A Probable Association of Aseptic Meningoencephalitis, Complicated With Cerebral Salt Wasting Syndrome Following COVID-19 Vaccination: A Case Report

Coronavirus disease-19 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred worldwide, and it affected millions of people around the world and killed millions of lives without a definitive treatment. During this challenging time, vaccine production has been hugely carried out leading to the invention of many vaccines against COVID-19. As any vaccine can have some side effects, COVID-19 vaccines also need surveillance and reporting side effects worldwide. Currently, more than 10 vaccines are available against SARS-CoV-2 infection globally. There are many neurological complications reported by SARS-CoV-2 vaccines. There are some reported neurological complications, such as ischemic stroke, Guillain-Barré syndrome, transverse myelitis, Bell's palsy, cerebral venous sinus thrombosis, optic neuritis, meningoencephalitis, small fiber neuropathy, and Tolosa-Hunt syndrome. We present a case of an elderly man who presented with fever, fits, hyponatremia, and polyuria following COVID-19 vaccination and was found to have cerebral salt wasting (CSW) with the exclusion of other causes.

"Sinopharm", "Oxford-AstraZeneca", and "Pfizer-BioNTech" COVID-19 vaccinations: testing efficacy using lung CT-volumetry with comparative analysis of variance (ANOVA)

Background

Several clinical studies tested the efficacy of the different COVID-19 vaccinations while very few radiological researches targeted this issue before.

Aim of the work

To verify the additive role of lung CT-Volumetry in testing the efficacy of three widely distributed COVID-19 vaccinations; namely the "Sinopharm", "Oxford-AstraZeneca", and "Pfizer-BioNTech" vaccinations, with comparative analysis of variance (ANOVA).

Results

This study was retrospectively conducted on 341 COVID-19 patients during the period between June/2021 and March/2022. Based on the immunization status, they were divided into four groups; group (A) included 156/341 (46%) patients who did not receive any vaccination (control group), group (B) included 92/341 (27%) patients who received "Sinopharm" vaccine, group (C) included 55/341 (16%) patients who received "Oxford-AstraZeneca" vaccine, group (D) included 38/341 (11%) patients who received "Pfizer-BioNTech" vaccine. Every group was subdivided based on the medical history into three groups; group (1) patients without comorbidities, group (2) patients with comorbidities, and group (3) immunocompromised patients. Automated CT volumetry was calculated for the pathological lung parenchyma. Five CT-severity scores were provided (score 0 = 0%, score 1 = 1–25%, score 2 = 25–50%, score 3 = 51–75%, and score 4 = 76–100%). Analysis of variance (ANOVA) including Tukey HSD testing was utilized in comparison to the non-immunized patients. The "Phizer-Biontech" vaccine succeeded to eliminate severity in patients without and with comorbidity, and also decreased severity in immunocompromised patients (from 79 to 17%). The "Oxford-AstraZeneca" vaccine and to a lesser extent "Sinopharm" vaccine also decreased the clinical severity in patients with comorbidities and immunocompromised patients (from 15 to 9% & 10% as well as from 79 to 20% & 50% respectively). Significant variance was proved regarding the use of "Sinopharm", "Oxford-AstraZeneca", and "Phizer-Biontech" vaccines in patients without comorbidities (f-ratio averaged 4.0282, 10.8049, and 8.4404 respectively, also p-value averaged 0.04632, 0.001268, and 0.004294). Significant variance was proved regarding the use of "Oxford-AstraZeneca", and "Phizer-Biontech" vaccines in patients with comorbidities and immunocompromised patients (f-ratio averaged 4.7521, and 4.1682 as well as 11.7811, and 15.6 respectively, also p-value averaged 0.03492, and 0.04857, as well as both 0.003177, and 0.0009394 respectively, all < 0.05). No significant variance was proved regarding the use of the "Sinopharm" vaccine.

Conclusions

In addition to the decline of clinical severity rates & CT severity scores, a significant variance was proved regarding the use of the "Sinopharm", "Oxford-AstraZeneca", and "Phizer-Biontech" vaccines in patients without comorbidities. Significant variance was also proved regarding the use of the "Oxford-AstraZeneca" and "Phizer-Biontech" vaccines in patients with comorbidities and immunocompromised patients. Despite that, no significant variance could be proved regarding the use of the "Sinopharm" vaccine in these patients, it decreases the percentage of clinical severity and CT severity scores.

A Case of Disseminated Herpes Zoster With Polyneuropathy Following the Third Dose of the Pfizer-BioNTech Vaccine

SARS-CoV-2 pandemic resulted in the fast development of new vaccines, which helped contain the pandemic, but some adverse events started to rise. Recently, post-administration of mRNA-based vaccines, varicella-zoster virus (VZV) reactivation was reported. We report a case of disseminated herpes zoster with polyneuropathy and cerebrospinal fluid (CSF) findings following the Pfizer-BioNTechvaccine. Our observation aims to increase clinicians' awareness of a possible relationship between herpes zoster reactivation and SARS-CoV-2 vaccines.

Myopericarditis After BNT162b2 mRNA Vaccination With Incidental Intramyocardial Bridging

Myocarditis and pericarditis are inflammatory conditions affecting the myocardium and pericardium, respectively. They are caused by infectious and non-infectious conditions, including autoimmune disorders, drugs, and toxins. Vaccine-induced myocarditis has been reported with viral vaccines, including influenza and smallpox. The BNT162b2 mRNA vaccine (Pfizer-BioNTech) has shown ‎great efficacy against symptomatic, severe coronavirus disease 2019 (COVID-19), hospital admissions, and ‎deaths.‎ The US FDA issued an emergency use authorization for the Pfizer-BioNTech COVID-19 mRNA vaccine for the prevention of COVID-19 in individuals ≥ five years. However, concerns were raised after reports of new cases of myocarditis following mRNA COVID-19 vaccines, especially among adolescents and young adults. Most cases developed symptoms after receiving the second dose. Here, we present a case of a previously healthy 34-year-old male who developed sudden and severe chest pain a week after the second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. Cardiac catheterization showed no angiographically obstructive coronary artery disease but it revealed intramyocardial bridging. This case report demonstrates that the mRNA COVID-19 vaccine can be associated with acute myopericarditis and the clinical presentation can mimic acute coronary syndrome. Despite that, acute myopericarditis associated with the mRNA COVID-19 vaccine is usually mild and can be managed conservatively. Incidental findings such as intramyocardial bridging should not exclude the diagnosis of myocarditis and should be carefully evaluated. COVID-19 infection has high mortality and morbidity even in young individuals, and all different COVID-19 vaccines were found effective in the prevention of severe COVID-19 infection and in decreasing COVID-19 mortality.

Suspected COVID-19 mRNA Vaccine-Induced Postural Orthostatic Tachycardia Syndrome

We present a case of a 15-year-old South Asian male who developed suspected postural orthostatic tachycardia syndrome (POTS) two weeks after receiving the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine booster, which was successfully managed with low-dose fludrocortisone and ivabradine. Clinicians should be aware of the Pfizer-BioNTech COVID-19 vaccine being implicated with the onset of POTS.

Intricacies Affiliated With Post-COVID Vaccine Complications in Makkah Province, Saudi Arabia

Introduction COVID-19 vaccine side effects have a fundamental role in public confidence in the vaccine and its uptake process. Thus far, evidence on vaccine safety has been exclusively obtained from manufacturer-sponsored studies; therefore, this study is designed to assess post-COVID-19 vaccine complications in Makkah province, Saudi Arabia. Method A cross-sectional study included 840 subjects conducted from August to November 2022 to collect data about COVID-19 vaccine side effects. A validated questionnaire was used with 21 multiple-choice items covering demographic data, COVID-19 vaccination type, side effects, and medication used to relieve side effects. The online Raosoft sample size calculator (Raosoft Inc., Seattle, Washington) was utilized for sample size calculation. The Statistical Package for the Social Sciences version 22.0 (IBM Inc., Armonk, New York) was utilized to carry out descriptive statistics. The Shapiro-Wilk test was used to evaluate normal data distribution. Significance of categorized data made by the Pearson's Chi-Squared test and of the vaccination side effects experienced in general wellbeing on a scale of 1-10 by the Kruskal-Wallis test. Result The survey found that most participants in the 18-26 age group were from Jeddah, women, and Saudis. Only 7.1% of participants had comorbidities alone, and 63.1% of participants had previously had COVID-19. The vaccine types used in this study were primarily Pfizer (83.3%), AstraZeneca (9.5%), Moderna (3.6%), and combination vaccines (3.6%). The majority of the participants received vaccination up to the third dose. No side effects were reported by 9.5% of participants, while mild and severe side effects were reported by 90.5% and 23.8% of participants, respectively. Mild side effects included injection site pain, redness, tenderness, or itching (34.5%), fatigue (22.6%), low-grade fever, chills, diarrhea, headache (17.9%), and myalgia (14.3%). Conclusion The majority of the side effects of COVID-19 vaccination were minor reactions (90.5%), but 23.8% were found to be serious side effects, most of which lasted one to three days. More independent studies are needed to investigate gender differences, COVID-19 vaccine efficacy, and the prevalence of side effects in other populations conducted by academic institutions. Additional independent research on vaccine safety is urgently needed to increase public confidence in vaccines and to better understand risk factors for vaccine side effects.

Changes Over Time in COVID-19 Incidence, Vaccinations, Serum Spike IgG, and Viral Neutralizing Potential Among Individuals From a North American Gaming Venue: December 2020-August 2021

OBJECTIVE

This study aims to evaluate COVID-19 cases and vaccine responses among workers in the gaming/entertainment industry.

METHODS

Participants provided detailed information on occupational risk factors, demographics, COVID-19 history, and vaccination status through questionnaire. Enzyme-linked immunosorbent assays were used to measure serum antiviral antibodies and neutralizing capacity.

RESULTS

Five hundred-fifty individuals participated with n = 228 (41.5%) returning for follow-up. At least 71% of participants were fully vaccinated within 8 months of vaccine availability and COVID-19 rates declined concomitantly. Serum anti-spike IgG levels and neutralizing capacity were significantly (P < 0.001) associated COVID-19 history and vaccine type, but not occupational risk factors, and declined (on average 36%) within 5 months. Few vaccine nonresponders (n = 12) and "breakthrough" infections (n = 1) were noted.

CONCLUSIONS

COVID-19 vaccination was associated with a marked decrease in infections; however, individual humoral responses varied and declined significantly over time.

Are COVID-19 mRNA vaccine side effects severe enough to cause missed work? Cross-sectional study of health care-associated workers

ABSTRACT

The Coronavirus Disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome-coronavirus-2, has claimed 5,587,549 lives worldwide as of January 20, 2022. Fortunately, large-scale vaccination can mitigate the impact of COVID-19 by making the disease milder and less common. Although 75.2% of the United States population has received at least 1 dose of a COVID-19 vaccines thus far, concerns regarding vaccine side effects have contributed to vaccine hesitancy. Furthermore, nearly 50% of adults in the United States are concerned not only about side effects, but about their downstream impact, including missed work.The goal of this cross-sectional study was to investigate the effect of messenger RNA vaccine adverse effects on the propensity to miss work among employees associated with a single, large academic health center.Using Qualtrics, all employees, including faculty, staff, and trainees, of 5 large departments were surveyed to determine whether they received the COVID-19 vaccine and which type, and any symptoms they experienced after receipt of either vaccine dose. We hypothesized that vaccine recipients would be more likely to miss work or feel sick enough to miss work following the second dose.Thirty-seven percent of respondents experienced events severe enough that they needed to miss work from either of the doses, with the majority (27.8%) related to the second dose. These findings are consistent with and expand on the results from the phase 3 trials for Pfizer-BionTech and Moderna, which showed that vaccine side effects were more common after the second dose than after the first dose. Our statistically significant finding was more common among Asians, women, trainees/house staff, and nonphysician clinical employees.With an increasing number of individuals taking the vaccine, employers will need to account for the impact of adverse effects on their employees' ability to work. These findings will further help organizations better plan for staffing as vaccinations increase to mitigate the spread of COVID-19.

Clinical Presentation and Outcomes of Myocarditis Post mRNA Vaccination: A Meta-Analysis and Systematic Review

BACKGROUND

Myocarditis is being increasingly reported as a potential complication of both Pfizer-BioNTech and Moderna vaccines for COVID-19. One thousand five hundred and twenty-two cases were reported as of September 02, 2021, as per CDC's (Centers for Disease Control) vaccine adverse event reporting system. Most of the published data is available in the form of case reports and series. There is a need to compile the demographic data, clinical features, and outcomes in these patients.  Methods: A systematic search was conducted in PubMed, Embase, Web of science, and google scholar for published literature between January 01, 2020, and July 17, 2021. Individual data of 69 patients were pooled from 25 qualifying case reports and case series.

RESULTS

The median age of onset was 21 years. 92.7% of the patients were male. 76.8% of patients received the Pfizer-BioNTech vaccine, and 23.2% received the Moderna vaccine. 88.5% developed symptoms after the second dose. Patients were admitted to the hospital a median of three days post-vaccination. All the patients had chest pain and elevated troponin. The myocarditis was confirmed on cardiac MRI in 87% of the patients. Most of the patients had late gadolinium enhancement on MRI. The median length of stay was four days. All the reported patients recovered and were discharged.

CONCLUSION

Post-mRNA vaccination myocarditis is seen predominantly in young males within a few days after their second dose of vaccination. The pathophysiology of myocarditis is not well known. The prognosis is good as all the reported patients recovered. The presence of late gadolinium enhancement on cardiac MRI indicated myocardial necrosis/fibrosis and further studies are needed to establish the long-term prognosis of the condition.

Immune Thrombocytopenic Purpura Following Pfizer-BioNTech COVID-19 Vaccine in an Elderly Female

Mass vaccination campaigns are being run all over the globe to combat the ongoing COVID-19 pandemic. There have been several reports of immune thrombocytopenic purpura (ITP) occurrence following COVID-19 vaccination. However, ITP due to the Pfizer-BioNTech vaccine has been rarely reported, and a causal link has not been identified. The pathophysiology behind immune thrombocytopenia is similar to heparin-induced thrombocytopenia. The management is also similar to other secondary immune thrombocytopenia. We present a case of a 67-year old female diagnosed with immune thrombocytopenia following Pfizer-BioNTech vaccination. The treatment was resistant to high-dose steroids, intravenous immunoglobulin (IVIG), and rituximab and eventually responded to a thrombopoietin-stimulating agent.

Isolated Tachycardia Presenting After Pfizer-BioNTech COVID-19 Vaccination

A 29-year-old woman presented to the emergency department with palpitations and a heart rate of over 140 beats per minute that started approximately six to eight hours after administration of her second COVID-19 vaccination. Many side effects have been associated with the administration of vaccines. We present the first documented case of tachycardia and palpitations, in the absence of other signs or symptoms, presenting within hours of receiving the Pfizer-BioNTech COVID-19 vaccination. Clinicians should be aware that this appears to be benign and resolved within 24 hours in our patient.

Acute Pancreatitis: A Possible Side Effect of COVID-19 Vaccine

For the first time, the mRNA technology was utilized to produce a vaccine against COVID-19 after the unprecedented pandemic equally affected every part of the world. Pfizer-BioNTech (BNT162b2) mRNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was granted emergency use authorization (EUA) by Food and Drug Administration (FDA) in December 2020. EUA has been widely discussed in the medical literature and the general public. The safety of the BNT162b2 vaccine has been investigated in short-term trials with data available for three months. We present a case of a 96-year-old female with a past surgical history of cholecystectomy who presented with acute onset severe abdominal pain a few days after getting the first dose of Pfizer-BioNTech COVID-19 vaccine. She was diagnosed with acute pancreatitis with a lipase level of 4036 U/L. Extensive history and investigations were unable to find any etiology. The patient was conservatively managed and discharged home without any complications. There has been some data available in medical literature showing an association between acute pancreatitis and COVID-19 infection. Trial data of Pfizer COVID-19 also shows one case of acute pancreatitis in the treatment group. There have also been individual cases of unexplained acute pancreatitis shared by medical professionals on online forums. Our main goal to write this case is to make medical literature aware of possible emerging side effects of the COVID-19 vaccine, one of such side effects being self-resolving uncomplicated acute pancreatitis.