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Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil

OBJECTIVE: Describe a case series of vaccine-induced immune thrombotic thrombocytopenia (VITT) after COVID-19 vaccination in Brazil that included ChAdOx1 nCoV-19, Ad26.COV2.S and BNT162b2 vaccines, describing their clinical and laboratory characteristics. METHODOLOGY: Descriptive case series study u...

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Autores principales: Mouta Nunes de Oliveira, Patricia, Mendes-de-Almeida, Daniela P., Bertollo Gomes Porto, Victor, Crespo Cordeiro, Catherine, Vitiello Teixeira, Gabriellen, Saraiva Pedro, Renata, Roberto Gomes Takey, Paulo, Kegele Lignani, Letícia, Reis Xavier, Janaína, Cardoso Doria da Gama, Vitor, Amorim Filho, Luiz, Emoingt Furtado, Bárbara, Santa Maria, André, Dahrug Barros, Tiago, Neves Waite Freitas, Livia, dos Santos Pereira, Tainá, Lima Abreu, Debora, Bernardes Ramos, Michael, Gabe, Caroline, Arnold, Donald, William Smith, James, Nazy, Ishac, Lourdes de Sousa Maia, Maria de
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Authors. Published by Elsevier Ltd. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9212666/
https://www.ncbi.nlm.nih.gov/pubmed/35779962
http://dx.doi.org/10.1016/j.vaccine.2022.06.014
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author Mouta Nunes de Oliveira, Patricia
Mendes-de-Almeida, Daniela P.
Bertollo Gomes Porto, Victor
Crespo Cordeiro, Catherine
Vitiello Teixeira, Gabriellen
Saraiva Pedro, Renata
Roberto Gomes Takey, Paulo
Kegele Lignani, Letícia
Reis Xavier, Janaína
Cardoso Doria da Gama, Vitor
Amorim Filho, Luiz
Emoingt Furtado, Bárbara
Santa Maria, André
Dahrug Barros, Tiago
Neves Waite Freitas, Livia
dos Santos Pereira, Tainá
Lima Abreu, Debora
Bernardes Ramos, Michael
Gabe, Caroline
Arnold, Donald
William Smith, James
Nazy, Ishac
Lourdes de Sousa Maia, Maria de
author_facet Mouta Nunes de Oliveira, Patricia
Mendes-de-Almeida, Daniela P.
Bertollo Gomes Porto, Victor
Crespo Cordeiro, Catherine
Vitiello Teixeira, Gabriellen
Saraiva Pedro, Renata
Roberto Gomes Takey, Paulo
Kegele Lignani, Letícia
Reis Xavier, Janaína
Cardoso Doria da Gama, Vitor
Amorim Filho, Luiz
Emoingt Furtado, Bárbara
Santa Maria, André
Dahrug Barros, Tiago
Neves Waite Freitas, Livia
dos Santos Pereira, Tainá
Lima Abreu, Debora
Bernardes Ramos, Michael
Gabe, Caroline
Arnold, Donald
William Smith, James
Nazy, Ishac
Lourdes de Sousa Maia, Maria de
author_sort Mouta Nunes de Oliveira, Patricia
collection PubMed
description OBJECTIVE: Describe a case series of vaccine-induced immune thrombotic thrombocytopenia (VITT) after COVID-19 vaccination in Brazil that included ChAdOx1 nCoV-19, Ad26.COV2.S and BNT162b2 vaccines, describing their clinical and laboratory characteristics. METHODOLOGY: Descriptive case series study using Bio-Manguinhos/Fiocruz/AstraZeneca Brazil and National Immunization Program/Ministry of Health (NIP/MoH) data on COVID-19 AEFI surveillance. We obtained patient-level data from pharmacovigilance for AEFI surveillance and used both the NIP/MoH and Bio-Manguinhos/Fiocruz pharmacovigilance databases to create the study database. Thirty-nine cases of suspect VITT were included, 36 after ChAdOx1 nCoV-19, one after BNT162b2 and two after Ad26.COV2.S vaccine. All cases were based on meeting the Brighton Collaboration criteria for VITT. The primary outcomes were clinical and laboratory features, site of thrombosis, and anti-PF4 ELISA, when available. RESULTS: Thirty-nine cases met the criteria, 38 of which were classified as level 1 and one as level 3 according to Brighton Collaboration. Most cases had the central nervous system (CNS) as the main site of thrombosis (21/39) and happened after the vaccine first dose (34/39). The median age of the cases was 41 years old (23 to 86 yo). Most of the cases (61.5%) occurred in women. The median interval between vaccination and onset of symptoms was 8 days (0–37 days). The platelet count and D-dimer count had median values of 34,000/µL and 19,235 µg FEU/L, respectively. The ELISA anti-PF4 antibody was positive in 18 samples. The overall mortality rate was 51% and was higher in cases of CNS thrombosis with intracerebral bleeding. CONCLUSION: Our case series shows that Brazilian VITT cases have similar clinical and laboratory profiles as demonstrated in the literature. Brazil has administered more than 300 million doses of COVID-19 vaccines (more than 110 million from ChAdOx1 nCoV-19). VITT seems to be a very rare but serious adverse event following COVID-19 immunization, especially adenoviral vector immunization.
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spelling pubmed-92126662022-06-22 Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil Mouta Nunes de Oliveira, Patricia Mendes-de-Almeida, Daniela P. Bertollo Gomes Porto, Victor Crespo Cordeiro, Catherine Vitiello Teixeira, Gabriellen Saraiva Pedro, Renata Roberto Gomes Takey, Paulo Kegele Lignani, Letícia Reis Xavier, Janaína Cardoso Doria da Gama, Vitor Amorim Filho, Luiz Emoingt Furtado, Bárbara Santa Maria, André Dahrug Barros, Tiago Neves Waite Freitas, Livia dos Santos Pereira, Tainá Lima Abreu, Debora Bernardes Ramos, Michael Gabe, Caroline Arnold, Donald William Smith, James Nazy, Ishac Lourdes de Sousa Maia, Maria de Vaccine Article OBJECTIVE: Describe a case series of vaccine-induced immune thrombotic thrombocytopenia (VITT) after COVID-19 vaccination in Brazil that included ChAdOx1 nCoV-19, Ad26.COV2.S and BNT162b2 vaccines, describing their clinical and laboratory characteristics. METHODOLOGY: Descriptive case series study using Bio-Manguinhos/Fiocruz/AstraZeneca Brazil and National Immunization Program/Ministry of Health (NIP/MoH) data on COVID-19 AEFI surveillance. We obtained patient-level data from pharmacovigilance for AEFI surveillance and used both the NIP/MoH and Bio-Manguinhos/Fiocruz pharmacovigilance databases to create the study database. Thirty-nine cases of suspect VITT were included, 36 after ChAdOx1 nCoV-19, one after BNT162b2 and two after Ad26.COV2.S vaccine. All cases were based on meeting the Brighton Collaboration criteria for VITT. The primary outcomes were clinical and laboratory features, site of thrombosis, and anti-PF4 ELISA, when available. RESULTS: Thirty-nine cases met the criteria, 38 of which were classified as level 1 and one as level 3 according to Brighton Collaboration. Most cases had the central nervous system (CNS) as the main site of thrombosis (21/39) and happened after the vaccine first dose (34/39). The median age of the cases was 41 years old (23 to 86 yo). Most of the cases (61.5%) occurred in women. The median interval between vaccination and onset of symptoms was 8 days (0–37 days). The platelet count and D-dimer count had median values of 34,000/µL and 19,235 µg FEU/L, respectively. The ELISA anti-PF4 antibody was positive in 18 samples. The overall mortality rate was 51% and was higher in cases of CNS thrombosis with intracerebral bleeding. CONCLUSION: Our case series shows that Brazilian VITT cases have similar clinical and laboratory profiles as demonstrated in the literature. Brazil has administered more than 300 million doses of COVID-19 vaccines (more than 110 million from ChAdOx1 nCoV-19). VITT seems to be a very rare but serious adverse event following COVID-19 immunization, especially adenoviral vector immunization. The Authors. Published by Elsevier Ltd. 2022-08-05 2022-06-16 /pmc/articles/PMC9212666/ /pubmed/35779962 http://dx.doi.org/10.1016/j.vaccine.2022.06.014 Text en © 2022 The Authors Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Mouta Nunes de Oliveira, Patricia
Mendes-de-Almeida, Daniela P.
Bertollo Gomes Porto, Victor
Crespo Cordeiro, Catherine
Vitiello Teixeira, Gabriellen
Saraiva Pedro, Renata
Roberto Gomes Takey, Paulo
Kegele Lignani, Letícia
Reis Xavier, Janaína
Cardoso Doria da Gama, Vitor
Amorim Filho, Luiz
Emoingt Furtado, Bárbara
Santa Maria, André
Dahrug Barros, Tiago
Neves Waite Freitas, Livia
dos Santos Pereira, Tainá
Lima Abreu, Debora
Bernardes Ramos, Michael
Gabe, Caroline
Arnold, Donald
William Smith, James
Nazy, Ishac
Lourdes de Sousa Maia, Maria de
Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil
title Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil
title_full Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil
title_fullStr Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil
title_full_unstemmed Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil
title_short Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil
title_sort vaccine-induced immune thrombotic thrombocytopenia after covid-19 vaccination: description of a series of 39 cases in brazil
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9212666/
https://www.ncbi.nlm.nih.gov/pubmed/35779962
http://dx.doi.org/10.1016/j.vaccine.2022.06.014
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