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Sa S, Lee CW, Shim SR, Yoo H, Choi J, Kim JH, Lee K, Hong M, Han HW. The Safety of mRNA-1273, BNT162b2 and JNJ-78436735 COVID-19 Vaccines: Safety Monitoring for Adverse Events Using Real-World Data. Vaccines (Basel) 2022; 10:320. [PMID: 35214779 PMCID: PMC8879025 DOI: 10.3390/vaccines10020320] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 02/05/2023] Open
Abstract
Two mRNA COVID-19 vaccines (mRNA-1273, Moderna; and BNT162b2, Pfizer-BioNTech) and one viral vector vaccine (JNJ-78436735, Janssen/Johnson and Johnson) are authorized in the US to hinder COVID-19 infections. We analyzed severe and common adverse events in response to COVID-19 vaccines using real-world, Vaccine Adverse Effect Reporting System (VAERS) data. From 14 December 2020 to 30 September 2021, 481,172 (50.7 ± 17.5 years, males 27.89%, 12.35 per 100,000 people) individuals reported adverse events (AEs). The median time to severe AEs was 2 days after injection. The risk of severe AEs following the one viral vector vaccine (OR = 1.044, 95% CI = 1.005-1.086) was significantly higher than that after the two mRNA vaccines, and the risk among males (OR = 1.374, 95% CI = 1.342-1.406) was higher than among females, except for anaphylaxis. For common AEs, however, the risk to males (OR = 0.621, 95% CI = 0.612-0.63) was lower than to females. In conclusion, we provided medical insight and clinical guidance about vaccine types by characterizing AEs using real-world data. In particular, COVID-19 mRNA vaccines are safer than viral vector vaccines with regard to coagulation disorders, whereas inflammation-related AEs are lower in the viral vaccine. The risk-benefit ratio of vaccines should be carefully considered, and close monitoring and management of severe AEs is needed.
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Affiliation(s)
- Soonok Sa
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam 13488, Korea; (S.S.); (C.W.L.); (S.R.S.); (J.H.K.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea
| | - Chae Won Lee
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam 13488, Korea; (S.S.); (C.W.L.); (S.R.S.); (J.H.K.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea
| | - Sung Ryul Shim
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam 13488, Korea; (S.S.); (C.W.L.); (S.R.S.); (J.H.K.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea
- Healthcare Big-Data Center, Bundang CHA Hospital, Seongnam 13488, Korea
- Department of Health and Medical Informatics, Kyungnam University, College of Health Sciences, Changwon 51767, Korea
| | - Hyounggyoon Yoo
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea;
| | - Jinwha Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul 08308, Korea;
| | - Ju Hee Kim
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam 13488, Korea; (S.S.); (C.W.L.); (S.R.S.); (J.H.K.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea
| | - Kiwon Lee
- Spidercore Inc., Daejeon 34134, Korea;
| | - Myunghee Hong
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam 13488, Korea; (S.S.); (C.W.L.); (S.R.S.); (J.H.K.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea
| | - Hyun Wook Han
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam 13488, Korea; (S.S.); (C.W.L.); (S.R.S.); (J.H.K.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea
- Healthcare Big-Data Center, Bundang CHA Hospital, Seongnam 13488, Korea
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Bettinger JA, Sadarangani M, De Serres G, Valiquette L, Vanderkooi OG, Kellner JD, Muller MP, Top KA, Isenor JE, McGeer A, Marty K. The Canadian National Vaccine Safety Network: surveillance of adverse events following immunisation among individuals immunised with the COVID-19 vaccine, a cohort study in Canada. BMJ Open 2022; 12:e051254. [PMID: 35058258 PMCID: PMC8783966 DOI: 10.1136/bmjopen-2021-051254] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION COVID-19 vaccines require enhanced safety monitoring after emergency approval. The Canadian National Vaccine Safety Network monitors the safety of COVID-19 vaccines and provides enhanced monitoring for healthy, auto-immune, immunocompromised, pregnant and breastfeeding populations and allows for the detection of safety signals. METHODS AND ANALYSIS Online participant reporting of health events in vaccinated and unvaccinated individuals 12 years of age and older is captured in three surveys: 1 week after dose 1, 1 week after dose 2 and 7 months after dose 1. Medically attended events are followed up by telephone. The number, percentage, rate per 10 000 and incident rate ratios with 95% CIs are calculated by health event, vaccine type, sex and in 10-year age groups. ETHICS AND DISSEMINATION Each study site has Research Ethics Board approvals for the project (UBC Children's & Women's, CIUSSS de l'Estrie-CHUS, Health PEI, Conjoint Health Research Ethics Board, University of Calgary and Alberta Health Services, IWK Health, Unity Health Toronto and CHU de Québec-Université Laval Research Ethics Boards). Individuals are invited to participate in this active surveillance and electronic consent is given before proceeding to each survey. Weekly reports are shared with public health and posted on the study website. At least one peer-reviewed manuscript is produced.
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Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Louis Valiquette
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Otto G Vanderkooi
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - James D Kellner
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Matthew P Muller
- Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jennifer E Isenor
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Allison McGeer
- University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Kimberly Marty
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Trombetta CM, Gianchecchi E, Montomoli E. Influenza vaccines: Evaluation of the safety profile. Hum Vaccin Immunother 2018; 14:657-670. [PMID: 29297746 PMCID: PMC5861790 DOI: 10.1080/21645515.2017.1423153] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/30/2017] [Accepted: 12/23/2017] [Indexed: 12/15/2022] Open
Abstract
The safety of vaccines is a critical factor in maintaining public trust in national vaccination programs. Vaccines are recommended for children, adults and elderly subjects and have to meet higher safety standards, since they are administered to healthy subjects, mainly healthy children. Although vaccines are strictly monitored before authorization, the possibility of adverse events and/or rare adverse events cannot be totally eliminated. Two main types of influenza vaccines are currently available: parenteral inactivated influenza vaccines and intranasal live attenuated vaccines. Both display a good safety profile in adults and children. However, they can cause adverse events and/or rare adverse events, some of which are more prevalent in children, while others with a higher prevalence in adults. The aim of this review is to provide an overview of influenza vaccine safety according to target groups, vaccine types and production methods.
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Affiliation(s)
| | | | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi srl, Siena, Italy
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McKinnon JE, Maksimowicz-McKinnon K. Autoimmune disease and vaccination: impact on infectious disease prevention and a look at future applications. Transl Res 2016; 167:46-60. [PMID: 26408802 DOI: 10.1016/j.trsl.2015.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 12/11/2022]
Abstract
Vaccines hold promise both for the prevention of infections and as potential immunologic therapy for patients with autoimmune disease (AD). These patients are at high risk for both common and opportunistic infections, but this risk can be significantly reduced and even obviated with the use of recommended available vaccines. Unfortunately, patients with ADs are not routinely offered or provided indicated vaccinations and have higher rates of complications from vaccine-preventable illnesses than patients without ADs. In addition, vaccine therapy is currently under study for the treatment of autoimmune disorders, with early studies demonstrating immunomodulatory effects that may counter undesired immune activation and alleviate disease activity.
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Affiliation(s)
- John E McKinnon
- Department of Medicine, Division of Infectious Diseases, Henry Ford Hospital System, Detroit, Mich.
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Rapid online identification of adverse events after influenza immunization in children by PCIRN's National Ambulatory Network. Pediatr Infect Dis J 2014; 33:1060-4. [PMID: 25361187 DOI: 10.1097/inf.0000000000000373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A National Ambulatory Network was created in 2009 to rapidly assess the safety of influenza vaccines. In 2012, the network was expanded to monitor the safety of live attenuated influenza vaccine and trivalent inactivated influenza vaccine in children. METHODS We used an online survey administered 7 days after influenza immunization to track new or exacerbated health problems that required medical consultation or prevented daily activities. Parents of immunized children completed the survey. Reported adverse events were followed up by telephone within 48 hours of the online report. A sample of nonresponders was contacted by telephone to ensure the online responder group was representative. Event rates after the 2 influenza vaccines were compared. RESULTS A total of 1230 parents completed an online or telephone survey, for a participation rate of 83%: 72% responded online and an additional 11% were reached by telephone. The rate of severe events in children immunized with an influenza vaccine was 4.7% (3.5-5.9%). The frequency and types of events reported were similar between online and telephone reports. Reported rates of severe events were similar after trivalent inactivated influenza or live attenuated influenza vaccine (4.0% vs. 5.1%, respectively). The online survey was easy to access and understand. Most respondents (94%) would participate next year. CONCLUSIONS The rate and type of adverse events after immunization with trivalent inactivated influenza versus live attenuated influenza vaccine were similar and did not vary by reporting process (online vs. telephone). The electronic surveillance methodology provided rapid vaccine safety data in children. The electronic survey methodology was acceptable and feasible.
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Wong CM, Yang L, Chan KP, Chan WM, Song L, Lai HK, Thach TQ, Ho LM, Chan KH, Lam TH, Peiris JSM. Cigarette smoking as a risk factor for influenza-associated mortality: evidence from an elderly cohort. Influenza Other Respir Viruses 2012; 7:531-9. [PMID: 22813463 PMCID: PMC5855151 DOI: 10.1111/j.1750-2659.2012.00411.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Please cite this paper as: Wong et al. (2012) Cigarette smoking as a risk factor for influenza‐associated mortality: evidence from an elderly cohort. Influenza and Other Respiratory Viruses 7(4), 531–539. Background The effects of individual lifestyle factors on the mortality risk after influenza infection have not been explored. Objectives In this study, we assessed the modifying effects of cigarette smoking on mortality risks associated with influenza in a cohort of Hong Kong elders with a follow‐up period of 1998–2009. Methods We used the Cox proportional hazards model with time‐dependent covariates of weekly proportions of specimens positive for influenza (termed as influenza virus activity), to calculate the hazard ratio of mortality associated with a 10% increase in influenza virus activity for never, ex‐ and current smokers. Other individual lifestyle and socioeconomic factors as well as seasonal confounders were also added into the models. Results The overall hazard ratio associated with influenza was 1·028 (95% confidence interval, 1·006, 1·051) for all natural cause mortality and 1·035 (1·003, 1·068) for cardiovascular and respiratory mortality. We found that influenza‐associated hazard ratio was greater in current and ex‐smokers than in never smokers for mortality of all natural causes, cardiovascular and respiratory diseases. Conclusions The findings suggest that smoking might increase influenza‐associated mortality risks among elders.
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Affiliation(s)
- Chit M Wong
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Karande P, Mitragotri S. Transcutaneous immunization: an overview of advantages, disease targets, vaccines, and delivery technologies. Annu Rev Chem Biomol Eng 2012; 1:175-201. [PMID: 22432578 DOI: 10.1146/annurev-chembioeng-073009-100948] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Skin is an immunologically active tissue composed of specialized cells and agents that capture and process antigens to confer immune protection. Transcutaneous immunization takes advantage of the skin immune network by inducing a protective immune response against topically applied antigens. This mode of vaccination presents a novel and attractive approach for needle-free immunization that is safe, noninvasive, and overcomes many of the limitations associated with needle-based administrations. In this review we will discuss the developments in the field of transcutaneous immunization in the past decade with special emphasis on disease targets and vaccine delivery technologies. We will also briefly discuss the challenges that need to be overcome to translate early laboratory successes in transcutaneous immunization into the development of effective clinical prophylactics.
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Affiliation(s)
- Pankaj Karande
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA.
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Newes-Adeyi G, Greece J, Bozeman S, Walker DK, Lewis F, Gidudu J. Active surveillance for influenza vaccine adverse events: the integrated vaccine surveillance system. Vaccine 2011; 30:1050-5. [PMID: 22200501 DOI: 10.1016/j.vaccine.2011.12.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 12/04/2011] [Accepted: 12/06/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We conducted a pilot study of the Integrated Vaccine Surveillance System (IVSS), a novel active surveillance system for monitoring influenza vaccine adverse events that could be used in mass vaccination settings. METHODS We recruited 605 adult vaccinees from a convenience sample of 12 influenza vaccine clinics conducted by public health departments of two U.S. metropolitan regions. Vaccinees provided daily reports on adverse reactions following immunization (AEFI) using an interactive voice response system (IVR) or the internet for 14 consecutive days following immunization. Followup with nonrespondents was conducted through computer-assisted telephone interviewing (CATI). Data on vaccinee reports were available real-time through a dedicated secure website. RESULTS 90% (545) of vaccinees made at least one daily report and 49% (299) reported consecutively for the full 14-day period. 58% (315) used internet, 20% (110) IVR, 6% (31) CATI, and 16% (89) used a combination for daily reports. Of the 545 reporters, 339 (62%) reported one or more AEFI, for a total of 594 AEFIs reported. The majority (505 or 85%) of these AEFIs were mild symptoms. CONCLUSIONS It is feasible to develop a system to obtain real-time data on vaccine adverse events. Vaccinees are willing to provide daily reports for a considerable time post vaccination. Offering multiple modes of reporting encourages high response rates. Study findings on AEFIs showed that the IVSS was able to exhibit the emerging safety profile of the 2008 seasonal influenza vaccine.
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Affiliation(s)
- Gabriella Newes-Adeyi
- Abt Associates Inc. 4550 Montgomery Avenue, Suite 800 N, Bethesda, MD 20814, United States. Gabriella
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Serious adverse events following receipt of trivalent inactivated influenza vaccine in Korea, 2003-2010. Vaccine 2011; 29:7727-32. [PMID: 21827815 DOI: 10.1016/j.vaccine.2011.07.129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vaccination is very important for the control and prevention of influenza, yet no vaccine is perfectly safe. Little is known, however, about influenza vaccination-associated serious adverse events following immunization (AEFI). This study aimed to identify background information on influenza vaccination-related serious AEFI in Korea. METHODS Retrospective review of data from Korea National Vaccine Injury Compensation Program from 2003 to 2010. RESULTS Distribution of approximately 75 million doses of influenza vaccine by end of 2010 gave rise to 42 potentially serious AEFI. In all, nine Guillain-Barré syndrome, eighteen other neurologic events, eight local events, and seven miscellaneous events were included. 62% of these events were identified to have unlike causal association with the vaccine. The reporting rate of serious AEFI ranged from 0.006 to 0.07 cases per 100,000 distributed doses of the vaccine. CONCLUSION GBS was the most common influenza vaccination-related serious AEFI. Enhancing post-vaccination GBS surveillance may increase public confidence in future routine and pandemic influenza vaccination.
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Choe YJ, Cho H, Bae GR, Lee JK. Guillain-Barré syndrome following receipt of influenza A (H1N1) 2009 monovalent vaccine in Korea with an emphasis on Brighton Collaboration case definition. Vaccine 2011; 29:2066-70. [PMID: 21255684 DOI: 10.1016/j.vaccine.2011.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/04/2011] [Accepted: 01/05/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2009-2010 season, with ongoing of influenza A (H1N1), employment of mass vaccination has generated concerns in issue of adverse events following immunization (AEFI). This study investigates the clinical and laboratory data of reported cases of Guillain-Barré syndrome (GBS) and Fisher syndrome (FS) following receipt of influenza A (H1N1) 2009 monovalent vaccine to the National Vaccine Injury Compensation Program (NVICP) in Korea, with all cases reviewed under case definition developed by Brighton Collaboration GBS Working Group. METHOD Retrospective review of medical records for all suspected cases of GBS ad FS following receipt of influenza A (H1N1) monovalent vaccine reported to NVICP from December 1, 2009, through April 28, 2010 was conducted. Additional analyses were performed for identification of levels of diagnostic certainty according to Brighton Collaboration case definition. RESULT Of 29 reported cases, 22 were confirmed to meet Brighton criteria level 1, 2, or 3 for GBS (21) or FS (1). Of those, 2 (9.1%) met level 1, 9 (40.9%) met level 2, and 11 (50.0%) met level 3. The male to female ratio was 2:0 in cases with level 1, 8:1 in cases with level 2, and 3:8 in cases with level 3. The mean age was older in cases with level 1 (54.0 ± 26.9) than that of cases with level 2 (25.6 ± 22.8), and level 3 (13.6 ± 2.4, P=0.005). The median onset interval was longer in cases with level 1 (16 days) than that of cases that met level 2 (12.44 days), and 3 (1.09 days, P=0.019). CONCLUSION The Brighton case definition was used to improve the quality of AEFI data in Korea, and was applicable in retrospective review of medical records in cases with GBS and FS after influenza A (H1N1) vaccination. These findings suggest that standardized case definition was feasible in clarifying the AEFI data, and to further increase the understanding of possible relationship of influenza vaccine and GBS.
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Affiliation(s)
- Young June Choe
- Division of Vaccine Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, Pepublic of Korea.
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Jones TF, McMillian M, Boothe E, Hanna S, Ingram LA. Hospital discharge data for Guillain-Barré syndrome and influenza A (H1N1) vaccine adverse events. Emerg Infect Dis 2010; 16:1500-1. [PMID: 20735949 PMCID: PMC3294969 DOI: 10.3201/eid1609.091837] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Guillain-Barré syndrome after exposure to influenza virus. THE LANCET. INFECTIOUS DISEASES 2010; 10:643-51. [PMID: 20797646 DOI: 10.1016/s1473-3099(10)70140-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Guillain-Barré syndrome (GBS) is an acute, acquired, monophasic autoimmune disorder of peripheral nerves that develops in susceptible individuals after infection and, in rare cases, after immunisation. Exposure to influenza via infection or vaccination has been associated with GBS. We review the relation between GBS and these routes of exposure. Epidemiological studies have shown that, except for the 1976 US national immunisation programme against swine-origin influenza A H1N1 subtype A/NJ/76, influenza vaccine has probably not caused GBS or, if it has, rates have been extremely low (less than one case per million vaccine recipients). By contrast, influenza-like illnesses seem to be relevant triggering events for GBS. The concerns about the risk of inducing GBS in mass immunisation programmes against H1N1 2009 do not, therefore, seem justified by the available epidemiological data. However, the experiences from the 1976 swine flu vaccination programme emphasise the importance for active and passive surveillance to monitor vaccine safety.
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Kraigher A, Ucakar V. Surveillance of adverse events following immunization against pandemic influenza in Slovenia in season 2009/10. Vaccine 2010; 28:5467-72. [PMID: 20598408 DOI: 10.1016/j.vaccine.2010.05.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 05/20/2010] [Accepted: 05/26/2010] [Indexed: 11/29/2022]
Abstract
The results of Slovenian surveillance system of AEFI which was in place for the early detection and investigation of rare adverse events were analysed. The reports about AEFI obtained from physicians, and self-assessment questionnaires from vaccinated persons showed predominantly non-serious and expected side effects. Nine reports (3%) included serious AEFI. No deaths consequent to vaccination were reported. A total of 1170 AEFI were reported by physicians and 1030 by self-assessment. Overall, the most commonly reported AEFI either by physicians or persons were local site reactions (37.3% and 50.5%), tiredness (11.9% and 6.8%) and fever or malaise (10.8% and 6.3%). More than 100,000 people were vaccinated with pandemic vaccines in Slovenia. The type and the frequency of AEFI detected through Slovenian AEFI surveillance system are comparable to the results from other surveillance systems. The benefit-risk balance for the pandemic vaccines used in Slovenia remains positive.
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Affiliation(s)
- Alenka Kraigher
- National Institute of Public Health Slovenia, Trubarjeva 2, 1000 Ljubljana, Slovenia.
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Greene SK, Kulldorff M, Lewis EM, Li R, Yin R, Weintraub ES, Fireman BH, Lieu TA, Nordin JD, Glanz JM, Baxter R, Jacobsen SJ, Broder KR, Lee GM. Near real-time surveillance for influenza vaccine safety: proof-of-concept in the Vaccine Safety Datalink Project. Am J Epidemiol 2010; 171:177-88. [PMID: 19965887 DOI: 10.1093/aje/kwp345] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The emergence of pandemic H1N1 influenza in 2009 has prompted public health responses, including production and licensure of new influenza A (H1N1) 2009 monovalent vaccines. Safety monitoring is a critical component of vaccination programs. As proof-of-concept, the authors mimicked near real-time prospective surveillance for prespecified neurologic and allergic adverse events among enrollees in 8 medical care organizations (the Vaccine Safety Datalink Project) who received seasonal trivalent inactivated influenza vaccine during the 2005/06-2007/08 influenza seasons. In self-controlled case series analysis, the risk of adverse events in a prespecified exposure period following vaccination was compared with the risk in 1 control period for the same individual either before or after vaccination. In difference-in-difference analysis, the relative risk in exposed versus control periods each season was compared with the relative risk in previous seasons since 2000/01. The authors used Poisson-based analysis to compare the risk of Guillain-Barré syndrome following vaccination in each season with that in previous seasons. Maximized sequential probability ratio tests were used to adjust for repeated analyses on weekly data. With administration of 1,195,552 doses to children under age 18 years and 4,773,956 doses to adults, no elevated risk of adverse events was identified. Near real-time surveillance for selected adverse events can be implemented prospectively to rapidly assess seasonal and pandemic influenza vaccine safety.
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Affiliation(s)
- Sharon K Greene
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim HealthCare Institute, 133 Brookline Avenue, Boston, MA 02215-3920, USA.
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Chang C, Gershwin ME. Drugs and autoimmunity--a contemporary review and mechanistic approach. J Autoimmun 2009; 34:J266-75. [PMID: 20015613 DOI: 10.1016/j.jaut.2009.11.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Drug-induced autoimmunity is an idiosyncratic, non-IgE immune related drug reaction. Interestingly, although many drugs have been reported to induce autoantibodies, only a few have a definitive association with drug-induced autoimmune disease. The prototype disease is drug-induced lupus and the typical drug for drug-induced lupus is minocycline. The production of autoantibodies and the induction of symptoms in drug-induced lupus results from a variety of mechanisms, which can include suppression of central or peripheral tolerance, alteration of gene transcription in T and B cells, abnormal cytokine and/or cytokine receptor balance and function, chromatin structure modification and antigen modification. Multiple mechanisms may apply for different drugs, and understanding the pharmacological actions of these agents helps us decipher the etiology. For example, DNA hypomethylation may occur with hydralazine, which leads to increased transcription, increased LFA-1, the generation of autoreactive T cells and a breakdown in peripheral tolerance. Frequently, more than one pathway may be involved. Interestingly, most patients with newly formed autoantibodies resulting from drugs do not develop clinical disease. Nonetheless, the explosion in the use of biological modifiers has been associated with production of autoantibodies, an observation that illustrates the complex nature of these interactions, in that these agents are frequently used to treat autoimmunity, yet may produce autoimmune diseases themselves.
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Affiliation(s)
- Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA 95616, USA.
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Evans D, Cauchemez S, Hayden FG. "Prepandemic" immunization for novel influenza viruses, "swine flu" vaccine, Guillain-Barré syndrome, and the detection of rare severe adverse events. J Infect Dis 2009; 200:321-8. [PMID: 19563262 PMCID: PMC2811391 DOI: 10.1086/603560] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The availability of immunogenic, licensed H5N1 vaccines and the anticipated development of vaccines against "swine" influenza A(H1N1) have stimulated debate about the possible use of these vaccines for protection of those exposed to potential pandemic influenza viruses and for immunization or "priming" of populations in the so-called "prepandemic" (interpandemic) era. However, the safety of such vaccines is a critical issue in policy development for wide-scale application of vaccines in the interpandemic period. For example, wide-scale interpandemic use of H5N1 vaccines could lead to millions of persons receiving vaccines of uncertain efficacy potentially associated with rare severe adverse events and against a virus that may not cause a pandemic. Here, we first review aspects of the 1976 National Influenza Immunization Programme against "swine flu" and its well-documented association with Guillain-Barré syndrome as a case study illustration of a suspected vaccine-associated severe adverse event in a mass interpandemic immunization setting. This case study is especially timely, given the recent spread of a novel influenza A(H1N1) virus in humans in Mexico and beyond. Following this, we examine available safety data from clinical trials of H5N1 vaccines and briefly discuss how vaccine safety could be monitored in a postmarketing surveillance setting.
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John Wiley & Sons, Ltd.. Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P. Safety of trivalent inactivated influenza vaccines in adults: background for pandemic influenza vaccine safety monitoring. Vaccine 2009; 27:2114-20. [PMID: 19356614 DOI: 10.1016/j.vaccine.2009.01.125] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 01/22/2009] [Accepted: 01/29/2009] [Indexed: 11/16/2022]
Abstract
In preparation for pandemic vaccine safety monitoring, we assessed adverse events reported to the Vaccine Adverse Event Reporting System following receipt of trivalent inactivated influenza vaccines among adults from 1990 through 2005. We calculated reporting rates for nonserious, serious, and neurological adverse events. We reviewed reports of recurrent events and deaths, as well as reports identified through advanced signal detection. The most frequently reported events were local reactions and systemic symptoms. Guillain-Barré syndrome was the most frequently reported serious event (0.70 reports per million vaccinations). Adverse event reporting rates have been reasonably constant over time. No new safety concerns emerged after our review of 15 years of post-licensure surveillance data. These findings provide useful information if pandemic vaccine is rapidly distributed and pre-licensure data are limited.
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Affiliation(s)
- Claudia Vellozzi
- Immunization Safety Office (ISO), Office of the Chief Science Officer (OCSO), Centers for Disease Control and Prevention, Atlanta, GA, United States.
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