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Godbole S, Diwan V, Das S, Reddy MM, Kalyanasundaram M, Rajendran D, Biswas D, Mamulwar M, Tiwari RR, Majumder J, Mishra A, Muthusamy SK, Memeenao M, Gupta N, Gupta S, George LS, Kadale P, Trushna T, Saha I, Alam U, Kathiresan J, Phukan SK, Sane S, Bhowmik K, Yadav GK, Krishnamurthy V, Gogoi P, Padhye K, Kant R, Ghosh P, Kharat M, Kulkarni A. Facilitators and barriers to the uptake of COVID-19 vaccine precaution dose among adult population: qualitative analysis across six different states of India. Front Public Health 2024; 11:1293600. [PMID: 38328539 PMCID: PMC10847555 DOI: 10.3389/fpubh.2023.1293600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction India launched the COVID-19 vaccination drive on 16th January 2021 by vaccinating the adult population above 18 years of age. This was followed by the introduction of an additional precaution dose. As on 18th October 2022, 1,02,66,96,808 (1.02 Billion) first dose and 94, 95, 39,516 (949 Million) second doses of COVID-19 vaccine were administered. However, when compared to the uptake of the primary doses, the precaution dose uptake lagged behind with only 21,75, 12,721 (217 million) doses administered. Even though, the uptake of the primary doses remained optimal, irrespective of different interventions by the Government of India, the uptake of the precaution dose remained poor. In this context, the Ministry of Health & Family Welfare wanted to understand the facilitators and Barriers for precaution dose uptake among adults so that future immunization campaigns could address these issues. Methods An exploratory qualitative study was conducted to assess the facilitators and barriers for COVID-19 precaution dose uptake at community level across 6 different states in India. From each of the states, two districts with the highest and lowest rates of COVID-19 vaccine precaution dose uptake were selected. In each of these districts, 2 block Primary Healthcare Centres (PHCs), one with high and one with low uptake were identified. Within these block PHCs, a PHC field area with high and low precaution dose uptakes was identified. From the identified sites a minimum of four IDIs, four FGDs were conducted among the community members. KIIs of the State Immunization Officers, District Immunisation Officers, PHC Medical Officers, healthcare workers like Accredited Social Health Activist/Auxiliary Nurse Midwife were also conducted. The data was audio recorded and it was transcribed, translated and analysed using framework approach. Results It was observed that rise in COVID-19 cases prompted the community to take the precaution dose, this along with the cost of hospitalization and the number of productive days being lost as a result of being infected resulted in vaccine uptake. The fear of non-availability of COVID-19 vaccines latter on also prompted people for vaccine uptake. While the barriers were, poor accessibility to vaccination centers, long hours of travel, poor road connectivity and lack of transportation facilities. However, the most prominent barriers observed across all study sites was that a sense of pandemic fatigue and complacency had developed both among the providers as well as the beneficiaries. Other barriers include differences in vaccination schedules and longer duration between the primary doses of some vaccines. Media was identified to be both a barrier and facilitator for Covid-19 Precaution dose uptake. Even though media played an important role in disseminating information in the beginning of the campaign, it was soon followed by the circulation of both misinformation and disinformation. Discussion The study identified that dissemination of accurate information and community involvement at each stage of planning and implementation are crucial for the success of any campaign. Efforts should be constantly made to address and re-invent strategies that will be most suitable for the needs of the community. Therefore, in order to ensure successful vaccination campaigns, it is crucial that along with political will it is also important to have a decentralized approach with inter-sectoral coordination with different stakeholders such as healthcare workers, community members and the different departments such as the local self-governments, education department, law & order department etc. These lessons learnt from COVID-19 vaccination campaigns must not be forgotten and must be applied in future vaccination campaigns and while framing public health policies.
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Affiliation(s)
| | - Vishal Diwan
- ICMR-National Institute for Research in Environmental Health, Bhopal, India
| | - Saibal Das
- ICMR-Centre for Ageing and Mental Health, Kolkata, India
| | | | | | | | - Dipankar Biswas
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, India
| | | | | | | | - Ayush Mishra
- ICMR-Regional Medical Research Centre Gorakhpur, Gorakhpur, India
| | | | - M. Memeenao
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, India
| | - Nivedita Gupta
- Division of Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Swati Gupta
- Division of Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Leyanna Susan George
- Division of Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | - Tanwi Trushna
- ICMR-National Institute for Research in Environmental Health, Bhopal, India
| | - Indranil Saha
- ICMR-Centre for Ageing and Mental Health, Kolkata, India
| | - Umaer Alam
- ICMR-Regional Medical Research Centre Gorakhpur, Gorakhpur, India
| | | | | | - Suvarna Sane
- ICMR-National AIDS Research Institute, Pune, India
| | - Kalyan Bhowmik
- ICMR-Centre for Ageing and Mental Health, Kolkata, India
| | | | | | - Punananda Gogoi
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, India
| | - Kedar Padhye
- ICMR-National AIDS Research Institute, Pune, India
| | - Rajni Kant
- ICMR-Regional Medical Research Centre Gorakhpur, Gorakhpur, India
| | - Pramit Ghosh
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, India
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Abrams EM. Vaccination and egg allergy: Considerations for family physicians. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:10-12. [PMID: 38262763 PMCID: PMC11126281 DOI: 10.46747/cfp.700110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Elissa M. Abrams
- Senior Medical Advisor in the Centre for Immunization Programs at the Public Health Agency of Canada (PHAC) in Ottawa, Ont; Associate Professor in the Pediatric Allergy and Immunology Program in the Department of Pediatrics and Child Health at the Max Rady College of Medicine at the University of Manitoba in Winnipeg; and Adjunct Professor in the Department of Pediatrics in the Division of Allergy and Immunology at the University of British Columbia in Vancouver
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Abrams EM. La vaccination et l’allergie aux œufs. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:13-15. [PMID: 38262764 PMCID: PMC11126295 DOI: 10.46747/cfp.700113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Elissa M. Abrams
- Conseillère médicale principale au Centre des programmes d’immunisation de l’Agence de la santé publique du Canada (ASPC) à Ottawa (Ontario); professeure agrégée au Programme d’allergie et d’immunologie pédiatriques du Département de pédiatrie et de santé des enfants au Collège Max Rady de médecine de l’Université du Manitoba à Winnipeg; et professeure adjointe au Département de pédiatrie à la Division de l’allergie et de l’immunologie de l’Université de la Colombie-Britannique à Vancouver (Colombie-Britannique)
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Lv L, Lin XQ, Chen Y, Chen HD, Zhang MX, Shao H, Tung TH, Zhu JS. Adverse reactions to inactivated COVID-19 vaccination in patients with chronic liver disease: The effect of anxiety. Hum Vaccin Immunother 2022; 18:2136435. [PMID: 36287551 PMCID: PMC9746530 DOI: 10.1080/21645515.2022.2136435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Studies have shown that patients with chronic liver disease are at a higher risk of contracting novel coronavirus pneumonia than healthy individuals, and many guidelines state that patients with chronic liver disease should be prioritized for COVID-19 vaccination, but there are a few studies on its safety in CLD patients. We aimed to evaluate the safety of the inactivated COVID-19 vaccine in patients with chronic liver disease, and the effect of anxiety on adverse reactions. A questionnaire survey for self-administered post-vaccination adverse reaction monitoring was conducted from June 17, 2021, to August 11, 2021, in patients with chronic liver disease attending a tertiary care hospital in Taizhou, China. We analyzed the data from of a total of 160 participants who scanned the QR code on social media to respond to the questionnaire. The overall incidence of adverse reactions after COVID-19 vaccination in patients with chronic liver disease was 44.4% (71/160), and the most common adverse reaction was local injection site reaction, accounting for 80.3% of adverse reactions (57/71). No serious adverse reactions were reported. Approximately 53.1% of the patients had anxiety about vaccination, and 51.8% of those who felt anxious reported adverse reactions. The safety of COVID-19 vaccination in patients with chronic liver disease is good, and there is a strong association between adverse reactions and vaccine anxiety. Pre-vaccination education for patients with vaccine anxiety and psychological counseling may reduce reports of adverse reactions and improve patients' confidence in the vaccine.
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Affiliation(s)
- Li Lv
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China
| | - Xiao-Qing Lin
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yan Chen
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - He-Dan Chen
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China
| | - Mei-Xian Zhang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Hui Shao
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China,Tao-Hsin Tung Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai 317000, Zhejiang Province, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jian-Sheng Zhu
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China,CONTACT Jian-Sheng Zhu Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Zhejiang University, 150 Ximen Street, Linhai317000, Zhejiang Province, China
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Buelow MT, Kowalsky JM, Brunell AB. Stability of Risk Perception Across Pandemic and Non-pandemic Situations Among Young Adults: Evaluating the Impact of Individual Differences. Front Psychol 2022; 13:840284. [PMID: 35282253 PMCID: PMC8907664 DOI: 10.3389/fpsyg.2022.840284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
Previous research suggests a higher perceived risk associated with a risky behavior predicts a lower likelihood of involvement in that behavior; however, this relationship can vary based on personality characteristics such as impulsivity and behavioral activation. During the COVID-19 pandemic, individuals began to re-evaluate the level of risk associated with everyday behaviors. But what about risks associated with “typical” risk-taking behaviors? In the present study, 248 undergraduate student participants completed measures of impulsivity, behavioral activation and inhibition, propensity to take risks, numeracy, and perceptions of and involvement in both risk-taking behavior and health promoting behavior (e.g., blood donation, registering as an organ donor, vaccination). Our study revealed that higher behavioral inhibition and greater propensity to take risks predicted greater likelihood of involvement in COVID-19-related risk behaviors, even after accounting for perceived risks and benefits of the behavior. Greater likelihood of involvement in social risk behaviors was predicted by greater numeracy and risk-taking propensity. Identifying as male, a greater propensity to take risks, and greater impulsivity predicted increased health/safety risk behaviors. Younger age, lower risk-taking propensity, and lower impulsivity were associated with a greater likelihood of donating blood. For the likelihood of registering to become an organ donor, increasing risk perception, both before and during the pandemic, was associated with greater likelihood of registering, but greater risk-taking propensity was associated with a decreased likelihood of organ donation registration. For flu vaccination, a greater propensity to take risks was associated with a greater likelihood of flu vaccination during the 2020–2021 flu season. Both cognitive and personality factors can predict involvement in risk-taking and health-promotion behaviors, warranting their continued examination.
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Affiliation(s)
- Melissa T Buelow
- Department of Psychology, The Ohio State University, Newark, OH, United States
| | - Jennifer M Kowalsky
- Department of Psychology, The Ohio State University, Newark, OH, United States
| | - Amy B Brunell
- Department of Psychology, The Ohio State University, Mansfield, OH, United States
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Calcaterra G, Bassareo PP, De Gregorio C, Barilla F, Romeo F, Mehta JL. COVID-19 Vaccine-Induced Pro-thrombotic Immune Thrombocytopenia (VIPIT): State of the Art. Curr Cardiol Rev 2022; 18:11-17. [PMID: 35319381 PMCID: PMC9896421 DOI: 10.2174/1573403x18666220321105909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/03/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022] Open
Abstract
In 2020, as the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic spread rapidly throughout the world, scientists worked relentlessly to develop and test the safety and effectiveness of potential vaccines. Usually, the vaccine development process involves years of investigation and testing prior to gaining approval for use in practice. A pathogenic PF4-dependent syndrome, unrelated to the use of heparin therapy, may be manifested following the administration of viral vector vaccines. It leads to severe clot formation at unusual sites approximately in 1 out of 110.000 vaccinated persons. This side effect, although rare, represents a newly devastating clotting phenomenon manifested in otherwise healthy young adults, who are often female. An in-depth description of the specific biological mechanisms implicated in the syndrome is here summarized.
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Affiliation(s)
| | - Pier Paolo Bassareo
- Address correspondence to this author at the University College of Dublin, School of Medicine, Mater Misericordiae University Hospital, Dublin, Republic of Ireland; E-mail:
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Acute unsolicited adverse events following BNT162b2 vaccine in Saudi Arabia, a real-world data. Vaccine 2021; 40:477-482. [PMID: 34916104 PMCID: PMC8668155 DOI: 10.1016/j.vaccine.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
Background Acute adverse events and anaphylaxis were reported after the administration of coronavirus disease (COVID-19) mRNA vaccines. We aim to explore the nature and outcome of adverse events following BNT162B2 vaccine in a community vaccination center, Riyadh, Saudi Arabia. Method Within 30 min post vaccination, all acute adverse events (AAEs) that occurred before March 31st, 2021, and in people older than 16 years were reviewed (AAE group). We used the case definition of Brighton collaboration on vaccine safety to define anaphylaxis. Patients’ demographics, comorbidities, allergy history, and outcome at disposition were collected. Observation duration after vaccination was short (<15 min) or extended (<3 h). Statistical analysis was performed to study AAEs association with the study variables and outcomes. Results Out of 71,221 vaccine recipients, 144 (0.002%) had developed 345 AAEs, at a rate of 48.4 events per 10,000 dose administered. The majority of cases in AAE group were first dose recipients (93.8%) and previously healthy (59%), while the minority had a previous history of allergy (6.3%) or a laboratory-confirmed COVID-19 (4.2%). We found a significant association between female gender and the occurrence of any AAE (p-value = 0.002). Per every 10,000 doses administered, non-anaphylactic AAEs were dizziness (17.8), headache (9.7), nausea (7.1), or syncope (3.2). Only one in every ten AAEs was considered serious and resulted in an extended observation (4.8 per 10,000 doses), but only 1/144 required hospitalization for non-anaphylaxis reasons (0.1 per 10,000 doses). According to the Brighton collaboration definition of anaphylaxis, no single case of high certainty anaphylaxis was recorded. No death was documented in this cohort. Conclusion Acute adverse events due to BNT162b2 vaccine were rare and mostly non-serious with a tendency to occur more in women. Further prospective studies on larger vaccine recipients to evaluate the incidence of anaphylaxis in the Saudi population are warranted.
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Davies C, Marshall HS, Zimet G, McCaffery K, Brotherton JML, Kang M, Garland S, Kaldor J, McGeechan K, Skinner SR. Effect of a School-Based Educational Intervention About the Human Papillomavirus Vaccine on Psychosocial Outcomes Among Adolescents: Analysis of Secondary Outcomes of a Cluster Randomized Trial. JAMA Netw Open 2021; 4:e2129057. [PMID: 34726749 PMCID: PMC8564580 DOI: 10.1001/jamanetworkopen.2021.29057] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Delivery of vaccination to adolescents via a school-based program provides an opportunity to promote their involvement in health decision-making, service provision, and self-efficacy (belief in one's ability to perform a certain behavior). OBJECTIVE To examine the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized trial and process and qualitative evaluation, adolescents aged 12 to 13 years (first year of high school) were recruited at high schools in Western Australia (WA) and South Australia (SA) in 2013 and 2014. Statistical analysis was performed from January 2016 to December 2020. INTERVENTIONS The complex intervention consisted of an adolescent intervention to promote knowledge and psychosocial outcomes, shared decisional support tool, and logistical strategies. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes were assessed. The HPV Adolescent Vaccination Intervention Questionnaire (HAVIQ) was used to measure changes in adolescent knowledge (6-item subscale), fear and anxiety (6-item subscale), self-efficacy (5-item subscale), and decision-making (8-item subscale). The hypothesis was that the intervention would improve adolescent involvement in vaccine decision-making (measured before dose 1 only), improve vaccine-related self-efficacy, and reduce vaccine-related fear and anxiety (measured before doses 1, 2, and 3). Mean (SD) scores for each subscale were compared between intervention and control students. In the process evaluation, focus groups were conducted. Analyses of the HAVIQ data were conducted from 2016 to 2020. Qualitative analyses of the focus groups were undertaken from 2017 to 2020. RESULTS The trial included 40 schools (21 intervention and 19 control) across sectors with 6967 adolescents (mean [SD] age, 13.70 [0.45] years). There were 3805 students (1689 girls and 2116 boys) in the intervention group and 3162 students (1471 girls and 1691 boys) in the control group. The overall response rate for the HAVIQ was 55%. In WA, where parental consent was required, the response rate was 35% (1676 of 4751 students); in SA, where parental consent was not required, it was 97% (2166 of 2216 students). The mean (SD) score for decision-making in the intervention group before dose 1 was 3.50 (0.42) of 5 points and 3.40 (0.40) in the control group, a small but significant difference of 0.11 point (95% CI, 0.06 to 0.16 point; P < .001). There was a small difference in favor of the intervention group in reduced vaccination-related anxiety (pre-dose 1 difference, -0.11 point [95% CI, -0.19 to -0.02 point]; pre-dose 2 difference, -0.18 point [95% CI, -0.26 to -0.10 point]; pre-dose 3 difference, -0.18 [95% CI, -0.24 to -0.11]) and increased vaccination self-efficacy (pre-dose 1 difference, 4.0 points; [95% CI, 1.0 to 7.0 points]; pre-dose 2 difference, 4.0 points [95% CI, 2.0 to 6.0 points]; pre-dose 3 difference, 3.0 points [95% CI, 1.0 to 5.0 points]). Focus group data from 111 adolescents in 6 intervention and 5 control schools revealed more confidence and less anxiety with each vaccine dose. CONCLUSIONS AND RELEVANCE In this cluster randomized trial, there was a small difference in adolescent decisional involvement and vaccine-related confidence and reduced vaccination-related fear and anxiety that was maintained throughout the vaccine course in the intervention vs control groups. Guidelines for vaccination at school should incorporate advice regarding how this outcome can be achieved. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12614000404628.
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Affiliation(s)
- Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Helen S. Marshall
- Women’s and Children’s Hospital and School of Medicine and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Gregory Zimet
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M. L. Brotherton
- VCS Population Health, VCS Foundation, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne Garland
- Centre for Women’s Infectious Diseases Research, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Reproductive and Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations. Vaccines (Basel) 2021; 9:vaccines9030221. [PMID: 33807579 PMCID: PMC7999280 DOI: 10.3390/vaccines9030221] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/18/2022] Open
Abstract
Vaccines constitute the most effective medications in public health as they control and prevent the spread of infectious diseases and reduce mortality. Similar to other medications, allergic reactions can occur during vaccination. While most reactions are neither frequent nor serious, anaphylactic reactions are potentially life-threatening allergic reactions that are encountered rarely, but can cause serious complications. The allergic responses caused by vaccines can stem from activation of mast cells via Fcε receptor-1 type I reaction, mediated by the interaction between immunoglobulin E (IgE) antibodies against a particular vaccine, and occur within minutes or up to four hours. The type IV allergic reactions initiate 48 h after vaccination and demonstrate their peak between 72 and 96 h. Non-IgE-mediated mast cell degranulation via activation of the complement system and via activation of the Mas-related G protein-coupled receptor X2 can also induce allergic reactions. Reactions are more often caused by inert substances, called excipients, which are added to vaccines to improve stability and absorption, increase solubility, influence palatability, or create a distinctive appearance, and not by the active vaccine itself. Polyethylene glycol, also known as macrogol, in the currently available Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines, and polysorbate 80, also known as Tween 80, in AstraZeneca and Johnson & Johnson COVID-19 vaccines, are excipients mostly incriminated for allergic reactions. This review will summarize the current state of knowledge of immediate and delayed allergic reactions in the currently available vaccines against COVID-19, together with the general and specific therapeutic considerations. These considerations include: The incidence of allergic reactions and deaths under investigation with the available vaccines, application of vaccination in patients with mast cell disease, patients who developed an allergy during the first dose, vasovagal symptoms masquerading as allergic reactions, the COVID-19 vaccination in pregnancy, deaths associated with COVID-19 vaccination, and questions arising in managing of this current ordeal. Careful vaccine-safety surveillance over time, in conjunction with the elucidation of mechanisms of adverse events across different COVID-19 vaccine platforms, will contribute to the development of a safe vaccine strategy. Allergists’ expertise in proper diagnosis and treatment of allergic reactions is vital for the screening of high-risk individuals.
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Abstract
Most vaccinations are administered with a needle, which can cause pain and pain-related symptoms such as fear and fainting. At present, interventions aimed at preventing pain and associated symptoms are not systematically integrated in the vaccination delivery process even though they contribute to negative experiences with vaccination and vaccination noncompliance. In this article, a novel framework for vaccination delivery called the CARD™ system was reviewed. CARD is an acronym for Comfort, Ask, Relax and Distract, whereby each letter category incorporates evidence-based interventions to reduce pain and fear and related symptoms. CARD can be integrated in usual vaccination planning and delivery activities in many settings to improve the vaccination experience and decrease pain and fear as barriers to vaccination. Immunizers in all settings and organizational leaders are invited to review their vaccination services against CARD to identify opportunities for enhancing the quality of care being provided.
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Logeman C, Taddio A, McMurtry CM, Bucci L, MacDonald N, Chalmers G, Gudzak V, Shah V, Coldham J, Little C, Samborn T, Dribnenki C, Snider J. Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E126. [PMID: 32899632 PMCID: PMC7552616 DOI: 10.3390/children7090126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C-Comfort, A-Ask, R-Relax and D-Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who had experience with school-based immunizations, either as recipients or onlookers (n = 7; 100% females 14 years old) participated. Students answered pre-post surveys, reviewed CARD™ educational materials and participated in a semi-structured focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis of qualitative data. Participants reported positive perceptions of CARD™ educational materials and that CARD™ could fit into the school immunization process. CARD™ improved knowledge about effective coping interventions and was recommended for education of both nurses and students. The results provide preliminary evidence that CARD™ is acceptable and appropriate for implementation in grade 9 school-based immunizations.
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Affiliation(s)
- Charlotte Logeman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - C. Meghan McMurtry
- Department of Psychology, The University of Guelph, Guelph, ON N1G 2W1, Canada;
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, ON K1Z 8R9, Canada;
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS B3K 6R8, Canada;
| | - Garth Chalmers
- University of Toronto Schools, Toronto, ON M5S 2R7, Canada;
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
| | - Joanne Coldham
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cheri Little
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Tracy Samborn
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cindy Dribnenki
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Joanne Snider
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
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