Safety of BNT162b2 or CoronaVac COVID-19 vaccines in patients with heart failure: A self-controlled case series study

Background: COVID-19 vaccines are important for patients with heart failure (HF) to prevent severe outcomes but the safety concerns could lead to vaccine hesitancy. This study aimed to investigate the safety of two COVID-19 vaccines, BNT162b2 and CoronaVac, in patients with HF. Methods: We conducted a self-controlled case series analysis using the data from the Hong Kong Hospital Authority and the Department of Health. The primary outcome was hospitalization for HF and the secondary outcomes were major adverse cardiovascular events (MACE) and all hospitalization. We identified patients with a history of HF before February 23, 2021 and developed the outcome event between February 23, 2021 and March 31, 2022 in Hong Kong. Incidence rate ratios (IRR) were estimated using conditional Poisson regression to evaluate the risks following the first three doses of BNT162b2 or CoronaVac. Findings: We identified 32,490 patients with HF, of which 3035 were vaccinated and had a hospitalization for HF during the observation period (BNT162b2 = 755;CoronaVac = 2280). There were no increased risks during the 0–13 days (IRR 0.64 [95% confidence interval 0.33–1.26];0.94 [0.50–1.78];0.82 [0.17–3.98]) and 14–27 days (0.73 [0.35–1.52];0.95 [0.49–1.84];0.60 [0.06–5.76]) after the first, second and third doses of BNT162b2. No increased risks were observed for CoronaVac during the 0–13 days (IRR 0.60 [0.41–0.88];0.71 [0.45–1.12];1.64 [0.40–6.77]) and 14–27 days (0.91 [0.63–1.32];0.79 [0.46–1.35];1.71 [0.44–6.62]) after the first, second and third doses. We also found no increased risk of MACE or all hospitalization after vaccination. Interpretation: Our results showed no increased risk of hospitalization for HF, MACE or all hospitalization after receiving BNT162b2 or CoronaVac vaccines in patients with HF. Funding: The project was funded by a Research Grant from the Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (Ref. No. COVID19F01). F.T.T.L. (Francisco T.T. Lai) and I.C.K.W. (Ian C.K. Wong)'s posts were partly funded by the D24H;hence this work was partly supported by AIR@InnoHK administered by Innovation and Technology Commission. © 2022 The Authors

Remote assessment of ADHD in children and adolescents: recommendations from the European ADHD Guidelines Group following the clinical experience during the COVID-19 pandemic.

The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.

UNPLANNED HOPSITAL ADMISSION AND EMERGENCY ATTENDANCE FOLLOWING TWO-DOSE OF BNT162B2 AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY

Background: Real-world population-based safety data about the COVID-19 mRNA vaccine is lacking in patients with various immunocompromised conditions, including inflammatory bowel disease (IBD). Aim: To determine the incidence rates of unplanned IBD-related hospital admission and all-cause emergency attendance following BNT162B2 vaccination in IBD patients. Methods: Through the Government commissioned, territory-wide active COVID19 safety surveillance, we linked population-level vaccination records and health outcome data, between March 10 (1st day of vaccination program) and September 30, 2021, to assess the association between two-dose of BNT162b2 and unplanned IBD-related hospitalization and all-cause emergency attendance. We used inverse probability treatment weightingbased cohort study design to balance the baseline characteristics between vaccinated and unvaccinated IBD patients. Poisson regression model was fitted to estimate the adjusted incidence rate ratio (IRR) of unplanned IBD hospital admission and 28-day emergency room attendance following the vaccination, using the unvaccinated group as the reference. Results: Among more than 4.1 million citizens with successful vaccine and health record-linkage, we identified 941 IBD patients (age: 46.0 ± 15.0 years, male: 64.2%) who completed twodose of BNT162b2 and 1196 age-sex matched unvaccinated IBD patients as control (age: 49.3 ± 18.3 years, male: 58.9%). After inverse propensity weighting, all baseline demographic and clinical characteristics were well balanced (standard mean difference < 0.1;Table 1). During a median follow-up of 59-60 days (181.2 person-years for BNT162b2 group;253.6 person-years for the unvaccinated group), there was no significant difference in the risk of unplanned IBD-related hospital admission [3.31 versus 5.13 per 100 person-years, IRR: 0.75 (0.38, 1.47)] and 28-day all-cause emergency room attendance [39.1 vs 47.5 per 100 person-years, IRR: 1.08 (0.76-1.53)] between BNT162b2 recipients and unvaccinated individuals. Series of stratified analyses, including patients with Crohn’s disease (N= 378) or ulcerative colitis (N=553), who received immunosuppressants (N=454) or biologics (N= 192), all showed that receiving two-dose of BNT162b2 vaccine was not associated with a higher risk of unplanned IBD-admission and 28-day emergency attendance when compared to their counterparts without vaccination (Figure 1). Conclusion: Results from this populationbased study showed no increase in risk of unplanned IBD-related hospitalization and allcause emergency attendance following two-dose of BNT162b2 Covid-19 vaccination in patients with IBD. This observation potentially reassures the medium-term safety of mRNA vaccine in patients with IBD, although there is still possible self-selection bias in receiving the vaccine. (Table Presented) (Figure Presented)

Cardiovascular sequalae in uncomplicated COVID-19 survivors

Background: A high proportion of COVID-19 patients were reported to have cardiac involvements. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance.

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of patients infected worldwide and indirectly affecting even more individuals through disruption of daily living. Long-term adverse outcomes have been reported with similar diseases from other coronaviruses, namely Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Emerging evidence suggests that COVID-19 adversely affects different systems in the human body. This review summarizes the current evidence on the short-term adverse health outcomes and assesses the risk of potential long-term adverse outcomes of COVID-19. Major adverse outcomes were found to affect different body systems: immune system (including but not limited to Guillain-Barré syndrome and paediatric inflammatory multisystem syndrome), respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy and coagulopathy), neurological system (sensory dysfunction and stroke), as well as cutaneous and gastrointestinal manifestations, impaired hepatic and renal function. Mental health in patients with COVID-19 was also found to be adversely affected. The burden of caring for COVID-19 survivors is likely to be huge. Therefore, it is important for policy makers to develop comprehensive strategies in providing resources and capacity in the healthcare system. Future epidemiological studies are needed to further investigate the long-term impact on COVID-19 survivors.