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Obidi J, Sridhar G, Dores GM, Whitaker B, Villa CH, Storch E, Chada K, Schilling LM, Natarajan K, Biondich P, Soares A, Spotnitz M, Falconer T, Purkayastha S, Draper NL, Wong HL, Stagg M, Reich C, Anderson S, Shoaibi A. Patterns of red blood cell utilization: Harnessing electronic health records data from the Information Standard for Blood and Transplant (ISBT) 128 system within the Biologics Effectiveness and Safety (BEST) initiative. Transfusion 2024. [PMID: 38689458 DOI: 10.1111/trf.17852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Current hemovigilance methods generally rely on survey data or administrative claims data utilizing billing and revenue codes, each of which has limitations. We used electronic health records (EHR) linked to blood bank data to comprehensively characterize red blood cell (RBC) utilization patterns and trends in three healthcare systems participating in the U.S. Food and Drug Administration Center for Biologics Evaluation and Research Biologics Effectiveness and Safety (BEST) initiative. METHODS We used Information Standard for Blood and Transplant (ISBT) 128 codes linked to EHR from three healthcare systems data sources to identify and quantify RBC-transfused individuals, RBC transfusion episodes, transfused RBC units, and processing methods per year during 2012-2018. RESULTS There were 577,822 RBC units transfused among 112,705 patients comprising 345,373 transfusion episodes between 2012 and 2018. Utilization in terms of RBC units and patients increased slightly in one and decreased slightly in the other two healthcare facilities. About 90% of RBC-transfused patients had 1 (~46%) or 2-5 (~42%)transfusion episodes in 2018. Among the small proportion of patients with ≥12 transfusion episodes per year, approximately 60% of episodes included only one RBC unit. All facilities used leukocyte-reduced RBCs during the study period whereas irradiated RBC utilization patterns differed across facilities. DISCUSSION ISBT 128 codes and EHRs were used to observe patterns of RBC transfusion and modification methods at the unit level and patient level in three healthcare systems participating in the BEST initiative. This study shows that the ISBT 128 coding system in an EHR environment provides a feasible source for hemovigilance activities.
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Affiliation(s)
- Joyce Obidi
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Graça M Dores
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Barbee Whitaker
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Carlos H Villa
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Emily Storch
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kinnera Chada
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lisa M Schilling
- Data Science to Patient Value Program and Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Andrey Soares
- Data Science to Patient Value Program and Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | - Nicole L Draper
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hui-Lee Wong
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Steven Anderson
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Azadeh Shoaibi
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Hu M, Shoaibi A, Feng Y, Lloyd PC, Wong HL, Smith ER, Amend KL, Kline A, Beachler DC, Gruber JF, Mitra M, Seeger JD, Harris C, Secora A, Obidi J, Wang J, Song J, McMahill-Walraven CN, Reich C, McEvoy R, Do R, Chillarige Y, Clifford R, Cooper DD, Forshee RA, Anderson SA. Safety of Ancestral Monovalent BNT162b2, mRNA-1273, and NVX-CoV2373 COVID-19 Vaccines in US Children Aged 6 Months to 17 Years. JAMA Netw Open 2024; 7:e248192. [PMID: 38656578 PMCID: PMC11043896 DOI: 10.1001/jamanetworkopen.2024.8192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/12/2024] [Indexed: 04/26/2024] Open
Abstract
Importance Active monitoring of health outcomes after COVID-19 vaccination provides early detection of rare outcomes that may not be identified in prelicensure trials. Objective To conduct near-real-time monitoring of health outcomes after COVID-19 vaccination in the US pediatric population. Design, Setting, and Participants This cohort study evaluated 21 prespecified health outcomes after exposure before early 2023 to BNT162b2, mRNA-1273, or NVX-CoV2373 ancestral monovalent COVID-19 vaccines in children aged 6 months to 17 years by applying a near-real-time monitoring framework using health care data from 3 commercial claims databases in the US (Optum [through April 2023], Carelon Research [through March 2023], and CVS Health [through February 2023]). Increased rates of each outcome after vaccination were compared with annual historical rates from January 1 to December 31, 2019, and January 1 to December 31, 2020, as well as between April 1 and December 31, 2020. Exposure Receipt of an ancestral monovalent BNT162b2, mRNA-1273, or NVX-CoV2373 COVID-19 vaccine dose identified through administrative claims data linked with Immunization Information Systems data. Main Outcomes and Measures Twenty-one prespecified health outcomes, of which 15 underwent sequential testing and 6 were only monitored descriptively due to lack of historical rates. Results Among 4 102 016 vaccinated enrollees aged 6 months to 17 years, 2 058 142 (50.2%) were male and 3 901 370 (95.1%) lived in an urban area. Thirteen of 15 sequentially tested outcomes did not meet the threshold for a statistical signal. Statistical signals were detected for myocarditis or pericarditis after BNT162b2 vaccination in children aged 12 to 17 years and seizure after vaccination with BNT162b2 and mRNA-1273 in children aged 2 to 4 or 5 years. However, in post hoc sensitivity analyses, a statistical signal for seizure was observed only after mRNA-1273 when 2019 background rates were selected; no statistical signal was observed when 2022 rates were selected. Conclusions and Relevance In this cohort study of pediatric enrollees across 3 commercial health insurance databases, statistical signals detected for myocarditis or pericarditis after BNT162b2 (ages 12-17 years) were consistent with previous reports, and seizures after BNT162b2 (ages 2-4 years) and mRNA-1273 vaccinations (ages 2-5 years) should be further investigated in a robust epidemiologic study with confounding adjustment. The US Food and Drug Administration concludes that the known and potential benefits of COVID-19 vaccination outweigh the known and potential risks of COVID-19 infection.
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Affiliation(s)
- Mao Hu
- Acumen LLC, Burlingame, California
| | - Azadeh Shoaibi
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | | | | | | | | | - Joyce Obidi
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | - Rose Do
- Acumen LLC, Burlingame, California
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Shoaibi A, Lloyd PC, Wong HL, Clarke TC, Chillarige Y, Do R, Hu M, Jiao Y, Kwist A, Lindaas A, Matuska K, McEvoy R, Ondari M, Parulekar S, Shi X, Wang J, Lu Y, Obidi J, Zhou CK, Kelman JA, Forshee RA, Anderson SA. Evaluation of potential adverse events following COVID-19 mRNA vaccination among adults aged 65 years and older: Two self-controlled studies in the U.S. Vaccine 2023:S0264-410X(23)00682-5. [PMID: 37344261 DOI: 10.1016/j.vaccine.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/09/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Our near-real-time safety monitoring of 16 adverse events (AEs) following COVID-19 mRNA vaccination identified potential elevation in risk for six AEs following primary series and monovalent booster dose administration. The crude association with AEs does not imply causality. Accordingly, we conducted robust evaluation of potential associations. METHODS We conducted two self-controlled case series studies of COVID-19 mRNA vaccines (BNT162b2 and mRNA-1273) in U.S. Medicare beneficiaries aged ≥ 65 years. Adjusted incidence rate ratio (IRRs) and 95 % confidence intervals (CIs) were estimated following primary series doses for acute myocardial infarction (AMI), pulmonary embolism (PE), immune thrombocytopenia (ITP), disseminated intravascular coagulation (DIC); and following monovalent booster doses for AMI, PE, ITP, Bell's Palsy (BP) and Myocarditis/Pericarditis (Myo/Peri). RESULTS The primary series study included 3,360,981 individuals who received 6,388,542 primary series doses; the booster study included 6,156,100 individuals with one monovalent booster dose. The AMI IRR following BNT162b2 primary series and booster was 1.04 (95 % CI: 0.91 to 1.18) and 1.06 (95 % CI: 1.003 to 1.12), respectively; for mRNA-1273 primary series and booster, 1.01 (95 % CI: 0.82 to 1.26) and 1.05 (95 % CI: 0.998 to 1.11), respectively. The hospital inpatient PE IRR following BNT162b2 primary series and booster was 1.19 (95 % CI: 1.03 to 1.38) and 0.86 (95 % CI: 0.78 to 0.95), respectively; for mRNA-1273 primary series and booster, 1.15 (95 % CI: 0.94 to 1.41) and 0.87 (95 % CI: 0.79 to 0.96), respectively. The studies' results do not support that exposure to COVID-19 mRNA vaccines elevate the risk of ITP, DIC, Myo/Peri, and BP. CONCLUSION We did not find an increased risk for AMI, ITP, DIC, BP, and Myo/Peri and there was not consistent evidence for PE after exposure to COVID-19 mRNA primary series or monovalent booster vaccines. These results support the favorable safety profile of COVID-19 mRNA vaccines administered in the U.S. elderly population.
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Affiliation(s)
- Azadeh Shoaibi
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Patricia C Lloyd
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Hui-Lee Wong
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Tainya C Clarke
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Yoganand Chillarige
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Rose Do
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Mao Hu
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Yixin Jiao
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Andrew Kwist
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Arnstein Lindaas
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Kathryn Matuska
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Rowan McEvoy
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Michelle Ondari
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Shruti Parulekar
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Xiangyu Shi
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Jing Wang
- Acumen, LLC, 500 Airport Blvd. Suite 100, Burlingame, CA 94010, United States.
| | - Yun Lu
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Joyce Obidi
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Cindy K Zhou
- Formerly Affiliated with US Food and Drug Administration, Silver Spring, MD, United States
| | - Jeffrey A Kelman
- Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mail Stop B3-30-03, Baltimore, MD 21244-1850, United States
| | - Richard A Forshee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
| | - Steven A Anderson
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, U. S. Food & Drug Administration, 10903 New Hampshire Ave., Building 71, Silver Spring, MD 20993, United States.
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4
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Hu M, Wong HL, Feng Y, Lloyd PC, Smith ER, Amend KL, Kline A, Beachler DC, Gruber JF, Mitra M, Seeger JD, Harris C, Secora A, Obidi J, Wang J, Song J, McMahill-Walraven CN, Reich C, McEvoy R, Do R, Chillarige Y, Clifford R, Cooper DD, Shoaibi A, Forshee R, Anderson SA. Safety of the BNT162b2 COVID-19 Vaccine in Children Aged 5 to 17 Years. JAMA Pediatr 2023:2805184. [PMID: 37213095 DOI: 10.1001/jamapediatrics.2023.1440] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Importance Active monitoring of health outcomes after COVID-19 vaccination offers early detection of rare outcomes that may not be identified in prelicensure trials. Objective To conduct near-real-time monitoring of health outcomes following BNT162b2 COVID-19 vaccination in the US pediatric population aged 5 to 17 years. Design, Setting, and Participants This population-based study was conducted under a public health surveillance mandate from the US Food and Drug Administration. Participants aged 5 to 17 years were included if they received BNT162b2 COVID-19 vaccination through mid 2022 and had continuous enrollment in a medical health insurance plan from the start of an outcome-specific clean window until the COVID-19 vaccination. Surveillance of 20 prespecified health outcomes was conducted in near real time within a cohort of vaccinated individuals from the earliest Emergency Use Authorization date for the BNT162b2 vaccination (December 11, 2020) and was expanded as more pediatric age groups received authorization through May and June 2022. All 20 health outcomes were monitored descriptively, 13 of which additionally underwent sequential testing. For these 13 health outcomes, the increased risk of each outcome after vaccination was compared with a historical baseline with adjustments for repeated looks at the data as well as a claims processing delay. A sequential testing approach was used, which declared a safety signal when the log likelihood ratio comparing the observed rate ratio against the null hypothesis exceeded a critical value. Exposure Exposure was defined as receipt of a BNT162b2 COVID-19 vaccine dose. The primary analysis assessed primary series doses together (dose 1 + dose 2), and dose-specific secondary analyses were conducted. Follow-up time was censored for death, disenrollment, end of the outcome-specific risk window, end of the study period, or a receipt of a subsequent vaccine dose. Main Outcomes Twenty prespecified health outcomes: 13 were assessed using sequential testing and 7 were monitored descriptively because of a lack of historical comparator data. Results This study included 3 017 352 enrollees aged 5 to 17 years. Of the enrollees across all 3 databases, 1 510 817 (50.1%) were males, 1 506 499 (49.9%) were females, and 2 867 436 (95.0%) lived in an urban area. In the primary sequential analyses, a safety signal was observed only for myocarditis or pericarditis after primary series vaccination with BNT162b2 in the age group 12 to 17 years across all 3 databases. No safety signals were observed for the 12 other outcomes assessed using sequential testing. Conclusions and Relevance Among 20 health outcomes that were monitored in near real time, a safety signal was identified for only myocarditis or pericarditis. Consistent with other published reports, these results provide additional evidence that COVID-19 vaccines are safe in children.
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Affiliation(s)
- Mao Hu
- Acumen, Burlingame, California
| | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | | | - Joann F Gruber
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | - Joyce Obidi
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | - Rose Do
- Acumen, Burlingame, California
| | | | | | | | - Azadeh Shoaibi
- US Food and Drug Administration, Silver Spring, Maryland
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5
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Jiao Y, Moll K, Dores GM, Tworkoski E, Zhou CK, Scott D, Wong HL, Fingar K, Burrell T, McEvoy R, Hobbi S, Chillarige Y, Obidi J, MaCurdy T, Kelman J, Shoaibi A. Immune globulin usage trends in commercially insured and Medicare populations, 2009-2019. Transfusion 2023; 63:516-530. [PMID: 36808746 DOI: 10.1111/trf.17261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Longitudinal patterns of immune globulins (IG) use have not been described in large populations. Understanding IG usage is important given potential supply limitations impacting individuals for whom IG is the sole life-saving/health-preserving therapy. The study describes US IG utilization patterns from 2009 to 2019. STUDY DESIGN AND METHODS Using IBM MarketScan commercial and Medicare claims data, we examined four metrics overall and by condition-specific categories during 2009-2019: (1) IG administrations per 100,000 person-years, (2) IG recipients per 100,000 enrollees, (3) average annual administrations per recipient, and (4) average annual dose per recipient. RESULTS In the commercial and Medicare populations respectively: IG administrations per 100,000 person-years increased by 120% (213-470) and 144% (692-1693); IG recipients per 100,000 enrollees grew by 71% (24-42) and 102% (89-179); average annual administrations per recipient rose by 28% (8-10) and 19% (8-9); and average annual dose (grams) per recipient increased by 29% (384-497) and 34% (317-426). IG administrations associated with immunodeficiency (per 100,000 person-years) increased by 154% (from 127 to 321) and 176% (from 365 to 1007). Autoimmune and neurologic conditions were associated with higher annual average administrations and dose than other conditions. DISCUSSION IG use increased, coinciding with a growth in the IG recipient population in the United States. Several conditions contributed to the trend, with the largest increase observed among immunodeficient individuals. Future investigations should assess changes in the demand for IVIG by disease state or indication and consider treatment effectiveness.
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Affiliation(s)
| | | | - Graça M Dores
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | | | - Cindy Ke Zhou
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Dorothy Scott
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Hui-Lee Wong
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | | | | | | | - Shayan Hobbi
- IBM Consulting, Bethesda, Maryland, USA
- Accenture Federal Services, Arlington, Virginia, USA
| | | | - Joyce Obidi
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Thomas MaCurdy
- Acumen LLC, Burlingame, California, USA
- Department of Economics, Stanford University, Stanford, California, USA
| | - Jeffrey Kelman
- Centers for Medicare & Medicaid Services, Washington, DC, USA
| | - Azadeh Shoaibi
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
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6
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Moll K, Lufkin B, Fingar KR, Ke Zhou C, Tworkoski E, Shi C, Hobbi S, Hu M, Sheng M, McCarty J, Shangguan S, Burrell T, Chillarige Y, Beers J, Saunders-Hastings P, Muthuri S, Edwards K, Black S, Kelman J, Reich C, Amend KL, Djibo DA, Beachler D, Ogilvie RP, Secora A, McMahill-Walraven CN, Seeger JD, Lloyd P, Thompson D, Dimova R, MaCurdy T, Obidi J, Anderson S, Forshee R, Wong HL, Shoaibi A. Background rates of adverse events of special interest for COVID-19 vaccine safety monitoring in the United States, 2019-2020. Vaccine 2023; 41:333-353. [PMID: 36404170 PMCID: PMC9640387 DOI: 10.1016/j.vaccine.2022.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The U.S. Food and Drug Administration (FDA) Biologics Effectiveness and Safety (BEST) Initiative conducts active surveillance of adverse events of special interest (AESI) after COVID-19 vaccination. Historical incidence rates (IRs) of AESI are comparators to evaluate safety. METHODS We estimated IRs of 17 AESI in six administrative claims databases from January 1, 2019, to December 11, 2020: Medicare claims for adults ≥ 65 years and commercial claims (Blue Health Intelligence®, CVS Health, HealthCore Integrated Research Database, IBM® MarketScan® Commercial Database, Optum pre-adjudicated claims) for adults < 65 years. IRs were estimated by sex, age, race/ethnicity (Medicare), and nursing home residency (Medicare) in 2019 and for specific periods in 2020. RESULTS The study included >100 million enrollees annually. In 2019, rates of most AESI increased with age. However, compared with commercially insured adults, Medicare enrollees had lower IRs of anaphylaxis (11 vs 12-19 per 100,000 person-years), appendicitis (80 vs 117-155), and narcolepsy (38 vs 41-53). Rates were higher in males than females for most AESI across databases and varied by race/ethnicity and nursing home status (Medicare). Acute myocardial infarction (Medicare) and anaphylaxis (all databases) IRs varied by season. IRs of most AESI were lower during March-May 2020 compared with March-May 2019 but returned to pre-pandemic levels after May 2020. However, rates of Bell's palsy, Guillain-Barré syndrome, narcolepsy, and hemorrhagic/non-hemorrhagic stroke remained lower in multiple databases after May 2020, whereas some AESI (e.g., disseminated intravascular coagulation) exhibited higher rates after May 2020 compared with 2019. CONCLUSION AESI background rates varied by database and demographics and fluctuated in March-December 2020, but most returned to pre-pandemic levels after May 2020. It is critical to standardize demographics and consider seasonal and other trends when comparing historical rates with post-vaccination AESI rates in the same database to evaluate COVID-19 vaccine safety.
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Affiliation(s)
| | | | | | - Cindy Ke Zhou
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | | | | | | | - Mao Hu
- Acumen LLC, Burlingame, CA, USA
| | | | | | | | | | | | | | | | | | | | | | - Jeff Kelman
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | - Patricia Lloyd
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Deborah Thompson
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Rositsa Dimova
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Thomas MaCurdy
- Acumen LLC, Burlingame, CA, USA,Department of Economics, Stanford University, Stanford, CA, USA
| | - Joyce Obidi
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Steve Anderson
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Richard Forshee
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Hui-Lee Wong
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Azadeh Shoaibi
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA.
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7
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Moll K, Hobbi S, Zhou CK, Fingar K, Burrell T, Hernandez-Medina V, Obidi J, Alawar N, Anderson SA, Wong HL, Shoaibi A. Assessment of performance characteristics of COVID-19 ICD-10-CM diagnosis code U07.1 using SARS-CoV-2 nucleic acid amplification test results. PLoS One 2022; 17:e0273196. [PMID: 35980905 PMCID: PMC9387790 DOI: 10.1371/journal.pone.0273196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
The Food and Drug Administration’s Biologics Effectiveness and Safety Initiative conducts active surveillance to protect public health during the coronavirus disease 2019 (COVID-19) pandemic. This study evaluated performance of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code U07.1 in identifying COVID-19 cases in claims compared with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid amplification test results in linked electronic health records (EHRs). Care episodes in three populations were defined using COVID-19-related diagnoses (population 1), SARS-CoV-2 nucleic acid amplification test procedures (population 2), and all-cause hospitalizations (population 3) in two linked claims-EHR databases: IBM® MarketScan® Explorys® Claims-EMR Data Set (commercial) and OneFlorida Data Trust linked Medicaid-EHR. Positive and negative predictive values were calculated. Respectively, populations 1, 2, and 3 included 26,686, 26,095, and 2,564 episodes (commercial) and 29,117, 23,412, and 9,629 episodes (Florida Medicaid). The positive predictive value was >80% and the negative predictive value was >95% in each population, with the highest positive predictive value in population 3 (commercial: 91.9%; Medicaid: 93.1%). Findings did not vary substantially by patient age. Positive predictive values in populations 1 and 2 fluctuated during April–June 2020. They then stabilized in the commercial but not the Medicaid population. Negative predictive values were consistent over time in all populations and databases. Our findings indicate that U07.1 has high performance in identifying COVID-19 cases and noncases in claims databases. Performance may vary across populations and periods.
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Affiliation(s)
- Keran Moll
- IBM Consulting, Bethesda, Maryland, United States of America
- * E-mail:
| | - Shayan Hobbi
- IBM Consulting, Bethesda, Maryland, United States of America
| | - Cindy Ke Zhou
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
| | - Kathryn Fingar
- IBM Consulting, Bethesda, Maryland, United States of America
| | - Timothy Burrell
- IBM Consulting, Bethesda, Maryland, United States of America
| | | | - Joyce Obidi
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
| | - Nader Alawar
- IBM Consulting, Bethesda, Maryland, United States of America
| | - Steven A. Anderson
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
| | - Hui-Lee Wong
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
| | - Azadeh Shoaibi
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, United States of America
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Wong HL, Hu M, Zhou CK, Lloyd PC, Amend KL, Beachler DC, Secora A, McMahill-Walraven CN, Lu Y, Wu Y, Ogilvie RP, Reich C, Djibo DA, Wan Z, Seeger JD, Akhtar S, Jiao Y, Chillarige Y, Do R, Hornberger J, Obidi J, Forshee R, Shoaibi A, Anderson SA. Risk of myocarditis and pericarditis after the COVID-19 mRNA vaccination in the USA: a cohort study in claims databases. Lancet 2022; 399:2191-2199. [PMID: 35691322 PMCID: PMC9183215 DOI: 10.1016/s0140-6736(22)00791-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several passive surveillance systems reported increased risks of myocarditis or pericarditis, or both, after COVID-19 mRNA vaccination, especially in young men. We used active surveillance from large health-care databases to quantify and enable the direct comparison of the risk of myocarditis or pericarditis, or both, after mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech) vaccinations. METHODS We conducted a retrospective cohort study, examining the primary outcome of myocarditis or pericarditis, or both, identified using the International Classification of Diseases diagnosis codes, occurring 1-7 days post-vaccination, evaluated in COVID-19 mRNA vaccinees aged 18-64 years using health plan claims databases in the USA. Observed (O) incidence rates were compared with expected (E) incidence rates estimated from historical cohorts by each database. We used multivariate Poisson regression to estimate the adjusted incidence rates, specific to each brand of vaccine, and incidence rate ratios (IRRs) comparing mRNA-1273 and BNT162b2. We used meta-analyses to pool the adjusted incidence rates and IRRs across databases. FINDINGS A total of 411 myocarditis or pericarditis, or both, events were observed among 15 148 369 people aged 18-64 years who received 16 912 716 doses of BNT162b2 and 10 631 554 doses of mRNA-1273. Among men aged 18-25 years, the pooled incidence rate was highest after the second dose, at 1·71 (95% CI 1·31 to 2·23) per 100 000 person-days for BNT162b2 and 2·17 (1·55 to 3·04) per 100 000 person-days for mRNA-1273. The pooled IRR in the head-to-head comparison of the two mRNA vaccines was 1·43 (95% CI 0·88 to 2·34), with an excess risk of 27·80 per million doses (-21·88 to 77·48) in mRNA-1273 recipients compared with BNT162b2. INTERPRETATION An increased risk of myocarditis or pericarditis was observed after COVID-19 mRNA vaccination and was highest in men aged 18-25 years after a second dose of the vaccine. However, the incidence was rare. These results do not indicate a statistically significant risk difference between mRNA-1273 and BNT162b2, but it should not be ruled out that a difference might exist. Our study results, along with the benefit-risk profile, continue to support vaccination using either of the two mRNA vaccines. FUNDING US Food and Drug Administration.
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Affiliation(s)
- Hui-Lee Wong
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Mao Hu
- Acumen, Burlingame, CA, USA
| | - Cindy Ke Zhou
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Patricia C Lloyd
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | - Yun Lu
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Yue Wu
- Acumen, Burlingame, CA, USA
| | | | | | | | | | | | | | | | | | | | | | - Joyce Obidi
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Richard Forshee
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Azadeh Shoaibi
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Steven A Anderson
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
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