Lino Maria Maddalena, Mather Susan, Trani Marianna, Chen Yan, Caubel Patrick, De Bernardi Barbara
Vaccine Research and Development and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, 20152 Milan, Italy.
Vaccine Research and Development and Worldwide Safety, Safety Surveillance and Risk Management, Pfizer, Collegeville, PA 10965, USA.
Vaccines (Basel). 2025 Apr 29;13(5):481. doi: 10.3390/vaccines13050481.
Vaccine marketing authorization holders (MAHs) are responsible for the conduction of global vaccine pharmacovigilance on their vaccine products. A safety signal is detected when a new adverse event (AE) or aspect of an AE occurs after exposure to the vaccine and warrants further investigation to determine whether a causal association may exist. Signal detection and evaluation (signal management) begins at the start of vaccine development, before an MAH submits an application for authorization to regulatory authorities, continues through the course of all clinical trials, and carries on beyond development into the post-marketing phase. As long as the vaccine remains authorized anywhere in the world, pharmacovigilance continues. During the time that the COVID-19 vaccine became widely available after authorization and approval, clinical trials were also ongoing, and therefore all clinical development and post-authorization safety information was closely monitored for safety by the MAH. MAH pharmacovigilance activities were adapted to manage the unprecedented volume of safety information that became available within a very short timeframe following worldwide vaccination campaigns. No vaccine had previously been administered to such a large number of individuals in such a short time, nor had there previously been a public health vaccine experience that was the subject of so many medical and non-medical writings. The MAH's COVID-19 vaccine signal detection methods included the continuous review of accruing clinical trial data and the quantitative and qualitative analyses of spontaneously reported experiences. Review of published and unpublished medical literature and epidemiology-based analyses such as observed vs. expected analysis based on reported adverse events following immunization (AEFIs) played key roles in pharmacovigilance and signal management. All methods of signal detection and evaluation have caveats, but when considered in totality, can advance our understanding of a vaccine's safety profile and therefore the risk-benefit considerations for vaccinating both individuals and large populations of people. All COVID-19 vaccines authorized for use were subject to an unprecedented level of pharmacovigilance by their individual MAHs, national regulatory authorities, public health organizations, and others during the years immediately following regulatory authorization and full approval. The intense worldwide focus on pharmacovigilance and the need for MAHs and regulatory/health authorities to quickly evaluate incoming safety information, spurred frequent and timely communications between national and regional health authorities and between MAHs and regulatory/health authorities, spotlighting a unique opportunity for individuals committed to patient safety to share important accruing safety information in a collegial and less traditionally formal manner than usual. The global pandemic precipitated by the SARS-CoV-2 virus created a significant impetus for MAHs to develop innovative vaccines to change the course of the COVID-19 pandemic. Pharmacovigilance also had to meet unprecedented needs. In this article, unique aspects of COVID-19 vaccine pharmacovigilance encountered by one MAH will be summarized.
疫苗上市许可持有人(MAHs)负责对其疫苗产品开展全球疫苗药物警戒工作。当在接种疫苗后出现新的不良事件(AE)或不良事件的某个方面,且有必要进一步调查以确定是否可能存在因果关系时,就检测到了一个安全信号。信号检测和评估(信号管理)在疫苗研发开始时就已启动,即在MAH向监管机构提交授权申请之前,贯穿于所有临床试验过程中,并在研发之后持续至上市后阶段。只要该疫苗在世界上任何地方仍获授权,药物警戒工作就会继续。在COVID-19疫苗获得授权和批准后广泛可用的期间,临床试验也在进行中,因此MAH对所有临床研发和上市后安全信息进行了密切的安全性监测。MAH的药物警戒活动进行了调整,以管理在全球疫苗接种运动后很短时间内出现的前所未有的大量安全信息。此前从未在如此短的时间内给如此多的人接种过疫苗,也从未有过如此多医学和非医学著作所关注的公共卫生疫苗接种经历。MAH的COVID-19疫苗信号检测方法包括持续审查累积的临床试验数据以及对自发报告的经验进行定量和定性分析。审查已发表和未发表的医学文献以及基于流行病学的分析,如基于免疫接种后报告的不良事件(AEFIs)进行的观察性与预期性分析,在药物警戒和信号管理中发挥了关键作用。所有信号检测和评估方法都有局限性,但综合考虑时,可以增进我们对疫苗安全性概况的了解,从而有助于对个体和大量人群接种疫苗的风险效益考量。在监管授权和全面批准后的几年里,所有获授权使用的COVID-19疫苗都受到其各自的MAH、国家监管机构、公共卫生组织及其他方面前所未有的药物警戒。全球对药物警戒的高度关注以及MAH和监管/卫生当局快速评估收到的安全信息的需求,促使国家和地区卫生当局之间以及MAH与监管/卫生当局之间频繁且及时地进行沟通,为致力于患者安全的人员提供了一个独特的机会,以一种比以往更具合作性且传统上形式没那么正式的方式分享重要的累积安全信息。由SARS-CoV-2病毒引发的全球大流行极大地推动了MAH研发创新疫苗以改变COVID-19大流行的进程。药物警戒也必须满足前所未有的需求。在本文中,将总结一个MAH在COVID-19疫苗药物警戒方面遇到的独特之处。
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