SARS-CoV-2 vaccines–induced thrombotic thrombocytopenia: should we consider immuno-hypersensitivity?
DOI:
https://doi.org/10.11606/s1518-8787.2021055003855Palabras clave:
COVID-19, prevention & control, SARS-CoV-2, immunology, COVID-19 Vaccines, Immunogenicity, Vaccine, Embolism and ThrombosisResumen
The coronavirus disease 2019 (COVID-19) pandemic is significantly causing unprecedented clinical, socioeconomic, and public health challenges globally. The successful global administration of effective, safe and sustainable vaccine(s) is widely believed to be crucial in mitigating as well as preventing COVID-19. However, the rising cases of severe adverse events following immunization (AEFI) with COVID-19 vaccines including thrombosis, thrombocytopenia, and in some instances, death have created serious global concerns and could enormously contribute to vaccine hesitancy. Although the complete underlying pathophysiology and immunopathology of the COVID-19 vaccines related to AEFI, including thrombosis and/or anaphylaxis, are yet to be determined, exploring possible immuno-hypersensitivity could be crucial in the mechanisms associated with these reactions, thereby mitigating their occurrences as well as restoring confidence in vaccine administration for a COVID-19 free world.
Referencias
World Health Organization. Statement of the WHO Global Advisory Committee on Vaccine Safety (GACVS) COVID-19 subcommittee on safety signals related to the AstraZeneca COVID-19 vaccine. Geneva (CH): WHO; 2020 [cited 2021 Apr 16]. Available from: https://www.who.int/news/item/19-03-2021-statement-of-the-who-global-advisory-committee-on-vaccine-safety-(gacvs)-covid-19-subcommittee-on-safety-signals-related-to-the-astrazeneca-covid-19-vaccine [ Links ]
World Health Organization. WHO adds Janssen vaccine to list of safe and effective emergency tools against COVID-19. Geneva (CH): WHO; 2020 [cited 2021 Apr 16]. Available from: https://www.who.int/news/item/12-03-2021-who-adds-janssen-vaccine-to-list-of-safe-and-effective-emergency-tools-against-covid-19 [ Links ]
Leek TKBV, Chan ES, Connors ES, Derfalvi B, Ellis AK, Upton JEM, et al. COVID-19 vaccine testing & administration guidance for allergists/immunologists from the Canadian Society of Allergy and Clinical Immunology (CSACI). Allergy Asthma Clin Immunol. 2021;17:29. https://doi.org/10.1186/s13223-021-00529-2 [ Links ]
Bloomberg Vaccine Tracker. New York; 2021 [cited 2021 Apr 26]. Available from: https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/?cmpid= socialflow-twitter-business&utm_medium=social&utm_campaign=socialflow-organic&utm_content=business&utm_source=twitter [ Links ]
Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med. 2021;384:2092-2101. https://doi.org/10.1056/NEJMoa2104840 [ Links ]
Centers for Disease Control and Prevention (US). Interim clinical considerations for use of mRNA COVID-19 vaccines currently authorized in the United States: Atlanta, GA: CDC; 2020 [reviewed 2020 Dec 20; cited 2020 Dec 31]. Available from: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html [ Links ]
Centers for Disease Control and Prevention (US). Interim clinical considerations for use of COVID-19 vaccines currently authorized in the United States. Atlanta, GA; CDC; 2021 [cited 2021 May 1]. Available from: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#footnote-03 [ Links ]
European Medicines Agency. COVID-19: latest updates. Amsterdam (NL): EMA; 2021 [cited 2021 May 1]. Available from: https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/covid-19-latest-updates [ Links ]
Mahase E. AstraZeneca vaccine: blood clots are “extremely rare and benefits outweigh risks, regulators conclude. BMJ. 2021;373:n931. https://doi.org/10.1136/bmj.n931 [ Links ]
European Medicines Agency Medicines and Healthcare products Regulatory Agency. Expert reaction to statements from MHRA and EMA in relation to the AstraZeneca vaccine and rare blood clots and low blood platelets. London (UK): Science Media Centre; 2021 [cited 2021 Apr 26]. Available from: https://www.sciencemediacentre.org/expert-reaction-to-statements-from-mhra-and-ema-in-relation-to-the-astrazeneca-vaccine-and-rare-blood-clots-and-low-blood-platelets/ [ Links ]
Noack R. Denmark and Norway suspend AstraZeneca covid vaccine over blood clot concerns, even as European regulator maintains it is safe. The Washington Post. 2021 March 11 [cited 2021 May 2]. Available from: https://www.washingtonpost.com/gdpr-consent/?next_url=https%3a%2f%2fwww.washingtonpost.com%2fworld%2fdenmark-temporarily-suspends-astrazeneca-vaccine-even-as-european-regulator-maintains-it-is-safe%2f2021%2f03%2f11%2fd48662e8-8267-11eb-be22-32d331d87530_story.html [ Links ]
Gascón BM. Bulgaria, Romania order halt to AstraZeneca vaccines. Balkan Insight. 2021 March 12 [cited 2021 Mar 4]. Available from: https://balkaninsight.com/2021/03/12/bulgaria-romania-order-halt-to-astrazeneca-vaccines/ [ Links ]
Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. Lancet. 2020;396(10267):1979-93. https://doi.org/10.1016/S0140-6736(20)32466-1 [ Links ]
Australian Technical Advisory Group on Immunisation. ATAGI statement on AstraZeneca vaccine in response to new vaccine safety concerns. Canberra (AUS): Australian Government, Department of Health; 2021 [cited 2021 Apr 8]. Available from: https://www.health.gov.au/news/atagi-statement-on-astrazeneca-vaccine-in-response-to-new-vaccine-safety-concerns [ Links ]
Germany restricts use of AstraZeneca vaccine to over 60s in most cases. Bonn (DE); DW: 2021 [cited 2021 Mar 30]. Available from: https://www.dw.com/en/germany-restricts-use-of-astrazeneca-vaccine-to-over-60s-in-most-cases/a-57049301 [ Links ]
Blumenthal KG, Robinson LB, Camargo Jr CA, Shenoy ES, Banerji A, Landman AB,, et al. Acute allergic reactions to mRNA COVID-19 vaccines. JAMA. 2021;325(15):1562-5. https://doi.org/10.1001/jama.2021.3976 [ Links ]
Kragholm K, Sessa M, Mulvad T, Andersen MP, Collatz-Christensen H, Blomberg SN, et al. (2021). Thrombocytopenia after COVID-19 vaccination. J Autoimmun. 123:102712. https://doi.org/10.1016/j.jaut.2021.102712 [ Links ]
Schultz NH, Sørvoll IH, Michelsen AE, Munthe LA, Fridtjof L, Lund-Johansen F, et al. Thrombosis and thrombocytopenia after ChAdOx1nCoV-19 vaccination. N Engl J Med. 2021;384:2124-30. https://doi.org/10.1056/nejmoa2104882 [ Links ]
Dreskin SC, Halsey NA, Kelso JM, Wood RA, Hummell DS, Edwards KM, et al. International Consensus (ICON): allergic reactions to vaccines. World Allergy Organ J. 2016;9(1):32. https://doi.org/10.1186/s40413-016-0120-5 [ Links ]
McNeil MM, DeStefano F. Vaccine-associated hyper-sensitivity. J Allergy Clin Immunol. 2018;141(2):463-72. https://doi.org/10.1016/j.jaci.2017.12.971 [ Links ]
Bertuola F, Morando C, Menniti-Ippolito F, Da Cas R, Capuano A, Perilongo G, et al. Association between drug and vaccine use and acute immune thrombocytopenia in childhood: a case-control study in Italy. Drug Saf. 2010;33(1):65-72. https://doi.org/10.2165/11530350-000000000-00000 [ Links ]
Moulis G, Sommet A, Sailler L, Lapeyre-Mestre M, Montastruc JL. Drug-induced immune thrombocytopenia: a descriptive survey in the French Pharmaco Vigilance database. Platelets. 2012;23(6):490-4. https://doi.org/10.3109/09537104.2011.633179 [ Links ]
Dalt LD, Zerbinati C, Strafella MS, Renna S, Riceputi L, Di Pietro P, et al.. Henoch-Schönlein purpura and drug and vaccine use in childhood: a case-control study. Ital J Pediatr. 2016;42(1):60. https://doi.org/10.1186/s13052-016-0267-2 [ Links ]
Cines DB, Bussel JB. SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia [editorial]. N Engl J Med. 2021;384:2254-6. https://doi.org/10.1056/NEJMe2106315 [ Links ]
Hundelshausen P, Lorenz R, Siess W, Weber C. Vaccine-induced immune thrombotic thrombocytopenia (VITT): targeting pathomechanisms with Bruton tyrosine kinase inhibitors. Thromb Haemost. 2021 Apr13. https://doi.org/10.1055/a-1481-3039. Epub ahead of print. [ Links ]
Warkentin TE, Makris M, Jay RM, Kelton JG. A spontaneous prothrombotic disorder resembling heparin-induced thrombocytopenia. Am J Med. 2008;121(7):632-6. https://doi.org/10.1016/j.amjmed.2008.03.012 [ Links ]
Esmon CT. The interactions between inflammation and coagulation. Br J Haematol. 2005;131(4):417-30. https://doi.org/10.1111/j.1365-2141.2005.05753.x [ Links ]
Levi M, Poll T. Coagulation in patients with severe sepsis. Semin Thromb Hemost. 2015;41(1):9-15. https://doi.org/10.1055/s-0034-1398376 [ Links ]
Sabroe I, Parker LC, Dower SK, Whyte MKB. The role of TLR activation in inflammation. J Pathol. 2008;214(2):126-35. https://doi.org/10.1002/path.2264 [ Links ]
Laplante P, Fuentes R, Salem D, Subang R, Gillis MA, Hachem A, et al. Antiphospholipid antibody-mediated effects in an arterial model of thrombosis are dependent on Toll-like receptor 4. Lupus. 2016;25(2):162-76. https://doi.org/10.1177/0961203315603146 [ Links ]
Yang X, Li L, Liu J, Lv B, Chen F. Extracellular histones induce tissue factor expression in vascular endothelial cells via TLR and activation of NF-kB and AP1. Thromb Res. 2016;137:211-8. https://doi.org/10.1016/j.thromres.2015.10.012 [ Links ]
Borgsteede S, Geersing TH, Tempels-Pavlica Z. Other excipients than PEG might cause serious hyper-sensitivity reactions in COVID-19 vaccines. Allergy. 2021;76(6):1941-2. https://doi.org/10.1111/all.14774 [ Links ]
Novak N, Akdis C, Cabanillas B. COVID-19 vaccines and the role of other potential allergenic components different from PEG. Authorea [Preprint]. 2021 Jan 25. https://doi.org/10.22541/au.161157257.70920317/v1 [ Links ]
Stone Jr CA, Liu Y, Relling MV, Krantz MS, Pratt AL, Abreo A, et al. Immediate hypersensitivity to polyethylene glycols and polysorbates: more common than we have recognized. J Allergy Clin Immunol Pract. 2019;7(5):1533-40.e8. https://doi.org/10.1016/j.jaip.2018.12.003 [ Links ]
Calogiuri G, Foti C, Nettis E, Di Leo E, Macchia L, Vacca A. Polyethylene glycols and polysorbates: two still neglected ingredients causing true IgE-mediated reactions. J Allergy Clin Immunol Pract. 2019;7(7):2509-10. https://doi.org/10.1016/j.jaip.2019.05.058 [ Links ]
Zhou ZH, Stone Jr CA, Jakubovic B, Phillips EJ, Sussman G, Park J, et al. Anti-PEG IgE in anaphylaxis associated with polyethylene glycol. J Allergy Clin Immunol Pract. 2021;9(4):1731-3.e3. https://doi.org/10.1016/j.jaip.2018.12.003 [ Links ]
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Derechos de autor 2021 Rine Christopher Reuben, Lillian Yami Adogo
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
