Pomara Cristoforo, Sessa Francesco, Ciaccio Marcello, Dieli Francesco, Esposito Massimiliano, Giammanco Giovanni Maurizio, Garozzo Sebastiano Fabio, Giarratano Antonino, Prati Daniele, Rappa Francesca, Salerno Monica, Tripodo Claudio, Mannucci Pier Mannuccio, Zamboni Paolo
Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, 95121 Catania, Italy.
Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
Diagnostics (Basel). 2021 May 26;11(6):955. doi: 10.3390/diagnostics11060955.
The current challenge worldwide is the administration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. Even if rarely, severe vascular adverse reactions temporally related to vaccine administration have induced diffidence in the population at large. In particular, researchers worldwide are focusing on the so-called "thrombosis and thrombocytopenia after COVID-19 vaccination". This study aims to establish a practical workflow to define the relationship between adverse events following immunization (AEFI) and COVID-19 vaccination, following the basic framework of the World Health Organization (WHO). Post-mortem investigation plays a pivotal role to support this causality relationship when death occurs. To demonstrate the usefulness and feasibility of the proposed workflow, we applied it to two exemplificative cases of suspected AEFI following COVID-19 vaccination. Based on the proposed model, we took into consideration any possible causality relationship between COVID-19 vaccine administration and AEFI. This led us to conclude that vaccination with ChAdOx1 nCov-19 may cause the rare development of immune thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4), which clinically mimics heparin-induced autoimmune thrombocytopenia. We suggest the adoption of the proposed methodology in order to confirm or rule out a causal relationship between vaccination and the occurrence of AEFI.
目前全球面临的挑战是新型严重急性呼吸综合征冠状病毒2(SARS-CoV-2)疫苗的接种。即使与疫苗接种在时间上相关的严重血管不良反应很少见,也已在广大人群中引发了疑虑。特别是,全球研究人员都在关注所谓的“新冠疫苗接种后血栓形成和血小板减少症”。本研究旨在遵循世界卫生组织(WHO)的基本框架,建立一个实用的工作流程,以确定免疫接种后不良事件(AEFI)与新冠疫苗接种之间的关系。当发生死亡时,尸检调查对于支持这种因果关系起着关键作用。为了证明所提出工作流程的实用性和可行性,我们将其应用于两例新冠疫苗接种后疑似AEFI的典型案例。基于所提出的模型,我们考虑了新冠疫苗接种与AEFI之间的任何可能因果关系。这使我们得出结论,接种ChAdOx1 nCov-19疫苗可能会导致罕见的由抗血小板因子4(PF4)的血小板激活抗体介导的免疫性血小板减少症,临床上类似于肝素诱导的自身免疫性血小板减少症。我们建议采用所提出的方法来确认或排除疫苗接种与AEFI发生之间的因果关系。