Vogt-Koyanagi-Harada disease following ChAdOx1 nCoV-19 and mRNA-1273 vaccination.

Almost all vaccines have been reported to be associated with ocular inflammation, which has caused some concern regarding global mass COVID-19 vaccination efforts. Vogt-Koyanagi-Harada disease (VKHD) is a granulomatous inflammation caused by an autoimmune response against antigens in melanocytes, including those in the eyes. The mechanism by which COVID-19 vaccines are associated with VKHD is still unclear. Here, we report two cases of VKHD following COVID-19 vaccination. The first is a case of probable VKHD that presented with bilateral vision loss after administration of the adenovirus-vectored vaccine ChAdOx1 nCoV-19 (AstraZeneca). The condition improved after intravenous methylprednisolone 1g daily for 3days, followed by oral methotrexate and a slow taper of oral corticosteroids. The second case is a patient with an established diagnosis of well-controlled VKHD who developed a reactivation of the disease after receiving the mRNA-based vaccine (mRNA-1273, Moderna). VKHD is a potential ocular event that could follow COVID-19 vaccination. Awareness of this association is key to early detection and treatment to prevent loss of vision.

A case report of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 in Maha Sarakham, Thailand

We report a case of a 19-year-old female with multisystemic inflammatory syndrome that was associated with the novel coronavirs disease 2019 (COVID-19), which manifested as serious illness that occurred four weeks after COVID-19 infection. Her clinical manifestations involved multiple organ systems including high-grade fever with shock syndrome, pulmonary edema, myopericarditis with pericardial effusion, hepatitis, generalized maculopapular rash, and several elevated inflammatory markers. She was treated with human immunoglobulin, methylprednisolone, acetylsalicylic acid, enoxaparin, and empirical antibiotics. She required a 2-week hospitalization and was discharged after improvement of clinical symptoms and normalization of inflammatory markers. A day prior to discharge, an echocardiography was done and it showed normal ventricular function and no coronary aneurysmal dilation.

Positive Concordance between Commercially Available SARS-CoV-2 Rapid Antigen Test and RT-PCR during the Omicron Wave in Thailand

Background: Rapid SARS-CoV-2 antigen tests are widely used throughout the world. False positive antigen tests have been reported. Objective(s): To evaluate the positive percentage concordance (PPC) between a rapid antigen test and the nucleic acid amplification testing (NAAT). Material(s) and Method(s): The present study was a retrospective laboratory-based study on rapid antigen test-positive nasopharyngeal or throat swabs sent for confirmation by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) between January 1 and April 8, 2022. The primary outcome was a PPC between antigen-positive samples and PCR-positive samples. Result(s): Of the 22,808 samples received, there were 3,656 or 16.04% of the samples with documented positive rapid antigen tests sent for confirmation by rRT-PCR. Overall, PPC was 92.67%, 95% CI 91.82 to 93.51. A higher PPC was found during the BA.2-dominant Omicron variant period at 96.08% (95% CI 95.2 to 96.95). Conclusion(s): The PPC between the rapid antigen test used and rRT-PCR was very high, especially during the BA.2-dominant period. Copyright © 2022 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND.

Incidence of SARS-CoV-2 Infection among Healthcare Personnel after Restarting an Elective Cataract Surgery during the First COVID-19 Wave

Background: During the COVID-19 pandemic, most elective surgeries were postponed, including cataract surgery. However, patients with severe and disabling visual impairment may have required urgent correction. Objective: To report the incidence of SARS-CoV-2 infection among healthcare personnel working with the patients requiring cataract surgery, under a pre-operative screening protocol. Materials and Methods: A retrospective observational study was conducted in the Suddhavej Hospital, Mahasarakham University, Mahasarakham, Thailand during the early unlocked phase in May 2020. The local pre-operative screening protocol used during the period included questionnaires and pre-operative nucleic acid testing to screen for COVID-19 infection among patients. A combination of serial single nucleic acid test and SARSCoV-2 IgG antibody testing were used to screen SARS-CoV-2 infection among healthcare personnel. Mask wearing and physical distancing were required during hospitalization. Results: One hundred fifty-eight patients underwent cataract surgery under local anesthesia. Thirty-three healthcare personnel were included. All tests for SARS-CoV-2 were negative for both patients and healthcare personnel. The incidence rate of COVID-19 infection among healthcare personnel was 0 (95% CI 0.000 to 0.003) per 100 person-hours. There were no reported symptoms compatible with COVID-19 during the observed period and follow-up. Conclusion: Due to a very low incidence rate of hospital-acquired SARS-CoV-2 infection among healthcare personnel, elective cataract surgery under local anesthesia could be continued during COVID-19 pandemic with strict adherence to screening protocol and other preventive measures. SARS-CoV-2 screening method by questionnaire alone may be feasible in a low COVID-19 incidence rate. © 2022 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND

SARS-CoV-2 IgG Seroprevalence Detected by Chemiluminescence Immunoassay Among Healthcare Personnel and Patients in a Province With a Low Incidence Rate of COVID-19 During the First Wave of COVID-19 in Thailand

Background There is limited evidence regarding seroprevalence during the first wave of COVID-19 in Thailand. The limited capacity of molecular laboratories in distant provinces may have resulted in fewer confirmed COVID-19 cases and possible undetected ongoing transmission, as suggested by a previously published seroprevalence study. Objectives This study aimed to assess the SARS-CoV-2 IgG and IgM seroprevalence among healthcare personnel and patients in Suddhavej Hospital and cross-reactivity of SARS-CoV-2 antibody assays with infectious and autoimmune diseases. Methods We conducted a cross-sectional study to determine seroprevalence among healthcare personnel and patients in Suddhavej Hospital, a secondary care hospital in Mahasarakham Province (population of 974,534 as of 2015). A chemiluminescence assay was used to test for IgG and/or IgM SARS-CoV-2 antibodies. Results The study included 112 healthcare personnel and 78 patients with a median age of 29 years (interquartile range, 25-40 years);35.8% were male. The study found an IgG seroprevalence of 3 of 190 (1.6%;95% confidence interval, 0.3%-4.5%). The 3 IgG-positive cases recalled possible exposure risk to COVID-19 infection outside the province. One case had a persistent elevated IgG level after 10 months of follow-up. No cross-reactivity was found among patients with a variety of infectious or immunologic diseases. Conclusions Our study suggests that there is a low seroprevalence among high-risk exposure groups. This evidence supports that the preventive measures used during the first wave of COVID-19 were effective in preventing asymptomatic transmission in a remote province with a low COVID-19 incidence rate.

Prevalence and predictors for high blood pressure during covid-19 vaccination in Thailand

Background: The Thai government mandates BP measurement prior to COVID-19 vaccination to ensure safety for all vaccinees. However, there is neither large study regarding the prevalence of high BP nor CV complication during COVID-19 vaccination. Purpose: To describe the prevalence of high BP defined as SBP≥140 or DBP≥90 mmHg, predictors for high BP and outcome during vaccination day. Methods: We enrolled all vaccinees at a Thai hospital, during June 2021. We reviewed medical records and compared vaccination day BP with BP from prior 2 visits extracted from the computer database. We used a fully automated non-invasive sphygmomanometers. Diagnosis of hypertension were extracted from the past records using ICD-10 code (I1-). Grade of hypertension were defined according to the ESC guideline 2018. Prior well-controlled BP was defined as SBP < 130 and DBP < 80 mmHg in the 2nd prior visit. Results: There were 2308 vaccinees during the period and 2307 with complete data for analysis. Female accounted for 57%. The mean age was 49.69 ± 17.44 years old. Body mass index were 25.77 ± 14.10 kg/m2. Prime COVID-19 vaccines shot accounted for 73.6%. All vaccinees were pre-assigned to receive either ChAdOx1 nCoV-19 or CoronaVac: 54.2% and 45.8%, respectively. Essential hypertension was previously diagnosed in 21.5%, and 0.3% for secondary hypertension. The vaccination day mean SBP and DBP were 135.23 ± 17.97 and 76.14 ± 12.06 mmHg. There were 56%, 33%, 10.3% and 0.4% classified as normotension, gradeI, II and III hypertension, respectively. Estimated prevalence for any hypertension and grade II or III hypertension were 44% (95% CI 41.9-46.0) and 11% (95% CI 9.7-12.3), respectively. There were 1,335 participants with at least 2 previous BP measurements prior to the vaccination day. We compared BP change between group of 142 vaccinees who had grade II or III hypertension and group of 1193 vaccinees with normotension or grade I hypertension at vaccination day. There was a significant increase in SBP and DBP at vaccination day in both groups, and significantly higher BP from prior visits in grade II or III hypertension group (Figure 1). After adjusting for age, gender, type of vaccine, dose, previous diagnosis of hypertension and prior well-controlled BP, we found that the previous diagnosis of hypertension and prior well-controlled BP were independent predictors for grade II or III hypertension at vaccination day: OR 2.93 (95% CI 1.97-4.36) and 0.47 (95% CI 0.23-0.96), respectively. There were 3.38% who required on-site medical attention due to high BP, resulting in a delay to vaccination of 1 hour (IQR, 0.5- 2). Vaccination was postponed in 0.56%. All were diagnosed with hypertensive urgency by the onsite physicians. Conclusions: Prevalence of high BP was relatively high among Thai vaccinees but without CV event at vaccination day. BP measurement may be unnecessary in asymptomatic vaccinees with previously well-controlled BP. (Figure Presented).