COVID-19 phase 4 vaccine candidates, effectiveness on SARS-CoV-2 variants, neutralizing antibody, rare side effects, traditional and nano-based vaccine platforms: a review

The spectrum of side effects associated with COVID-19 vaccines in patients with inborn errors of immunity

OBJECTIVE

COVID-19 immunization was implemented with emergency-use authorization. We had concerns/lack of information on mRNA vaccine side effects in different inborn errors of immunity (IEI) types.

METHODS

We enrolled 141 patients (IEIP) and 151 healthy controls(HC) who received SARS-CoV-2 vaccine/s(Sinovac and/or Pfizer-BioNTech(mRNA vaccine), one to five doses), questioned them for side-effects, evaluated in three groups according to the vaccine/s they received; only Sinovac, only Pfizer-BioNTech, and both vaccines.

RESULTS

Arm pain, generalized weakness, myalgia, and fever were common side effects in IEI-P and HC groups. Generalized weakness/fatigue, fever, and palpitation were significantly frequent in IEI-P who experienced COVID-19 compared to those who did not (p = 0.021, p = 0.047, and p = 0.024, respectively). Severe symptoms after vaccination, new-onset splenomegaly and pancytopenia, urticaria, herpes simplex virus (HSV), and varicella zoster virus (VZV) reactivation were seen in four IEI-P (2.8%).

CONCLUSION

IEI-P mRNA vaccination is relatively safe compared to the conventional vaccine. Individuals who experience uncommon side effects should undergo immunological screening.

Immunogenicity of Mix-and-Match CoronaVac/BNT162b2 Regimen versus Homologous CoronaVac/CoronaVac Vaccination: A Single-Blinded, Randomized, Parallel Group Superiority Trial

(1) Background: This study aimed to compare the immunogenicity of the mix-and-match CoronaVac/BNT162b2 vaccination to the homologous CoronaVac/CoronaVac regimen. (2) Methods: We conducted a simple-blinded randomized superiority trial to measure SARS-CoV-2 neutralization antibodies and anti-spike receptor binding domain (RBD) IgG concentrations in blood samples of participants who had received the first dose of CoronaVac vaccine followed by a dose of BNT162b2 or CoronaVac vaccine. The primary endpoint for immunogenicity was the serum-neutralizing antibody level with a percentage of inhibition at 90% at 21-35 days after the boost. A difference of 25% between groups was considered clinically relevant. (3) Results: Among the 240 eligible participants, the primary endpoint data were available for 100 participants randomly allocated to the mix-and-match group versus 99 participants randomly allocated to the homologous dose group. The mix-and-match regimen elicited significantly higher levels of neutralizing antibodies (median level of 96%, interquartile range (IQR) (95-97) versus median level of 94%, IQR (81-96) and anti-spike IgG antibodies (median level of 13,460, IQR (2557-29,930) versus median level of 1190, IQR (347-4964) compared to the homologous group. Accordingly, the percentage of subjects with a percentage of neutralizing antibodies > 90% was significantly higher in the mix-and-match group (90.0%) versus the homologous (60.6%). Interestingly, no severe events were reported within 30 days after the second dose of vaccination in both groups. (4) Conclusions: Our data showed the superiority of the mix-and-match CoronaVac/BNT162b2 vaccination compared to the CoronaVac/CoronaVac regimen in terms of immunogenicity, thus constituting a proof-of-concept study supporting the use of inactivated vaccines in a mix-and-match strategy while ensuring good immunogenicity and safety.

An update on vaccine status and the role of nanomedicine against SARS-CoV-2: A narrative review

Background and Aims

Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 novel coronavirus, is a highly communicable disease that gave rise to the ongoing pandemic. Despite prompt action across many laboratories in many countries, effective management of this disease is still out of reach. The focus of this review is to describe various vaccination approaches and nanomedicine-based delivery systems against COVID-19.

Methods

The articles included in this study were searched and added from different electronic databases, including PubMed, Scopus, Cochrane, Embase, and preprint databases.

Results

Mass immunization with vaccines is currently at the forefront of COVID-19 infection control. Such vaccines are live attenuated vaccines, inactivated vaccines, nucleic acid-based vaccines, protein subunit vaccines, viral-vector vaccines, and virus-like particle platforms. However, many promising avenues are currently being explored in laboratory and clinical settings, including treatment options, prevention, diagnosis, and management of the disease. Soft nanoparticles like lipid nanoparticles (solid lipid nanoparticles (SLNPs), liposomes, nanostructured lipid carriers, nanoemulsions, and protein nanoparticles play an essential role in nanomedicine. Because of their unique and excellent properties, nanomedicines have potential applications in treating COVID-19 disease.

Conclusions

This review work provides an overview of the therapeutic aspects of COVID-19, including vaccination and the role of nanomedicines in the diagnosis, treatment, and prevention of COVID-19.

Empyema with an extensive retroperitoneal abscess after the first dose of the COVID-19 vaccine, a case report

INTRODUCTION

The most common side effects were mild pain at the injection site and fever after the COVID-19 vaccination. A retroperitoneal abscess is a rare disorder with a deceptive onset and difficult diagnosis. It has various reasons and is related to a high mortality rate.

CASE PRESENTATION

A 29-year-old man with a recent history of first-dose Covid-19 vaccination, was referred for dyspnea, chest, and abdominal pain. Chest imaging revealed a lung abscess evacuated to pleural space. Left posterolateral thoracotomy surgery was done. Post-operation abdominopelvic imaging revealed increased fat stranding and fluid collection, suggesting retroperitoneal infection and abscess formation and the patient underwent drainage.

CLINICAL DISCUSSION

Common side effects after COVID-19 vaccination were mild and expectable without hospitalization. But in our case, a rare complicated side effect was seen.

CONCLUSION

Uncommon side effects should be observed to recognize whether they are related to the vaccine or not.

Effects of Different Types of COVID-19 Vaccines on Menstrual Cycles of Females of Reproductive Age Group (15-49): A Multinational Cross-Sectional Study

Background Globally, there are more than 474 million cases and around 6 million deaths due to COVID-19. The case fatality rate was 0.5-2.8% while for 80-89 years old, it was 3.7-14.8%. Given the seriousness of this infection, prevention becomes critical. Hence, the introduction of vaccines led to a significant reduction (> 75% protection) in COVID-19 cases. On the other hand, patients seeking help for serious pulmonary, cardiovascular, neurological, and gynecological complaints have also been recorded. Clinical studies on the effects of vaccination focused mostly on life-or-death results rather than reproductive outcomes such as menstruation, fertility, or even pregnancy outcomes. This survey was conducted to get more evidence on the association between menstrual cycle irregularities and some globally most prevalent COVID-19 vaccines. Methods An online cross-sectional survey was conducted by a team from Taif University, Kingdom of Saudi Arabia, from January to June 2022 on females within the reproductive age group (15-49 years) using a semi-structured questionnaire. Data were analyzed using SPSS Statistics version 22.0 and presented as frequency and percentage. The chi-square test was applied for the association and a p-value of <0.05 was considered significant. Results A total of 2381 responses were included. The mean age of respondents was 25±7.7 years. Around 1604 (67%) participants observed post-vaccination menstrual changes, and the findings were significant (p< 0.001). A strong association (p=.008) was found between the type of vaccine and changes in the menstrual cycle in participants (AstraZeneca 11 (36%)) after one dose. A strong association (p=.004) was also seen between the type of vaccine (Pfizer 543 (83%)) and menstrual changes after the booster dose. Cycles became irregular 180 (36%) or prolonged 144 (29%) in females inoculated with Pfizer after two doses of vaccination (p=0.012). Conclusion Post-vaccination menstrual irregularities were reported by females of reproductive age, especially the new vaccines. Prospective studies for similar insights are needed. Finding the co-occurring impacts of vaccination and COVID-19 infections in the wake of the emerging new long-haul COVID-19 phenomena is crucial for reproductive health.

Lessons learned from the SARS-CoV-2 pandemic; from nucleic acid nanomedicines, to clinical trials, herd immunity, and the vaccination divide

INTRODUCTION

In November 2019, the idea of a zoonotic virus crossing over to human transmission in a seafood market in Wuhan, China, and then soaring across the globe to claim over 6.3 million lives and persisting to date, seemed more like wild science fiction than a future reality. As the SARS-CoV-2 pandemic continues, it is important to hallmark the imprints the pandemic has made on science.

AREAS COVERED

This review covers the biology of SARS-CoV-2, vaccine formulations and trials, the concept of 'herd resistance,' and the vaccination divide.

EXPERT OPINION

The SARS-CoV-2 pandemic has changed the landscape of medicine. The rapid approval of SARS-CoV-2 vaccines has changed the culture of drug development and clinical approvals. This change is already leading to more accelerated trials. The RNA vaccines have opened the market for nucleic acid therapies and the applications are limitless - from cancer to influenza. A phenomenon that has occurred is that the low efficacy of current vaccines and the rapid mutation rate of the virus is preventing herd immunity from being attained. Instead, herd resistance is being acquired. Even with future, more effective vaccines, anti-vaccination attitudes will continue to challenge the quest for SARS-CoV-2 herd immunity.

Enhancement of immunogenicity and neutralizing responses against SARS-CoV-2 spike protein using the Fc fusion fragment

AIMS

Vaccination has played an important role in protecting against death and the severity of COVID-19. The recombinant protein vaccine platform has a long track record of safety and efficacy. Here, we fused the SARS-CoV-2 spike S1 subunit to the Fc region of IgG and investigated immunogenicity, reactivity to human vaccinated sera, and neutralizing activity as a candidate protein vaccine.

MATERIALS AND METHOD

We evaluated the immunogenicity of CHO-expressed S1-Fc fusion protein and tag-free S1 protein in rabbits via the production of S1-specific polyclonal antibodies. We subsequently compared the neutralizing activities of sera from immunized rabbits and human-vaccinated individuals using a surrogate Virus Neutralization Test (sVNT).

KEY FINDINGS

The results indicate that S1-specific polyclonal antibodies were induced in all groups; however, antibody levels were higher in rabbits immunized with S1-Fc fusion protein than tag-free S1 protein. Moreover, the reactivity of human vaccinated sera against S1-Fc fusion protein was significantly higher than tag-free S1 protein. Lastly, the results of the virus-neutralizing activity revealed that vaccination with S1-Fc fusion protein induced the highest level of neutralizing antibody response against SARS-CoV-2.

SIGNIFICANCE

Our results demonstrate that the S1 protein accompanied by the Fc fragment significantly enhances the immunogenicity and neutralizing responses against SARS-CoV-2. It is hoped that this platform can be used for human vaccination.

Cross-sectional study of the knowledge, perception and attitude of first-year university students in Iraq towards SARS-CoV-2 Omicron variant and COVID-19 vaccines

OBJECTIVES

The aim of this study was to first assess the knowledge and perception of first-year university students in Iraq about COVID-19 in general and SARS-CoV-2 latest variant of concern, and to evaluate the attitudes towards protection measures including vaccination.

STUDY DESIGN

A cross-sectional study was conducted among newly enrolled students at the American University of Iraq-Baghdad. Mann-Whitney U and Kruskal-Wallis tests were used to test an association between the outcomes measured on a 5-point Likert scale and the binary and the categorical independent variables, respectively. χ² test was used to test the association between nominal categorical variables, while Kendall's τ-b was used for ordinal variables.

PARTICIPANTS

Students (n=432) were invited to fill out a survey specifically tailored to assess their knowledge, perception and attitude towards Omicron variant and COVID-19 vaccines acceptance. 363 students enrolled in various majors participated in this study.

RESULTS

Assessment of COVID-19 knowledge and perception revealed that students still lack reliable info and data about FDA-approved treatment options (70.5%), SARS-CoV-2 variants (96.5%) and approved vaccines. Students' attitude and practices towards recommended safety measures should be reassessed to better manage the pandemic. Adherence level was shown to be associated with the belief in its capacity to effectively manage the new variant. Interestingly, 85% of the students have received at least one dose of approved vaccine. A significant positive correlation was detected between the level of adherence to recommended precautions and the intention to take a third booster shot if proven effective.

CONCLUSIONS

Students' reliable knowledge about COVID-19 pandemic including the various strains and approved vaccines should be improved to better manage the pandemic and set foundations for a more appropriate approach when another pandemic occurs. Special workshops should be organised to ensure that students and the public have a more trusted source of information about COVID-19.

Towards novel nano-based vaccine platforms for SARS-CoV-2 and its variants of concern: Advances, challenges and limitations

Vaccination is the most effective tool available for fighting the spread of COVID-19. Recently, emerging variants of SARS-CoV-2 have led to growing concerns about increased transmissibility and decreased vaccine effectiveness. Currently, many vaccines are approved for emergency use and more are under development. This review highlights the ongoing advances in the design and development of different nano-based vaccine platforms. The challenges, limitations, and ethical consideration imposed by these nanocarriers are also discussed. Further, the effectiveness of the leading vaccine candidates against all SARS-CoV-2 variants of concern are highlighted. The review also focuses on the possibility of using an alternative non-invasive routes of vaccine administration using micro and nanotechnologies to enhance vaccination compliance and coverage.

New-onset crescent IgA nephropathy following the CoronaVac vaccine: A case report

RATIONALE

Although coronavirus disease 2019 (COVID-19) remains a global threat, administering effective and safe vaccines is currently the most promising strategy to curb the ongoing pandemic and decrease the number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. However, there remains some uncertainty regarding the safety of vaccines for patients with kidney disease.

PATIENT CONCERNS

A 58-year-old man presented at our institution with gross hematuria 48 hours after receiving his first dose of the CoronaVac (Sinovac) vaccine.

DIAGNOSES

Analysis of a renal biopsy sample led to the diagnosis of crescentic immunoglobulin A nephropathy (IgAN), which we considered an adverse event of receiving the CoronaVac vaccine in China.

INTERVENTIONS

The patient's serum creatinine and albumin levels were 1.20 mg/dL and 31.3 g/L, respectively; as such, he was administered a diuretic. His serum creatinine level had risen to 7.45 mg/dL 1 month later, and he developed high blood pressure. The patient then received conventional doses of hormone therapy but developed recurrent fever, which led to the suspicion of active tuberculosis (which he had a history of) and suspension of the hormone therapy.

OUTCOMES

The patient's renal function deteriorated further, and he ultimately underwent dialysis.

LESSONS

The patient's course of events of apparent IgAN exacerbation should prompt nephrologists to closely follow patients with glomerular disease after they receive a COVID-19 vaccine, especially if persistent gross hematuria occurs.

A Comparative Analysis of a Self-Reported Adverse Events Analysis after Receiving One of the Available SARS-CoV-2 Vaccine Schemes in Ecuador

The COVID-19 pandemic has put a lot of pressure on health systems worldwide. Mass vaccination against SARS-CoV-2 has reduced morbidity and mortality worldwide. Despite their safety profiles, vaccines, as with any other medical product, can cause adverse events. Yet, in countries with poor epidemiological surveillance and monitoring systems, reporting vaccine-related adverse events is a challenge. The objective of this study was to describe self-reported vaccine adverse events after receiving one of the available COVID-19 vaccine schemes in Ecuador. A cross-sectional analysis based on an online, self-reported, 32-item questionnaire was conducted in Ecuador from 1 April to 15 July 2021. Participants were invited by social media, radio, and TV to voluntarily participate in our study. A total of 6654 participants were included in this study. Furthermore, 38.2% of the participants reported having at least one comorbidity. Patients received AstraZeneca, Pfizer, and Sinovac vaccines, and these were distributed 38.4%, 31.1%, and 30.5%, respectively. Overall, pain or swelling at the injection site 17.2% (n = 4500) and headache 13.3% (n = 3502) were the most reported adverse events. Women addressed events supposedly attributable to vaccination or immunization [ESAVIs] (66.7%), more often than men (33.2%). After receiving the first dose of any available COVID-19 vaccine, a total of 19,501 self-reported ESAVIs were informed (87.0% were mild, 11.5% moderate, and 1.5% severe). In terms of the vaccine type and brand, the most reactogenic vaccine was AstraZeneca with 57.8%, followed by Pfizer (24.9%) and Sinovac (17.3%). After the second dose, 6776 self-reported ESAVIs were reported (87.1% mild, 10.9% moderate, and 2.1% severe). AstraZeneca vaccine users reported a higher proportion of ESAVIs (72.2%) in comparison to Pfizer/BioNTech (15.9%) and Sinovac Vaccine (11.9%). Swelling at the injection site, headache, muscle pain, and fatigue were the most common ESAVIs for the first as well as second doses. In conclusion, most ESAVIs were mild. AstraZeneca users were more likely to report adverse events. Participants without a history of COVID-19 infection, as well as those who received the first dose, were more prone to report ESAVIs.

Nucleic Acids as Biotools at the Interface between Chemistry and Nanomedicine in the COVID-19 Era

The recent development of mRNA vaccines against the SARS-CoV-2 infection has turned the spotlight on the potential of nucleic acids as innovative prophylactic agents and as diagnostic and therapeutic tools. Until now, their use has been severely limited by their reduced half-life in the biological environment and the difficulties related to their transport to target cells. These limiting aspects can now be overcome by resorting to chemical modifications in the drug and using appropriate nanocarriers, respectively. Oligonucleotides can interact with complementary sequences of nucleic acid targets, forming stable complexes and determining their loss of function. An alternative strategy uses nucleic acid aptamers that, like the antibodies, bind to specific proteins to modulate their activity. In this review, the authors will examine the recent literature on nucleic acids-based strategies in the COVID-19 era, focusing the attention on their applications for the prophylaxis of COVID-19, but also on antisense- and aptamer-based strategies directed to the diagnosis and therapy of the coronavirus pandemic.

Public attitudes and influencing factors toward COVID-19 vaccination for adolescents/children: a scoping review

OBJECTIVE

This study aimed to systematically clarify attitudes and influencing factors of the public toward COVID-19 vaccination for children or adolescents.

STUDY DESIGN

This was a scoping review.

METHODS

This scoping review screened, included, sorted, and analyzed relevant studies on COVID-19 vaccination for children or adolescents before December 31, 2021, in databases, including PubMed, Elsevier, Web of Science, Cochrane Library, and Wiley.

RESULTS

A total of 34 studies were included. The results showed that the public's acceptance rate toward COVID-19 vaccination for children or adolescents ranged from 4.9% (southeast Nigerian mothers) to 91% (Brazilian parents). Parents' or adolescents' age, gender, education level, and cognition and behavior characteristics for the vaccines were the central factors affecting vaccination. The vaccine's safety, effectiveness, and potential side-effects were the main reasons affecting vaccination.

CONCLUSIONS

Realizing current public attitudes of COVID-19 vaccination for adolescents or children can effectively develop intervention measures and control the pandemic as soon as possible through herd immunity.