Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Int Immunopharmacol. 2024 Jan 25;127:111455. doi: 10.1016/j.intimp.2023.111455. Epub 2023 Dec 28.
Immune-mediated diseases (IMDs) after nucleic acid-based vaccines have been sporadically reported since their introduction during the worldwide COVID-19 crisis. Confirming their cause-effect association remains challenging. We analysed the effects of AZD1222 (ChAdOx1 nCoV-19), BNT-162b2, and/or mRNA-1273 on the development &/or deterioration of IMDs in terms of the time of clinical onsets of IMDs after exposure to these vaccines.
We retrospectively reviewed 78 in-patients in Taipei Veterans General Hospital, who presented with IMDs within 120 days after receiving AZD1222, BNT-162b2, &/or mRNA-1273 vaccinations in Taiwan from May 2021 to April 2022. The duration from inoculation to development of IMD was analysed by two-tailed Kolmogorov-Smirnov (K-S) test for goodness of fit.
The average time to new IMDs or flare-up of the diseases following vaccinations was 36 ± 26 days for all 91 events in these 78 patients. The onset time of IMDs after vaccinations was not haphazard as analysed by two-tailed K-S test for overall 91 events (40 new and 51 deteriorating episodes, p < 0.001). The IMDs presenting as non-connective tissue diseases (non-CTDs) have a shorter duration of incubation after vaccinations than those of CTDs (<14.7 days, 95 % confidence interval [CI], 3.0 to 26.4, p = 0.014). Furthermore, systemic vasculitis and type 2 inflammatory diseases were observed exclusively in those receiving AZD1222.
AZD1222, BNT-162b2, or mRNA-1273 influence the activities of IMDs in ways yet to be explored. High index of suspicion to IMDs after nucleic acid-based vaccine inoculation against COVID-19 may be important for primary care physicians.
自全球 COVID-19 危机期间引入核酸疫苗以来，已零星报道了免疫介导性疾病（IMD）。证实其因果关联仍然具有挑战性。我们分析了 AZD1222（ChAdOx1 nCoV-19）、BNT-162b2 和/或 mRNA-1273 对 IMD 发展和/或恶化的影响，根据 IMD 临床发病时间与暴露于这些疫苗之间的关系。
我们回顾性分析了 2021 年 5 月至 2022 年 4 月期间在台北荣民总医院接受 AZD1222、BNT-162b2 和/或 mRNA-1273 疫苗接种后 120 天内出现 IMD 的 78 例住院患者。通过双尾 Kolmogorov-Smirnov（K-S）检验分析接种后发生 IMD 的时间。
78 例患者共发生 91 例新 IMD 或疾病加重事件，接种后新发 IMD 或疾病加重的平均时间为 36 ± 26 天。通过双尾 K-S 检验对所有 91 例事件进行分析，结果显示接种后 IMD 的发病时间并非随机（40 例新发和 51 例恶化，p < 0.001）。与 CTD 相比，非结缔组织疾病（non-CTD）的潜伏期更短（<14.7 天，95%置信区间[CI]3.0 至 26.4，p = 0.014）。此外，全身性血管炎和 2 型炎症性疾病仅见于接受 AZD1222 治疗的患者。
AZD1222、BNT-162b2 或 mRNA-1273 以尚未探索的方式影响 IMD 的活动。接种 COVID-19 核酸疫苗后对 IMD 的高度怀疑可能对初级保健医生很重要。
