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2.
BMJ Case Rep ; 15(4)2022 Apr 06.
Article in English | MEDLINE | ID: covidwho-1779331

ABSTRACT

A 49-year-old woman presented with severe abdominal pain and per rectal bleed, 13 days after receiving the first dose of the AstraZeneca vaccine. Blood tests showed remarkably low platelet count, unmeasurable D-dimer levels and low fibrinogen levels, consistent with a diagnosis of vaccine-induced thrombotic thrombocytopaenia and disseminated intravascular coagulation. CT mesenteric angiogram revealed massive portosplenic mesenteric vein thrombosis. CT head also noted non-occlusive thrombosis at several sites. She was treated with intravenous immunoglobulins, plasma exchange, anticoagulants and transjugular intrahepatic portosystemic shunt procedure. Following a prolonged inpatient stay, she was discharged with subsequent short bowel syndrome and long-term parenteral nutrition. This particular clinical scenario aims to highlight the importance for clinicians to remain vigilant for rare complications associated with the AstraZeneca vaccine and the subsequent management involved, at a time where it is vital to vaccinate globally in order to control the spread of the COVID-19 pandemic.


Subject(s)
COVID-19 , Thrombocytopenia , Thrombosis , Vaccines , Venous Thrombosis , COVID-19 Vaccines/adverse effects , Edema , Female , Humans , Ischemia , Middle Aged , Pandemics , SARS-CoV-2 , Thrombocytopenia/chemically induced , Thrombocytopenia/diagnosis , Vaccines/adverse effects , Venous Thrombosis/etiology
4.
Front Immunol ; 13: 839433, 2022.
Article in English | MEDLINE | ID: covidwho-1775671

ABSTRACT

Background: Omicron scares and speculations are gaining momentum. Amid the nonstop debates and discussions about COVID-19 vaccines, the "vaccine fatigue" phenomenon may become more prevalent. However, to date, no research has systematically examined factors that shape people's vaccine fatigue. To bridge the research gap, this study aims to investigate the antecedents that cause or catalyze people's vaccine fatigue. Methods: A narrative literature review was conducted in PubMed, Scopus, and PsycINFO to identify factors that shape people's vaccine fatigue. The search was completed on December 6, 2021, with a focus on scholarly literature published in English. Results: A total of 37 articles were reviewed and analyzed. Vaccine fatigue was most frequently discussed in the context of infectious diseases in general at the pre-vaccination stage. Vaccine fatigue has been identified in the general public, the parents, and the doctors. Overall, a wide range of antecedents to vaccine fatigue has been identified, ranging from the frequency of immunization demands, vaccine side effects, misconceptions about the severity of the diseases and the need for vaccination, to lack of trust in the government and the media. Conclusion: Vaccine fatigue is people's inertia or inaction towards vaccine information or instruction due to perceived burden and burnout. Our study found that while some contributors to vaccine fatigue are rooted in limitations of vaccine sciences and therefore can hardly be avoided, effective and empathetic vaccine communications hold great promise in eliminating preventable vaccine fatigue across sectors in society.


Subject(s)
COVID-19 , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Fatigue , Humans , Vaccination/adverse effects , Vaccines/adverse effects
5.
Pediatr Infect Dis J ; 41(5): e188-e193, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1764688

ABSTRACT

BACKGROUND: Recent global outbreaks of vaccine-preventable diseases, both before and since the coronavirus disease 2019 pandemic, have led to the introduction or strengthening of vaccine mandate policies to target vaccine refusal. Globally, there is wide variation in how governments and jurisdictions implement and enforce mandatory vaccination as well as the financial and educational consequences to those who fail to comply. We explored the impact of mandate vaccination policies on Australian Immunization Specialists who work in Specialist Immunization Clinics (SIC) for approving vaccine exemptions outside of the mandated criteria. In particular, their interactions with patients and families. METHODS: A national, prospective, mixed methods, survey-based study conducted with members of the Australian Adverse Event Following Immunisation Clinical Assessment Network between February 2020 and June 2020. RESULTS: Sixteen Immunization physicians and nurse practitioner specialists working in a SIC completed the survey. All sixteen respondents had been requested by parents to provide a Medical Exemptions at least once. 88% of respondents felt pressure to provide an exemption that was not medically justified according to legislation. Seventy-five percent of SIC consultants felt that the "No Jab" policies created a moderate or extreme amount of stress to both themselves and parents. All respondents reported experiencing hostility from parents with three respondents having received threats of violence. CONCLUSIONS: Mandatory vaccination policies are associated with increased vaccination coverage but can result in widened financial and social inequity, and may harm families' relationships with health care providers. Countries considering the implementation of vaccination mandates should use the least restrictive health policies to ensure a balance between the public health and individual benefit whilst minimizing burdens on health care professionals, children and their parents.


Subject(s)
COVID-19 , Vaccines , Australia/epidemiology , Child , Health Policy , Humans , Immunization , Immunization Programs , Parents , Prospective Studies , Vaccination , Vaccines/adverse effects
6.
Vaccine ; 40(18): 2588-2603, 2022 Apr 20.
Article in English | MEDLINE | ID: covidwho-1747506

ABSTRACT

BACKGROUND: Growing narratives emphasize using primary care physicians as leaders in efforts to promote COVID-19 vaccination among the vaccine hesitant. Critically however, little is known about vaccine confidence among primary care physicians themselves. The objective of this study was to assess both physician confidence that in general, vaccines are safe, effective, and important, as well as physician confidence in each COVID-19 vaccine in the United States. METHODS: We rely on data from a national survey of primary care physicians conducted from May 14-May 25, 2021. We assess the influence of demographic, social, and political factors on physician beliefs that in general, vaccines are safe, effective, and important, as well as physician confidence in the safety of the Moderna, Pfizer, and Johnson & Johnson COVID-19 vaccines. RESULTS: 10.1% of primary care physicians do not agree that, in general, vaccines are safe, 9.3% do not agree they are effective, and 8.3% do not agree they are important. While 68.7% of physicians were 'very confident' in the safety of the Moderna vaccine and 72.7% were 'very confident' in the safety of the Pfizer vaccine, only 32.1% of physicians were 'very confident' in the safety of the Johnson & Johnson COVID-19 vaccine. CONCLUSION: A troubling proportion of primary care physicians lack high levels of vaccine confidence. These physicians may not be well positioned to actively promote COVID-19 vaccination even as political and media narratives push physicians to lead this effort. Interventions aimed at improving vaccine confidence among some physicians may be needed so that all physicians can fulfill needed roles as trusted vaccine communicators.


Subject(s)
COVID-19 , Physicians, Primary Care , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , Humans , United States , Vaccination , Vaccines/adverse effects
7.
Clin Med (Lond) ; 22(2): 140-144, 2022 03.
Article in English | MEDLINE | ID: covidwho-1742943

ABSTRACT

In the new science emanating from the COVID-19 pandemic, effective vaccine development has made a huge difference and saved countless lives. Vaccine roll-out led to the identification of rare cases of severe thrombotic and thrombocytopenic problems in some recipients. This apparent coupling of thrombosis with haemorrhagic potentiation might seem baffling but the ensuing clinical investigation rapidly shed important light on its molecular mechanism. This review outlines the current understanding on the role of adenovirus-based platforms, the immunogenic triggers and the immunothrombotic response underlying vaccine-induced immune thrombotic thrombocytopenia.


Subject(s)
COVID-19 , Thrombocytopenia , Thrombosis , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Pandemics , SARS-CoV-2 , Thrombocytopenia/chemically induced , Vaccines/adverse effects
8.
Curr Sports Med Rep ; 21(3): 78-83, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1731572

ABSTRACT

ABSTRACT: Shoulder injury related to vaccine administration (SIRVA), an entity that causes acute shoulder pain and may limit range of motion (ROM) after vaccination, is a condition where a small but significant percentage of patients are experiencing in light of the current push for mass immunizations against SARS-CoV-2 worldwide. A search of literature related to SIRVA was performed across multiple electronic databases. Women, patients reporting vaccine injection location to be too high, and patients without prior history of shoulder pain were the most common historical factors in those experiencing SIRVA. Tenderness to palpation and limited shoulder ROM were the most associated physical examination findings. When using magnetic resonance imaging, tendinopathy, subacromial-subdeltoid bursitis, and rotator cuff tears (partial or complete) were the most common findings. Radiographic imaging rarely aided the diagnosis. SIRVA is an entity that health care providers should be aware of to improve the care of patients that may experience these symptoms after vaccine administration.


Subject(s)
COVID-19 , Rotator Cuff Injuries , Shoulder Injuries , Vaccines , COVID-19/prevention & control , Female , Humans , SARS-CoV-2 , Shoulder , Shoulder Injuries/etiology , Shoulder Pain/etiology , Vaccination/adverse effects , Vaccines/adverse effects
9.
Hum Vaccin Immunother ; 18(1): 2036556, 2022 Dec 31.
Article in English | MEDLINE | ID: covidwho-1730546

ABSTRACT

We report a case of vaccine-induced immune thrombotic thrombocytopenia (VITT) in a 73-year-old gentleman who presented with pulmonary embolism and thrombocytopenia, two weeks after receiving inactivated COVID-19 vaccine. He responded well to nonheparin anticoagulation with complete resolution of symptoms and platelet count.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Thrombocytopenia , Vaccines , Aged , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Male , SARS-CoV-2 , Thrombocytopenia/chemically induced , Vaccines/adverse effects
11.
Blood ; 139(12): 1903-1907, 2022 03 24.
Article in English | MEDLINE | ID: covidwho-1673896

ABSTRACT

Vaccine-induced thrombotic thrombocytopenia (VITT) is triggered by vaccination against COVID-19 with adenovirus vector vaccines (ChAdOx1 nCoV-19; Ad26.COV2-S). In this observational study, we followed VITT patients for changes in their reactivity of platelet-activating antiplatelet factor 4 (PF4) immunoglobulin G (IgG) antibodies by an anti-PF4/heparin IgG enzyme immunoassay (EIA) and a functional test for PF4-dependent, platelet-activating antibodies, and new thrombotic complications. Sixty-five VITT patients (41 females; median, 51 years; range, 18-80 years) were followed for a median of 25 weeks (range, 3-36 weeks). In 48/65 patients (73.8%; CI, 62.0% to 83.0%) the functional assay became negative. The median time to negative functional test result was 15.5 weeks (range, 5-28 weeks). In parallel, EIA optical density (OD) values decreased from median 3.12 to 1.52 (P < .0001), but seroreversion to a negative result was seen in only 14 (21.5%) patients. Five (7.5%) patients showed persistent platelet-activating antibodies and high EIA ODs for >11 weeks. None of the 29 VITT patients who received a second vaccination dose with an mRNA COVID-19 vaccine developed new thromboses or relevant increase in anti-PF4/heparin IgG EIA OD, regardless of whether PF4-dependent platelet-activating antibodies were still present. PF4-dependent platelet-activating antibodies are transient in most patients with VITT. VITT patients can safely receive a second COVID-19 mRNA-vaccine shot.


Subject(s)
COVID-19 , Thrombocytopenia , Thrombosis , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Heparin/adverse effects , Humans , Immunoglobulin G , Platelet Factor 4 , Thrombocytopenia/chemically induced , Vaccines/adverse effects
12.
Vaccine ; 40(9): 1246-1252, 2022 02 23.
Article in English | MEDLINE | ID: covidwho-1665512

ABSTRACT

BACKGROUND: Between May 2005 and March 2007, three vaccines were recommended by the Advisory Committee on Immunization Practices for routine use in adolescents in the United States: quadrivalent meningococcal conjugate vaccine (MenACWY), tetanus, diphtheria and acellular pertussis vaccine (Tdap), and human papillomavirus vaccine (HPV). Understanding historical adolescent vaccination patterns may inform future vaccination coverage efforts for these and emerging adolescent vaccines, including COVID-19 vaccines. METHODS: This was a descriptive, retrospective cohort study. All vaccines administered to adolescents aged 11 through 18 years in the Vaccine Safety Datalink population between January 1, 2007 and December 31, 2016 were examined. Vaccination coverage was assessed by study year for ≥1 dose Tdap or Td, ≥1 dose Tdap, ≥1 dose MenACWY, ≥1 dose HPV, and ≥3 dose HPV. The proportion of vaccine visits with concurrent vaccination (≥2 vaccines administered at the same visit) was calculated by sex and study year. The most common vaccine combinations administered in the study population were described by sex for two time periods: 2007-2010 and 2011-2016. RESULTS: The number of 11-18-year-olds in the study population averaged 522,565 males and 503,112 females per study year. Between January 2007 and December 2016 there were 4,884,553 vaccine visits in this population (45% among males). The overall proportion of concurrent vaccine visits among males was 43% (33-61% by study year). Among females, 39% of all vaccine visits included concurrent vaccination (32-48% by study year). Vaccine coverage for Tdap, MenACWY, and 1- and 3-dose HPV increased across the study period. A wide variety of vaccine combinations were administered among both sexes and in both time periods. CONCLUSIONS: The high vaccine uptake and multitude of vaccine combinations administered concurrently in the adolescent population of the Vaccine Safety Datalink provide historical patterns with which to compare future adolescent vaccination campaigns.


Subject(s)
Vaccination , Vaccines , Adolescent , COVID-19 , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , Diphtheria-Tetanus-acellular Pertussis Vaccines/administration & dosage , Diphtheria-Tetanus-acellular Pertussis Vaccines/adverse effects , Female , Humans , Immunization Schedule , Male , Meningococcal Vaccines/administration & dosage , Meningococcal Vaccines/adverse effects , Papillomavirus Vaccines/administration & dosage , Papillomavirus Vaccines/adverse effects , Retrospective Studies , SARS-CoV-2 , United States , Vaccination/trends , Vaccines/administration & dosage , Vaccines/adverse effects
14.
J Stroke Cerebrovasc Dis ; 31(4): 106311, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1654846

ABSTRACT

OBJECTIVES: Vaccine-induced thrombotic thrombocytopenia (VITT) is a rare complication after adenoviral vector vaccination against COVID-19 reported up to 24 days after ChAdOx1 nCOV-19 (AZD1222) vaccination. This report describes a case with a significantly later onset of VITT with cerebral venous sinus thrombosis. CASE DESCRIPTION: We report a 42-year-old woman presenting to the emergency department 53 days after AZD1222 vaccination with sudden onset sensory aphasia and an 18-day history of headache. Cranial computed tomography (CT) showed acute intracranial hemorrhage and CT venogram demonstrated thrombosis of the left vein of Labbé and transverse and sigmoid sinus. D-dimers were elevated and despite a normal platelet count, platelet-activating anti-PF4 antibody testing was positive, confirming the diagnosis of VITT. The patient was treated with intravenous immunoglobulins and argatroban, and was discharged without any neurological deficit on day 12. CONCLUSION: Our report of VITT with symptom onset on day 35 and diagnosis of cerebral sinuous thrombosis on day 53 after AZD1222 vaccination significantly enhances the time window during which VITT may occur.


Subject(s)
COVID-19 , Sinus Thrombosis, Intracranial , Thrombocytopenia , Vaccines , Adult , COVID-19 Vaccines/adverse effects , Female , Humans , SARS-CoV-2 , Sinus Thrombosis, Intracranial/chemically induced , Sinus Thrombosis, Intracranial/diagnostic imaging , Sinus Thrombosis, Intracranial/drug therapy , Vaccines/adverse effects
15.
Phlebology ; 37(3): 180-187, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1651054

ABSTRACT

OBJECTIVES: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a new and rare syndrome resulting from the largest vaccination campaign against SARS-CoV-2 in the history of mankind. The aim of this review is to clarify underlying mechanisms, pathology, diagnosis, and therapy, with the related clinical implications. METHODS: We performed a comprehensive literature review in order to collect the clinical and treatment data about patients suffering from VITT. PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened regarding patients who developed VITT. Last search was launched on June 30th 2021. RESULTS: Abdominal and/or neurological symptoms develop between 5 and 20 days after vaccine administration and do not involve the lower extremities. VITT is suspected if the platelet count is lower than 100.000/mm3 and D-dimer is higher than the age-adjusted range. Medical treatment is mainly based on intravenous immunoglobulins, corticosteroids, and anticoagulant drugs with a short plasma half-life, but the complete avoidance of low molecular weight heparin is recommended. Endovascular treatment and/or decompressive craniectomy might be an option in a minority of cases. CONCLUSION: Due to widespread vaccination concerns, the vascular specialist and phlebologist are increasingly consulted to prevent or diagnose VITT. The latter has peculiar and completely different localizations, symptoms, and treatment compared to the common pictures of venous thrombosis.


Subject(s)
COVID-19 , Thrombocytopenia , Thrombosis , Vaccines , Venous Thrombosis , COVID-19 Vaccines/adverse effects , Humans , SARS-CoV-2 , Vaccines/adverse effects , Venous Thrombosis/etiology
17.
Neurol Sci ; 43(3): 1499-1502, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1616161

ABSTRACT

We report a case of massive cerebral venous sinus thrombosis in the contest of vaccine-induced immune thrombotic thrombocytopenia that required the rapid coordination of many specialists from different departments, notably emergency, neurology, neuroradiology, hematology, and neurosurgery. The patient was rapidly treated with steroids, immunoglobulin, and fondaparinux. She underwent within 6 h after hospital admission a mechanical thrombectomy in order to allow flow restoration in cerebral venous systems. Neuroendovascular treatment in cerebral venous thrombosis related to VITT has never been described before. It can represent a complementary tool along with the other therapies and a multidisciplinary approach.


Subject(s)
COVID-19 , Sinus Thrombosis, Intracranial , Thrombocytopenia , Vaccines , COVID-19 Vaccines , Female , Humans , Sinus Thrombosis, Intracranial/chemically induced , Sinus Thrombosis, Intracranial/diagnostic imaging , Vaccines/adverse effects
18.
Matern Child Health J ; 26(2): 280-288, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1610655

ABSTRACT

OBJECTIVES: Increasing vaccine hesitancy and decreasing acceptance of the Centers for Disease Control and Prevention's (CDC) recommended schedule for childhood vaccines represent a crucial public health issue. The present study directly compares vaccine acceptance behavior across four different groups: those who are fully accepting of the CDC-recommended schedule, those who are accepting but on a delayed schedule, those who only partially vaccinate, and those who do not vaccinate at all. METHODS: A total of 779 adults residing in the United States with at least one child under the age of 18 years participated in an online survey. RESULTS: Logistic and Ordinary Least Squares regression analyses revealed clear differences between the vaccination behavior groups on a variety of demographic, psychographic, and behavioral metrics. Results suggest financial and insurance-related barriers still hinder full vaccination, and there are differences by race, ethnicity, and educational attainment. Sources of information about vaccines also differed by vaccination behavior group, with those who never vaccinate more likely to rely on friends and family for information. Finally, those whose child experienced what the parent interpreted as an adverse reaction to a previous vaccine, even if that reaction was within the bounds of "normal", were more likely to report they delay or partially vaccinate. CONCLUSIONS FOR PRACTICE: These results have implications for public health policy and intervention campaigns, in particular that two-step flow campaigns and increased knowledge of normal vaccine side effects may ameliorate some vaccine hesitancy.


Subject(s)
Vaccines , Adolescent , Adult , Child , Health Knowledge, Attitudes, Practice , Humans , Parents , Patient Acceptance of Health Care , United States , Vaccination , Vaccines/adverse effects
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