. Results adjusted by age and gender, were reported in terms of odds ratios and 95%CI. Results The final models include as predictors of mortality (7,667 deaths, 5.2%) 10, 12, and 5 chronic diseases, respectively. The older age categories shared, as risk factors, chronic renal failure, chronic heart failure, cerebrovascular disease, Parkinson disease and psychiatric diseases. In the younger age category, predictors included neoplasm, organ transplantation and psychiatric conditions. Results were consistent with those obtained on mortality at 60 days from diagnosis (6,968 deaths). Conclusion This approach defines a two-level stratification for priorities in the vaccination that can easily be applied by health authorities, eventually adapted to local results in terms of number and types of comorbidities, and rapidly updated with current data. After the early phase of vaccination, data on effectiveness and safety will give the opportunity to revise prioritization and discuss the future approach in the remaining population.
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Affiliation(s)
- Antonio Giampiero Russo
- Epidemiology Unit, Agency for Health Protection of the Metropolitan Area of Milan, Milan, Italy.
| | - Adriano Decarli
- Epidemiology Unit, Agency for Health Protection of the Metropolitan Area of Milan, Milan, Italy
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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