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Yin A, Wang N, Shea PJ, Rosser EN, Kuo H, Shapiro JR, Fenstermacher KZJ, Pekosz A, Rothman RE, Klein SL, Morgan R. Sex and gender differences in adverse events following influenza and COVID-19 vaccination. Biol Sex Differ 2024; 15:50. [PMID: 38890702 PMCID: PMC11184791 DOI: 10.1186/s13293-024-00625-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. In a predominately young adult female population of healthcare workers, we sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized. METHODS This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the mandatory annual fall 2019-2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination for bivalent COVID-19 and influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants' experiences with AEs also were collected for the COVID-19 vaccine recipients. RESULTS Females were more likely to report local AEs after either influenza (OR = 2.28, p = 0.001) or COVID-19 (OR = 2.57, p = 0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after either influenza (OR = 1.18, p = 0.552) or COVID-19 (OR = 0.96, p = 0.907) vaccination. Hormonal birth control use did not impact the rates of reported AEs following influenza vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs. CONCLUSIONS Our findings highlight the need for sex- and gender-inclusive policies to inform more effective mandatory occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers, a predominately female population, and to more fully characterize the post-vaccination behavioral differences between men and women.
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Affiliation(s)
- Anna Yin
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nadia Wang
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick J Shea
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erica N Rosser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Helen Kuo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janna R Shapiro
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sabra L Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Li J, Hsu KS, Howe SE, Hoang T, Xia Z, Berzofsky JA, Sui Y. Sex-biased immunogenicity of a mucosal subunit vaccine against SARS-CoV-2 in mice. Front Immunol 2024; 15:1386243. [PMID: 38835757 PMCID: PMC11148259 DOI: 10.3389/fimmu.2024.1386243] [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: 02/14/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction Current vaccines against COVID-19 administered via parenteral route have limited ability to induce mucosal immunity. There is a need for an effective mucosal vaccine to combat SARS-CoV-2 virus replication in the respiratory mucosa. Moreover, sex differences are known to affect systemic antibody responses against vaccines. However, their role in mucosal cellular responses against a vaccine remains unclear and is underappreciated. Methods We evaluated the mucosal immunogenicity of a booster vaccine regimen that is recombinant protein-based and administered intranasally in mice to explore sex differences in mucosal humoral and cellular responses. Results Our results showed that vaccinated mice elicited strong systemic antibody (Ab), nasal, and bronchiole alveolar lavage (BAL) IgA responses, and local T cell immune responses in the lung in a sex-biased manner irrespective of mouse genetic background. Monocytes, alveolar macrophages, and CD103+ resident dendritic cells (DCs) in the lungs are correlated with robust mucosal Ab and T cell responses induced by the mucosal vaccine. Discussion Our findings provide novel insights into optimizing next-generation booster vaccines against SARS-CoV-2 by inducing spike-specific lung T cell responses, as well as optimizing mucosal immunity for other respiratory infections, and a rationale for considering sex differences in future vaccine research and vaccination practice.
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MESH Headings
- Animals
- Female
- Mice
- SARS-CoV-2/immunology
- COVID-19 Vaccines/immunology
- COVID-19/prevention & control
- COVID-19/immunology
- COVID-19/virology
- Vaccines, Subunit/immunology
- Vaccines, Subunit/administration & dosage
- Male
- Immunity, Mucosal
- Immunogenicity, Vaccine
- Antibodies, Viral/immunology
- Antibodies, Viral/blood
- Lung/immunology
- Lung/virology
- T-Lymphocytes/immunology
- Spike Glycoprotein, Coronavirus/immunology
- Mice, Inbred C57BL
- Administration, Intranasal
- Sex Factors
- Immunoglobulin A/immunology
- Dendritic Cells/immunology
- Immunization, Secondary
- Immunity, Humoral
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Affiliation(s)
- Jianping Li
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Kevin S Hsu
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Savannah E Howe
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Tanya Hoang
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Zheng Xia
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Jay A Berzofsky
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Yongjun Sui
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
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Suzumura Y. Importance of Examining Incidentality in Vaccine Safety Assessment. Vaccines (Basel) 2024; 12:555. [PMID: 38793806 PMCID: PMC11126085 DOI: 10.3390/vaccines12050555] [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: 04/19/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
The author believes that the principles of statistical methods for vaccine safety can be divided into three categories: comparison of adverse event incidence rates between vaccinated and unvaccinated groups, analysis of incidentality in the vaccinated group, and a combination of both. The first category includes the cohort study; the second, the self-controlled risk interval design (SCRI); and the third, the self-controlled case series method. A single p-value alone should not determine a scientific conclusion, and analysis should be performed using multiple statistical methods with different principles. The author believes that using both the cohort study and the SCRI for analysis is the best method to assess vaccine safety. When the cohort study may not detect a significant difference owing to a low incidence rate of an adverse event in the vaccinated group or a high one in the unvaccinated group, the SCRI may detect it. Because vaccines must have a higher level of safety than the pharmaceuticals used for treatment, vaccine safety is advisable to be assessed using methods that can detect a significant difference even for any value of the incidence rate of an adverse event. The author believes that the analyses of COVID-19 vaccine safety have areas for improvement because the proportion of papers that used the cohort study and the SCRI was negligible.
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Stefanizzi P, Moscara L, Palmieri C, Martinelli A, Di Lorenzo A, Venerito V, Germinario CA, Tafuri S. Safety profile of recombinant adjuvanted anti-herpes zoster vaccine (RZV) in high-risk groups: Data from active surveillance program. Puglia (Italy), 2021-23. Vaccine 2024; 42:2966-2974. [PMID: 38582693 DOI: 10.1016/j.vaccine.2024.03.024] [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: 01/15/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Since 2021 a recombinant adjuvanted anti-Herpes Zoster vaccine(Recombinant Zoster Vaccine, RZV) is offered in Italy to high-risk patients. Few real-life data about RZV safety are available in target populations. OBJECTIVES This study investigates Adverse Events Following Immunization(AEFIs), baseline disease flare-ups, and Herpes Zoster (HZ) episodes occurring after RZV administration in a heterogeneous population of fragile patients to design its safety profile. METHODS This is a retrospective population-based study. RZV-vaccinated patients at Bari Policlinico General Hospital vaccination clinic from October 1st, 2021, to March 31st, 2023, were enrolled. Subjects were screened for reason of RZV eligibility and baseline chronic pathologies. AEFIs occurred in the first 7-days post-vaccination period were collected, and baseline disease flare-ups and post-vaccination HZ episodes were assessed via a 3-month follow-up. RESULTS Five-hundred-thirty-eight patients were included and total of 1,031 doses were administered. Most patients were vaccinated due to ongoing immunosuppressive therapy(54.65 %); onco-hematological and cardiovascular conditions were the most common chronic baseline pathologies. Out of 1,031 follow-ups, 441 AEFI cases were reported(42.7/100). The most common symptoms were injection site pain/itching(35.60/100), asthenia/malaise(11.44/100), and fever (10.09/100). Four serious AEFIs occurred(0.38/100). Older age, male sex, and history of cardiovascular diseases(OR:0.71; 95CI:0.52-0.98; p-value <0.05) were found to decrease AEFIs risk, while endocrine-metabolic illnesses(OR:1.61; 95CI:1.15-2.26; p-value <0.05) increased it. Twelve patients(2.23 %) reported a flare-up/worsening of their baseline chronic condition within the first three months after vaccination(mean interval 31.75 days, range 0-68 days). Patients with rheumatological illnesses had a higher risk of relapse(OR:16.56; 95CI:3.58-76.56; p-value <0.001), while male sex behaved as a protective factor. Twelve patients who completed the vaccination cycle(2.43%) had at least one HZ episode by the long-term follow-up. CONCLUSIONS The study demonstrates RZV safety in a significant number of high-risk patients. Hence, RZV should be actively offered as part of tailored vaccination programs to decrease the burden of HZ in fragile populations.
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Affiliation(s)
- Pasquale Stefanizzi
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - Lorenza Moscara
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Claudia Palmieri
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea Martinelli
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Di Lorenzo
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Vincenzo Venerito
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Cinzia Annatea Germinario
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Silvio Tafuri
- Hygiene Unit - Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
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Ouaddouh C, Duijster JW, Lieber T, van Hunsel FPAM. The role of co-morbidities in the development of an AEFI after COVID-19 vaccination in a large prospective cohort with patient-reported outcomes in the Netherlands. Expert Opin Drug Saf 2024; 23:323-331. [PMID: 37796980 DOI: 10.1080/14740338.2023.2267971] [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: 06/14/2023] [Accepted: 08/25/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The effect of a preexisting comorbidity on the occurrence of adverse events after immunization (AEFIs) has been studied poorly. In this longitudinal cohort study, we assess the association between co-morbidities and the occurrence of AEFIs after COVID-19 vaccination. Also, we described the occurrence of flare-ups and their manifestation after COVID-19 vaccination in people with rheumatic diseases. RESEARCH DESIGN AND METHODS We performed multivariable logistic regression to investigate the association between the occurrence of AEFIs and 10 common comorbidities using patient-reported data from people vaccinated with the AstraZeneca, Johnson&Johnson, Moderna, or Pfizer vaccine. RESULTS Occurrence of any AEFI, injection site reactions, headache, fatigue, and/or malaise was significantly associated with presence of comorbidities, including psychological disorders, musculoskeletal disorders, and endocrine disorders after the first and second doses (OR ranges 1.23-1.77). One participant with rheumatoid arthritis experienced a flare-up after receiving the first dose of the AstraZeneca vaccine. DISCUSSION/CONCLUSION The results showed that the odds of reporting an AEFI after COVID-19 vaccination is significantly higher in the presence of some comorbidities whilst flare-ups are uncommon after receiving COVID-19 vaccination in people with rheumatic disease. In-depth research is needed to validate our results and unravel the observed associations from a mechanistic perspective.
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Affiliation(s)
- C Ouaddouh
- Vaccine Team, Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
| | - J W Duijster
- Vaccine Team, Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
| | - T Lieber
- Vaccine Team, Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
| | - F P A M van Hunsel
- Vaccine Team, Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
- Faculty of Science and Engineering, FarmacoTherapie, Epidemiologie en Economie Groningen Research Institute of Pharmacy, Groningen, the Netherlands
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Yin A, Wang N, Shea PJ, Rosser EN, Kuo H, Shapiro JR, Fenstermacher KZJ, Pekosz A, Rothman RE, Klein SL, Morgan R. Sex and gender differences in adverse events following receipt of influenza and COVID-19 vaccination among healthcare workers. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.17.24301440. [PMID: 38318206 PMCID: PMC10843156 DOI: 10.1101/2024.01.17.24301440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Introduction Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. We sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized. Methods This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the annual fall 2019-2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination (DPV) for bivalent COVID-19 and Influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants' experiences with AEs also were collected for the COVID-19 vaccine recipients. Results Females were more likely to report local AEs after influenza (OR=2.28, p=0.001) or COVID-19 (OR=2.57, p=0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after influenza (OR=1.18, p=0.552) or COVID-19 (OR=0.96, p=0.907) vaccination. Exogenous hormones from birth control use did not impact the rates of reported AEs following COVID-19 vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs. Conclusions Our findings highlight the need for sex- and gender-inclusive policies to inform more effective occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers and to more fully characterize the post-vaccination behavioral differences between men and women. KEY MESSAGE What is already known on this topic: ⇒ Among diversely aged adults 18-64 years, females report more AEs to vaccines, including the influenza and COVID-19 vaccines, than males.⇒ Vaccine AEs play a role in shaping vaccine hesitancy and uptake.⇒ Vaccine uptake related to influenza and COVID-19 are higher among men than women.⇒ Research that addresses both the sex and gender disparities of vaccine outcomes and behaviors is lacking.What this study adds: ⇒ This prospective active reporting study uses both quantitative and qualitative survey data to examine sex and gender differences in AEs following influenza or COVID-19 vaccination among a cohort of reproductive-aged healthcare workers.How this study might affect research, practice, or policy: ⇒ Sex and gender differences in AEs and perceptions relating to vaccination should drive the development of more equitable and effective vaccine strategies and policies in occupational health settings.
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Serbanescu-Kele Apor de Zalán C, Bouwman M, van Osch F, Damoiseaux J, Funnekotter-van der Snoek MA, Verduyn Lunel F, Van Hunsel F, de Vries J. Changes in Local and Systemic Adverse Effects following Primary and Booster Immunisation against COVID-19 in an Observational Cohort of Dutch Healthcare Workers Vaccinated with BNT162b2 (Comirnaty ®). Vaccines (Basel) 2023; 12:39. [PMID: 38250852 PMCID: PMC10821042 DOI: 10.3390/vaccines12010039] [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: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
In healthcare workers (HCWs) and in the general population, fear of adverse effects is among the main reasons behind COVID-19 vaccine hesitancy. We present data on self-reported adverse effects from a large cohort of HCWs who underwent primary (N = 470) and booster (N = 990) mRNA vaccination against SARS-CoV-2. We described general patterns in, and predictors of self-reported adverse effect profiles. Adverse effects following immunisation (AEFI) were reported more often after the second dose of primary immunisation than after the first dose, but there was no further increase in adverse effects following the booster round. Self-reported severity of systemic adverse effects was less following booster immunisation. Prior infection with SARS-CoV-2 was found to be a significant predictor of AEFI following primary immunisation, but was no longer a predictor after booster vaccination. Compared to other studies reporting specifically on adverse effects of SARS-CoV-2 vaccination in healthcare workers, we have a relatively large cohort size, and are the first to compare adverse effects between different rounds of vaccination. Compared to studies in the general population, we have a considerably homogenous population. Insights in AEFI following primary and booster vaccinations may help in addressing vaccine hesitancy, both in HCWs and in the general population.
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Affiliation(s)
- Christiaan Serbanescu-Kele Apor de Zalán
- Department of Intensive Care, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
| | - Maud Bouwman
- Department of Medical Microbiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands; (M.B.); (J.D.); (J.d.V.)
| | - Frits van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands;
- Department of Epidemiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Jan Damoiseaux
- Department of Medical Microbiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands; (M.B.); (J.D.); (J.d.V.)
- Central Diagnostic Laboratory, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | | | - Frans Verduyn Lunel
- Department of Medical Microbiology, Utrecht University Medical Centre, 3584 CX Utrecht, The Netherlands;
| | - Florence Van Hunsel
- Department of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands;
- Netherlands Pharmacovigilance Centre (Lareb), 5237 MH Hertogenbosch, The Netherlands
| | - Janneke de Vries
- Department of Medical Microbiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands; (M.B.); (J.D.); (J.d.V.)
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Slingerland P, van Hunsel FPAM, Lieber T, van Balveren L, Duijster JW. The Effect of Sex on the Incidence, Latency, Duration and Perceived Burden of Adverse Events Following Seasonal Influenza Vaccination in the Netherlands. Drug Saf 2023; 46:1323-1334. [PMID: 37882905 DOI: 10.1007/s40264-023-01356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION The annual reformulation of the seasonal influenza vaccine results in fluctuating frequencies and severity of adverse effects following immunization (AEFIs), which stresses the importance of pharmacovigilance. Also, sex-related factors are known to influence the development of AEFIs. This study aims to describe the difference in incidence and course (i.e., time-to-onset, time-to-recovery, and perceived burden) of AEFIs between males and females after seasonal influenza vaccination. METHODS We assessed data from cohort event monitoring studies, which were performed over nine consecutive years (2013-2021), each covering several months during the seasonal influenza campaign in the Netherlands. Participants reported information about AEFIs over a 30-day period in three questionnaires. The effect of sex, age, body mass index, study year, and comorbidities on the incidence of any AEFI, local reactions, fever and the five most reported AEFIs was analyzed using logistic regression. The difference in time-to-onset, time-to-recovery, and perceived burden between males and females was analyzed by the Kruskal-Wallis test. RESULTS The cohort included 7789 participants (53.0% females). Females had around 2.5-fold (p < 0.001) higher odds of developing any AEFI compared with males. Some study years and comorbidities were positively associated with AEFI incidence, whereas age was negatively associated. An AEFI had a significant shorter time-to-onset, a longer time-to-recovery, and a higher perceived burden in females compared to males. CONCLUSION Overall, the results confirm that females experience AEFIs more often than males. Additionally, this study shows that the course of AEFIs only partially differs between the sexes.
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Affiliation(s)
- P Slingerland
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, The Netherlands
| | - Florence P A M van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, The Netherlands.
| | - T Lieber
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, The Netherlands
| | - L van Balveren
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, The Netherlands
| | - J W Duijster
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, The Netherlands
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Kaswandani N, Medise BE, Leonard E, Satari HI, Sundoro J, Hadinegoro SRH, Putra A, Angkasa PF. Safety profile of inactivated COVID-19 in healthy adults aged ≥ 18 years: A passive surveillance in Indonesia. PLoS One 2023; 18:e0286484. [PMID: 37824453 PMCID: PMC10569643 DOI: 10.1371/journal.pone.0286484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/17/2023] [Indexed: 10/14/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) vaccination in Indonesia has shown effectiveness in reducing the morbidity and mortality of Covid-19. The study aims to evaluate the incidence rate and severity of Adverse Events Following Immunization (AEFI) of inactivated SARS-CoV-2 vaccine during the first quarter of 2021 until the second quarter of 2022 in Indonesia. More than two hundred million Sinovac/CoronaVac were given from January 13th, 2021, until June 30th, 2022. Data for this study were collected manually and electronically from the national vaccine safety website managed by the National Committee (NC) of AEFI Indonesia and the Ministry of Health Indonesia. The total number of injections observed in the study was 264,311,992 doses consisting of 142,449,795 (first dose), 121,613,324 (second dose), and 248,873 (booster dose). Of the injections given, 301 subjects with Serious AEFIs (SAE) and 10.261 subjects with non-serious AEFIs (AE) reported, with a majority of SAE and AEs found in the first dose. Most of the SAEs were classified as coincidental events by the NC AEFI (IR 0.8/1 million doses on first dose injection; 0.31 on second dose injection). ISRR (immunization stress-related response) is in the second rank of SAEs reported (0.59 IR/1 million doses on the first dose; 0.14 on the second dose). The incidence rate of SAEs and AEs, both in the variable of age, sex, and symptoms per 1 million dose injections in Indonesia, was very rare according to WHO guidelines. Most SAEs were classified as coincidences or unrelated to the vaccine. The result showed that the Sinovac/CoronaVac in Indonesia is safe.
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Affiliation(s)
- Nastiti Kaswandani
- Faculty of Medicine, Department of Child Health, University of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- National Adverse Events Following Immunization (NC AEFI) of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
| | - Bernie Endyarni Medise
- Faculty of Medicine, Department of Child Health, University of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- National Adverse Events Following Immunization (NC AEFI) of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
| | - Elcha Leonard
- National Adverse Events Following Immunization (NC AEFI) of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
| | - Hindra Irawan Satari
- Faculty of Medicine, Department of Child Health, University of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- National Adverse Events Following Immunization (NC AEFI) of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
| | - Julitasari Sundoro
- National Adverse Events Following Immunization (NC AEFI) of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
| | - Sri Rezeki Harun Hadinegoro
- Faculty of Medicine, Department of Child Health, University of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- National Adverse Events Following Immunization (NC AEFI) of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
| | - Ade Putra
- National Adverse Events Following Immunization (NC AEFI) of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
| | - Putra Fajar Angkasa
- National Adverse Events Following Immunization (NC AEFI) of Indonesia, Central Jakarta, DKI Jakarta, Indonesia
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Hung PV, Nguyen TD, Ha LT, Toi PL, Tram TH. Common Adverse Events from Mixing COVID-19 Vaccine Booster in Hanoi, Vietnam. Vaccines (Basel) 2023; 11:1097. [PMID: 37376486 DOI: 10.3390/vaccines11061097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Mixing vaccines was proposed as a solution to tackle supply chain interruptions during the crisis of the COVID-19 pandemic. This study aimed to investigate the safety of mixing COVID-19 vaccines for a booster dose in Hanoi, Vietnam. METHOD A cross-sectional study was conducted via a telephone-based interview to identify the adverse events following COVID-19 vaccination among 719 participants in Hanoi, Vietnam. RESULTS In total, 45.76% of participants experienced at least one adverse event following two doses of the COVID-19 vaccine. Most of the adverse events were local effects with mild symptoms such as fever, headache, muscle pain, and/or pain at the site. In general, matching two doses in the same vaccines was not associated with the adverse events as compared to mixing vaccines (OR = 1.43, 96%CI: 0.93-2.2), except matching two doses of Pfizer (OR = 2.25, 95%CI: 1.33-3.82). CONCLUSION The findings of this study suggest the overall safety of mixed vaccination. In light of the vaccine shortage, mixing vaccinations for COVID-19 prevention is a good solution. Further studies with larger cohorts and investigating immunity following mixing vaccines are needed to elucidate the mechanism.
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Affiliation(s)
- Pham Van Hung
- National Institute for Control of Vaccine and Biologicals, Hanoi 100000, Vietnam
| | - Thai Duy Nguyen
- National Institute for Control of Vaccine and Biologicals, Hanoi 100000, Vietnam
| | - Luu Thi Ha
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Phung Lam Toi
- Health Strategy and Policy Institute, Ministry of Health, Hanoi 100000, Vietnam
| | - Tran Hong Tram
- National Institute for Control of Vaccine and Biologicals, Hanoi 100000, Vietnam
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Sirisuk W, Limvorapitak W, Lolekha P, Methaset K, Kulkantrakorn K. Incidence and clinical characteristics of adverse neurological events and stroke-like syndrome associated with immune stress-related response after COVID-19 vaccination in 2021 from Thailand. Clin Neurol Neurosurg 2023; 231:107804. [PMID: 37295197 PMCID: PMC10226278 DOI: 10.1016/j.clineuro.2023.107804] [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: 03/07/2023] [Revised: 05/02/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES AEFIs (adverse events following immunizations), especially ISRR ( immune stress related response) which can cause stroke-like symptoms may affect the vaccine roll-out campaign to prevent the coronavirus 2019 outbreak. METHODS This study aimed to describe the incidence and clinical characteristics of neurological AEFIs and stroke-like symptoms associated with ISRR after COVID-19 vaccination. Characteristics of ISRR were compared to minor ischemic stroke patients during the same period of the study. During March to September 2021, we retrospectively collected data of participants aged ≥ 18 years who received COVID-19 vaccine and developed AEFIs from Thammasat university vaccination center (TUVC). Data of neurological AEFIs patients and minor ischemic stroke patients were collected from hospital electronic medical record system. RESULTS COVID-19 vaccine were administered at TUVC for 245,799 doses. AEFIs were reported in 129,652 instances (52.6%). ChADOx-1 nCoV-19 viral vector vaccine has the most frequent occurrence of AEFIs (58.0%), and neurological AEFIs (12.6%). 83% of neurological AEFI was headache. Most were mild and did not need medical attention. Of 119 patients who received COVID-19 vaccine from anywhere with neurological AEFIs and presented to TUH, ISRR was diagnosed in 107 patients (89.9%) and all patients who has follow-up data (30.8%) showed clinical improvement. In comparison with minor ischemic stroke (116 patients), ISRR patients had significantly less ataxia, facial weakness, weakness of arm/leg and speech disturbances (P < 0.001). CONCLUSION The incidence of neurological AEFIs after COVID-19 vaccination was higher among recipients of ChAdOx-1 nCoV-19 vaccine (12.6%) than inactivated vaccine (6.2%) and mRNA vaccine (7.5%). However, most neurological AEFIs were ISRR, had mild severity and resolved within 30 days. Stroke-like symptoms occurred less frequently than patients with minor ischemic stroke.
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Affiliation(s)
- Wikawee Sirisuk
- Division of Neurology, Depeartment of Internal Medicine, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani 12120, Thailand
| | - Wasithep Limvorapitak
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani 12120, Thailand
| | - Praween Lolekha
- Division of Neurology, Depeartment of Internal Medicine, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani 12120, Thailand
| | - Kanthida Methaset
- Division of Pharmacy, Thammasat University Hospital, Klongluang, Pathumthani 12120, Thailand
| | - Kongkiat Kulkantrakorn
- Division of Neurology, Depeartment of Internal Medicine, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani 12120, Thailand.
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van der Boor SC, Schmitz-de Vries ETJ, Smits D, Scholl JHG, Rolfes L, van Hunsel F. Spontaneously reported adverse events following COVID-19 basic and booster immunizations in the Netherlands. Vaccine 2023:S0264-410X(23)00614-X. [PMID: 37286408 DOI: 10.1016/j.vaccine.2023.05.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The rapid roll-out of novel COVID-19 vaccines made near real-time post-marketing safety surveillance essential to identify rare and long-term adverse events following immunization (AEFIs). In light of the ongoing booster vaccination campaigns, it is key to monitor changes in observed safety patterns post-vaccination. The effect of sequential COVID-19 vaccinations, as well as heterologous vaccination sequences, on the observed post-vaccination safety pattern, remains largely unknown. METHODS The primary objective of this study was to describe the profile of spontaneously reported AEFIs following COVID-19 vaccination in the Netherlands, including the primary and booster series. Reports from consumers and healthcare professionals were collected via a COVID-19 vaccine-tailored online reporting form by the National Pharmacovigilance Centre Lareb (Lareb) between 6 January 2021 and 31 August 2022. The data were used to describe the most frequently reported AEFIs per vaccination moment, the consumer experienced burden per AEFI, and differences in AEFIs reported for homologous and heterologous vaccination sequences. RESULTS Lareb received 227,884 spontaneous reports over a period of twenty months. Overall, a high degree of similarity in local and systemic AEFIs per vaccination moment was observed, with no apparent change in the number of reports of serious adverse events after multiple COVID-19 vaccinations. No differences in the pattern of reported AEFIs per vaccination sequence was observed. CONCLUSION Spontaneous reported AEFIs demonstrated a similar reporting pattern for homologous and heterologous primary and booster series of COVID-19 vaccination in the Netherlands.
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Affiliation(s)
- Saskia C van der Boor
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH 's-Hertogenbosch, The Netherlands.
| | - Else T J Schmitz-de Vries
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH 's-Hertogenbosch, The Netherlands.
| | - Dennis Smits
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH 's-Hertogenbosch, The Netherlands.
| | - Joep H G Scholl
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH 's-Hertogenbosch, The Netherlands.
| | - Leàn Rolfes
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH 's-Hertogenbosch, The Netherlands.
| | - Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH 's-Hertogenbosch, The Netherlands.
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