Clinical and Experimental Vaccine Research最新文献

{"title":"Adverse events following immunisation with the first dose of sputnik V among Iranian health care providers.","authors":"Reza Jafarzadeh Esfehani,&nbsp;Masood Zahmatkesh,&nbsp;Reza Goldozian,&nbsp;Javad Farkhonde,&nbsp;Ehsan Jaripour,&nbsp;Asghar Hatami,&nbsp;Hamid Reza Bidkhori,&nbsp;Seyyed Khosro Shamsian,&nbsp;Seyyed AliAkbar Shamsian,&nbsp;Faezeh Mojahedi","doi":"10.7774/cevr.2023.12.1.25","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.1.25","url":null,"abstract":"<p><strong>Purpose: </strong>Since late 2019, the novel coronavirus disease has been a global concern, and alongside preventive strategies, including social distancing and personal hygiene, vaccination is now the primary hope for controlling the pandemic. Sputnik V is an adenovirus vector vaccine used against coronavirus disease 2019 (COVID-19) among Iranian health care providers, and there is a lack of information regarding the Adverse Events Following Immunisation (AEFI) by Sputnik V among the Iranian population. The present study aimed to evaluate AEFI by Sputnik V vaccine among Iranian population.</p><p><strong>Materials and methods: </strong>Every member of the Islamic Republic of Iran Medical Council received their first dose of the Sputnik V vaccine in Mashhad (Iran) and was referred to receive their second dose enrolled in the present study and asked to fill an English language checklist asking about development of any AEFI following immunization with the first dose of Sputnik V vaccine.</p><p><strong>Results: </strong>A total number of 1,347 with a mean±standard deviation age of 56.2±9.6 years filled the checklist. Most of the participants were male (838 [62.2%]). The present study demonstrated that immunization with the first dose of Sputnik V results in at least one AEFI in 32.8% of the Iranian medical council members. Most of the AEFI was related to musculoskeletal symptoms, including myalgia. By considering the age of 55 years as a cut-off point, individuals younger than 55 had a higher rate of AEFI (41.3% vs. 22.5%, p=0.0001). Male gender, use of analgesics, beta-blockers, and previous COVID-19 infection have a lower chance of developing AEFI (p<0.05).</p><p><strong>Conclusion: </strong>The present study demonstrated that most of the AEFI was related to musculoskeletal symptoms, including myalgia, and older individuals, male gender and those receiving analgesics and beta-blockers were less likely to develop AEFI following immunization with the first dose of Sputnik V.</p>","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"12 1","pages":"25-31"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/a1/cevr-12-25.PMC9950228.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10781808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seroconversion rates in kidney transplant recipients following SARS-CoV-2 vaccination and its association with immunosuppressive agents: a systematic review and meta-analysis.","authors":"Maria Riastuti Iryaningrum,&nbsp;Alius Cahyadi,&nbsp;Fachreza Aryo Damara,&nbsp;Ria Bandiara,&nbsp;Maruhum Bonar Hasiholan Marbun","doi":"10.7774/cevr.2023.12.1.13","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.1.13","url":null,"abstract":"<p><p>This systematic and meta-analysis aims to evaluate humoral and cellular responses to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine among kidney transplant recipients (KTRs). We conducted a systematic literature search across databases to evaluate seroconversion and cellular response rates in KTRs receiving SARS-CoV-2 vaccines. We extracted studies that assessed seroconversion rates described as the presence of antibody <i>de novo</i> positivity in KTRs following SARS-CoV-2 vaccination published up to January 23rd, 2022. We also performed meta-regression based on immunosuppression therapy used. A total of 44 studies involving 5,892 KTRs were included in this meta-analysis. The overall seroconversion rate following complete dose of vaccines was 39.2% (95% confidence interval [CI], 33.3%-45.3%) and cellular response rate was 41.6% (95% CI, 30.0%-53.6%). Meta-regression revealed that low antibody response rate was significantly associated with the high prevalence of mycophenolate mofetil/mycophenolic acid (p=0.04), belatacept (p=0.02), and anti-CD25 induction therapy uses (p=0.04). Conversely, tacrolimus use was associated with higher antibody response (p=0.01). This meta-analysis suggests that postvaccination seroconversion and cellular response rates in KTRs are still low. And seroconversion rate was correlated with the type of immunosuppressive agent and induction therapy used. Additional doses of the SARS-CoV-2 vaccine for this population using a different type of vaccine are considered.</p>","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"12 1","pages":"13-24"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/ca/cevr-12-13.PMC9950232.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10789680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The threat of Monkeypox in the Philippines: another problematic preparation and management for the healthcare system?","authors":"Dalmacito A Cordero","doi":"10.7774/cevr.2023.12.1.77","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.1.77","url":null,"abstract":"The Philippines is still in a tight battle with the coronavirus disease 2019 pandemic since many cases are detected daily. With the continuous spread of another disease worldwide—monkeypox, many Filipinos are alarmed if the country’s healthcare system is prepared enough, especially with the detection of its first case. Learning from the unfortunate experiences of the country during the current pandemic is essential in facing another health crisis. With this, recommendations for a robust healthcare system are proposed centered on: a massive digital information campaign about the disease; training healthcare workers to raise awareness about the virus and its transmission, management, and treatment; an intensified surveillance and detection procedure to monitor cases and execute contact tracing properly; and a persistent procurement of vaccines and drugs for treatment, with a well-designed vaccination program.","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"12 1","pages":"77-79"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/c6/cevr-12-77.PMC9950230.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10789220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psoriasis flares after COVID-19 vaccination: adherence to biologic therapy reduces psoriasis exacerbations: a case-control study.","authors":"Martina Burlando,&nbsp;Astrid Herzum,&nbsp;Emanuele Cozzani,&nbsp;Aurora Parodi","doi":"10.7774/cevr.2023.12.1.80","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.1.80","url":null,"abstract":"<p><p>This study aimed to evaluate if patients under biologics have a lower risk of psoriasis flares after coronavirus disease 2019 (COVID-19) vaccination than other psoriatic patients. Of 322 recently vaccinated patients admitted for psoriasis at the Dermatological Psoriasis Unit during January and February 2022, 316 (98%) had no psoriasis flares after COVID-19 vaccination (79% under biologic treatment, 21% not biologically treated) and 6 (2%) presented psoriasis flares after COVID-19 vaccination (33.3% under biologic treatment, 66.6% not biologically treated). Overall, psoriasis patients under biologic treatment, developed fewer psoriasis flares after COVID-19 vaccination (33.3%), than patients not under biologic treatment (66.6%) (p=0.0207; Fisher's exact test).</p>","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"12 1","pages":"80-81"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/ae/cevr-12-80.PMC9950225.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10799394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humoral immune response to SARS-CoV-2 mRNA vaccines is associated with choice of vaccine and systemic adverse reactions.","authors":"Hanna Klingel,&nbsp;Alexander Krüttgen,&nbsp;Matthias Imöhl,&nbsp;Michael Kleines","doi":"10.7774/cevr.2023.12.1.60","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.1.60","url":null,"abstract":"<p><strong>Purpose: </strong>Although the fast development of safe and effective messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 has been a success, waning humoral immunity has led to the recommendation of booster immunization. However, knowledge of the humoral immune response to different booster strategies and the association with adverse reactions is limited.</p><p><strong>Materials and methods: </strong>We investigated adverse reactions and anti-spike protein immunoglobulin G (IgG) concentrations among health care workers who received primary immunization with mRNA-1273 and booster immunization with mRNA-1273 or BNT162b2.</p><p><strong>Results: </strong>Adverse reactions were reported by 85.1% after the first dose, 94.7% after the second dose, 87.5% after a third dose of BNT162b2, and 86.0% after a third dose of mRNA-1273. They lasted for a median of 1.8, 2.0, 2.5, and 1.8 days, respectively; 6.4%, 43.6%, and 21.0% of the participants were unable to work after the first, second, and third vaccination, respectively, which should be considered when scheduling vaccinations among essential workers. Booster immunization induced a 13.75-fold (interquartile range, 9.30-24.47) increase of anti-spike protein IgG concentrations with significantly higher concentrations after homologous compared to heterologous vaccination. We found an association between fever, chills, and arthralgia after the second vaccination and anti-spike protein IgG concentrations indicating a linkage between adverse reactions, inflammation, and humoral immune response.</p><p><strong>Conclusion: </strong>Further investigations should focus on the possible advantages of homologous and heterologous booster vaccinations and their capability of stimulating memory B-cells. Additionally, understanding inflammatory processes induced by mRNA vaccines might help to improve reactogenicity while maintaining immunogenicity and efficacy.</p>","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"12 1","pages":"60-69"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/ca/cevr-12-60.PMC9950231.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10789683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual expression and processing of hepatitis C virus E1/E2 epitopes-based DNA vaccine candidate in healthy humans' peripheral blood mononuclear cells.","authors":"Rola Nadeem,&nbsp;Amany Sayed Maghraby,&nbsp;Dina Nadeem Abd-Elshafy,&nbsp;Ahmed Barakat Barakat,&nbsp;Mahmoud Mohamed Bahgat","doi":"10.7774/cevr.2023.12.1.47","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.1.47","url":null,"abstract":"<p><strong>Purpose: </strong>The development and study of hepatitis C virus (HCV) vaccine candidates' individualized responses are of great importance. Here we report on an HCV DNA vaccine candidate based on selected envelope (E1/E2) epitopes. Besides, we assessed its expression and processing in human peripheral blood mononuclear cells (PBMCs) and <i>in vivo</i> cellular response in mice.</p><p><strong>Materials and methods: </strong>HCV E1/E2 DNA construct (EC) was designed. The antigen expression of EC was assayed in PBMCs of five HCV-uninfected donors via a real-time quantitative polymerase chain reaction. Serum samples from 20 HCV antibody-positive patients were used to detect each individual PBMCs expressed antigens via enzyme-linked immunosorbent assay. Two groups, five Swiss albino mice each, were immunized with the EC or a control construct. The absolute count of lymph nodes' CD4⁺ and CD8⁺ T-lymphocytes was assessed.</p><p><strong>Results: </strong>Donors' PBMCs showed different levels of EC expression, ranging between 0.83-2.61-fold in four donors, while donor-3 showed 34.53-fold expression. The antigens expressed in PBMCs were significantly reactive to the 20 HCV antibody repertoire (all p=0.0001). All showed comparable reactivity except for donor-3 showing the lowest reactivity level. The absolute count % of the CD4⁺ T-cell significantly increased in four of the five EC-immunized mice compared to the control group (p=0.03). No significant difference in CD8⁺ T-cells % was observed (p=0.89).</p><p><strong>Conclusion: </strong>The inter-individual variation in antigen expression and processing dominance was evident, showing independence in individuals' antigen expression and reactivity levels to antibodies. The described vaccine candidate might result in a promising natural immune response with a possibility of CD4⁺ T-cell early priming.</p>","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"12 1","pages":"47-59"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/9d/cevr-12-47.PMC9950224.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10793190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunization of mice with chimeric protein-loaded aluminum hydroxide and selenium nanoparticles induces reduction of <i>Brucella melitensis</i> infection in mice","authors":"Tahereh Goudarzi, Morteza Abkar, Zahra Zamanzadeh, Mahdi Fasihi-Ramandi","doi":"10.7774/cevr.2023.12.4.304","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.4.304","url":null,"abstract":"Purpose Due to the many problems with commercially available vaccines, the production of effective vaccines against brucellosis is a necessity. The aim of this study was to evaluate the immune responses caused by the chimeric protein consisting of trigger factor, Bp26, and Omp31 (TBO) along with aluminum hydroxide (AH/TBO) and selenium (Se/TBO) nanoparticles (NPs) as adjuvants in mouse model. Materials and Methods Recombinant antigen expression was induced in Escherichia coli BL21 (DE3) bacteria using IPTG (isopropyl-d-1-thiogalactopyranoside). Purification and characterization of recombinant protein was conducted through NiFe3O4 NPs, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and Western blot. NP characteristics, including morphology and particle size, were measured in vitro. The recombinant TBO was loaded on to AH and Se NPs and were administered subcutaneously. After mice immunization, measurement of antibody titter and protection assay was performed. Results The average sizes of AH and Se NPs were about 60 nm and 150 nm, respectively. The enzyme-linked immunosorbent assay results showed that the serum of mice immunized by subcutaneous injection with both nanovaccines produced significant immunoglobulin G (IgG) responses against the chimeric antigen. The results of TBO-specific IgG isotype (IgG2a/IgG1) analysis showed that both AH and Se NPs induced a type to T-helper immune response. In addition, the results of the challenge with the pathogenic strain of Brucella melitensis 16M showed that vaccinated mice with AH/TBO NPs indicated a higher reduction of bacterial culture than immunized mice with Se/TBO NPs and TBO alone. Conclusion The results showed that AH NPs carrying chimeric antigen can be a promising vaccine candidate against brucellosis by producing protective immunity.","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135668160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of gold nanoparticles and Alum as immune enhancers against rabies vaccine and related immune reactivity, physiological, and histopathological alterations: <i>in vivo</i> study.","authors":"Rehab Essam El-Din El-Hennamy,&nbsp;Sahar Mohamed Mahmoud,&nbsp;Nabil Ahmed El-Yamany,&nbsp;Hanaa Hassan Hassanein,&nbsp;Mohamed Elsayed Amer,&nbsp;Aly Fahmy Mohamed","doi":"10.7774/cevr.2023.12.1.32","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.1.32","url":null,"abstract":"<p><strong>Purpose: </strong>The present study aimed to compare the immune-enhancing potential of gold nanoparticles (AuNPs) to Alum against rabies vaccine and the related immunological, physiological, and histopathological effects.</p><p><strong>Materials and methods: </strong>Alum and AuNPs sole and in combination with rabies vaccine were used at 0.35 mg/mL and 40 nM/mL, respectively. Rats used were categorized into six groups (20/each): control rats, rabies vaccine, aluminum phosphate gel, rabies vaccine adsorbed to Alum, AuNPs, and rabies vaccine adjuvant AuNPs.</p><p><strong>Results: </strong>Liver and kidney functions were in the normal range after AuNPs and Alum adjuvanted vaccine compared to control. Interleukin-6 and interferon-γ levels were significantly increased in groups immunized with Alum and AuNPs adjuvanted vaccine, the peak level was in the case of AuNP adjuvanted vaccine on the 14th day. Ninety days post-vaccination, total immunoglobulin G (IgG) against adjuvanted rabies vaccine showed a significantly elevated anti-rabies IgG with AuNPs and Alum adsorbed vaccine compared with unadjuvanted one. The total antioxidant capacity, malondialdehyde (MDA) levels, superoxide dismutase, and glutathione peroxidase activities were significantly increased post-adjuvanted AuNPs adjuvanted vaccine vaccination than in Alum adsorbed vaccine, while MDA was significantly decreased. The histopathological examination revealed detectable alterations post-AuNPs and Alum adjuvanted vaccine immunization compared with liver and kidney profiles post-administration of unadjuvanted and non-immunized groups, meanwhile, splenic tissue revealed hyperplasia of lymphoid follicles indicating increased immune reactivity.</p><p><strong>Conclusion: </strong>The AuNPs are promising enhancers of the immune response as Alum, and the undesirable effects of AuNPs could be managed by using suitable sizes, shapes, and concentrations.</p>","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"12 1","pages":"32-46"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/07/cevr-12-32.PMC9950229.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10781807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serological response 5 months after the BNT162b2 COVID-19 vaccination in patients with various hematological disorders in Japan","authors":"Yoshiaki Marumo, Takashi Yoshida, Yuki Furukawa, Kenji Ina, Ayumi Kamiya, Takae Kataoka, Satoshi Kayukawa","doi":"10.7774/cevr.2023.12.4.319","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.4.319","url":null,"abstract":"Purpose Patients with hematological malignancies are at an increased risk of severe infection with coronavirus disease 2019 (COVID-19). However, developing an adequate immune response after vaccination is difficult, especially in patients with lymphoid neoplasms. Since the long-term effects of the BNT162b2 vaccine are unclear, the humoral immune response 5 months after the two vaccinations in patients with hematological disorders was analyzed. Materials and Methods Samples were collected from 96 patients vaccinated twice with BNT162b2 and treated with at least one line of an antitumor or immunosuppressive drug in our hospital from November 2021 to February 2022. Serum anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) spike (S) antibody titers were analyzed. Patients were age- and sex-matched using propensity matching and compared with a healthy control group. Patients with serum anti-SARS-CoV-2 S antibodies were defined as ‘responder’ if >50 U/mL. The patients had B-cell non-Hodgkin lymphoma (B-NHL), multiple myeloma, chronic myeloid leukemia, etc. Results Patients had significantly low antibody levels (median, 55.3 U/mL vs. 809.8 U/mL; p<0.001) and a significantly low response rate (p<0.001). Multivariate analysis showed that patients with B-NHL, aged >72 years, were associated with a low response to vaccination. There were no significant differences between patients with chronic myeloid leukemia and healthy controls. Conclusion Our study shows that patients with hematological disorders are at risk of developing severe COVID-19 infections because of low responsiveness to vaccination. Moreover, the rate of antibody positivity differed between the disease groups. Further studies are warranted to determine an appropriate preventive method for these patients, especially those with B-NHL.","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135668162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Before blaming SARS-CoV-2 vaccines for thalamic lacunar stroke, alternative etiologies must be ruled out.","authors":"Josef Finsterer","doi":"10.7774/cevr.2023.12.1.85","DOIUrl":"https://doi.org/10.7774/cevr.2023.12.1.85","url":null,"abstract":"We read with interest the article by Shahali et al. [1] about a 72-year-old male who was admitted 9 days after the first dose of the AstraZeneca vaccine for headache, dizziness, gait disturbance with a tendency to fall, and right-sided hemichorea. The neurological deficits were attributed to left thalamic lacunar stroke due to vaccination-induced immune thrombotic thrombocytopenia and treatment with low molecular heparin (nadroparin), ozagrel, edaravone, prednisolone, and haloperidol was started. Two weeks after the start, the patient received warfarin [1]. The outcome after 3 weeks was described as “satisfactory” [1]. The study is excellent but raises concerns that should be discussed. We disagree with the notion that there is a causal relationship between vaccination and thalamic stroke. In addition to vaccination, several other causes of lacunar stroke have not been ruled out. The patient has not undergone echocardiography to rule out congestive heart failure, cardiomyopathy, myocardial ischemia, Takotsubo syndrome, noncompaction, endocarditis, or myocarditis. Or do the authors mean “echocardiography” when they use the term “echo-Doppler”? The results of the standard electrocardiogram or Holter recordings are not mentioned. Because a lacunar stroke can also be embolic, it is crucial to rule out all causes of cardioembolism, including atrial fibrillation or ventricular arrhythmias. There is no evidence of blood pressure monitoring at admission or during the 3-week hospital stay. Readers were not informed of hemoglobin A1c levels, pro-natriuretic peptide levels, or troponin levels. No information was given on anti-nuclear and anti-neutrophil cytoplasmic antibodies. There is also no information on the results of the carotid ultrasound. Because lacunar stroke is most commonly caused by microangiopathy, it is crucial that studies of generalized atherosclerosis have been performed. It remains unclear whether the patient was a smoker or not. We do not know if the patient had hyperlipidemia or a normal lipid profile. No evidence has been provided that the thalamic lesion shown in Fig. 1 of Shahali et al. [1] truly represents cytotoxic edema. We were to be told whether the apparent diffusion coefficient maps were hypo-, iso-, or hyperintense. Especially in a patient with no history of cardiovascular risk factors, it is important that cerebral ischemia be confirmed or ruled out by multimodal magnetic resonance imaging. The patient was admitted because of headache, but no explanation for the headache was given. The D-dimer was significantly increased [1]. Therefore, it is important that venous sinus thrombosis is adequately ruled out by magnetic resonance venography © Korean Vaccine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/ by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provid","PeriodicalId":51768,"journal":{"name":"Clinical and Experimental Vaccine Research","volume":"12 1","pages":"85-86"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/a1/cevr-12-85.PMC9950233.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10781804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}