Inmunización con vacunas ARN mensajero contra la COVID-19 en pacientes adolescentes con antecedente de síndrome inflamatorio multisistémico: serie de casos / Immunization with messenger RNA vaccines against COVID-19 in adolescents with a history of multisystem inflammatory

Los niños cursan mayormente la infección por el virus SARS-CoV-2 en forma leve. Sin embargo, de forma muy infrecuente algunos pueden desarrollar una patología con marcada gravedad denominada síndrome inflamatorio multisistémico en niños relacionado temporalmente con COVID-19 (SIM-C). Dado su reciente surgimiento, aún hay aspectos de su fisiopatología que se desconocen. La posibilidad de recidiva en caso de reinfección o ante la vacunación contra SARS-CoV-2 son nuevos interrogantes a los que nos enfrentamos. Reportamos una serie de casos de 4 pacientes adolescentes que cursaron SIM-C y meses después han sido vacunados contra SARS-CoV-2 con plataformas ARN mensajero (ARNm) sin presentar recurrencia de la enfermedad ni efectos adversos cardiológicos

In most cases, children with SARS-CoV-2 have a mild infection. However, very rarely, some children may develop a severe disease called multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C). Given its recent emergence, some aspects of its pathophysiology are still unknown. The possibility of recurrence in case of reinfection or SARS-CoV-2 vaccination are new questions we are facing. Here we report a case series of 4 adolescent patients who developed MIS-C and, months later, received the SARS-CoV-2 vaccine with messenger RNA (mRNA) platforms without disease recurrence or cardiac adverse events.

Safety of BNT162b2 COVID-19 vaccine in adolescent patients of UP-PGH

Background@#In response to the pandemic brought about by COVID-19, vaccines were developed immediately. Together with adhering to safety protocols, vaccines are needed to help decrease the mortality and morbidity. As with any other, COVID-19 vaccines are evaluated based on efficacy and safety. Real world data is important in the recommendation of vaccines.@*Objectives@#This study aims to assess the short-term safety of BNT162b2 COVID-19 vaccines administered to Filipino adolescents from October 15, 2021 to December 15, 2021 at the Philippine General Hospital. The number and type of local and systemic reaction within 7 days of vaccination were determined.@*Methods@#This is a retrospective cohort study. The review of the recorded events was done through an electronic diary that was accessed from the official Electronic Medical Records of University of the Philippines-Philippine General Hospital (UP-PGH). This included solicited and prespecified local and systemic reactions that occurred within 7 days of receipt of vaccine dose. Descriptive statistics was used to present the data.@*Results@#Out of the 1,756 BNT162b2 vaccines administered (Dose 1- 890; Dose 2- 866), 13% (N=221) indicated having adverse reaction. Injection site pain was the overall most common reaction with majority (81%) experiencing it within 7 days of vaccination. Systemic reactions made up 60% of the reactions after Dose 1 and 85% of the reactions after Dose 2. This includes tiredness, headache and fever. None of the reactions required hospitalization or further workup.@*Conclusion@#BNT162b2 vaccine has a good safety profile among adolescents vaccinated at UP-PGH, since most of the reported adverse events within 7 days of vaccination were local and systemic reactogenic reactions that did not necessitate hospitalization or work-up. No serious adverse events were reported. Further follow-up is suggested to assess longer term safety.

Immunogenicity and reactogenicity of heterologous immunization schedules with COVID-19 vaccines: a systematic review and network meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Data on the immunogenicity and safety of heterologous immunization schedules are inconsistent. This study aimed to evaluate the immunogenicity and safety of homologous and heterologous immunization schedules.@*METHODS@#Multiple databases with relevant studies were searched with an end date of October 31, 2021, and a website including a series of Coronavirus disease 2019 studies was examined for studies before March 31, 2022. Randomized controlled trials (RCTs) that compared different heterologous and homologous regimens among adults that reported immunogenicity and safety outcomes were reviewed. Primary outcomes included neutralizing antibodies against the original strain and serious adverse events (SAEs). A network meta-analysis (NMA) was conducted using a random-effects model.@*RESULTS@#In all, 11 RCTs were included in the systematic review, and nine were ultimately included in the NMA. Among participants who received two doses of CoronaVac, another dose of mRNA or a non-replicating viral vector vaccine resulted in a significantly higher level of neutralizing antibody than a third CoronaVac 600 sino unit (SU); a dose of BNT162b2 induced the highest geometric mean ratio (GMR) of 15.24, 95% confidence interval [CI]: 9.53-24.39. Following one dose of BNT162b2 vaccination, a dose of mRNA-1273 generated a significantly higher level of neutralizing antibody than BNT162b2 alone (GMR = 1.32; 95% CI: 1.06-1.64), NVX-CoV2373 (GMR = 1.60; 95% CI: 1.16-2.21), or ChAdOx1 (GMR = 1.80; 95% CI: 1.25-2.59). Following one dose of ChAdOx1, a dose of mRNA-1273 was also more effective for improving antibody levels than ChAdOx1 (GMR = 11.09; 95% CI: 8.36-14.71) or NVX-CoV2373 (GMR = 2.87; 95% CI: 1.08-3.91). No significant difference in the risk for SAEs was found in any comparisons.@*CONCLUSIONS@#Relative to vaccination with two doses of CoronaVac, a dose of BNT162b2 as a booster substantially enhances immunogenicity reactions and has a relatively acceptable risk for SAEs relative to other vaccines. For primary vaccination, schedules including mRNA vaccines induce a greater immune response. However, the comparatively higher risk for local and systemic adverse events introduced by mRNA vaccines should be noted.@*REGISTRATION@#PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; No. CRD42021278149.

Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

INTRODUCTION@#Despite reports suggesting an association between COVID-19 mRNA vaccination and pericarditis and myocarditis, detailed nationwide population-based data are sparsely available. We describe the incidence of pericarditis and myocarditis by age categories and sex after COVID-19 mRNA vaccination from a nationwide mass vaccination programme in Singapore.@*METHODS@#The incidence of adjudicated cases of pericarditis and myocarditis following COVID-19 mRNA vaccination that were reported to the vaccine safety committee between January to July 2021 was compared with the background incidence of myocarditis in Singapore.@*RESULTS@#As of end July 2021, a total of 34 cases were reported (9 pericarditis only, 14 myocarditis only, and 11 concomitant pericarditis and myocarditis) with 7,183,889 doses of COVID-19 mRNA vaccine administered. Of the 9 cases of pericarditis only, all were male except one. The highest incidence of pericarditis was in males aged 12-19 years with an incidence of 1.11 cases per 100,000 doses. Of the 25 cases of myocarditis, 80% (20 cases) were male and the median age was 23 years (range 12-55 years) with 16 cases after the second dose. A higher-than-expected number of cases were seen in males aged 12-19 and 20-29 years, with incidence rates of 3.72 and 0.98 case per 100,000 doses, respectively.@*CONCLUSION@#Data from the national registry in Singapore indicate an increased incidence of pericarditis and myocarditis in younger men after COVID-19 mRNA vaccination.

Posicionamento da Associação Brasileira de Alergia e Imunologia sobre o manejo da imunoterapia específica com alérgenos (ITA) em pacientes vacinados contra COVID­19 / Position statement of the Brazilian Association of Allergy and Immunology on the management of allergen-specific immunotherapy (AIT) in patients vaccinated against COVID­19

A pandemia de COVID-19 representa um grande desafio para todas as especialidades médicas. A imunoterapia com alérgenos (ITA) é considerada o único procedimento terapêutico capaz de modificar a história natural das doenças alérgicas, e caracteriza o estado da arte na área de Alergia e Imunologia. Esta estratégia terapêutica de imunomodulação é capaz de promover a remissão e controle das doenças alérgicas por períodos prolongados, mesmo após o seu término. Existem poucos dados em relação ao emprego da ITA em pacientes vacinados contra COVID-19, e até o momento não há um posicionamento oficial das sociedades internacionais da área de Alergia e Imunologia Clínica. Este documento tem como objetivo estabelecer recomendações práticas para o manejo da ITA em pacientes que receberam a vacina contra COVID-19. Os fenômenos imunológicos envolvidos na imunoprofilaxia vacinal e no mecanismo de ação da ITA foram comparados, proporcionando o estabelecimento de recomendações precisas.

The COVID-19 pandemic represents a serious challenge for all medical specialties. Allergen-specific immunotherapy (AIT) is considered the only therapeutic procedure capable of modifying the natural history of allergic diseases and characterizes the state of the art in the field of allergy and immunology. This therapeutic strategy of immunomodulation is able to promote remission and control of allergic diseases for prolonged periods, even after cessation. There are few data regarding use of AIT in patients vaccinated against COVID-19 and, to date, there is no official position statement published by international allergy and clinical immunology societies. This document aims to establish practical recommendations for the management of AIT in patients who have received the COVID-19 vaccine. The immunological mechanisms involved in immunoprophylaxis with vaccines and the mechanism of action of AIT have been compared to provide a solid basis for establishing precise recommendations.