Sessa Francesco, Salerno Monica, Esposito Massimiliano, Di Nunno Nunzio, Zamboni Paolo, Pomara Cristoforo
Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, 95121 Catania, Italy.
J Clin Med. 2021 Dec 15;10(24):5876. doi: 10.3390/jcm10245876.
The current challenge worldwide is the administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Considering that the COVID-19 vaccination represents the best possibility to resolve this pandemic, this systematic review aims to clarify the major aspects of fatal adverse effects related to COVID-19 vaccines, with the goal of advancing our knowledge, supporting decisions, or suggesting changes in policies at local, regional, and global levels. Moreover, this review aims to provide key recommendations to improve awareness of vaccine safety. All studies published up to 2 December 2021 were searched using the following keywords: "COVID-19 Vaccine", "SARS-CoV-2 Vaccine", "COVID-19 Vaccination", "SARS-CoV-2 Vaccination", and "Autopsy" or "Post-mortem". We included 17 papers published with fatal cases with post-mortem investigations. A total of 38 cases were analyzed: 22 cases were related to ChAdOx1 nCoV-19 administration, 10 cases to BNT162b2, 4 cases to mRNA-1273, and 2 cases to Ad26.COV2.S. Based on these data, autopsy is very useful to define the main characteristics of the so-called vaccine-induced immune thrombotic thrombocytopenia (VITT) after ChAdOx1 nCoV-19 vaccination: recurrent findings were intracranial hemorrhage and diffused microthrombi located in multiple areas. Moreover, it is fundamental to provide evidence about myocarditis related to the BNT162B2 vaccine. Finally, based on the discussed data, we suggest several key recommendations to improve awareness of vaccine safety.
目前全球面临的挑战是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗的接种。鉴于2019冠状病毒病（COVID-19）疫苗接种是解决这一疫情的最佳途径，本系统评价旨在阐明与COVID-19疫苗相关的致命不良反应的主要方面，目的是增进我们的认识、支持决策或建议在地方、区域和全球层面改变政策。此外，本评价旨在提供关键建议以提高对疫苗安全性的认识。使用以下关键词检索了截至2021年12月2日发表的所有研究：“COVID-19疫苗”、“SARS-CoV-2疫苗”、“COVID-19疫苗接种”、“SARS-CoV-2疫苗接种”以及“尸检”或“死后检查”。我们纳入了17篇发表的有尸检调查的致命病例论文。共分析了38例病例：22例与ChAdOx1 nCoV-19接种有关，10例与BNT162b2有关，4例与mRNA-1273有关，2例与Ad26.COV2.S有关。基于这些数据，尸检对于确定ChAdOx1 nCoV-19疫苗接种后所谓的疫苗诱导的免疫性血栓性血小板减少症（VITT）的主要特征非常有用：反复出现的发现是颅内出血和多个部位的弥漫性微血栓。此外，提供与BNT162B2疫苗相关的心肌炎证据至关重要。最后，基于所讨论的数据，我们提出了几项关键建议以提高对疫苗安全性的认识。
