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Edwards KM, Griffin MR. Postmarketing Vaccine Safety Assessments: Important Work in Progress. JAMA 2024; 331:915-917. [PMID: 38502085 DOI: 10.1001/jama.2023.26630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
| | - Marie R Griffin
- School of Medicine, Vanderbilt University, Nashville, Tennessee
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2
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Chandler RE, Balakrishnan MR, Brasseur D, Bryan P, Espie E, Hartmann K, Jouquelet-Royer C, Milligan J, Nesbitt L, Pal S, Precioso A, Takey P, Chen RT. Collaboration within the global vaccine safety surveillance ecosystem during the COVID-19 pandemic: lessons learnt and key recommendations from the COVAX Vaccine Safety Working Group. BMJ Glob Health 2024; 9:e014544. [PMID: 38453518 PMCID: PMC10921508 DOI: 10.1136/bmjgh-2023-014544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/01/2024] [Indexed: 03/09/2024] Open
Abstract
This analysis describes the successes, challenges and opportunities to improve global vaccine safety surveillance as observed by the Vaccine Safety Working Group from its role as a platform of exchange for stakeholders responsible for monitoring the safety of vaccines distributed through the COVAX mechanism. Three key elements considered to be essential for ongoing and future pandemic preparedness for vaccine developers in their interaction with other members of the vaccine safety ecosystem are (1) the availability of infrastructure and capacity for active vaccine safety surveillance in low-income and middle-income countries (LMICs), including the advancement of concepts of safety surveillance and risk management to vaccine developers and manufacturers from LMICs; (2) more comprehensive mechanisms to ensure timely exchange of vaccine safety data and/or knowledge gaps between public health authorities and vaccine developers and manufacturers; and (3) further implementation of the concept of regulatory reliance in pharmacovigilance. These aims would both conserve valuable resources and allow for more equitable access to vaccine safety information and for benefit/risk decision-making.
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Affiliation(s)
| | | | | | - Philip Bryan
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Linda Nesbitt
- Biovac Institute, Pinelands, Cape Town, South Africa
| | | | | | | | - Robert T Chen
- The Task Force for Global Health, Decatur, Georgia, USA
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3
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Salmon DA, Chen RT, Black S, Sharfstein J. Lessons learned from COVID-19, H1N1, and routine vaccine pharmacovigilance in the United States: a path to a more robust vaccine safety program. Expert Opin Drug Saf 2024; 23:161-175. [PMID: 38343204 DOI: 10.1080/14740338.2024.2305707] [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: 08/23/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Vaccine pharmacovigilance is an essential component of vaccine safety programs. Vaccine pharmacovigilance refers to detecting uncommon adverse events following immunization (AEFI), determining whether they are due to the vaccine or are only a coincidence, and, for those AEFI considered related to vaccination, characterizing them further. When AEFI are due to vaccination, it is important to characterize the attributable risk and ascertain the biological mechanism causing the adverse reaction to inform efforts to prevent or mitigate the risk. A robust post-authorization safety system is necessary for vaccine decision-making, clinical recommendations, vaccine compensation, and vaccine communication and confidence. AREAS COVERED This paper describes the key characteristics of vaccine pharmacovigilance programs, reviews US vaccine pharmacovigilance for routine vaccination programs, COVID-19, and H1N1, and makes recommendations for improving future vaccine safety systems. EXPERT OPINION The key characteristics of vaccine pharmacovigilance programs include passive surveillance, active surveillance, clinical investigation and special studies, and causality assessment. Recent examples illustrate the strengths of US pharmacovigilance systems, including systems for passive and active surveillance, as well as areas for improvement, including study of pathogenesis, consistent funding, and leadership. We make recommendations that would, if implemented, further strengthen the vaccine safety system for future routine and pandemic immunizations.
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Affiliation(s)
- Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert T Chen
- Brighton Collaboration, A program of the Task Force for Global Health, Decatur, GA, USA
| | - Steve Black
- Global Vaccine Data Network, Auckland, New Zealand
| | - Joshua Sharfstein
- Department of Health, Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Black SB, Chandler RE, Edwards KM, Sturkenboom MCJM. Assessing vaccine safety during a pandemic: Recent experience and lessons learned for the future. Vaccine 2023:S0264-410X(23)00468-1. [PMID: 37198019 DOI: 10.1016/j.vaccine.2023.04.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
During the roll out of vaccines during a pandemic, questions regarding vaccine safety often arise. This was surely true during the SARS-CoV-2 pandemic. Different tools and capabilities exist during the pre-authorization phase and post introduction each with its strengths and limitations. Here we review the various tools and their strengths and limitations and discuss what functioned well in high income settings and the limitations that unequal vaccine safety pharmacovigilance capacity imposed upon middle and low income countries.
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Affiliation(s)
| | | | - Kathryn M Edwards
- Sarah H. Sell and Cornelius Vanderbilt Professor of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States.
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5
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Piché‐Renaud P, Morris SK, Top KA. A narrative review of vaccine pharmacovigilance during mass vaccination campaigns: Focus on myocarditis and pericarditis after COVID-19 mRNA vaccination. Br J Clin Pharmacol 2022; 89:967-981. [PMID: 36480113 PMCID: PMC9878271 DOI: 10.1111/bcp.15625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccines have had a tremendous impact on reducing the burden of infectious diseases; however, they have the potential to cause adverse events following immunization (AEFIs). Prelicensure clinical trials are limited in their ability to detect rare AEFIs that may occur in less than one per thousand individuals. While postmarketing surveillance systems have shown COVID-19 mRNA vaccines to be safe, they led to the identification of rare cases of myocarditis and pericarditis after COVID-19 vaccination that were not initially detected in clinical trials. In this narrative review, we highlight concepts of vaccine pharmacovigilance during mass vaccination campaigns and compare the approaches used in the context of myocarditis and pericarditis following COVID-19 vaccination to historical examples. We describe mechanisms of passive and active surveillance, their strengths and limitations, and how they interacted to identify and characterize the safety signal of myocarditis and pericarditis after COVID-19 mRNA vaccination. Articles were synthesized from a PubMed search using relevant keywords for articles published on vaccine surveillance systems and myocarditis and pericarditis after COVID-19 vaccination, as well as the authors' collections of relevant publications and grey literature reports. The global experience around the identification and monitoring of myocarditis and pericarditis after COVID-19 mRNA vaccination has provided important lessons for vaccine safety surveillance and highlighted its importance in maintaining public trust in mass vaccination programmes in a pandemic context.
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Affiliation(s)
| | - Shaun K. Morris
- Division of Infectious DiseasesThe Hospital for Sick ChildrenTorontoOntarioCanada,Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of Pediatrics, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Clinical Public Health, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Karina A. Top
- Department of PediatricsDalhousie University and Canadian Center for Vaccinology, IWK Health CentreHalifaxNova ScotiaCanada
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6
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Buoninfante A, Andeweg A, Baker AT, Borad M, Crawford N, Dogné JM, Garcia-Azorin D, Greinacher A, Helfand R, Hviid A, Kochanek S, López-Fauqued M, Nazy I, Padmanabhan A, Pavord S, Prieto-Alhambra D, Tran H, Wandel Liminga U, Cavaleri M. Understanding thrombosis with thrombocytopenia syndrome after COVID-19 vaccination. NPJ Vaccines 2022; 7:141. [PMID: 36351906 PMCID: PMC9643955 DOI: 10.1038/s41541-022-00569-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alessandra Buoninfante
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands
| | - Arno Andeweg
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands
| | - Alexander T. Baker
- grid.417468.80000 0000 8875 6339Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ 85054 USA ,grid.5600.30000 0001 0807 5670Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Mitesh Borad
- grid.417467.70000 0004 0443 9942Mayo Clinic Cancer Center, Phoenix, AZ 85054 USA
| | - Nigel Crawford
- grid.1008.90000 0001 2179 088XRoyal Children’s Hospital, Murdoch Children’s Research Institute, Department Paediatrics, The University of Melbourne, Melbourne, VIC Australia
| | - Jean-Michel Dogné
- grid.6520.10000 0001 2242 8479Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium ,grid.452397.eEMA Pharmacovigilance Risk Assessment Committee member, Amsterdam, The Netherlands
| | - David Garcia-Azorin
- grid.411057.60000 0000 9274 367XDepartment of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Andreas Greinacher
- grid.5603.0Department of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rita Helfand
- grid.416738.f0000 0001 2163 0069National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA ,grid.3575.40000000121633745WHO’s Global Advisory Committee on Vaccine Safety, WHO, Geneva, Switzerland
| | - Anders Hviid
- grid.5254.60000 0001 0674 042XPharmacovigilance Research Center, Department of Drug Development and Clinical Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.6203.70000 0004 0417 4147Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Stefan Kochanek
- grid.6582.90000 0004 1936 9748Department of Gene Therapy, University of Ulm, Ulm, Germany
| | - Marta López-Fauqued
- grid.452397.eVaccines and Therapies for Infectious Diseases, European Medicines Agency, Amsterdam, the Netherlands
| | - Ishac Nazy
- grid.25073.330000 0004 1936 8227McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON Canada
| | - Anand Padmanabhan
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Sue Pavord
- grid.410556.30000 0001 0440 1440Department Hematology, Oxford University Hospitals NHS Foundation Trust, Oxfordshire, UK
| | - Daniel Prieto-Alhambra
- grid.4991.50000 0004 1936 8948Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK ,grid.5645.2000000040459992XDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Huyen Tran
- grid.1623.60000 0004 0432 511XDepartment of Clinical Haematology, The Alfred Hospital, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, VIC Australia
| | - Ulla Wandel Liminga
- grid.452397.eEMA Pharmacovigilance Risk Assessment Committee member, Amsterdam, The Netherlands ,grid.415001.10000 0004 0475 6278Medical Products Agency, Uppsala, Sweden
| | - Marco Cavaleri
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands ,grid.452397.eEMA Emergency Task Force Chair, Amsterdam, The Netherlands
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Laemmle-Ruff I, Lewis G, Clothier HJ, Dimaguila GL, Wolthuizen M, Buttery J, Crawford NW. Vaccine safety in Australia during the COVID-19 pandemic: Lessons learned on the frontline. Front Public Health 2022; 10:1053637. [PMID: 36408022 PMCID: PMC9672672 DOI: 10.3389/fpubh.2022.1053637] [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: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Victoria's vaccine safety service for reporting adverse events following immunisation (AEFI), has provided integrated spontaneous surveillance and clinical services for individuals affected by AEFI since 2007. We describe SAEFVIC's response to the COVID-19 vaccine program, and reflect on lessons learned for vaccine safety. The massive scale of the Australian COVID-19 vaccine program required rapid adaptations across all aspects of SAEFVIC's vaccine safety services. Collection of AEFI reports was streamlined and expanded, incorporating both spontaneous and active surveillance data. Dramatically increased report volumes were managed with additional staffing, and innovations to automate, filter, and triage reports for priority follow up. There were two major adverse events of special interest (AESI): thrombosis with thrombocytopaenia syndrome and myocarditis, with multiple other AESI also investigated. Rapid escalation mechanisms to respond to AESI were established, along with AESI-specific databases for enhanced monitoring. Vaccine education and training resources were developed and public-facing vaccine safety reports updated weekly. Frequent communication with local and national government and regulatory bodies, and consultation with specialist groups was essential. The COVID-19 vaccine program has highlighted the importance of vaccine safety in supporting public confidence in vaccines and informing evidence-based immunisation policy. Supporting the COVID-19 vaccine program has required flexibility in adapting to policy changes and evolving vaccine safety signals, careful triage and prioritisation, informatics innovation, and enhanced engagement with the public regarding vaccine safety. Long-term investment to continue strengthening vaccine safety systems, building on lessons learned, will be essential for the ongoing success of Australian vaccination programs.
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Affiliation(s)
- Ingrid Laemmle-Ruff
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia,*Correspondence: Ingrid Laemmle-Ruff
| | - Georgina Lewis
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Hazel J. Clothier
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia,Melbourne School of Population & Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia,Centre for Health Analytics, Melbourne, VIC, Australia
| | - Gerardo Luis Dimaguila
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia,Centre for Health Analytics, Melbourne, VIC, Australia
| | - Michelle Wolthuizen
- Vaccine Safety & Evaluation, COVID-19 Response, Department of Health, Victorian Government, Melbourne, VIC, Australia
| | - Jim Buttery
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia,Centre for Health Analytics, Melbourne, VIC, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia,Immunisation Service and General Medicine, Royal Children's Hospital, Parkville, VIC, Australia
| | - Nigel W. Crawford
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia,Immunisation Service and General Medicine, Royal Children's Hospital, Parkville, VIC, Australia
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