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Hernández-Hernández JG, Quintanilla-Flores DL, González-Galván CR, Nuzzolo-Shihadeh L, Camacho-Ortiz A, Salinas-Martínez R, Morales-Delgado R. Impact of influenza vaccination history in the clinical course of older adults hospitalized with COVID-19. Med Clin (Barc) 2024; 162:477-482. [PMID: 38342706 DOI: 10.1016/j.medcli.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND AND PURPOSE Some studies have shown that influenza vaccination is associated with a lower risk of SARS-CoV-2 infection; in patients with COVID-19 infection, admission to intensive care is reduced, with less need for mechanical ventilation, shorter hospital stays, and reduced mortality. This study aimed to determine if a history of annual influenza vaccination impacts the clinical course of SARS-CoV-2 infection during hospitalization. METHODS This was an observational, prospective, cohort study of patients older than 65 admitted to the COVID-19 unit from January to June 2021. The history of influenza vaccination over the last 5 years was assessed in each patient during hospitalization. We measured the length of hospital stay, the need for admission to the intensive care unit (ICU), the patient's oxygen requirements, complications during hospitalization, and outcome (medical discharge or death). Patients with a history of vaccination against SARS-CoV-2 were not included. RESULTS We analyzed 125 patients, 50.4% (n=63) with history of influenza vaccination and 49.6% (n=62) without a history of influenza vaccination. In-hospital mortality was 44.8%, higher in the unvaccinated (54.8%) population (p=0.008). ICU admission was 27% higher in vaccinated (35%) patients (p=0.05). Patients without a history of influenza vaccination had a higher prevalence of cardiac (8% vs. 5%, p=0.04) and renal complications (29% vs. 13%, p=0.02). Patients with a history of vaccination had a greater need for invasive mechanical ventilation (25.4%, p=0.02). CONCLUSION In this study, a history of influenza vaccination in older adults with SARS-CoV-2 infection was related to lower in-hospital mortality.
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Affiliation(s)
- José G Hernández-Hernández
- Servicio de Geriatría Clínica, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Dania L Quintanilla-Flores
- Departamento de Endocrinología, Hospital de Especialidades UMAE 25 del Instituto Mexicano del Seguro Social, IMSS, Monterrey, Nuevo León, Mexico
| | - Célica R González-Galván
- Servicio de Geriatría Clínica, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Laura Nuzzolo-Shihadeh
- Servicio de Infectología, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Adrián Camacho-Ortiz
- Servicio de Infectología, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Ricardo Salinas-Martínez
- Servicio de Geriatría Clínica, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Rocío Morales-Delgado
- Servicio de Geriatría Clínica, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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2
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Gaddh M, Scott D, Wysokinski WE, McBane RD, Casanegra AI, Baumann Kreuziger L, Houghton DE. Comparison of Venous Thromboembolism Outcomes after COVID-19 and Influenza Vaccinations. TH OPEN 2023; 7:e303-e308. [PMID: 38053618 PMCID: PMC10695705 DOI: 10.1055/a-2183-5269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 12/07/2023] Open
Abstract
Background Published data on the risk of venous thromboembolism (VTE) with coronavirus disease 2019 (COVID-19) vaccines are scarce and inconclusive, leading to an unmet need for further studies. Methods A retrospective, multicentered study of adult patients vaccinated for one of the three approved COVID-19 vaccines in the United States of America and a pre-COVID-19 cohort of patients vaccinated for influenza at two institutions: Mayo Clinic Enterprise sites and the Medical College of Wisconsin, looking at rate of VTE over 90 days. VTE was identified by applying validated natural language processing algorithms to relevant imaging studies. Kaplan-Meier curves were used to evaluate rate of VTE and Cox proportional hazard models for incident VTE after vaccinations. Sensitivity analyses were performed for age, sex, outpatient versus inpatient status, and type of COVID-19 vaccine. Results A total of 911,381 study subjects received COVID-19 vaccine (mean age: 56.8 [standard deviation, SD: 18.3] years, 55.3% females) and 442,612 received influenza vaccine (mean age: 56.5 [SD: 18.3] years, 58.7% females). VTE occurred within 90 days in 1,498 (0.11%) of the total 1,353,993 vaccinations: 882 (0.10%) in the COVID-19 and 616 (0.14%) in the influenza vaccination cohort. After adjusting for confounding variables, there was no difference in VTE event rate after COVID-19 vaccination compared with influenza vaccination (adjusted hazard ratio: 0.95 [95% confidence interval: 0.85-1.05]). No significant difference in VTE rates was observed between the two cohorts on sensitivity analyses. Conclusion In this large cohort of COVID-19-vaccinated patients, risk of VTE at 90 days was low and no different than a pre-COVID-19 cohort of influenza-vaccinated patients.
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Affiliation(s)
- Manila Gaddh
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - David Scott
- Department of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | | | - Robert D. McBane
- Versiti, Blood Research Institute, Milwaukee, Wisconsin, United States
| | - Ana I. Casanegra
- Versiti, Blood Research Institute, Milwaukee, Wisconsin, United States
| | - Lisa Baumann Kreuziger
- Department of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Division of Vascular Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Damon E. Houghton
- Versiti, Blood Research Institute, Milwaukee, Wisconsin, United States
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
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3
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d’Almeida S, Markovic S, Hermann P, Bracht H, Peifer J, Ettrich TJ, Imhof A, Zhou S, Weiss M, Viardot A, Rottbauer W, Dahme T. Thromboembolism after Astra Zeneca COVID-19 vaccine: Not always PF4- antibody mediated. Hum Vaccin Immunother 2023; 19:2252239. [PMID: 37655367 PMCID: PMC10478733 DOI: 10.1080/21645515.2023.2252239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Cases of thromboembolic events in 2021 flared up the discussion about the safety of Astra Zeneca's AZD1222 vaccine. We hereby report three cases of pulmonary embolism (PE), one case of extended portal vein thrombosis, and one case of combined portal vein thrombosis and PE within 2 weeks after vaccination with the Astra Zeneca AZD1222 vaccine in a 60-year-old, a 50-year old, a 33-year-old, a 30-year old, and a 40-year-old male in that year. All patients were healthy before. In three patients, we observed thrombocytopenia and to some extent unusually low antibody levels for the Spike Protein (S-protein), while the other two had normal thrombocyte counts. Only one patient had anti-platelet factor 4 (PF4)-antibodies detectable as it has been described in the "heparin-induced thrombocytopenia (HIT)-like" disease of "vaccine-induced prothrombotic immune thrombocytopenia" (VIPIT) and we therefore assume that heterogeneous mechanisms led to PE. Therefore, we advise to collect and report more cases, in order to determine the age-related risks of vaccination balanced against the benefits of immunity to SARS-COV-2 for the AZD1222 vaccine in order to gain knowledge for the next pandemic.
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Affiliation(s)
- Sascha d’Almeida
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Sinisa Markovic
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Patrick Hermann
- Department of Medicine I, Ulm University Medical Center, Ulm, Germany
| | - Hendrik Bracht
- Central Emergency Department, Ulm University Medical Center, Ulm, Germany
| | - Johannes Peifer
- Central Emergency Department, Ulm University Medical Center, Ulm, Germany
| | - Thomas J. Ettrich
- Department of Medicine I, Ulm University Medical Center, Ulm, Germany
| | - Armin Imhof
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Shaoxia Zhou
- Department of Laboratory Medicine, Ulm University Medical Center, Ulm, Germany
| | - Manfred Weiss
- Department of Anesthesiology and Intensive Care, Ulm University Medical Center, Ulm, Germany
| | - Andreas Viardot
- Department of Medicine III, Ulm University Medical Center, Ulm, Germany
| | | | - Tillman Dahme
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
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4
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Mohseni Afshar Z, Sharma A, Babazadeh A, Alizadeh-Khatir A, Sio TT, Taghizadeh Moghadam MA, Tavakolli Pirzaman A, Mojadad A, Hosseinzadeh R, Barary M, Ebrahimpour S. A review of the potential neurological adverse events of COVID-19 vaccines. Acta Neurol Belg 2023; 123:9-44. [PMID: 36385246 PMCID: PMC9668235 DOI: 10.1007/s13760-022-02137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
Despite the advantages of getting access to the coronavirus disease 2019 (COVID-19) vaccines, their potential ability to induce severe adverse events (AEs) has been a significant concern. Neurological complications are significant among the various adverse events following immunization (AEFI) due to their likely durability and debilitating sequelae. Neurological AEs following COVID-19 vaccination can either exacerbate or induce new-onset neuro-immunologic diseases, such as myasthenia gravis (MG) and Guillain-Barre syndrome (GBS). The more severe spectrum of AEs post-COVID19 vaccines has included seizures, reactivation of the varicella-zoster virus, strokes, GBS, Bell's palsy, transverse myelitis (TM), and acute disseminated encephalomyelitis (ADEM). Here, we discuss each of these neurological adverse effects separately.
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Affiliation(s)
- Zeinab Mohseni Afshar
- grid.412112.50000 0001 2012 5829Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akanksha Sharma
- grid.417468.80000 0000 8875 6339Department of Neurology, Mayo Clinic, Scottsdale, AZ USA
| | - Arefeh Babazadeh
- grid.411495.c0000 0004 0421 4102Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Alizadeh-Khatir
- grid.411495.c0000 0004 0421 4102Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Terence T. Sio
- grid.417468.80000 0000 8875 6339Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ USA
| | | | - Ali Tavakolli Pirzaman
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Ahmadreza Mojadad
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Rezvan Hosseinzadeh
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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5
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Rasouli Dezfouli E, Delen D, Zhao H, Davazdahemami B. A Machine Learning Framework for Assessing the Risk of Venous Thromboembolism in Patients Undergoing Hip or Knee Replacement. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2022; 6:423-441. [PMID: 36744082 PMCID: PMC9892391 DOI: 10.1007/s41666-022-00121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a well-recognized complication that is prevalent in patients undergoing major orthopedic surgery (e.g., total hip arthroplasty and total knee arthroplasty). For years, to identify patients at high risk of developing VTE, physicians have relied on traditional risk scoring systems, which are too simplistic to capture the risk level accurately. In this paper, we propose a data-driven machine learning framework to identify such high-risk patients before they undergo a major hip or knee surgery. Using electronic health records of more than 392,000 patients who undergone a major orthopedic surgery, and following a guided feature selection using the genetic algorithm, we trained a fully connected deep neural network model to predict high-risk patients for developing VTE. We identified several risk factors for VTE that were not previously recognized. The best FCDNN model trained using the selected features yielded an area under the ROC curve (AUC) of 0.873, which was remarkably higher than the best AUC obtained by including only risk factors previously known in the medical literature. Our findings suggest several interesting and important insights. The traditional risk scoring tables that are being widely used by physicians to identify high-risk patients are not considering a comprehensive set of risk factors, nor are they as powerful as cutting-edge machine learning methods in distinguishing low- from high-risk patients.
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Affiliation(s)
| | - Dursun Delen
- Oklahoma State University, Stillwater, OK USA
- Istinye University, Istanbul, Turkey
| | - Huimin Zhao
- University of Wisconsin-Milwaukee, Milwaukee, WI USA
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6
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Marietta M, Coluccio V, Luppi M. Potential mechanisms of vaccine-induced thrombosis. Eur J Intern Med 2022; 105:1-7. [PMID: 35953336 PMCID: PMC9359676 DOI: 10.1016/j.ejim.2022.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare syndrome characterized by high-titer anti-platelet factor 4 (PF4) antibodies, thrombocytopenia and arterial and venous thrombosis in unusual sites, as cerebral venous sinuses and splanchnic veins. VITT has been described to occur almost exclusively after administration of ChAdOx1 nCoV-19 and Ad26.COV2.S adenovirus vector- based COVID-19 vaccines. Clinical and laboratory features of VITT resemble those of heparin-induced thrombocytopenia (HIT). It has been hypothesized that negatively charged polyadenylated hexone proteins of the AdV vectors could act as heparin to induce the conformational changes of PF4 molecule that lead to the formation of anti-PF4/polyanion antibodies. The anti-PF4 immune response in VITT is fostered by the presence of a proinflammatory milieu, elicited by some impurities found in ChAdOx1 nCoV-19 vaccine, as well as by soluble spike protein resulting from alternative splice events. Anti-PF4 antibodies bind PF4, forming immune complexes which activate platelets, monocytes and granulocytes, resulting in the VITT's immunothrombosis. The reason why only a tiny minority of patents receiving AdV-based COVID-19 vaccines develop VITT is still unknown. It has been hypothesized that individual intrinsic factors, either acquired (i.e., pre-priming of B cells to produce anti-PF4 antibodies by previous contacts with bacteria or viruses) or inherited (i.e., differences in platelet T-cell ubiquitin ligand-2 [TULA-2] expression) can predispose a few subjects to develop VITT. A better knowledge of the mechanistic basis of VITT is essential to improve the safety and the effectiveness of future vaccines and gene therapies using adenovirus vectors.
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Affiliation(s)
- Marco Marietta
- Hematology Unit, Azienda Ospedaliero- Universitaria, Modena, Italy.
| | - Valeria Coluccio
- Hematology Unit, Azienda Ospedaliero- Universitaria, Modena, Italy
| | - Mario Luppi
- Hematology Unit, Azienda Ospedaliero- Universitaria, Modena, Italy; Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
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7
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Gollamudi J, Sartain SE, Navaei AH, Aneja S, Kaur Dhawan P, Tran D, Joshi J, Gidudu J, Gollamudi J, Chiappini E, Varricchio F, Law B, Munoz FM. Thrombosis and thromboembolism: Brighton collaboration case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022; 40:6431-6444. [PMID: 36150973 DOI: 10.1016/j.vaccine.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
This is a Brighton Collaboration case definition of thrombosis and thromboembolism to be used in the evaluation of adverse events following immunization, and for epidemiologic studies for the assessment of background incidence or hypothesis testing. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of SARS-CoV-2 vaccines. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected expert reviewers prior to submission.
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Affiliation(s)
- Jahnavi Gollamudi
- Department of Medicine, Section of Hematology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Sartain
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Amir Hassan Navaei
- Pediatric Critical Care, Transfusion Medicine & Coagulation, Pediatrics and Pathology & Immunology Departments, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite WB110, Houston 77021, TX, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Gr Noida, India
| | | | - Dat Tran
- Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention Section, Portland, OR, USA
| | - Jyoti Joshi
- International Centre for Antimicrobial Resistance Solutions (ICARS), Orestads Boulevard 5, 2300 Copenhagen, Denmark
| | - Jane Gidudu
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | | | - Barbara Law
- SPEAC, Brighton Collaboration, Independent Consultant, Vancouver, BC, Canada
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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Vallone MG, Falcón AL, Castro HM, Ferraris A, Cantarella RF, Staneloni MI, Aliperti VI, Ferloni A, Mezzarobba D, Vázquez FJ, Ratti MFG. Thrombotic events following Covid-19 vaccines compared to Influenza vaccines. Eur J Intern Med 2022; 99:82-88. [PMID: 35288031 PMCID: PMC8904150 DOI: 10.1016/j.ejim.2022.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 12/22/2022]
Abstract
IMPORTANCE The actual risk of thrombotic events after Covid-19 vaccination is unknown. OBJECTIVE To evaluate the risk of thrombotic events after Covid-19 vaccination. DESIGN Retrospective cohort study which included consecutive adult patients vaccinated with the first dose of Covid-19 vaccine between January 1 and May 30, 2021, and a historic control group, defined as consecutive patients vaccinated with influenza vaccine between March 1 and July 30, 2019. SETTING Hospital Italiano de Buenos Aires, a tertiary hospital in Argentina. PARTICIPANTS Non-Hospitalized Adults vaccinated with the first dose of a Covid-19 vaccine. EXPOSURE Vaccination with Covid-19 vaccines available during the study period: Gam-COVID-Vac (Sputnik), ChAdOx1 nCoV-19 (AstraZeneca/Oxford or Covishield), BBIBP-CorV (Beijing Institute of Biological Products) (Sinopharm). Active comparator group exposure was Influenza vaccine. MAIN OUTCOME Primary endpoint was cumulative incidence of any symptomatic thrombotic event at 30 days, defined as the occurrence of at least one of the following: symptomatic acute deep venous thrombosis (DVT); symptomatic acute pulmonary embolism (PE); acute ischemic stroke (AIS); acute coronary syndrome (ACS) or arterial thrombosis. RESULTS From a total of 29,985 adult patients who received at least a first dose of Covid-19 vaccine during study period and 24,777 who received Influenza vaccine in 2019, we excluded those who were vaccinated during hospitalization. We finally included 29,918 and 24,753 patients respectively. Median age was 73 years old (IQR 75-81) and 67% were females in both groups. Thirty six subjects in the Covid-19 vaccination group (36/29,918) and 15 patients in the Influenza vaccination group (15/24,753) presented at least one thrombotic event. The cumulative incidence of any thrombotic event at 30 days was 12 per 10,000 (95%CI 9-17) for Covid-19 group and 6 per 10,000 (95%CI 4-10) for Influenza group (p-value=0.022). CONCLUSIONS AND RELEVANCE This study shows a significant increase in thrombotic events in subjects vaccinated with Covid-19 vaccines in comparison to a control group. The clinical implication of these findings should be interpreted with caution, in light of the high effectiveness of vaccination and the inherent risk of thrombosis from Covid-19 infection itself.
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Affiliation(s)
- Marcelo Gabriel Vallone
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina.
| | - Andre Luis Falcón
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina
| | - Horacio Matias Castro
- Pulmonology Section, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Augusto Ferraris
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina
| | - Ramiro Francisco Cantarella
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina
| | - María Inés Staneloni
- Infectious Diseases Department, Infection Control Committee, Hospital Italiano de Buenos Aires, Argentina
| | | | - Analia Ferloni
- Investigation Department, Hospital Italiano de Buenos Aires, Argentina
| | - Daniela Mezzarobba
- Hematology Section, Hospital Italiano de Buenos Aires. Ciudad Autónoma de Buenos Aires, Argentina; Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Javier Vázquez
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina; CONICET Independent Research
| | - María Florencia Grande Ratti
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; CONICET Independent Research
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9
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Iba T, Levy JH. Thrombosis and thrombocytopenia in COVID-19 and after COVID-19 vaccination. Trends Cardiovasc Med 2022; 32:249-256. [PMID: 35202800 PMCID: PMC8861143 DOI: 10.1016/j.tcm.2022.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 12/30/2022]
Abstract
Thrombosis that occurs in coronavirus disease 19 (COVID-19) is a serious complication and a critical aspect of pathogenesis in the disease progression. Although thrombocytopenia is uncommon in the initial presentation, it may also reflect disease severity due to the ability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to activate platelets. This occurs directly through the spike protein-angiotensin converting enzyme 2 (ACE2) interaction and indirectly by coagulation and inflammation activation. Dysregulation in both innate and adaptive immune systems is another critical factor that causes thrombosis and thrombocytopenia in COVID-19. Vaccination is the most potent and effective tool to mitigate COVID-19; however, rare side effects, namely vaccine-induced immune thrombotic thrombocytopenia (VITT)/thrombosis with thrombocytopenia syndrome (TTS) can occur following adenovirus-vectored vaccine administration. VITT/TTS is rare, and thrombocytopenia can be the clue to detect this serious complication. It is important to consider that thrombocytopenia and/or thromboembolism are not events limited to post-vaccination with vectored vaccine, but are also seen rarely after vaccination with other vaccines. Various conditions mimic VITT/TTS, and it is vital to achieving the correct diagnosis at an earlier stage. Antiplatelet factor 4 (PF4) antibody detection by the enzyme-linked immunosorbent assay (ELISA) is used for diagnosing VITT/TTS. However, false-positive rates also occur in vaccinated people, who do not show any thrombosis or thrombocytopenia. Vaccinated people with messenger RNA vaccine can show positive but low density and non-functional in terms of platelet aggregation, it is vital to check the optical density. If anti-PF4 ELISA is not available, discriminating other conditions such as antiphospholipid syndrome, thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, systemic lupus erythematosus, and hemophagocytic syndrome/hemophagocytic lymphohistiocytosis is critical when the patients show thrombosis with thrombocytopenia after COVID-19 vaccination.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA.
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10
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Bhan C, Bheesham N, Shakuntulla F, Sharma M, Sun C, Weinstein M. An unusual presentation of acute deep vein thrombosis after the Moderna COVID-19 vaccine-a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1605. [PMID: 34790811 PMCID: PMC8576696 DOI: 10.21037/atm-21-2772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/30/2021] [Indexed: 12/04/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a worldwide pandemic of the multisystem disease coronavirus disease-2019 (COVID-19). Since the development of COVID-19 vaccines, there has been extensive monitoring for potential serious side effects. We report an unusual presentation of acute deep vein thrombosis (DVT) in the right upper extremity of a 27-year-old Caucasian female, 3 days after receipt of her second dose of the Moderna COVID-19 vaccine. Her relevant thrombophilia workup was negative on initial presentation. She was treated with rivaroxaban for 3 months and her symptoms of right upper extremity swelling, and pain improved. Considering our case did not have any evidence of thrombocytopenia, we discuss the possible pathophysiology of acute DVT following Moderna COVID-19 vaccine in contrast to adenoviral vector COVID-19 vaccines (ChAdOx1 nCoV-19 and Ad26.COV2.S), including mRNA COVID-19 vaccine binding to pattern recognition receptors (PRR) in the endosomes and cytosol leading to a pro inflammatory cascade and coagulopathy. We highlight the importance of initial workup for acute DVT post COVID-19 vaccination, that should include complete blood count (CBC) with platelet count, international normalized ratio (INR), prothrombin time (PTT), D-dimer levels, fibrinogen levels, platelet factor 4 (PF4)/heparin enzyme-linked immunosorbent assays (ELISA) followed by a confirmatory PF4 platelet activation assay such as serotonin release assay, P-selectin expression assay, or heparin induced platelet aggregation (HIPA) assay, and imaging for thrombosis.
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Affiliation(s)
- Chandur Bhan
- Department of Internal Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA.,Section of General Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Nimarta Bheesham
- Department of Internal Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA.,Section of General Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Fnu Shakuntulla
- Department of Internal Medicine, Section of General Medicine, OSF Heart of Mary Medical Center, Urbana, IL, USA
| | - Monica Sharma
- Section of General Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA.,Department of Infectious Diseases, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Chenyu Sun
- Department of Internal Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA.,Section of General Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Mitchell Weinstein
- Section of General Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA.,Department of Infectious Diseases, Amita Health Saint Joseph Hospital, Chicago, IL, USA
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11
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Sen A, Bakken IJ, Govatsmark RES, Varmdal T, Bønaa KH, Mukamal KJ, Håberg SE, Janszky I. Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study. BMC Cardiovasc Disord 2021; 21:31. [PMID: 33435871 PMCID: PMC7803467 DOI: 10.1186/s12872-020-01836-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/22/2020] [Indexed: 01/21/2023] Open
Abstract
Background US and European guidelines diverge on whether to vaccinate adults who are not at high risk for cardiovascular events against influenza. Here, we investigated the associations between influenza vaccination and risk for acute myocardial infarction, stroke and pulmonary embolism during the 2009 pandemic in Norway, when vaccination was recommended to all adults. Methods Using national registers, we studied all vaccinated Norwegian individuals who suffered AMI, stroke, or pulmonary embolism from May 1, 2009 through September 30, 2010. We defined higher-risk individuals as those using anti-diabetic, anti-obesity, anti-thrombotic, pulmonary or cardiovascular medications (i.e. individuals to whom vaccination was routinely recommended); all other individuals were regarded as having lower-risk. We estimated incidence rate ratios with 95% CI using conditional Poisson regression in the pre-defined risk periods up to 180 days following vaccination compared to an unexposed time-period, with adjustment for season or daily temperature. Results Overall, we observed lower risk for cardiovascular events following influenza vaccination. When stratified by baseline risk, we observed lower risk across all three outcomes in association with vaccination among higher-risk individuals. In this subgroup, relative risks were 0.72 (0.59–0.88) for AMI, 0.77 (0.59–0.99) for stroke, and 0.73 (0.45–1.19) for pulmonary embolism in the period 1–14 days following vaccination when compared to the background period. These associations remained essentially the same up to 180 days after vaccination. In contrast, the corresponding relative risks among subjects not using medications were 4.19 (2.69–6.52), 1.73 (0.91–3.31) and 2.35 (0.78–7.06). Conclusion In this nationwide study, influenza vaccination was associated with overall cardiovascular benefit. This benefit was concentrated among those at higher cardiovascular risk as defined by medication use. In contrast, our results demonstrate no comparable inverse association with thrombosis-related cardiovascular events following vaccination among those free of cardiovascular medications at baseline. These results may inform the risk–benefit balance for universal influenza vaccination.
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Affiliation(s)
- Abhijit Sen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11 and Mauritz Hanssens gate, 7491, Trondheim, Norway. .,Center for Oral Health Services and Research (TkMidt), Trondheim, Norway.
| | - Inger Johanne Bakken
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Directorate of Health, Trondheim, Norway
| | - Ragna Elise Støre Govatsmark
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11 and Mauritz Hanssens gate, 7491, Trondheim, Norway.,Department of Medical Quality Registries, St. Olav's University Hospital, Trondheim, Norway
| | - Torunn Varmdal
- Department of Medical Quality Registries, St. Olav's University Hospital, Trondheim, Norway
| | - Kaare Harald Bønaa
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic for Heart Disease, St. Olav's University Hospital, Trondheim, Norway.,Department of Community Medicine, UiT Arctic University of Norway, Tromsø, Norway
| | - Kenneth Jay Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Siri Eldevik Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Imre Janszky
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11 and Mauritz Hanssens gate, 7491, Trondheim, Norway.,Regional Center for Health Care Improvement, St Olav's Hospital, Trondheim, Norway
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12
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Saleem A, Akhtar MF, Haris M, Abdel-Daim MM. Recent updates on immunological, pharmacological, and alternative approaches to combat COVID-19. Inflammopharmacology 2021; 29:1331-1346. [PMID: 34331179 PMCID: PMC8324454 DOI: 10.1007/s10787-021-00850-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023]
Abstract
The pandemic coronavirus disease 2019 (COVID-19) is instigated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is mainly transmitted via the inhalation route and characterized by fever, coughing and shortness of breath. COVID-19 affects all age groups with no single cure. The drug discovery, manufacturing, and safety studies require extensive time and sources and, therefore, struggled to match the exponential spread of COVID-19. Yet, various repurposed drugs (antivirals, immune-modulators, nucleotide analogues), and convalescent plasma therapy have been authorized for emergency use against COVID-19 by Food and Drug Administration under certain limits and conditions. The discovery of vaccine is the biggest milestone achieved during the current pandemic era. About nine vaccines were developed for human use with varying claims of efficacy. The rapid emergence of mutations in SARS-CoV-2, suspected adverse drug reactions of current therapies in special population groups and limited availability of drugs in developing countries necessitate the development of more efficacious, safe and cheap drugs/vaccines for treatment and prevention of COVID-19. Keeping in view these limitations, the current review provides an update on the efficacy and safety of the repurposed, and natural drugs to treat COVID-19 as well as the vaccines used for its prophylaxis.
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Affiliation(s)
- Ammara Saleem
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Furqan Akhtar
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore Campus, Lahore, Pakistan
| | - Muhammad Haris
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Mohamed M. Abdel-Daim
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522 Egypt ,Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, P.O. Box 6231, Jeddah, 21442 Saudi Arabia
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13
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Moro PL, Haber P, McNeil MM. Challenges in evaluating post-licensure vaccine safety: observations from the Centers for Disease Control and Prevention. Expert Rev Vaccines 2019; 18:1091-1101. [PMID: 31580725 DOI: 10.1080/14760584.2019.1676154] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Vaccination is one of the most successful and cost-effective public health interventions. Although vaccines undergo extensive safety and efficacy evaluations prior to licensure, vaccine safety assessment post-licensure is essential for detecting rare and longer-term adverse events (AEs) and maintaining public confidence in vaccines and recommended immunization programs. Despite the proven effect of vaccines to save lives and prevent disease and overwhelming evidence of vaccines' safety and societal benefit, like any drug, no vaccine can be considered as completely safe and completely effective. New vaccines continue to be introduced and require rapid safety assessment post-licensure through pharmacovigilance reports as well as epidemiologic studies to investigate any potential safety signals.Areas covered: We discuss selected challenges for conducting pharmacovigilance and epidemiologic studies of AEs after vaccination in the United States using the post-licensure safety surveillance infrastructure of the Centers for Disease Control and Prevention (CDC).Expert opinion: The availability of specific post-licensure surveillance systems to monitor and study AEs after vaccination, such as the Vaccine Adverse Event Reporting System, the Vaccine Safety Datalink, and the Clinical Immunization Safety Assessment Project, each with its unique set of strengths and limitations, provide a harmonized and supportive approach to meet several of these barriers.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Penina Haber
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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