Neurological manifestations of immune origin after COVID-19 vaccination: retrospective case study.

Objectives: To know the frequency and characteristics of neurological manifestations of probable immune origin occurring after exposure to COVID-19 vaccination. In addition, to pre-study the usefulness of the Spanish pharmacovigilance system and lymphocyte transformation test in establishing causality. Methods: Retrospective case study, including patients admitted to the Neurology department from January 2021 to May 2022 with a probable neuroimmune disorder. Demographic, clinical and COVID-19 vaccination antecedent data were collected from medical records. Results: From a total of 108 patients, 30 were excluded due to a different etiological diagnosis after follow-up. Thirty-six patients (46.2%) had received the COVID-19 vaccine in the previous 3 months (21.8% during the previous month). BioNTech-Pfizer vaccine was the most frequent in this group (63.9%). 69/108 were female and mean age 51.2 years (SD 22.59), with no significant difference with not recently-vaccinated (U-Mann Whitney, p = 0.256). The neurological syndromes found were (vaccinated/total): polyradiculoneuropathy (8/16), encephalitis (5/11), multiple sclerosis relapse (5/16), optic neuritis (1/4), myelitis (3/6), cranial neuropathy (6/10), aseptic meningitis (1/3) and others (7/11). Acute immunosuppressive treatment was administered in 61.1% of cases and 47.2% presented complete clinical improvement, without significant differences with non-vaccinated patients (chi-square, p = 0.570). Eleven vaccinated patients were studied in the pharmacovigilance office for possible adverse drug reaction. Causality according to the Spanish pharmacovigilance system (SPVS) algorithm was "Related" to COVID-19 vaccine (score ≥ 4) in 11 cases with positive in vitro study (lymphocyte transformation test) to polyethylene glycol-2000 and polysorbate-80 in 4 cases. Conclusion: Neuroimmune disorders appearing after administration of COVID-19 vaccine do not seem to present important differentiating clinical and/or evolutive features. Delayed hypersensitivity to vaccine excipients could be one of the pathophysiological mechanisms, and lymphocyte transformation test is a useful tool to identify it.

High serum prevalence of autoreactive IgG antibodies against peripheral nerve structures in patients with neurological post-COVID-19 vaccination syndrome.

Background: Patients suffering from neurological symptoms after COVID-19 vaccination (post-COVID-19 vaccination syndrome (PCVS)) have imposed an increasing challenge on medical practice, as diagnostic precision and therapeutic options are lacking. Underlying autoimmune dysfunctions, including autoantibodies, have been discussed in neurological disorders after SARS-CoV-2 infection and vaccination. Here, we describe the frequency and targets of autoantibodies against peripheral nervous system tissues in PCVS. Methods: Sera from 50 PCVS patients with peripheral neurological symptoms after COVID-19 vaccination and 35 vaccinated healthy controls were used in this study. IgG autoreactivity was measured via indirect immunofluorescence assays on mouse sciatic nerve teased fibers. The frequencies of autoantibodies were compared between groups using Fisher's exact test. Serum anti-ganglioside antibodies were measured in ganglioside blots. Autoantibody target identification was performed using immunoprecipitation coupled to mass spectrometry. Subsequent target confirmation was conducted via cell-based assays and ELISA. Results: Compared with controls, PCVS patients had a significantly greater frequency of autoantibodies against peripheral nervous system structures (9/50(18%) vs 1/35(3%); p=0.04). Autoantibodies bound to paranodes (n=5), axons (n=4), Schmidt-Lanterman incisures (n=2) and Schwann cell nuclei (n=1). Conversely, antibodies against gangliosides were absent in PCVS patients. Target identification and subsequent confirmation revealed various subunits of neurofilaments as well as DFS-70 as autoantibody epitopes. Conclusion: Our data suggest that autoantibodies against nervous system tissue could be relevant in PCVS patients. Autoantibodies against neurofilaments and cell nuclei with so far non-established links to this disease spectrum should be further elucidated to determine their biomarker potential.

Humoral immunity and safety of respiratory virus vaccines in systemic lupus erythematosus population: a meta-analysis based on twenty-five observational studies.

BACKGROUND: Systemic lupus erythematosus (SLE), an extensive autoimmune disorder, compromises viral resistance and alters immune responses post respiratory virus vaccines. This study aims to assess immune response levels and safety in SLE patients following respiratory virus vaccines. METHODS: Extensive searches, until 1 March 2024, were conducted using PubMed, EMBASE, and Cochrane Library. Outcomes, encompassing seroconversion rate (SCR), antibody and IgG titers, neutralizing antibodies, anti-spike antibodies, anti-receptor binding domain (RBD) IgG, and adverse events, were appraised. RESULTS: Sixteen articles, comprising 25 observational studies, were included. SLE patients exhibited lower SCR (OR = 0.42, 95%CI: 0.26 to 0.69), antibody titers (SMD=-2.84, 95%CI: -3.36 to -1.61), and neutralizing antibodies (OR = 0.27, 95%CI: 0.13 to 0.56) compared to the healthy population post respiratory virus vaccines. Notably, differences were statistically insignificant for anti-RBD IgG (OR = 1.75, 95%CI: 0.10 to 29.42), IgG titers (SMD=-2.54, 95%CI: -5.57 to -0.49), anti-spike antibodies (OR = 0.35, 95%CI: 0.08 to 1.53), injection site discomfort (OR = 1.03, 95%CI: 0.52 to 2.06), fatigue (OR = 1.23, 95%CI: 0.74 to 2.03), fever (OR = 1.02, 95%CI: 0.64 to 1.63), localized reactions (OR = 0.69, 95%CI: 0.37 to 1.30), systemic reactions (OR = 1.00, 95%CI: 0.59 to 1.69), allergic reactions (OR = 5.11, 95%CI: 0.24 to 107.10), self-reported vaccination-related adverse events (OR = 1.61, 95%CI: 0.56 to 4.63), and disease flares after vaccination (OR = 1.00, 95%CI: 0.14 to 7.28). CONCLUSION: Despite the reduced immune response and host protection in SLE patients post-Corona Virus Disease 2019 (COVID-19) and influenza vaccines compared to the healthy population, safety profiles are comparable. Therefore, it is recommended that SLE patients receive COVID-19 and influenza viral vaccines to fortify their resistance.

Central Retinal Artery Occlusion Leading to Diagnosis of Eosinophilic Granulomatous Polyangiitis After Adenovirus Vector COVID-19 Vaccination.

Purpose: To present a case of central retinal artery occlusion (CRAO) leading to the diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) within 1 week of an adenovirus vector COVID-19 vaccination. Methods: A case was reviewed. Results: A 50-year-old man with atopic dermatitis and asthma presented with acute painless vision loss in 1 eye. An examination and imaging findings showed CRAO. Further evaluation found eosinophilia and elevated inflammatory markers. A workup for vasculitis showed elevated cytoplasmic-antineutrophil cytoplasmic antibody, perinuclear-antineutrophil cytoplasmic antibody, myeloperoxidase antibody, rheumatoid factor, and total immunoglobulin E. Skin biopsies were consistent with eosinophilic granulomatosis with polyangiitis. Steroids, cyclophosphamide, and mepolizumab were initiated. At 1 year, the patient's systemic symptoms had improved but his vision had not. Conclusions: Few reports exist of CRAO associated with eosinophilic granulomatosis with polyangiitis, with no other instances related to an adenovirus vector COVID-19 vaccination. Treating a systemic vasculitis early can be vision saving in the fellow eye and prevent systemic life-threatening complications.

Adverse Menstrual Events Reported After and Before (or Without) COVID-19 Vaccination: A Systematic Review and Meta-Analysis of Comparative Observational Studies.

BACKGROUND: Reports of adverse menstrual events emerged during the COVID-19 vaccination campaign in multiple countries. This raised the question whether these reports were caused by the vaccines. The aim of this systematic review was to evaluate comparative studies on this topic (registered at PROSPERO [CRD42022324973]). METHODS: We included observational studies such as cohort studies and surveys comparing the response to self-reported questionnaires between post- versus pre-vaccination data. PubMed and Cochrane Library searches were conducted on 1 September 2023. The primary outcome was the incidence of any prespecified adverse menstrual event, and the outcome measure was the risk ratio. The meta-analysis was conducted by using the Mantel-Haenszel method and the random effects model. We summarized the results on risk factors as well as key findings of the studies included. RESULTS: We retrieved 161 references from electronic databases and additional sources such as references lists. Of those, we considered 21 comparative observational studies. The meta-analysis of any adverse menstrual adverse event reported in 12 studies resulted in a pooled estimate (risk ratio 1.13; 95% CI, 0.96-1.31) that did not favor any group. The analysis was constrained by considerable clinical and statistical heterogeneity. Risk factors for self-reported menstrual changes included a history of COVID-19 infection, the concern about COVID-19 vaccines, smoking, previous cycle irregularities, depression, and stress, and other issues. CONCLUSIONS: The risk ratio did not favor any group and heterogeneity was prevalent among the studies. Most studies suggested that the reported changes were temporary, minor, and nonserious.

Immunization-related stress and stress-related responses of mucosal versus intramuscular COVID-19 vaccination among adults in China.

BACKGROUND: In late 2022, China became the first country to roll out mucosal COVID-19 vaccines. No prior study has yet compared the immunization stress-related responses (ISRR) among different routes of COVID-19 vaccine delivery. We aimed to compare the immunization-related psychological stress and ISRR between mucosal and intramuscular COVID-19 vaccines. METHODS: A cross-sectional questionnaire survey using a biopsychosocial framework design was performed from January 11 to 20, 2023. Adults with COVID-19 vaccination were eligible for the study, and a total of 1073 adults participated with community-based sample. Primary outcomes were the psychological stress levels and prevalence of ISRR. Multivariate regression models were employed to compare these outcomes between the two vaccination groups. The potential mediating effects of stress on vaccination and ISRR were examined using bootstrap sampling method. To further ensure the robustness of our results, sensitivity analysis with propensity score matching was performed. FINDINGS: In the univariate analysis, participants who received mucosal vaccination reported significantly lower stress levels compared to those who received intramuscular vaccination (3.39 ± 3.02 vs. 3.93 ± 3.24, P = .006). The prevalence of overall ISRR was significantly lower in the mucosal group compared to the intramuscular group (38.4% vs. 47.9%, P = .002). Multivariate regression models revealed that participants who received mucosal vaccination had a significantly lower stress level (ß = -0.516, 95% CI: -0.852 to -0.180; P = .003) and 38.7% fewer overall ISRR (OR = 0.613, 95% CI: 0.427 to 0.881; P = .008), particularly in terms of neurological symptoms. The immunization-related stress mediated the association between vaccination type and ISRR, with indirect effects estimated at 0.0663 (95% CI: 0.0195 to 0.1346) for overall ISRR. CONCLUSIONS: Mucosal COVID-19 vaccination was associated with reduced psychological stress and physical responses, as compared to intramuscular vaccination, which may contribute to increased trust and compliance with routine or mass vaccination efforts in the future.

Multicentric reticulohistiocytosis with oral and laryngeal involvement in association with autoimmune/inflammatory syndrome induced by adjuvants (ASIA): expanding the spectrum of two uncommon entities.

Multicentric reticulohistiocytosis (MRH) is the most frequent entity in the group of reticulohistiocytoses. It is usually accompanied by a symmetrical erosive polyarthritis and is frequently associated with cancer and autoimmune disorders. Autoimmune syndrome induced by adjuvants (ASIA) is an inflammatory syndrome triggered by adjuvants such as those contained in vaccines or by silicone implants. Here we report a 71-years old female with a history of breast cancer treated with surgery and subsequent prosthesis who developed a systemic hyperinflammatory syndrome including seronegative symmetric polyarthritis, multiple skin lesions and two large nodular lesions in the oral cavity and larynx. Clinical picture was consistent with a clinical diagnosis of ASIA, with breast implant rupture and/or vaccination against SARS-CoV-2 as possible triggers. Histopathology of skin, oral and laryngeal nodules revealed cutaneous/mucous and submucosal infiltration of large epithelioid mononuclear or binucleated cells with fine granular ground glass-like cytoplasm and round to kidney-shaped nuclei with prominent nucleoli, without atypical features or relevant pleomorphism, accompanied by sparse giant cells and lymphocytes. These cells stained positive for CD68 and CD45 and negative for S100, CD1a, and markers of epithelial or neural/melanocytic differentiation, altogether consistent with a diagnosis of reticulohistiocytosis. Clinic-pathological correlation allowed the final diagnosis of MRH. To our knowledge, this is the first report of a co-occurrence of MRH with ASIA and this is relevant to broaden the spectrum of those both rare diseases.

Tinnitus after COVID-19 vaccination: Findings from the vaccine adverse event reporting system and the vaccine safety datalink.

PURPOSE: To assess the occurrence of tinnitus following COVID-19 vaccination using data mining and descriptive analyses in two U.S. vaccine safety surveillance systems. METHODS: Reports of tinnitus after COVID-19 vaccination to the Vaccine Adverse Event Reporting System (VAERS) from 2020 through 2024 were examined using empirical Bayesian data mining and by calculating reporting rates. In the Vaccine Safety Datalink (VSD) population, ICD-10 coded post-vaccination medical visits were examined using tree-based data mining, and tinnitus visit incidence rates during post-vaccination days 1-140 were calculated by age group for COVID-19 vaccines and for comparison, influenza vaccine. RESULTS: VAERS data mining did not find disproportionate reporting of tinnitus for any COVID-19 vaccine. VAERS received up to 84.82 tinnitus reports per million COVID-19 vaccine doses administered. VSD tree-based data mining found no signals for tinnitus. VSD tinnitus visit incidence rates after COVID-19 vaccines were similar to those after influenza vaccine except for the group aged ≥65 years (Moderna COVID-19 vaccine, 165 per 10,000 person-years; Pfizer-BioNTech COVID-19 vaccine, 154; influenza vaccine, 135). CONCLUSIONS: Overall, these findings do not support an increased risk of tinnitus following COVID-19 vaccination but cannot definitively exclude the possibility. Descriptive comparisons between COVID-19 and influenza vaccines were limited by lack of adjustment for potential confounding factors.

COVID-19 Vaccination Acceptance During Pregnancy in Europe.

Pregnant women have been shown to have a higher risk of SARS-CoV-2 infection. Vaccination against the infection is the most effective strategy for preventing both severe disease and related complications. Nevertheless, vaccination hesitancy among pregnant women is an important issue affecting vaccine uptake and a major challenge for Public Health, as high rates of hesitancy can lead to complete refusal of vaccination, with health implications not only for the mother but also for the fetus. Based on the above, this review aims to capture the rates of vaccination against COVID-19 in pregnancy among European countries, from August 2020 to May 2022, as well as to highlight the predictive factors of its acceptance among pregnant women in these countries. The review of the available literature found that in Europe the acceptance of vaccination against COVID-19 among pregnant women varies with rates ranging from 21.3% to 87% for at least one dose and from 29.5% to 82.7%, for two doses of vaccine. Higher maternal education level, older age at pregnancy, previous vaccination against influenza and pertussis, positive attitude towards vaccines, and acceptance of vaccines during pregnancy are the most frequently reported positive predictors that are associated with higher vaccination rates. The information obtained from this study can contribute in the future, during epidemics or pandemics that may occur, to the development of targeted medical and communication strategies for the effective promotion of vaccination programs and the greatest possible coverage of the population, especially those belonging to vulnerable groups such as pregnant women.

Motivators and Barriers to COVID-19 Vaccination Intentions Across U.S. County-Level Barriers in the COVID-19 Vaccine Coverage Index.

BACKGROUND: County-level barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, low vaccination history) may impact individuals' reasons for receiving the COVID-19 vaccine. METHODS: This study linked data from REACH-US (Race-Related Experiences Associated with COVID-19 and Health in the United States), a nationally representative, online survey of 5475 adults living in the U.S (January-March 2021) to county-level barriers in the COVID-19 Vaccine Coverage Index. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Participants reported why they would or would not receive the COVID-19 vaccine in an open-ended item and their responses were coded using thematic analysis. Descriptive statistics and chi-square tests assessed whether reasons for COVID-19 vaccination intentions varied by county-level barriers and whether these distributions varied across racial/ethnic groups. RESULTS: Thematic analysis revealed twelve themes in participants' reasons why they would or would not receive the COVID-19 vaccine. Themes of societal responsibility (9.8% versus 7.7%), desire to return to normal (8.1% versus 4.7%), and trust in science/healthcare/government (7.7% versus 5.1%) were more frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Concerns of COVID-19 vaccine side effects/safety/development (25.3% versus 27.9%) and concerns of access/costs/availability/convenience (1.9% versus 3.6%) were less frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Trends in the prevalence of these themes varied across racial/ethnic groups (p-values < 0.05). CONCLUSIONS: Future pandemic responses should consider potential ways county-level barriers shape reasons for COVID-19 vaccination.

The negative impact of misinformation and vaccine conspiracy on COVID-19 vaccine uptake and attitudes among the general public in Iraq.

Background: Vaccine hesitancy is a major barrier to infectious disease control. Previous studies showed high rates of COVID-19 vaccine hesitancy in the Middle East. The current study aimed to investigate the attitudes towards COVID-19 vaccination and COVID-19 vaccine uptake among adult population in Iraq. Methods: This self-administered survey-based study was conducted in August-September 2022. The survey instrument assessed participants' demographics, attitudes to COVID-19 vaccination, beliefs in COVID-19 misinformation, vaccine conspiracy beliefs, and sources of information regarding the vaccine. Results: The study sample comprised a total of 2544 individuals, with the majority reporting the uptake of at least one dose of COVID-19 vaccination (n = 2226, 87.5 %). Positive attitudes towards COVID-19 vaccination were expressed by the majority of participants (n = 1966, 77.3 %), while neutral and negative attitudes were expressed by 345 (13.6 %) and 233 (9.2 %) participants, respectively. Factors associated with positive attitudes towards COVID-19 vaccination in multivariate analysis included disbelief in COVID-19 misinformation and disagreement with vaccine conspiracies. Higher COVID-19 vaccine uptake was significantly associated with previous history of COVID-19 infection, higher income, residence outside the Capital, disbelief in COVID-19 misinformation, disagreement with vaccine conspiracies, and reliance on reputable information sources. Conclusion: COVID-19 vaccine coverage was high among the participants, with a majority having positive attitudes towards COVID-19 vaccination. Disbelief in COVID-19 misinformation and disagreement with vaccine conspiracies were correlated with positive vaccine attitudes and higher vaccine uptake. These insights can inform targeted interventions to enhance vaccination campaigns.

Acute pancreatitis complicated with diabetic ketoacidosis following COVID-19 mRNA vaccination: a case report.

Objective: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination has substantially reduced mortality and hospitalization rates worldwide, with rare adverse events reported in clinical settings. Herein, we present a case of acute pancreatitis complicated by diabetic ketoacidosis (DKA) following the third COVID-19 vaccination dose. Patient: A 72-year-old male with a history of diabetes mellitus developed generalized fatigue, mild epigastric pain, nausea, and frequent vomiting after receiving the COVID-19 vaccine. Results: Blood analysis revealed elevated levels of pancreatic enzymes, hyperglycemia, and acidemia. Computed tomography revealed evidence of acute pancreatitis, leading to a diagnosis of both DKA and acute pancreatitis. Treatment with a large volume of saline and intravenous insulin improved both DKA and acute pancreatitis. After a thorough examination, no other factors capable of causing acute pancreatitis were identified. Hence, we concluded that acute pancreatitis was induced by COVID-19 vaccination. Conclusion: Acute pancreatitis is a rare but potentially life-threatening adverse event associated with COVID-19 vaccination. Delaying the treatment or diagnosis of acute pancreatitis can increase mortality risk in patients with both acute pancreatitis and DKA. Hence, it is crucial for healthcare professionals to consider the potential occurrence of acute pancreatitis and DKA following COVID-19 vaccination.

Seroprevalence of SARS-CoV-2 and risk factors for infection among children in Uganda: a serial cross-sectional study.

Background: Understanding COVID-19's impact on children is vital for public health policy, yet age-specific data is scarce, especially in Uganda. This study examines SARS-CoV-2 seroprevalence and risk factors among Ugandan children at two timepoints, along with COVID-19-related knowledge and practices in households, including adult vaccination status. Methods: Baseline surveys were conducted in 12 communities from April to May 2021 (post-Alpha wave) and follow-up surveys in 32 communities from November 2021 to March 2022 (Omicron wave). Household questionnaires and blood samples were collected to test for malaria by microscopy and for SARS-CoV-2 using a Luminex assay. Seroprevalence was estimated at both the survey and community level. Mixed-effects logistic regression models assessed the association between individual and household factors and SARS-CoV-2 seropositivity in children, adjusting for household clustering. Results: More households reported disruptions in daily life at baseline compared to follow-up, though economic impacts lingered. By the follow-up survey, 52.7% of adults had received at least one COVID-19 vaccine dose. Overall seroprevalence in children was higher at follow-up compared to baseline (71.6% versus 19.2%, p < 0.001). Seroprevalence in children ranged across communities from 6-37% at baseline and 50-90% at follow-up. At baseline, children from the poorest households were more likely to be infected. Increasing age remained the only consistent risk factor for SARS-CoV-2 seroconversion at both timepoints. Conclusions: Results indicate that a larger number of children were infected by the Delta and Omicron waves of COVID-19 compared to the Alpha wave. This study is the largest seroprevalence survey in children in Uganda, providing evidence that most children were infected with SARS-CoV-2 before the vaccine was widely available to pediatric populations. Pediatric infections were vastly underreported by case counts, highlighting the importance of seroprevalence surveys in assessing disease burden when testing and reporting rates are limited and many cases are mild or asymptomatic.

Analyzing the 7C psychological antecedents of vaccine acceptance throughout the COVID-19 pandemic among healthcare sector workers in France: A repeated cross-sectional study (CappVac-Cov).

BACKGROUND: Across various stages of the COVID-19 pandemic and related vaccine recommendations in France, we assessed the association of the 7C-psychological antecedents with vaccine uptake/intention for booster vaccination among healthcare-sector workers (HCSWs). We also assessed whether 7C-antecedent profiles changed over time. METHODOLOGY: The Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES) conducted three repeated web-surveys which were disseminated by email chain-referral among HCSWs throughout France. The questionnaires waves took place: July-November 2021, February-March 2022 and January-March 2023 (P2, P3 and P4). We also reanalysed data from a prior similar study conducted late 2020-early 2021 (Moirangthem et al. (2022)) (P1). To evaluate the association of 7C-items with vaccine uptake-intention for future vaccination, we estimated adjusted prevalence ratios (aPR) using robust variance Poisson regression. We report the 7C-item population attributable loss in vaccine intention. RESULTS: The four surveys (P1-P4) encompassed 5234, 339, 351 and 437 participants. At earlier stages of the vaccine campaign, the principal antecedents of vaccine intention were favorable perception of vaccination benefit-risk-balance (BRB) (vs. unfavorable, aPR: 2.32), reactance to employer encouragement for vaccination (motivates vs. dissuades-me, aPR:2.23), vaccine confidence (vs. not-being-confident, aPR: 1.71) and social conformism towards vaccination (favorable vs. skeptical opinion in private environment, aPR: 1.33). Under a vaccine mandate for HCSWs, only perceiving vaccination as a collective action was associated with current vaccine status (agree vs. disagree, aPR: 2.19). At later stages of the epidemic, hypothetical booster vaccine intentions were strongly associated with BRB perception (favorable vs. unfavorable, aPR: 2.07) and perceiving vaccination as a collective action (agree vs. disagree, aPR: 1.69). Fearing a severe side effect from vaccination decreased population vaccine intention by 26.2 %. CONCLUSION: Our results suggest that both 7C-antecedents and their association with vaccine behaviour can change over time, and underscore the importance of assuring confidence in vaccine safety.

Predicting COVID-19 vaccine uptake: Comparing the health belief model and theory of planned behavior.

The COVID-19 outbreak has had a significant impact on the global health landscape, underscoring the crucial role that vaccinations play in achieving herd immunity and reducing the effects of pandemics. Given the importance of this issue, it is imperative to gain a deeper understanding of the various factors that influence individuals' decisions to seek vaccination. This study aimed to compare the prediction level of the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and a combined model in explaining the intention of adults to receive COVID-19 immunization. A cross-sectional online survey was conducted among adults (n = 505) in Saudi Arabia. The survey contained variables related to the HBM and TPB. The prediction level of the two models as well as a combined model were evaluated utilizing Structural Equation Modeling (SEM). Among the recruited 505 participants, 88% fell within the 18 to 30 age range, and 54.5% were male. The proposed HBM model accounted for 68% of the variation in intention, whereas the TPB model explained 78.2% of the variation in COVID-19 vaccination intention. The combined model showed greater explanatory power (82%). The variables of susceptibility (ß = 0.20, p < .001), severity (ß = 0.49, p < .001), advantages (ß = 0.63, p < .001), and obstacles (ß = - 0.24, p < .001), perceptions of behavioral control (ß = 1.58, p < .001) and attitudes (ß = 0.44, p < .001) were found to significantly predict increased vaccination intentions in the combined model. However, the subjective norm construct did not significantly predict vaccination intentions (ß = 0.06, p = .34). The TPB has greater explanatory power than the HBM in predicting the intention to obtain COVID-19 vaccination. However, the combined model showed a greater prediction level. Understanding and identifying people's perceived health beliefs and practices is critical for developing successful COVID-19 intervention methods.

COVID-19 vaccination and long COVID among 50 years older and above European: The role of chronic multimorbidity.

BACKGROUND AND AIMS: We aimed to explore the association between coronavirus disease-19 (COVID-19) vaccination and long COVID according to the status of chronic multimobidity. METHODS: A total of 1913 participants were recruited in the cross-sectional study on the basis of the Survey of Health and Retirement in Europe. COVID-19 vaccination was defined as vaccination within the last 12 months. Chronic multimorbidity was defined as history of 2 + chronic disease. The study outcome was long COVID during the 12-month follow-up. Multivariable logistic models were performed to estimate the influence of chronic multimorbidity on the association of vaccination with long COVID. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. RESULTS: Chronic multimorbidity significantly modified the association of COVID-19 vaccination with long COVID (Pinteraction = 0.024). The rates of study outcome were significantly lower among vaccinated participants in the chronic multimorbidity subgroup, but not in the other subgroup. Multivariable odds ratios (95 % confidence intervals) of study outcome for unvaccination vs. vaccination were 1.494 (1.013-2.203) in those with multimorbidity and 0.915 (0.654-1.280) in those without multimorbidity, respectively. Adding COVID-19 vaccination to a model containing conventional risk factors significantly improved risk reclassification for study outcome among those with chronic multimobidity (continuous NRI was 25.39 % [P = 0.002] and IDI was 0.42 % [P = 0.075]) CONCLUSION: An inverse association of COVID-19 vaccination with long COVID was found among participants with chronic multimorbidity, but not among those without chronic multimorbidity. Chronic multimorbidity might expand the influence of unvaccination on developing long COVID among European aged ≥50 years.

Temporal Trends in SARS-CoV-2 Antibody Levels Among COVID-19 Patients in Kerala During the First Wave and Pre-vaccination Period.

BACKGROUND: The SARS-CoV-2 virus interacts with host cells through the S1 domain of its spike protein. This study measures the IgG immune response to this domain in COVID-19 patients from Kerala, India, and explores its association with various health factors. METHODS: A cohort of 258 COVID-19 patients was analyzed for IgG antibodies targeting the S1 spike protein domain. The temporal pattern of the IgG response and its correlation with hospitalization needs, intensive care, and pre-existing conditions such as diabetes, hypertension, and coronary artery disease were assessed. RESULTS: A significant IgG response (76.4%) was detected, indicating robust immune activation post-infection. The IgG levels peaked between two to four and four to eight weeks post-infection, with a notable increase at 12 weeks, hinting at possible secondary exposure or an immune memory response. No correlation was found between IgG levels and the presence of diabetes mellitus, hypertension, or coronary artery disease. However, higher IgG responses correlated with the severity of the infection, as seen in patients requiring hospitalization or intensive care. CONCLUSIONS: The IgG response to the S1 spike protein domain serves as a potential marker of immune activation in COVID-19. It reflects the body's defense mechanism against the virus and may predict disease severity and outcomes. The findings suggest that IgG levels could be indicative of the viral load, inflammatory response, and possibly the likelihood of protection against reinfection.

Effects of vaccination on COVID-19 infection symptoms in multiple sclerosis patients.

Background: Patients with multiple sclerosis (MS) are at higher risk of having infections due to receiving disease modifying therapies. The current study was conducted among Iranian MS patients who had experienced at least one episode of COVID-19 infection in order to evaluate the effects of COVID-19 vaccination on symptoms of their infection. Data on demographic information, MS characteristics, COVID-19 infection details, and vaccination status were collected. Statistical analyses, were performed to evaluate the association between vaccination and symptoms of COVID-19 infection. Methods: This cross-sectional study was conducted on confirmed MS patients. Demographic data and COVID-19 related symptoms were gathered via an online questionnaire. Confirmation of patients' who declared to be vaccinated was checked by their COVID-19 vaccination card. Results: A total of 236 MS patients participated in the study. The majority were female (79.7%), with a mean age of 36.1 ± 7.9 years. Among the participants, 72.5% had received the COVID-19 vaccine before their first episode of COVID-19 infection. The analysis showed a significant difference in the incidence of respiratory symptoms (P-value: 0.01) and headache (P-value: 0.04) between vaccinated and non-vaccinated individuals. Logistic regression analysis revealed that vaccinated MS patients had lower odds of developing respiratory symptoms (OR:0.29, 95% CI: 0.16 to 0.53, P-value<0.001) or headache (OR: 0.50, 95% CI: 0.25 to 0.98, P-value: 0.04) during their next COVID-19 infection episode. Moreover, MS patients who were receiving immunosuppressive drugs were less likely to have respiratory symptoms (OR:0.35, 95% CI: 0.16 to 0.77, P-value:0.009) but not headache (OR: 0.69, 95% CI: 0.30 to 1.60, P-value: 0.39). Conclusion: COVID-19 vaccination can reduce the incidence of respiratory symptoms and headaches in MS patients during COVID-19 infection episodes. Additionally, patients who are receiving immunosuppressive drugs may benefit from COVID-19 vaccination.

Vaccination against COVID-19 among healthcare workers as a cocoon strategy for people living with HIV.

Introduction: Healthcare professionals working in infectious disease units are often engaged in the care of patients with HIV infection. A cocoon vaccination strategy may protect those who are immunocompromised from a severe course of COVID-19. Methods: The research was conducted between January 2021 and June 2022. The study participants were 450 healthcare workers (HCWs) from the Hospital for Infectious Diseases in Warsaw who were vaccinated against COVID-19 with the BNT162b2 mRNA vaccine (Pfizer-BioNTech) -, thefirst available type of vaccine in Poland. Sera were collected according to the schedule of the study. Statistical analyses were performed with non-parametric tests: Wilcoxon's test was used to compare dependent numerical variables, and Fisher's exact test and the Chi-squared test to compare categorical variables. A p value of <0.05 was considered statistically significant. Results: Among the 450 HCWs working in the Hospital for Infectious Diseases in Warsaw 412 (91,5 %) were vaccinated against COVID-19. In total 170 (41,3 %) vaccinated HCWs were included in the final analysis. Their median age was 51 years [interquartile range (IQR): 41-60 years] and median body mass index (BMI) was 25.10 [IQR: 22.68-29.03]. Most of the cohort consisted of women (n = 137, 80.59 %), with the majority working directly with patients (n = 137, 73.21 %). It was found that as early as 14 days after the second dose of the vaccine, 100 % of the study participants achieved a positive result for SARS CoV-2 S-RBD antibodies. There were 168 subjects who had had a COVID-19 diagnosis before entering study and after vaccination 65 HCWs was diagnosed with COVID-19. Conclusions: Due to the fact that people living with HIV with severe immunodeficiency may have an incomplete immune response to COVID vaccination and be at risk of a severe course of the disease, the cocoon strategy of vaccinating medical personnel may be beneficial for these patients.

Case report: A case of unilateral combined central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis following a third dose of COVID-19 vaccination.

Purpose: The aim of this study was to present a case of severe visual loss due to retinal arteriovenous occlusion and papillitis in one eye following vaccination against coronavirus disease (COVID-19). Methods: A 45-year-old man undergoing treatment for hypertension had severely reduced visual acuity in the right eye 1 day after receiving a third dose of a COVID-19 vaccine manufactured by Moderna. Clinical examination showed that the best-corrected visual acuity in the right eye was counting fingers. Other findings included circumferential retinal hemorrhage, perimacular ischemic color, severe macular edema, and severe optic disc swelling, indicating the presence of central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis. Based on the possibility of post-vaccination inflammation and/or abnormal immune response, three courses of steroid pulse therapy were administered, and the visual acuity slightly improved to 20/1,000. Results: Three months after the onset of symptoms, macular edema disappeared; conversely, retinal thinning of the macula and extensive non-perfusion areas mainly on the nasal side were noted. Conclusion: The findings in this case suggest that inflammation and abnormal immune response after receiving a COVID-19 vaccination may lead to combined retinal arteriovenous occlusion and papillitis.