ABSTRACT
Introduction: Cases of de novo immune thrombocytopenia (ITP), including a fatality following SARS-CoV-2 vaccination in a previously healthy recipient, led to studying its impact in pre-existing ITP. Published reports are limited but suggest that most patients with ITP tolerate the COVID-19 vaccines well without frequent ITP exacerbations (Kuter, BJH, 2021). Data regarding risk factors for exacerbation and relationship of response to first dose to that of second dose are limited. Methods: Data for patients with pre-existing ITP were obtained via 3 sources. First, via a ten-center retrospective study of adults with ITP who received a SARS-CoV-2 vaccine between December 2020 and March 2021 and had a post-vaccination platelet count (n=117);9 centers were in the United States. Eighty-nine percent of patients received mRNA-based vaccines. The second and third sources of data were surveys distributed by the Platelet Disorder Support Association (PDSA) and the United Kingdom ITP Support Association. A 'stable platelet count' was defined as a post-vaccination platelet count within 20% of the pre-vaccination level. ITP exacerbation was defined as any one or more of: platelet decrease ≥ 50% compared to pre-vaccination baseline, platelet decrease by >20% compared to prevaccination baseline with platelet nadir < 30x10 9/L, receipt of rescue therapy for ITP. Continuous variables were described as mean ±SD or median [interquartile range];categorical variables were described as n (%). Relative risks and 95% confidence interval were calculated to estimate strength of association. Results: Among 117 patients with pre-existing ITP from 10 centers who received a SARS-CoV-2 vaccine, mean age was 63±17 years, 62% were female, with median 12 [4-23] years since diagnosis of ITP;patients had received a median of 3 [2-4] prior medical treatments. Sixtynine patients were on ITP treatment at the time of vaccination (Table 1). There was an almost even distribution of platelet count response following each vaccine dose. In 109 patients with data for dose 1, platelet counts increased in 32 (29%), were stable in 43 (39%), and decreased in 34 (31%);in 70 patients following dose 2, platelet counts increased in 24 (34%), were stable in 25 (36%), and decreased in 21 (30%) (Figure 1). Nineteen (17%) patients experienced an ITP exacerbation following the first dose and 14 (20%) of 70 after a second dose. In total, fifteen patients received and responded to rescue treatments (n = 6 after dose 1, n = 8 after dose 2, n = 1 after both doses). Of 7 patients who received rescue treatment after dose 1, 5 received dose 2 and only 1/5 received rescue treatment again. Rescue consisted of increased dose of ongoing medication, steroids, IVIG, and rituximab. Splenectomized persons and those who received 5 or more prior lines of medical therapy were at highest risk of ITP exacerbation. Only 1 of 47 patients who had neither undergone splenectomy nor received 5 or more lines of therapy developed ITP exacerbation after dose 1. There were 14 patients offtreatment at the time of dose 1 and 7 patients at time of dose 2;1 patient in each group developed ITP exacerbation with both these having had normal counts prior to vaccination and having undergone splenectomy. In 43 patients whose platelet counts were stable or increased after dose 1 and received dose 2, only 6 (14%) had platelet decreases to <50 x10 9/L after dose 2. Age, gender, vaccine type, and concurrent autoimmune disease did not impact post-vaccine platelet counts. In surveys of 57 PDSA and 43 U.K. ITP patients, similar rates of platelet change were seen (33% of participants reported decreased platelet count in both surveys) and prior splenectomy was significantly associated with worsened thrombocytopenia in each. Conclusions: Thrombocytopenia may worsen in pre-existing ITP post-SARS-CoV2-vaccination but when ITP exacerbation occurred, it responded well to rescue treatment. No serious bleeding events were noted. Rescue treatment was needed in 13% of patients. Proactive vaccination surveillance of patien s with known ITP, especially those post-splenectomy and with more refractory disease, is indicated. These findings should encourage patients with ITP to not only be vaccinated, but to receive the second dose when applicable to ensure optimal immunization. Rituximab interferes with vaccination response and ideally would be held until a minimum of 2 weeks after completion of vaccination.
ABSTRACT
There is no question that it is crucial to document, as precisely and thoroughly as we can, how this arguably unprecedented global crisis has changed the way news is produced, diffused, and consumed, with what effects. By critically analyzing our collective experiences of and responses to the global health crisis as related to journalism, which range from data-driven news production, to existing and emergent threats to press freedom, to misinformation and conspiracy theories, to individuals' news use as well as news avoidance, this special issue highlights the key issues in journalism and journalism scholarship in times of extremely high epistemic uncertainty and ambiguity. After briefly reviewing several noteworthy aspects of the research presented in the current issue, I propose several directions in which future research can extend, refine, and advance the findings as well as research agendas reported herein.
ABSTRACT
Background and purpose: With the wide spread of coronavirus disease 2019 (COVID-19) around the world, not only patients with COVID-19, but also patients with other disease such as stroke have undergone many changes in their health-seeking behavior. Between late February and March 2020, COVID-19 was epidemic in the community of Daegu city and Gyeongsangbuk-do region (D-G region) in Korea. We aimed to clarify the changes in the health-seeking behaviors of stroke patients and stroke care services by region in Korea through analysis of data from Korean Stroke Registry (KSR). Methods: We retrospectively reviewed the data with acute stroke and transient ischemic attack (TIA) patients between 2019 and 2020. We compared the stroke onset to hospital arrival (onset-todoor) time of these patients in the D-G region and other regions in Korea during the epidemic period in 2020 (post-COVID-19: February 18-March 31, 2020) and the same period in 2019 (Pre-COVID- 19). In addition, we investigated the in-hospital stroke pathways with the patients. Results: 1,792 patients in pre-COVID-19 and 1,555 patients in post-COVID-19 who visited KSRregistered hospitals were analyzed. Compared to pre-COVID-19, the number of patients registered in KSR decreased in most regions in post-COVID-19. In the D-G region, the number of registered patients decreased by two thirds, and the proportion of patients with TIA decreased significantly. (9.97% to 2.91%). Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 versus 526.5 minutes, p=0.0084). The proportion of patients with onset-to-door time within 3 hours also decreased significantly (36.45% versus 28.16%, p=0.0485). Patients in their 60s and 70s and mild symptoms (NIHSS score 0 to 3) came to the hospital later. As a result, the patients who underwent thrombectomy also decreased, but the treatment time did not differ between the two periods. Conclusion: During the epidemic of COVID-19, the patients residing in the epicenter showed distinct changes in health-seeking behavior. Appropriate public education about stroke is needed during the COVID-19 pandemic.