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Joy M, Agrawal U, Fan X, Robertson C, Anand SN, Ordonez-Mena J, Byford R, Goudie R, Jamie G, Kar D, Williams J, Marsden GL, Tzortziou-Brown V, Sheikh SA, Hobbs FR, de Lusignan S. Thrombocytopenic, thromboembolic and haemorrhagic events following second dose with BNT162b2 and ChAdOx1: self-controlled case series analysis of the English national sentinel cohort. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100681. [PMID: 37671127 PMCID: PMC10477035 DOI: 10.1016/j.lanepe.2023.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/07/2023]
Abstract
Background Thrombosis associated with thrombocytopenia was a matter of concern post first and second doses of BNT162b2 and ChAdOx1 COVID-19 vaccines. Therefore, it is important to investigate the risk of thrombocytopenic, thromboembolic and haemorrhagic events following a second dose of BNT162b2 and ChAdOx1 COVID-19 vaccines. Methods We conducted a large-scale self-controlled case series analysis, using routine primary care data linked to hospital data, among 12.3 million individuals (16 years old and above) in England. We used the nationally representative Oxford-Royal College of General Practitioners (RCGP) sentinel network database with baseline and risk periods between 8th December 2020 and 11th June 2022. We included individuals who received two vaccine (primary) doses of the BNT162b2 mRNA (Pfizer-BioNTech) and two vaccine doses of ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines in our analyses. We carried out a self-controlled case series (SCCS) analysis for each outcome using a conditional Poisson regression model with an offset for the length of risk period. We reported the incidence rate ratios (IRRs) and 95% confidence intervals (CI) of thrombocytopenic, thromboembolic (including arterial and venous events) and haemorrhagic events, in the period of 0-27 days after receiving a second dose of BNT162b2 or ChAdOx1 vaccines compared to the baseline period (14 or more days prior to first dose, 28 or more days after the second dose and the time between 28 or more days after the first and 14 or more days prior to the second dose). We adjusted for a range of potential confounders, including age, sex, comorbidities and deprivation. Findings Between December 8, 2020 and February 11, 2022, 6,306,306 individuals were vaccinated with two doses of BNT162b2 and 6,046,785 individuals were vaccinated with two doses of ChAdOx1. Compared to the baseline, our analysis show no increased risk of venous thromboembolic events (VTE) for both BNT162b2 (IRR 0.71, 95% CI: 0.65-0.770) and ChAdOx1 (IRR 0.91, 95% CI: 0.84-0.98); and similarly there was no increased risk for cerebral venous sinus thrombosis (CVST) for both BNT162b2 (IRR 0.87, 95% CI: 0.41-1.85) and ChAdOx1 (IRR 1.73, 95% CI: 0.82-3.68). We additionally report no difference in IRR for pulmonary embolus, and deep vein thrombosis, thrombocytopenia, including idiopathic thrombocytopenic purpura (ITP), and haemorrhagic events post second dose for both BNT162b2. Interpretation Reassuringly, we found no associations between increased risk of thrombocytopenic, thromboembolic and haemorrhagic events post vaccination with second dose for either of these vaccines. Funding Data and Connectivity: COVID-19 Vaccines Pharmacovigilance study.
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Affiliation(s)
- Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Sneha N. Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Jose Ordonez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Rosalind Goudie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Gavin Jamie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | | | | | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Alami A, Villeneuve PJ, Farrell PJ, Mattison D, Farhat N, Haddad N, Wilson K, Gravel CA, Crispo JAG, Perez-Lloret S, Krewski D. Myocarditis and Pericarditis Post-mRNA COVID-19 Vaccination: Insights from a Pharmacovigilance Perspective. J Clin Med 2023; 12:4971. [PMID: 37568373 PMCID: PMC10419493 DOI: 10.3390/jcm12154971] [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: 06/10/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Concerns remain regarding the rare cardiovascular adverse events, myocarditis and pericarditis (myo/pericarditis), particularly in younger individuals following mRNA COVID-19 vaccination. Our study aimed to comprehensively assess potential safety signals related to these cardiac events following the primary and booster doses, with a specific focus on younger populations, including children as young as 6 months of age. Using the Vaccine Adverse Events Reporting System (VAERS), the United States national passive surveillance system, we conducted a retrospective pharmacovigilance study analyzing spontaneous reports of myo/pericarditis. We employed both frequentist and Bayesian methods and conducted subgroup analyses by age, sex, and vaccine dose. We observed a higher reporting rate of myo/pericarditis following the primary vaccine series, particularly in males and mainly after the second dose. However, booster doses demonstrated a lower number of reported cases, with no significant signals detected after the fourth or fifth doses. In children and young adults, we observed notable age and sex differences in the reporting of myo/pericarditis cases. Males in the 12-17 and 18-24-year-old age groups had the highest number of cases, with significant signals for both males and females after the second dose. We also identified an increased reporting for a spectrum of cardiovascular symptoms such as chest pain and dyspnea, which increased with age, and were reported more frequently than myo/pericarditis. The present study identified signals of myo/pericarditis and related cardiovascular symptoms after mRNA COVID-19 vaccination, especially among children and adolescents. These findings underline the importance for continued vaccine surveillance and the need for further studies to confirm these results and to determine their clinical implications in public health decision-making, especially for younger populations.
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Affiliation(s)
- Abdallah Alami
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Paul J. Villeneuve
- Department of Neuroscience, Faculty of Science, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Patrick J. Farrell
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
| | - Donald Mattison
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Nawal Farhat
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
| | - Nisrine Haddad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Christopher A. Gravel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1Y7, Canada
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - James A. G. Crispo
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Division of Human Sciences, NOSM University, Sudbury, ON P3E2C6, Canada
| | - Santiago Perez-Lloret
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires C1033AAJ, Argentina
- Observatorio de Salud Pública, Pontificia Universidad Católica Argentina, Buenos Aires C1107AAZ, Argentina
- Department of Physiology, Faculty of Medicine, University of Buenos Aires, Buenos Aires C1121ABG, Argentina
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
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Yong SJ, Halim A, Halim M, Liu S, Aljeldah M, Al Shammari BR, Alwarthan S, Alhajri M, Alawfi A, Alshengeti A, Khamis F, Alsalman J, Alshukairi AN, Abukhamis NA, Almaghrabi FS, Almuthree SA, Alsulaiman AM, Alshehail BM, Alfaraj AH, Alhawaj SA, Mohapatra RK, Rabaan AA. Inflammatory and vascular biomarkers in post-COVID-19 syndrome: A systematic review and meta-analysis of over 20 biomarkers. Rev Med Virol 2023; 33:e2424. [PMID: 36708022 DOI: 10.1002/rmv.2424] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/29/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 may inflict a post-viral condition known as post-COVID-19 syndrome (PCS) or long-COVID. Studies measuring levels of inflammatory and vascular biomarkers in blood, serum, or plasma of COVID-19 survivors with PCS versus non-PCS controls have produced mixed findings. Our review sought to meta-analyse those studies. A systematic literature search was performed across five databases until 25 June 2022, with an updated search on 1 November 2022. Data analyses were performed with Review Manager and R Studio statistical software. Twenty-four biomarkers from 23 studies were meta-analysed. Higher levels of C-reactive protein (Standardized mean difference (SMD) = 0.20; 95% CI: 0.02-0.39), D-dimer (SMD = 0.27; 95% CI: 0.09-0.46), lactate dehydrogenase (SMD = 0.30; 95% CI: 0.05-0.54), and leukocytes (SMD = 0.34; 95% CI: 0.02-0.66) were found in COVID-19 survivors with PCS than in those without PCS. After sensitivity analyses, lymphocytes (SMD = 0.30; 95% CI: 0.12-0.48) and interleukin-6 (SMD = 0.30; 95% CI: 0.12-0.49) were also significantly higher in PCS than non-PCS cases. No significant differences were noted in the remaining biomarkers investigated (e.g., ferritin, platelets, troponin, and fibrinogen). Subgroup analyses suggested the biomarker changes were mainly driven by PCS cases diagnosed via manifestation of organ abnormalities rather than symptomatic persistence, as well as PCS cases with duration of <6 than ≥6 months. In conclusion, our review pinpointed certain inflammatory and vascular biomarkers associated with PCS, which may shed light on potential new approaches to understanding, diagnosing, and treating PCS.
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Affiliation(s)
- Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Alice Halim
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Michael Halim
- Department of Biomedical Science, School of Science, Engineering and Environment, University of Salford, Greater Manchester, UK
| | - Shiliang Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohammed Aljeldah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin, Saudi Arabia
| | - Basim R Al Shammari
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin, Saudi Arabia
| | - Sara Alwarthan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mashael Alhajri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulsalam Alawfi
- Department of Pediatrics, College of Medicine, Taibah University, Al-Madinah, Saudi Arabia
| | - Amer Alshengeti
- Department of Pediatrics, College of Medicine, Taibah University, Al-Madinah, Saudi Arabia
- Department of Infection Prevention and Control, Prince Mohammad Bin Abdulaziz Hospital, National Guard Health Affairs, Al-Madinah, Saudi Arabia
| | - Faryal Khamis
- Infection Diseases Unit, Department of Internal Medicine, Royal Hospital, Muscat, Oman
| | - Jameela Alsalman
- Infection Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain
| | - Abeer N Alshukairi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Nujoud A Abukhamis
- Molecular Virology Laboratory, East Jeddah Hospital, Jeddah, Saudi Arabia
| | | | - Souad A Almuthree
- Department of Infectious Disease, King Abdullah Medical City, Makkah, Saudi Arabia
| | | | - Bashayer M Alshehail
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amal H Alfaraj
- Pediatric Department, Abqaiq General Hospital, First Eastern Health Cluster, Abqaiq, Saudi Arabia
| | - Shorouq A Alhawaj
- Department of Nursing Model of Care, Nephrology Dialysis & Transplant Unit, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Ranjan K Mohapatra
- Department of Chemistry, Government College of Engineering, Keonjhar, India
| | - Ali A Rabaan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
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No evidence of an increased risk for cardiac complications following mRNA COVID-19 vaccines. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:64. [PMID: 36621253 PMCID: PMC9817719 DOI: 10.1016/j.eimce.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 01/09/2023]
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Martins-Filho PR, Sousa ACS. No evidence of an increased risk for cardiac complications following mRNA COVID-19 vaccines. Enferm Infecc Microbiol Clin 2023; 41:64. [PMID: 36278120 PMCID: PMC9574941 DOI: 10.1016/j.eimc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Paulo Ricardo Martins-Filho
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, SE, Brazil
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brazil
| | - Antônio Carlos Sobral Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, SE, Brazil
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Wouters F, van Loon AM, Rutten JJ, Smalbrugge M, Hertogh CM, Joling KJ. Risk of death in nursing home residents after COVID-19 vaccination. J Am Med Dir Assoc 2022; 23:1750-1753.e2. [PMID: 36113605 PMCID: PMC9411144 DOI: 10.1016/j.jamda.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/26/2022] [Accepted: 08/20/2022] [Indexed: 11/14/2022]
Abstract
Objectives In the first months of 2021, the Dutch COVID-19 vaccination campaign was disturbed by reports of death in Norwegian nursing homes (NHs) after vaccination. Reports predominantly concerned persons >65 years of age with 1 or more comorbidities. Also, in the Netherlands adverse events were reported after COVID-19 vaccination in this vulnerable group. Yet, it was unclear whether a causal link between vaccination and death existed. Therefore, we investigated the risk of death after COVID-19 vaccination in Dutch NH residents compared with the risk of death in NH residents prior to the COVID-19 pandemic. Design Population-based longitudinal cohort study with electronic health record data. Setting and Participants We studied Dutch NH residents from 73 NHs who received 1 or 2 COVID-19 vaccination(s) between January 13 and April 16, 2021 (n = 21,762). As a historical comparison group, we included Dutch NH residents who were registered in the same period in 2019 (n = 27,591). Methods Data on vaccination status, age, gender, type of care, comorbidities, and date of NH entry and (if applicable) discharge or date of death were extracted from electronic health records. Risk of death after 30 days was evaluated and compared between vaccinated residents and historical comparison residents with Kaplan-Meier and Cox regression analyses. Regression analyses were adjusted for age, gender, comorbidities, and length of stay. Results Risk of death in NH residents after one COVID-19 vaccination (regardless of whether a second vaccination was given) was decreased compared with historical comparison residents from 2019 (adjusted HR 0.77, 95% CI 0.69-0.86). The risk of death further decreased after 2 vaccinations compared with the historical comparison group (adjusted HR 0.57, 95% CI 0.50-0.64). Conclusions and Implications We found no indication that risk of death in NH residents is increased after COVID-19 vaccination. These results indicate that COVID-19 vaccination in NH residents is safe and could reduce fear and resistance toward vaccination.
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