Factors Associated with Stroke after COVID-19 Vaccination: A Statewide Analysis (preprint)

ABSTRACT

Background: The objective of our study was to evaluate baseline characteristics, COVID-19 infection and vaccine type and their association with stroke early after COVID-19 vaccination. Methods: In a retrospective cohort study, we estimated the 21-day post vaccination incidence of stroke among COVID-19 first dose vaccine recipients. We linked the Georgia Immunization Registry with the Georgia Coverdell Acute Stroke Registry and the Georgia State Electronic Notifiable Disease Surveillance System data to assess the relative risk of stroke by vaccine type. Results: About 5 million adult Georgians received at least one COVID-19 vaccine from December 1, 2020 to February 28, 2022 54% received BNT162b2, 41% mRNA-1273 and 5% Ad26.COV2.S. Those with concurrent COVID infection within 21 days post vaccine had an increased risk of ischemic (OR=8.00, 95% CI 4.18, 15.31) and hemorrhagic stroke (OR=5.23, 95% CI 1.11, 24.64) with no evidence for interaction between vaccine type and concurrent COVID-19 infection. The 21-day post vaccination incidence of ischemic stroke was 8.14, 11.14, and 10.48 per 100,000 for BNT162b2, mRNA-1273 and Ad26.COV2.S recipients, respectively. After adjusting for age, race, gender, and COVID-19 infection status there was a 57% higher risk (OR=1.57, 95% CI 1.02, 2.42) for ischemic stroke within 21 days of vaccination associated with the Ad26.COV2.S vaccine compared to BNT162b2. Conclusions: Concurrent COVID-19 infection had the strongest association with early ischemic and hemorrhagic stroke after first dose COVID-19 vaccination. The Ad26.COV2.S vaccine was associated with a higher risk of early post-vaccination ischemic stroke than BNT162b2.