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Shemer A, Toledano A, Altarescu A, Dubinsky-Pertzov B, Rozenberg A, Hecht I, Einan-Lifshitz A, Pras E. COVID-19 Vaccination and Acute Anterior Uveitis-A Case Control Study. Vaccines (Basel) 2025; 13:176. [PMID: 40006723 PMCID: PMC11860193 DOI: 10.3390/vaccines13020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 01/26/2025] [Accepted: 02/07/2025] [Indexed: 02/27/2025] Open
Abstract
OBJECTIVE To evaluate the association between the BNT162b2 (Pfizer-BioNTech®) coronavirus disease vaccine and new-onset anterior uveitis. METHODS A retrospective case control study of patients admitted and diagnosed with new-onset acute anterior uveitis, and matched controls admitted for other reasons (1:3 ratio), was completed. Rates of exposure to the BNT162b2 vaccine were compared between groups, and odds ratios for exposure to the vaccine were calculated. A secondary analysis of the overall number of patients with new-onset anterior uveitis in the six preceding years was conducted. This study was conducted in one academic center in Israel. RESULTS A total of 16 patients were admitted for acute anterior uveitis during the study period. Of the 16 cases, 11 (69%) received the first dose of the BNT162b2 vaccine prior to presentation and 8 (50%) also received the second dose. This compares to 39 (81.2%) in the control group. The odds ratio for exposure to the vaccine among cases was 0.508 (95% confidence interval 0.141-1.829, p = 0.300). Compared with preceding years, the rate of cases diagnosed with acute anterior uveitis in 2021 was similar to the six preceding years (mean 11.8 ± 3.4 cases). CONCLUSIONS In this case control study and comparison with preceding years, we found no evidence to suggest an association between vaccination with the BNT162b2 (Pfizer-BioNTech®) COVID-19 vaccine and new-onset acute anterior uveitis.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel; (A.T.); (A.A.); (B.D.-P.); (A.R.); (I.H.); (A.E.-L.); (E.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amit Toledano
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel; (A.T.); (A.A.); (B.D.-P.); (A.R.); (I.H.); (A.E.-L.); (E.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Aya Altarescu
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel; (A.T.); (A.A.); (B.D.-P.); (A.R.); (I.H.); (A.E.-L.); (E.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel; (A.T.); (A.A.); (B.D.-P.); (A.R.); (I.H.); (A.E.-L.); (E.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Assaf Rozenberg
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel; (A.T.); (A.A.); (B.D.-P.); (A.R.); (I.H.); (A.E.-L.); (E.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel; (A.T.); (A.A.); (B.D.-P.); (A.R.); (I.H.); (A.E.-L.); (E.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel; (A.T.); (A.A.); (B.D.-P.); (A.R.); (I.H.); (A.E.-L.); (E.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel; (A.T.); (A.A.); (B.D.-P.); (A.R.); (I.H.); (A.E.-L.); (E.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Matlow’s Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin 70300, Israel
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Karam R, Iskandar K, Watfa M, Zeitoun A. Serious adverse events following immunization with COVID-19 vaccines in Lebanon: a retrospective analysis of the National Pharmacovigilance Database. BMC Public Health 2024; 24:2905. [PMID: 39434043 PMCID: PMC11495130 DOI: 10.1186/s12889-024-20297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 10/04/2024] [Indexed: 10/23/2024] Open
Abstract
Continuous surveillance and risk assessment of inactivated Coronavirus Disease 2019 (COVID-19)) vaccines provide an understanding of their safety profiles, guide vaccination strategy and public health policy. This study aims to analyze the characteristics and prevalence of officially reported serious adverse events following immunization (AEFIs) with inactivated COVID-19 vaccines by System Organ Class (SOC), age, and sex.To achieve this aim, a retrospective observational study was conducted between February 14th, 2021, and June 30th, 2022. Reported AEFIs were evaluated for data completeness. Causality assessment adhered to the World Health Organization guidelines.Findings revealed that the AEFIs occurrence did not significantly differ between vaccines used (ChAdOx1 vs. BNT162b2), sex, or SOC. The most prevalent AEFIs were vascular disorders (37%), followed by cardiac (25%) and nervous system disorders (14%). The adverse events were predominantly reported post-vaccination with the BNT162b2 vaccine, mainly after the first dose. The mean age was highest for miscellaneous disorders (70 ± 21.7 years) and the lowest for nervous system (46 ± 22 years) and immune system disorders (45 ± 19 years). Age differences were statistically different for vascular disorders (p = 0.003) and immune system disorders (p = 0.012).In conclusion, ongoing surveillance and risk assessment of the vaccine's safety profile is crucial for detecting potential safety signals. Active surveillance of the reported serious AEFIs is highly needed to support evidence-based vaccination strategies and maintain public confidence in immunization programs.
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Affiliation(s)
- Rita Karam
- Department of Chemistry and Biochemistry, Faculty of Science, Section 1, Lebanese University, Beirut, Lebanon
- Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health, Beirut, Lebanon
| | - Katia Iskandar
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Lebanese University, P.O. Box 6573/14, Beirut, Lebanon
| | - Myriam Watfa
- Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health, Beirut, Lebanon
| | - Abeer Zeitoun
- Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health, Beirut, Lebanon.
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3
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Chaudhary MH, Yennam AK, Bojanki NLSVA, Dela Cruz ANG, Chaudhary NK, Kinha H, Annepu YR. Autoimmune Hemolytic Anemia Secondary to COVID-19 Vaccine: A Case Report. Cureus 2023; 15:e46678. [PMID: 37942375 PMCID: PMC10628599 DOI: 10.7759/cureus.46678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Autoimmune hemolytic anemia (AIHA) is an acquired hemolysis caused by one's immune system targeting red blood cell surface antigens, resulting in a shortening of the normal red-cell lifespan of 120 days. In this case report, we present an unusual case of a middle-aged woman with no known autoimmune diseases. After ruling out all other possible etiologies, she was later diagnosed with AIHA about two months after receiving her first dose of the Oxford-AstraZeneca COVID-19 vaccine (COVISHIELD). We discuss the possible underlying cause, the COVID-19 vaccine, for the precipitation of AIHA. The importance of identifying rare adverse events that could occur during mass vaccination is highlighted in this case. The patient was treated with oral steroids and received three blood transfusions. She was discharged after 21 days from the hospital and followed up after six months with no relapse.
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Affiliation(s)
| | | | | | | | - Nirali K Chaudhary
- General Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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4
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Jacobs JW. Autoimmune hemolytic anemia and COVID-19 vaccination. Hematol Transfus Cell Ther 2023; 45:410-411. [PMID: 36212090 PMCID: PMC9527192 DOI: 10.1016/j.htct.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/19/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
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5
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Jafarzadeh A, Jafarzadeh S, Pardehshenas M, Nemati M, Mortazavi SMJ. Development and exacerbation of autoimmune hemolytic anemia following COVID-19 vaccination: A systematic review. Int J Lab Hematol 2023; 45:145-155. [PMID: 36208056 PMCID: PMC9874780 DOI: 10.1111/ijlh.13978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023]
Abstract
Autoimmune hemolytic anemia (AIHA) is caused by the production of autoantibodies against RBCs. COVID-19 vaccines can reduce the risk of severe disease, however, various adverse effects such as AIHA were observed following vaccination. This review aimed to assess the relationship of AIHA and COVID-19 vaccination using the PRISMA guidelines. Among 18 cases included in this review, new post-vaccination AIHA development was reported in 11 patients (7 women and 4 men) with a median age of 67.0 years. In 7 of 11 and 3 of 11 cases, the onset of symptoms occurred after first and second vaccine dose with median times of 7 and 14 days, respectively. In 1 of 11 cases, the AIHA occurred on Day 17 after booster vaccination. Ten of 11 and 1 of 11 AIHA patients received mRNA- and vector-based vaccine, respectively. After vaccination, 9 of 11, 1 of 11, and 1 of 11 AIHA patients developed warm IgG, cold IgM, and mixed autoantibodies against RBCs, respectively. Significant AIHA exacerbation was reported in seven patients (four women and three men) with a median age of 73.0 years. In 4 of 7 and 2 of 7 exacerbated AIHA cases, the onset of symptoms occurred after first and second vaccine dose with median times of 7 and 3 days, respectively. In 1 of 7 exacerbated AIHA cases, the onset of symptoms was observed on Day 2 after booster vaccination. All exacerbated AIHA cases received mRNA-based vaccines; 3 of 7 and 4 of 7 exacerbated AIHA cases developed IgG and IgM against RBCs, respectively. This review provides a comprehensive explanation regarding the AIHA development and exacerbation after COVID-19 vaccination.
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Affiliation(s)
- Abdollah Jafarzadeh
- Department of Immunology, School of MedicineKerman University of Medical SciencesKermanIran
- Molecular Medicine Research CenterResearch Institute of Basic Medical Sciences, Rafsanjan University of Medical SciencesRafsanjanIran
- Department of Immunology, School of MedicineRafsanjan University of Medical SciencesRafsanjanIran
| | - Sara Jafarzadeh
- Student Research Committee, School of MedicineKerman University of Medical SciencesKermanIran
| | - Mohammad Pardehshenas
- Department of Microbiology, School of MedicineKerman University of Medical SciencesKermanIran
| | - Maryam Nemati
- Immunology of Infectious Diseases Research CenterResearch Institute of Basic Medical Sciences, Rafsanjan University of Medical SciencesRafsanjanIran
- Department of Haematology and Laboratory Sciences, School of Para‐MedicineKerman University of Medical SciencesKermanIran
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Malakah MA, Baghlaf BA, Alsulami SE. Co-Occurring Hemolysis and Methemoglobinemia After COVID-19 Infection in Patient With G6PD Deficiency. Cureus 2023; 15:e35020. [PMID: 36938163 PMCID: PMC10022702 DOI: 10.7759/cureus.35020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
Hemolytic anemia and methemoglobinemia are known complications in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. They can be elicited by various oxidative stressors. Here we report a case of an adult with the first episode of G6PD deficiency associated hemolysis and methemoglobinemia after acquiring COVID-19 infection, who had no recent exposure to oxidative drugs or fava beans. A 52-year-old gentleman known to have myocardial bridging on aspirin and beta-blocker, with no other medical illnesses, developed anemia symptoms, jaundice, and hypoxia after contracting COVID-19 infection. Further laboratory work revealed non-immune hemolytic anemia, methemoglobinemia, and a positive G6PD screen test. He was treated conservatively with a blood transfusion, and his oxygen saturation improved thereafter. With the widespread COVID-19 infection and its morbidity worldwide, it is crucial to consider methemoglobinemia in the differential diagnosis of hypoxia. Testing for G6PD is an essential next step in such cases, as starting methylene blue in G6PD deficiency can worsen hemolysis. Apart from COVID-19, there is no other identified trigger for the acute event in this patient. It is not known whether COVID-19 infection alone is enough to result in G6PD deficiency-associated hemolysis and methemoglobinemia simultaneously.
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Affiliation(s)
- Manar A Malakah
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Bayan A Baghlaf
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Samaher E Alsulami
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
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7
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Lee SB, Park CY, Park SG, Lee HJ. Case mistaken for leukemia after mRNA COVID-19 vaccine administration: A case report. World J Clin Cases 2022; 10:12268-12277. [PMID: 36483810 PMCID: PMC9724544 DOI: 10.12998/wjcc.v10.i33.12268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/06/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Following the global outbreak of coronavirus disease 2019 (COVID-19), unlike other vaccines, COVID-19 vaccines were developed and commercialized in a relatively short period of time. The large-scale administration of this vaccine in a short time-period led to various unexpected side effects, including severe cytopenia and thrombosis with thrombocytopenia syndrome. Despite many reports on adverse reactions, vaccination was necessary to prevent the spread of COVID-19; thus, it is essential to understand and discuss various cases of adverse reactions after vaccination.
CASE SUMMARY A 77-year-old woman was administered the second dose of Pfizer mRNA COVID-19 vaccine. After vaccination she experienced fever, myalgia, and weakness. Antibiotics were subsequently administered for several days, but there was no improvement in the symptoms. The patient showed severe thrombocytopenia and leukocytosis. Thoracic and abdominopelvic computed tomography showed no infection related findings, but splenomegaly and cirrhotic liver features were observed. A large number of immature cells were observed in the peripheral blood smear; thus, bone marrow examination was performed for acute leukemia. However, there were no abnormalities. The patient recovered after administration of hepatotoxins and transfusion treatment for cytopenia and was diagnosed with an adverse reaction to COVID-19 vaccination.
CONCLUSION Adverse reactions of vaccination could be mistaken for hematologic malignancies including leukemia. We report a patient with leukocytosis following COVID-19 vaccination.
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Affiliation(s)
- Seul Bi Lee
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Chi Young Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Sang-Gon Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Hee Jeong Lee
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
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8
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Ng TYM, Teo WZY, Ng TYM, Teng GG. New-onset Evans syndrome in a patient with SLE post SARS-CoV2 mRNA vaccination. Ann Hematol 2022; 102:235-236. [PMID: 36369498 PMCID: PMC9652039 DOI: 10.1007/s00277-022-05034-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Timothy Y. M. Ng
- Chronic and Fast Programs, Alexandra Hospital, National University Hospital System, Singapore, Singapore
| | - Winnie Z. Y. Teo
- Chronic and Fast Programs, Alexandra Hospital, National University Hospital System, Singapore, Singapore ,Department of Haematology-Oncology, National University Cancer Institute Singapore (NCIS), National University Health System, Singapore, Singapore
| | - Terence Y. M. Ng
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Gim Gee Teng
- Chronic and Fast Programs, Alexandra Hospital, National University Hospital System, Singapore, Singapore ,Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
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9
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Suzuki Y, Shiba T. Chronic cold agglutinin disease after a third COVID-19 mRNA vaccination. Int J Hematol 2022; 117:618-621. [PMID: 36309629 PMCID: PMC9617524 DOI: 10.1007/s12185-022-03480-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022]
Abstract
COVID-19 mRNA vaccines manufactured by Pfizer-BioNTech and Moderna have been approved in many countries, and have been administered since 2020. Recent reports of mRNA vaccination exacerbating autoimmune hematologic disorders, such as immune thrombocytopenia or autoimmune hemolytic anemia, have caught the attention of the general public, resulting in alarm over the risks of serious consequences. Meanwhile, in very rare cases, vaccination was reported to trigger new onset of hemolytic anemia. However, it remains unknown whether this was a transient reaction or a persistent event, because all cases reported to date were immediately treated with corticosteroids or rituximab. Here, we present a case of newly diagnosed cold agglutinin disease after a third COVID-19 mRNA vaccination. The patient was followed for 4 months without treatment and continued to exhibit high levels of cold agglutinin and aggregation of red blood cells. The present case indicates that the disease can become chronic, and provides insights into the pathogenesis and treatment strategies.
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Alhumaid S, Al Mutair A, Rabaan AA, ALShakhs FM, Choudhary OP, Yong SJ, Nainu F, Khan A, Muhammad J, Alhelal F, Al Khamees MH, Alsouaib HA, Al Majhad AS, Al-Tarfi HR, ALyasin AH, Alatiyyah YY, Alsultan AA, Alessa ME, Alessa ME, Alissa MA, Alsayegh EH, Alshakhs HN, Al Samaeel HA, AlShayeb RA, Alnami DA, Alhassan HA, Alabdullah AA, Alhmed AH, AlDera FH, Hajissa K, Al-Tawfiq JA, Al-Omari A. New-onset and relapsed liver diseases following COVID-19 vaccination: a systematic review. BMC Gastroenterol 2022; 22:433. [PMID: 36229799 PMCID: PMC9559550 DOI: 10.1186/s12876-022-02507-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Liver diseases post-COVID-19 vaccination is extremely rare but can occur. A growing body of evidence has indicated that portal vein thrombosis, autoimmune hepatitis, raised liver enzymes and liver injuries, etc., may be potential consequence of COVID-19 vaccines. OBJECTIVES To describe the results of a systematic review for new-onset and relapsed liver disease following COVID-19 vaccination. METHODS For this systematic review, we searched Proquest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA guideline for studies on the incidence of new onset or relapsed liver diseases post-COVID-19 vaccination, published from December 1, 2020 to July 31, 2022, with English language restriction. RESULTS Two hundred seventy-five cases from one hundred and eighteen articles were included in the qualitative synthesis of this systematic review. Autoimmune hepatitis (138 cases) was the most frequent pathology observed post-COVID-19 vaccination, followed by portal vein thrombosis (52 cases), raised liver enzymes (26 cases) and liver injury (21 cases). Other cases include splanchnic vein thrombosis, acute cellular rejection of the liver, jaundice, hepatomegaly, acute hepatic failure and hepatic porphyria. Mortality was reported in any of the included cases for acute hepatic failure (n = 4, 50%), portal vein thrombosis (n = 25, 48.1%), splanchnic vein thrombosis (n = 6, 42.8%), jaundice (n = 1, 12.5%), raised liver enzymes (n = 2, 7.7%), and autoimmune hepatitis (n = 3, 2.2%). Most patients were easily treated without any serious complications, recovered and did not require long-term hepatic therapy. CONCLUSION Reported evidence of liver diseases post-COIVD-19 vaccination should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively very small in relation to the hundreds of millions of vaccinations that have occurred and the protective benefits offered by COVID-19 vaccination far outweigh the risks.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Al-Ahsa, 31982, Saudi Arabia.
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.,College of Nursing, Princess Norah Bint Abdul Rahman University, Riyadh, Saudi Arabia.,School of Nursing, University of Wollongong, Wollongong, Australia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia.,Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Fatemah M ALShakhs
- Respiratory Therapy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Om Prakash Choudhary
- Department of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl, Mizoram, 796015, India
| | - Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Malaysia
| | - Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | - Amjad Khan
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Javed Muhammad
- Department of Microbiology, The University of Haripur, Haripur, 22620, Khyber Pakhtunkhwa, Pakistan
| | - Fadil Alhelal
- Optometry Department, Dhahran Eye Specialist Hospital, Ministry of Health, Dhahran, Saudi Arabia
| | | | - Hussain Ahmed Alsouaib
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ahmed Salman Al Majhad
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hassan Redha Al-Tarfi
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ali Hussain ALyasin
- Medical Store Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Ali Ahmed Alsultan
- Medical Supply Store, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mohammed Essa Alessa
- Inventory Control Unit, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mustafa Essa Alessa
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mohammed Ahmed Alissa
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Emad Hassan Alsayegh
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hassan N Alshakhs
- Pharmacy Department, Aloyoon General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Rugayah Ahmed AlShayeb
- Pharmacy Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Dalal Ahmed Alnami
- Pharmacy Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hussain Ali Alhassan
- Pharmacy Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | | | - Ayat Hussain Alhmed
- Administration of Nursing Care, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Faisal Hussain AlDera
- General Surgery Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Khalid Hajissa
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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11
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Jafarzadeh A, Jafarzadeh S, Pardehshenas M, Nemati M, Mortazavi SMJ. Development and exacerbation of autoimmune hemolytic anemia following COVID-19 vaccination: A systematic review. Int J Lab Hematol 2022. [PMID: 36208056 DOI: 10.1111/ijlh.13978.10.1111/ijlh.13978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Autoimmune hemolytic anemia (AIHA) is caused by the production of autoantibodies against RBCs. COVID-19 vaccines can reduce the risk of severe disease, however, various adverse effects such as AIHA were observed following vaccination. This review aimed to assess the relationship of AIHA and COVID-19 vaccination using the PRISMA guidelines. Among 18 cases included in this review, new post-vaccination AIHA development was reported in 11 patients (7 women and 4 men) with a median age of 67.0 years. In 7 of 11 and 3 of 11 cases, the onset of symptoms occurred after first and second vaccine dose with median times of 7 and 14 days, respectively. In 1 of 11 cases, the AIHA occurred on Day 17 after booster vaccination. Ten of 11 and 1 of 11 AIHA patients received mRNA- and vector-based vaccine, respectively. After vaccination, 9 of 11, 1 of 11, and 1 of 11 AIHA patients developed warm IgG, cold IgM, and mixed autoantibodies against RBCs, respectively. Significant AIHA exacerbation was reported in seven patients (four women and three men) with a median age of 73.0 years. In 4 of 7 and 2 of 7 exacerbated AIHA cases, the onset of symptoms occurred after first and second vaccine dose with median times of 7 and 3 days, respectively. In 1 of 7 exacerbated AIHA cases, the onset of symptoms was observed on Day 2 after booster vaccination. All exacerbated AIHA cases received mRNA-based vaccines; 3 of 7 and 4 of 7 exacerbated AIHA cases developed IgG and IgM against RBCs, respectively. This review provides a comprehensive explanation regarding the AIHA development and exacerbation after COVID-19 vaccination.
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Affiliation(s)
- Abdollah Jafarzadeh
- Department of Immunology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Immunology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Sara Jafarzadeh
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Pardehshenas
- Department of Microbiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Nemati
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Haematology and Laboratory Sciences, School of Para-Medicine, Kerman University of Medical Sciences, Kerman, Iran
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13
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Awan MH, Samreen S, Salim B, Gul H, Perveen S, Nasim A. Corona Virus Disease-19 Vaccine-associated Autoimmune Disorders. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2022; 3:111-119. [PMID: 36788969 PMCID: PMC9895874 DOI: 10.2478/rir-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 02/16/2023]
Abstract
Coronavirus disease is a highly infectious viral disease caused by severe acute respiratory syndrome virus (SARS nCoV2). It was declared a pandemic within a few months of identification of its index case. The spread of COVID-19 across the globe was rampant, overwhelming healthcare systems and crippling global economies. Since the world was caught off guard by the pandemic, vaccine programs had to be rolled out in emergency to curb its spread. Ten vaccines have been granted Emergency Use Authorization thus far. Much of the side effects we know today are post-marketing adverse effects. Most of them are mild like myalgia and injection-site reactions, but a few of them such as post-vaccination autoimmune diseases have alerted the medical community. These include vaccine-induced thrombotic thrombocytopenia, autoimmune hepatitis, myocarditis, and Graves' disease. We attempt to summarize the diverse autoimmune phenomena reported after COVID-19 vaccination, with an aim to sensitize the medical community so that they can be better equipped in management when confronted with these diseases. This review by no means refutes the potential benefit of COVID-19 vaccination which has consolidated its place in preventing infections and substantially reducing severity and mortality.
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Affiliation(s)
- Marriam Hussain Awan
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Saba Samreen
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Babur Salim
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Haris Gul
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Shahida Perveen
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Amjad Nasim
- Postgraduate Resident in Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
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Al-Beltagi M, Saeed NK, Bediwy AS. COVID-19 disease and autoimmune disorders: A mutual pathway. World J Methodol 2022; 12:200-223. [PMID: 36159097 PMCID: PMC9350728 DOI: 10.5662/wjm.v12.i4.200] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/17/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a real challenge for humanity with high morbidity and mortality. Despite being primarily a respiratory illness, COVID-19 can affect nearly every human body tissue, causing many diseases. After viral infection, the immune system can recognize the viral antigens presented by the immune cells. This immune response is usually controlled and terminated once the infection is aborted. Nevertheless, in some patients, the immune reaction becomes out of control with the development of autoimmune diseases. Several human tissue antigens showed a strong response with antibodies directed against many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proteins, such as SARS-CoV-2 S, N, and autoimmune target proteins. The immunogenic effects of SARS-CoV-2 are due to the sizeable viral RNA molecules with interrupted transcription increasing the pool of epitopes with increased chances of molecular mimicry and interaction with the host immune system, the overlap between some viral and human peptides, the viral induced-tissue damage, and the robust and complex binding between sACE-2 and SARS-CoV-2 S protein. Consequently, COVID-19 and its vaccine may trigger the development of many autoimmune diseases in a predisposed patient. This review discusses the mutual relation between COVID-19 and autoimmune diseases, their interactive effects on each other, the role of the COVID-19 vaccine in triggering autoimmune diseases, the factors affecting the severity of COVID-19 in patients suffering from autoimmune diseases, and the different ways to minimize the risk of COVID-19 in patients with autoimmune diseases.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al-Habib Medical Group, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Chest Disease, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al-Habib Medical Group, Manama 26671, Manama, Bahrain
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15
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Jacobs JW, Booth GS. COVID-19 and Immune-Mediated RBC Destruction. Am J Clin Pathol 2022; 157:844-851. [PMID: 34919640 PMCID: PMC8755306 DOI: 10.1093/ajcp/aqab210] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To summarize the epidemiologic, clinical, and laboratory characteristics of autoimmune hemolytic anemia (AIHA) secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination. METHODS We conducted a systematic review using standardized keyword search to identify all reports of SARS-CoV-2 infection or vaccination and AIHA across PubMed, Web of Science, Scopus, and Google Scholar through September 24, 2021. RESULTS Fifty patients (mean [SD] age, 50.8 [21.6] years) diagnosed with coronavirus disease 2019 (COVID-19) and AIHA were identified. AIHA subtypes and number of patients were as follows: cold AIHA (n = 18), warm AIHA (n = 14), mixed-type AIHA (n = 3), direct antiglobulin test (DAT)-negative AIHA (n = 1), DAT-negative Evans syndrome (n = 1), Evans syndrome (n = 3), and subtype not reported (n = 10). Mean (SD) hemoglobin at AIHA diagnosis was 6.5 [2.8] g/dL (95% confidence interval, 5.7-7.3 g/dL). Median time from COVID-19 symptom onset to AIHA diagnosis was 7 days. In total, 19% (8/42) of patients with COVID-19-associated AIHA with reported outcomes were deceased. Four patients (mean [SD] age, 73.5 [16.9] years) developed AIHA following SARS-CoV-2 vaccination: Pfizer-BioNTech BNT162b2 vaccine (n = 2); Moderna mRNA-1273 vaccine (n = 1); undisclosed mRNA vaccine (n = 1). AIHA occurred after 1 dose in 3 patients (median, 5 days). CONCLUSIONS SARS-CoV-2 infection and vaccination are associated with multiple AIHA subtypes, beginning approximately 7 days after infectious symptoms and 5 days after vaccination.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Chong KM, Yang CY, Lin CC, Lien WC. Severe immune thrombocytopenia following COVID-19 vaccination (Moderna) and immune checkpoint inhibitor: A case report. Am J Emerg Med 2022; 56:395.e1-395.e3. [PMID: 35339338 PMCID: PMC8932008 DOI: 10.1016/j.ajem.2022.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
Safe and effective prophylactic vaccines are urgently needed to contain the coronavirus disease 2019 (COVID-19) pandemic. However, several vaccination-related adverse effects have been reported. Here, we report a rare case of severe immune thrombocytopenia occurring 3 days after receiving the mRNA-1273 (Moderna) COVID-19 vaccine in an Asian woman with a history of refractory lung adenocarcinoma treated with durvalumab, an immune checkpoint inhibitor. Treatment with platelet transfusion (12 units) and oral prednisolone (1 mg/kg per day) significantly improved her hemoptysis with thrombocytopenia. To the best of our knowledge, this is the first case of ITP following Moderna inoculation among Asians. This study highlights a potential adverse effect of mRNA-based COVID-19 vaccines in cancer patients receiving immune checkpoint inhibitors.
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Affiliation(s)
- Kah-Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Yao Yang
- Division of Pulmonology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Chin Lin
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Fatima Z, Reece BRA, Moore JS, Means RT. Autoimmune Hemolytic Anemia After mRNA COVID Vaccine. J Investig Med High Impact Case Rep 2022; 10:23247096211073258. [PMID: 35045762 PMCID: PMC8777324 DOI: 10.1177/23247096211073258] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Discussion of the hematologic complications of vaccination for severe acute respiratory syndrome coronavirus-2 (COVID-19) has primarily focused on the development of vaccine-associated immune thrombosis with thrombocytopenia (VITT). Other hematologic complications are uncommon. We report the case of a patient who developed immunoglobulin G (IgG)-mediated autoimmune hemolytic anemia (AIHA) after the Moderna COVID-19 messenger ribonucleic acid (mRNA) vaccine.
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COVID-19 vaccine and autoimmunity. A new case of autoimmune hepatitis and review of the literature. J Transl Autoimmun 2022; 5:100140. [PMID: 35013724 PMCID: PMC8730708 DOI: 10.1016/j.jtauto.2022.100140] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 12/19/2022] Open
Abstract
Autoimmunity following COVID-19 vaccination has been reported. Herein, a 79-year-old man with clinical and immunological features of autoimmune hepatitis type 1 after ChAdOx1 nCoV-19 vaccination is presented. Clinical manifestations rapidly remitted after the instauration of immunomodulatory management. This case, together with a comprehensive review of the literature, illustrates the association between COVID-19 vaccines and the development of autoimmune conditions.
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