Nahab Fadi, Bayakly Rana, Sexton Mary Elizabeth, Lemuel-Clarke Manet, Henriquez Laura, Rangaraju Srikant, Ido Moges
Departments of Neurology & Pediatrics, Emory University, Atlanta, GA, United States.
Georgia Department of Public Health, Atlanta, GA, United States.
Front Neurol. 2023 Jun 28;14:1199745. doi: 10.3389/fneur.2023.1199745. eCollection 2023.
The objective of our study was to evaluate vaccine type, COVID-19 infection, and their association with stroke soon after COVID-19 vaccination.
In a retrospective cohort study, we estimated the 21-day post-vaccination incidence of stroke among the recipients of the first dose of a COVID-19 vaccine. We linked the Georgia Immunization Registry with the Georgia Coverdell Acute Stroke Registry and the Georgia State Electronic Notifiable Disease Surveillance System data to assess the relative risk of stroke by the vaccine type.
Approximately 5 million adult Georgians received at least one COVID-19 vaccine between 1 December 2020 and 28 February 2022: 54% received BNT162b2, 41% received mRNA-1273, and 5% received Ad26.COV2.S. Those with concurrent COVID-19 infection within 21 days post-vaccination had an increased risk of ischemic (OR = 8.00, 95% CI: 4.18, 15.31) and hemorrhagic stroke (OR = 5.23, 95% CI: 1.11, 24.64) with no evidence for interaction between the vaccine type and concurrent COVID-19 infection. The 21-day post-vaccination incidence of ischemic stroke was 8.14, 11.14, and 10.48 per 100,000 for BNT162b2, mRNA-1273, and Ad26.COV2.S recipients, respectively. After adjusting for age, race, gender, and COVID-19 infection status, there was a 57% higher risk (OR = 1.57, 95% CI: 1.02, 2.42) for ischemic stroke within 21 days of vaccination associated with the Ad26.COV2.S vaccine compared to BNT162b2; there was no difference in stroke risk between mRNA-1273 and BNT162b2.
Concurrent COVID-19 infection had the strongest association with early ischemic and hemorrhagic stroke after the first dose of COVID-19 vaccination. Although not all determinants of stroke, particularly comorbidities, were considered in this analysis, the Ad26.COV2.S vaccine was associated with a higher risk of early post-vaccination ischemic stroke than BNT162b2.
我们研究的目的是评估疫苗类型、新冠病毒感染及其与新冠病毒疫苗接种后不久发生的中风之间的关联。
在一项回顾性队列研究中，我们估计了接种第一剂新冠病毒疫苗的人群接种后21天内中风的发病率。我们将佐治亚州免疫登记处与佐治亚州科弗代尔急性中风登记处以及佐治亚州电子法定疾病监测系统的数据相链接，以评估不同疫苗类型导致中风的相对风险。
在2020年12月1日至2022年2月28日期间，约500万成年佐治亚州居民接种了至少一剂新冠病毒疫苗：54%接种了BNT162b2，41%接种了mRNA-1273，5%接种了Ad26.COV2.S。接种疫苗后21天内并发新冠病毒感染的人群发生缺血性中风（比值比=8.00，95%置信区间：4.18，15.31）和出血性中风（比值比=5.23，95%置信区间：1.11，24.64）的风险增加，且没有证据表明疫苗类型与并发新冠病毒感染之间存在相互作用。接种BNT162b2、mRNA-1273和Ad26.COV2.S的人群接种后21天内缺血性中风的发病率分别为每10万人8.14、11.14和10.48例。在调整年龄、种族、性别和新冠病毒感染状况后，与BNT162b2相比，接种Ad26.COV2.S疫苗后21天内发生缺血性中风的风险高57%（比值比=1.57，95%置信区间：1.02，2.42）；mRNA-1273与BNT162b2之间的中风风险没有差异。
接种第一剂新冠病毒疫苗后，并发新冠病毒感染与早期缺血性和出血性中风的关联最为密切。尽管本分析未考虑中风的所有决定因素，尤其是合并症，但与BNT162b2相比，Ad26.COV2.S疫苗接种后早期缺血性中风的风险更高。
