COVID-19 Vaccine-Associated Uveitis in Patients With a History of Uveitis.

Importance: Understanding the potential risk of uveitis recurrence after COVID-19 vaccination in individuals with a history of uveitis is crucial for vaccination strategies and clinical monitoring. Objective: To investigate the risk of uveitis recurrence after COVID-19 vaccination in a cohort of individuals with a history of uveitis. Design, Setting, and Participants: This retrospective population-based cohort study included individuals diagnosed with uveitis between January 1, 2015, and February 25, 2021, in South Korea. After excluding individuals without COVID-19 vaccination or with SARS-CoV-2 infection, individuals with a history of uveitis who had received at least 1 dose of a messenger RNA (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) or adenovirus vector-based (ChAdOx1 [AstraZeneca] or Ad26.COV2.S [Janssen]) COVID-19 vaccine were included. Data were analyzed from February 26, 2021, to December 31, 2022. Exposure: Demographic and clinical data, along with vaccination details, were retrieved from the Korean National Health Insurance Service and Korea Disease Control and Prevention Agency databases. Main Outcomes and Measures: Outcomes of interest were incidence and risk of postvaccination uveitis in association with different COVID-19 vaccines and periods before and after COVID-19 vaccination. Uveitis was categorized by onset (early, within 30 days, or delayed) and type (anterior or nonanterior). Hazard ratios (HRs) with 95% CIs were calculated to evaluate the risk of uveitis following COVID-19 vaccination, stratified according to vaccine type and vaccination period. Results: Of 543 737 individuals with history of uveitis, 473 934 individuals (mean [SD] age, 58.9 [17.4] years; 243 127 [51.3] female) had documented COVID-19 vaccination and were included in analysis. The cumulative incidence of postvaccination uveitis was 8.6% at 3 months, 12.5% at 6 months, and 16.8% at 1 year, predominantly of the anterior type. Variations in the risk of postvaccination uveitis were observed across different vaccines and intervaccination periods. The risk of early postvaccination uveitis was increased for individuals receiving the BNT162b2 (HR, 1.68; 95% CI, 1.52-1.86), mRNA-1273 (HR, 1.51; 95% CI, 1.21-1.89), ChAdOx1 (HR, 1.60; 95% CI, 1.43-1.79), and Ad26.COV2.S (HR, 2.07; 95% CI, 1.40-3.07) vaccines. The risk of uveitis was higher particularly between the first and second vaccination doses (HR, 1.64; 95% CI, 1.55-1.73). Conclusions and Relevance: These findings suggest that there was an elevated risk of uveitis following COVID-19 vaccination, with the vaccine type and period mediating this risk. For individuals with a history of uveitis, clinicians should consider the potential risk of uveitis recurrence in vaccination strategies and clinical monitoring.

Reported side-effects following Oxford/AstraZeneca COVID-19 vaccine in the north-west province, Iran: A cross-sectional study.

While the vaccination was introduced as a promising tool to control the Coronavirus disease 2019 (COVID-19) pandemic, concerns about vaccine-related side effects had grown. Due to the widespread administration of the COVID-19 vaccine worldwide for the first time, it was necessary to evaluate the safety and potential side effects in recipients. This study aims to assess, the incidence of adverse effects following Oxford-AstraZeneca vaccination and identify their related factors. In this cross-sectional survey-based study, 453 volunteers participated, including 235 men and 218 women. The reported adverse reactions from recipients of the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine were collected by using a questionnaire. The findings showed that the incidence of adverse reactions, such as neurological, systematic, gastrointestinal, respiratory, and local symptoms were significantly higher after the first dose compared to the second dose. Systematic symptoms were the most prevalent reported side effects after the first and second dose injection. The demographical study of participants showed that individuals aged 18-34 and females were more prone to present adverse events following vaccination. However, no significant relationship was found between the occurrence of side effects and the recipients' body mass index. Despite the life-saving role of vaccination against SARS-CoV-2, it may have some adverse reactions in recipients. The severity and frequency of side effects were different. So, they were dependent on several factors, including gender and age. Altogether, post-vaccination adverse reactions were mild and tolerable.

Adverse events following immunisation (AEFI) of COVISHIELD vaccination among healthcare workers in Ghana.

OBJECTIVE: To describe the incidence of adverse events following immunisation (AEFI) and determine the factors that affect the onset and duration of AEFI after COVISHIELD vaccination among healthcare workers. DESIGN: Prospective cohort study. SETTING: Tertiary healthcare, Korle-Bu, Ghana. PARTICIPANT: Three thousand and twenty-two healthcare workers at least 18 years of age were followed up for 2 months after receiving two doses of the COVISHIELD vaccine. PRIMARY OUTCOME: The occurrence of the AEFI was identified by self-reporting to the AEFI team members. RESULTS: A total of 3022 healthcare workers had at least one AEFI (incidence rate of 706.0 (95% CI 676.8 to 736.1) per 1000 doses) with an incidence rate of 703.0 (95% CI 673.0 to 732.0) per 1000 doses for non-serious AEFI and an incidence rate of 3.3 (95% CI 1.6 to 6.1) per 1000 doses for serious AEFI. The most commonly reported systemic adverse events were headache (48.6%), fever (28.5%), weakness (18.4%) and body pains (17.9%). The estimated median time to onset of the AEFI following the first-dose vaccination was 19 hours and the median AEFI duration was 40 hours or 2 days. Delayed-onset AEFI occurred in 0.3% after first dose and 0.1% after second dose. Age, sex, previous SARS-CoV-2 infection, history of allergies and comorbidity were not significantly associated with the onset and duration of AEFI. However, participants who used paracetamol seemed to be significantly protected (HR 0.15; 95% CI 0.14, 0.17) from having a long duration of AEFI. CONCLUSION: The results of our study indicate a high incidence of non-serious AEFI and the rare occurrence of serious AEFI after COVISHIELD vaccination in healthcare workers. The rate of AEFI was higher after the first dose than after the second dose. Sex, age, previous SARS-CoV-2 infection, allergies and comorbidity were not significantly associated with the onset and duration of AEFI.

Microsurgical complication associated with vaccine-induced immune thrombotic thrombocytopenia (VITT): A case report.

RATIONALE: The use of ChAdOx1 nCoV-19 (Astra Zeneca) vaccine has proven beneficial, but in a limited number of the general population, it was found to be associated with vaccine-induced immune thrombotic thrombocytopenia (VITT). However, there have been no reports of this complication occurring in a microsurgical free tissue transfer. PATIENT CONCERNS: A 49-year-old man developed an acute myocardial infarction 3 weeks after receiving his first dose of ChAdOx1 nCoV-19 in June 2021. Three months later, he presented with right third toe wet gangrene with extension into the plantar foot nine days after receiving his second dose of ChAdOx1 nCoV-19 vaccine. DIAGNOSIS: Based on recent exposure to vaccination, the timing of inoculation before the development of his symptoms, and serology tests (platelet, D-dimer, and anti-PF4 antibodies), the patient was diagnosed with VITT. INTERVENTIONS: Fasciectomy and sequestrectomy were performed for wound bed preparation. Limb salvage was done using free vastus lateralis muscle flap and skin graft for reconstruction. OUTCOME: The flap was complicated by persistent microthrombi leading to superficial necrosis without vascular pedicle compromise. Repeated debridement of the superficial necrosis was done. Three months after the development of VITT, no further new superficial necrosis was seen. A well-contoured flap was seen 5 months after the initial surgery. LESSONS: We believe this is the first case describing microthrombi in the free flap due to VITT after microsurgical reconstruction. Patients and surgeons should be advised of this possible risk when contemplating microsurgery once VITT has developed after ChAdOx1 nCoV-19 administration.

Cerebral venous thrombosis after ChAdOx1 nCoV-19 vaccination: a systematic review.

OBJECTIVE: To perform a systematic review of case reports or case series regarding thrombosis with thrombocytopenia syndrome (TTS) and cerebral venous thrombosis (CVT) related to ChAdOx1 nCoV-19 vaccination to address the clinical features, laboratory findings, treatment modalities, and prognosis related with CVT. SUBJECTS AND METHODS: We included 64 TTS patients from 19 articles, 6 case series and 13 case reports, in which thrombosis occurred after the first dose of ChAdOx1 nCoV-19 vaccination published up to 30 June 2021 in Embase, ePubs, Medline/PubMed, Scopus, and Web of Science databases. RESULTS: Of the 64 TTS patients, 38 (59.3%) had CVT. Patients with CVT were younger (median 36.5 vs. 52.5 years, p<0.001), had lower fibrinogen levels (130 vs. 245 mg/dL, p=0.008), had more frequent history of intracerebral hemorrhage (ICH), and had higher mortality rate (48.6% vs. 19.2%, p=0.020) than that of patients without CVT. In multivariable analysis, the possibility of presence of CVT was higher in younger age groups [odd ratio (OR): 0.91, 95% confidence interval (CI): (0.86-0.97, p<0.001)] and those with accompanying intracerebral hemorrhage (ICH) (OR: 13.60, 95% CI (1.28-144.12, p=0.045). CONCLUSIONS: Our study demonstrated that CVT related to ChAdOx1 nCoV-19 vaccination was associated with younger age, low levels of fibrinogen, presence of ICH and more frequent mortality compared to those of non-CVT. If TTS occurs after ChAdOx1 nCoV-19 vaccination, the presence of CVT in patients with young age or ICH should be considered.

Postmortem PF4 antibodies confirm a rare case of thrombosis thrombocytopenia syndrome associated with ChAdOx1 nCoV-19 anti-COVID vaccination.

We report a case of cerebral venous sinus thrombosis, bilateral adrenal hemorrhage, and thrombocytopenia in a 70-year-old man found dead. He had previously received the ChAdOx1 nCoV-19 vaccine (Vaxzevria®, AstraZeneca) 18 days before, and had since developed unspecific and undiagnosed characteristics of what proved to be a rare case of vaccine-associated thrombocytopenia with thrombosis syndrome (TTS). He was found dead 1 week after the beginning of symptoms (day 25 post-vaccine). Autopsy yielded venous hemorrhagic infarction with the presence of thrombi within dural venous sinuses, and extensive hemorrhagic necrosis of the central part of the adrenal glands. Antibodies against platelet factor 4 (PF4) were strongly positive in postmortem fluids, as measured with an enzyme-linked immunosorbent assay (ELISA). This difficult diagnosis is usually made during the patient's lifetime. After eliminating differential diagnoses, we concluded on a fatal case of vaccine-induced immune TTS with positive anti-PF4 antibodies in cadaveric blood, 3 weeks after ChAdOx1 nCoV-19 vaccination. Specific search for anti-PF4 antibodies in cadaveric blood appears therefore paramount to assess postmortem cases of TTS associated with anti-COVID vaccines.

Postvaccinal GABA-B receptor antibody encephalitis after ChAdOx1 nCoV-19 vaccination.

Several cases of autoimmune encephalitis have been reported after ChAdOx1 nCoV-19 (AZD1222) vaccination. We encountered a male patient who presented with generalized tonic-clonic seizures, cognitive decline, and gait disturbance that occurred suddenly after the second dose of the ChAdOx1 nCoV-19 vaccine. Clinical presentation and magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) test results were compatible with limbic encephalitis. Synaptic autoantibody tests confirmed serum and CSF GABA B receptor antibodies were present. The patient was treated with immunotherapy with intravenous immunoglobulin and rituximab. This GABA-B receptor antibody encephalitis case occurred presumably due to transient autoantibody production following vaccine administration.

Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland.

We investigated thrombocytopenic, thromboembolic and hemorrhagic events following a second dose of ChAdOx1 and BNT162b2 using a self-controlled case series analysis. We used a national prospective cohort with 2.0 million(m) adults vaccinated with two doses of ChAdOx or 1.6 m with BNT162b2. The incidence rate ratio (IRR) for idiopathic thrombocytopenic purpura (ITP) 14-20 days post-ChAdOx1 second dose was 2.14, 95% confidence interval (CI) 0.90-5.08. The incidence of ITP post-second dose ChAdOx1 was 0.59 (0.37-0.89) per 100,000 doses. No evidence of an increased risk of CVST was found for the 0-27 day risk period (IRR 0.83, 95% CI 0.16 to 4.26). However, few (≤5) events arose within this risk period. It is perhaps noteworthy that these events all clustered in the 7-13 day period (IRR 4.06, 95% CI 0.94 to 17.51). No other associations were found for second dose ChAdOx1, or any association for second dose BNT162b2 vaccination. Second dose ChAdOx1 vaccination was associated with increased borderline risks of ITP and CVST events. However, these events were rare thus providing reassurance about the safety of these vaccines. Further analyses including more cases are required to determine more precisely the risk profile for ITP and CVST after a second dose of ChAdOx1 vaccine.

Self-reported side effects of the Oxford AstraZeneca COVID-19 vaccine among healthcare workers in Ethiopia, Africa: A cross-sectional study.

Introduction: Ethiopia is the second most populous country in Africa. Ethiopia received most of its COVID-19 vaccines through donations. The Oxford AstraZeneca vaccine is the first to be donated to Ethiopia by the COVAX facility. Healthcare workers were the priority population that received the Oxford AstraZeneca COVID-19 vaccine. However, there was no nationwide study on the safety of the vaccine in Ethiopia. This study aimed to measure the prevalence and predictors of self-reported side effects of the Oxford AstraZeneca vaccine. Materials and methods: The study employed a cross-sectional design. A sample of healthcare workers who took Oxford AstraZeneca COVID-19 vaccine was drawn from four regions of Ethiopia; namely, Amhara, Oromia, Somali, and Southwest. Data were collected on sociodemographic characteristics, medical anamnesis, COVID-19 related anamnesis, and COVID-19 vaccine anamnesis via telephone interview. Descriptive and inferential analyses were done. The software, IBM SPSS Statistics v21.0, was used for analyses of data. Results: Out of 384 people, 346 responded (response rate: 90.1%). Female accounted for 34.1% of the respondents. The mean age of the respondents was 31.0 years (Standard Deviation (SD) = 7.4). Nurses accounted for 43.7% of the respondents. The prevalence of at least one local- and systemic-side effect was 50.6 and 44.5%, respectively. The most frequent local- and systemic- side effect were injection site pain and headache, respectively. Both types of side effects mostly subsided in the first 3 days. A third of healthcare workers with side effects took at least one medication. Paracetamol followed by diclofenac sodium were taken by healthcare workers to overcome side effects. There was no independent predictor of local side effect. After controlling for age and chronic diseases, the odds of healthcare workers with COVID-19 like symptoms to experience systemic side effects was 1.38 (Confidence Interval (CI): 1.04-1.82) times more than that of healthcare workers without COVID-19 like symptoms. Conclusions: The prevalence of local- and systemic-side effects of the Oxford AstraZeneca COVID-19 vaccine was modest. As the symptoms were mostly common in the first 3 days, it is preferable to monitor healthcare workers at least in the first 3 days following the administration of the vaccine.

Acute Kidney Injury after First Dose of AstraZeneca COVID-19 Vaccine Managed in a Nigerian Hospital.

INTRODUCTION: The association of kidney disease and COVID-19 vaccination has been reported with minimal change disease being a common presentation. CASE REPORT: Index patient is a 54-year-old female who presented with a history of reduction in urine output within 3 weeks of receiving the Oxford-AztraZeneca COVID-19 vaccine. Her serum creatinine on admission was 1,057 µmol/L with a premorbid serum creatinine of 78 µmol/L. Her vital signs were stable. She was on antihypertensive and antidiabetic medications for hypertension and diabetes mellitus, respectively. Renal biopsy was precluded by her morbid obesity and she was commenced on oral prednisolone. She had 5 sessions of hemodialysis and her serum creatinine gradually reduced to 106 µmol/L, and she is being followed up on an outpatient basis. CONCLUSION: We report a case of a female patient with acute kidney injury following COVID-19 Oxford-AztraZeneca vaccination. Further studies are required to better understand the pathogenesis of the renal affectation post-vaccination.

INTRODUCTION: L'association de la maladie rénale et de la vaccination COVID-19 a été signalée, la maladie à changement minimal est une présentation courante. RAPPORT DE CAS: La patiente à l'étude est une femme de 54 ans qui a présenté des antécédents de réduction du débit urinaire dans les 3 semaines après avoir reçu le vaccin COVID-19 d'Oxford-AztraZeneca. Sa créatinine sérique à l'admission était de 1 057 µmol/L avec une créatinine sérique prémorbide de 78 µmol/L. Ses signes vitaux étaient stables. Elle prenait des médicaments antihypertenseurs et antidiabétiques pour l'hypertension et le diabète sucré, respectivement. Une biopsie rénale était impossible à cause de son obésité morbide et elle a été mise sous prednisolone par voie orale. Elle a subi 5 sessions d'hémodialyse et son taux de créatinine sérique a progressivement à 106 µmol/L, et elle est suivie en ambulatoire. CONCLUSION: Nous rapportons le cas d'une patiente souffrant d'une lésion rénale aiguë après la vaccination par le COVID-19 Oxford-AztraZeneca. D'autres études sont nécessaires pour mieux comprendre la pathogenèse de l'affectation rénale post-vaccination. Mots-clés: Vaccin COVID-19, Événement Indésirable, Lésion Rénale Aiguë.

Reactivation of adult-onset Still's disease after use of the COVID-19 ChAdOx1-S vaccine.

A woman in her 60s with a history of adult-onset Still's disease (AOSD) in remission for 14 years received the ChAdOx1-S vaccine as a booster to her initial vaccination schedule (two doses of CoronaVac vaccine 6 months apart). Two weeks later, she consulted for symptoms suggestive of AOSD reactivation. This was confirmed during hospitalisation, where renal and cardiac involvement were also observed. Despite using high-dose corticosteroids, troponin T and N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) were persistently elevated. Tocilizumab was used, with which the patient achieved complete remission of her symptoms and normalised her laboratory tests.

Anaphylaxis to SARS-CoV-2 Vaccines in the Setting of a Nationwide Passive Epidemiological Surveillance Program.

BACKGROUND: Information on anaphylaxis among recipients of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains scarce. OBJECTIVE: To identify the observed incidence of anaphylaxis in recipients of different anti-SARS-CoV-2 vaccines. METHODS: A nationwide observational study among recipients of 61,414,803 doses of seven different anti-SARS-CoV-2 vaccines, describing the incidence and characteristics of adult patients (age ≥ 18 years) who developed anaphylaxis as an adverse event following immunization (AEFI) against SARS-CoV-2 vaccines between December 24, 2020, and October 15, 2021, in Mexico. RESULTS: Sixty-six patients developed anaphylaxis as an AEFI, for an overall observed incidence of 1.07 cases per 1,000,000 (95% CI 0.84-1.37) administered doses. Eighty-six percent of the patients were female, consistent with previous reports of AEFI to COVID-19 vaccines. mRNA-based vaccine recipients had the highest frequency of anaphylaxis, followed by adenovirus-vectored vaccines and inactivated virus recipients, with an observed incidence of 2.5, 0.7, and 0.2 cases per 1,000,000 doses administered, respectively. Only 46% of the patients received correct treatment with epinephrine as the first-line treatment through the appropriate route and dose. We detected one case of anaphylactic reaction-related death occurring 5 min following immunization with ChAdOx1 nCov-19 for a mortality rate of 1.5% among those who developed this AEFI. CONCLUSIONS: In our population, anaphylactic reactions were infrequent. Our study provides further evidence supporting the security of these newly developed vaccines.

Prevalence of COVID-19 Vaccine Side Effects among Early-Vaccinated Healthcare Workers in Eastern Ethiopia.

Background: The Ministry of Health of Ethiopia launched the COVID-19 vaccination campaign in March 2021, with frontline healthcare workers as first-round recipients and a goal of vaccinating 20% of the population by the end of 2021. The study aims to estimate the prevalence of COVID-19 vaccination side effects among early vaccinated healthcare workers in Adama hospital medical college. Methods: A cross-sectional study was carried out between March and June 2021, following the vaccination of COVID-19 vaccine among healthcare workers in Adama hospital medical college. The study used a structured self-administered questionnaire and additional telephone surveys on items covering the participants' demographic data, local and systemic manifestations after vaccination. Results: A total of 540 health care workers and supportive staff were enrolled in this study. The overall any-symptom report after the first dose of ChAdOx1 nCoV- 19 vaccine was 84.3%. The majority (39.6%) of participants had both systemic and local symptoms and 25.7% had only local and 18.9% had only systemic symptoms. Injection site pain was the most prevalent side effect symptom (64.1%), followed by fatigue (35.7%), headache (28.9%), joint pain (26.5%), and muscle pain (21.5%). Conclusion: Vaccine side effects were common and found to be well-tolerated among the recipients of the first dose of ChAdOx1 nCoV-19 at Adama hospital medical college healthcare workers. The side effects were mainly mild to moderate. More side-effect profiles should be studied and disseminated to detect rare adverse reactions.

Risk of gout flares after COVID-19 vaccination: A case-crossover study.

OBJECTIVE: Routine vaccinations are associated with an increased risk of gout flares. We examined the association between COVID-19 vaccination, an immunization program implemented to a large proportion of population, and the risk of gout flares. METHODS: We conducted a time-stratified case-crossover study among patients with gout who experienced gout flares between December 2020 and September 2021, using data from The Health Improvement Network. We compared the risk of gout flares on each of the seven days on and after the day of COVID-19 vaccination vs. no vaccination during that period using conditional logistic regression. In addition, we performed subgroup analyses stratified by different COVID-19 vaccines (i.e., BNT162b2, hereafter referred to as BNT, and ChAdOx1 nCov-19, hereafter referred to as ChAd). RESULTS: Among 5,904 patients with gout (mean age: 63·1 years; 85·5% male) who experienced gout flares within one month, the risk of gout flares slightly increased on the second day after COVID-19 vaccination (odds ratio: 1·44; 95% CI: 1·02 to 2·07). The risk of gout flares also slightly increased after receiving COVID-19 vaccine on other remaining days (ORs ranged from 1·03 to 1·22); however, none of them was statistically significant. An increased risk of gout flares on the second day after vaccination was mainly observed for the ChAd vaccine (odds ratio: 1·44; 95% CI: 1·00 to 2·05), but not for BNT vaccine (odds ratio: 1·18; 95% CI: 0·67 to 2·02). CONCLUSION: COVID-19 vaccination, mainly ChAd vaccination, slightly increases the risk of gout flares on the second day after vaccination. This finding reassures the safety of COVID-19 vaccination for patients with gout.

Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines.

BACKGROUND AND PURPOSE: Information on Guillain-Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS-CoV-2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti-SARS-CoV-2 vaccines between December 24, 2020, and October 29, 2021, in Mexico. METHODS: Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA-based (mRNA-1273 and BNT162b2), adenovirus-vectored (ChAdOx1 nCov-19, rAd26-rAd5, Ad5-nCoV, and Ad26.COV2-S), and inactivated whole-virion-vectored (CoronaVac) vaccines. RESULTS: We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33-60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97-1.45), with incidence higher among Ad26.COV2-S (3.86/1,000,000 doses, 95% CI 1.50-9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36-2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3-17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID-19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy-five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently. CONCLUSIONS: Guillain-Barré syndrome was an extremely infrequent AEFI against SARS-CoV-2. The protection provided by these vaccines outweighs the risk of developing GBS.

COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT). Last updated: 22 June 2022

This guideline covers vaccine-induced immune thrombocytopenia and thrombosis (VITT), a syndrome which has been reported in rare cases after COVID-19 vaccination. VITT may also be called vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) or thrombotic thrombocytopenic syndrome (TTS). Because VITT is a new condition, there is limited evidence available to inform clinical management, identification and management of the condition is evolving quickly as the case definition becomes clearer. This guideline was produced to support clinicians to diagnose and manage this newly recognised syndrome. NICE is continually monitoring the evidence. Future versions of the guideline will reflect changes in the evidence base and clinical practice. On 22 June 2022, we updated the advice on plasma exchange with fresh frozen plasma in people at high risk of a poor prognosis to recommend it is considered earlier in the care pathway. We have published this guideline in MAGICapp, a global evidence ecosystem already being used by key partners such as the Australian Taskforce for COVID-19 and the World Health Organization. The MAGICapp platform allows the efficient sharing of evidence between guideline developers from around the world. This means NICE can develop and update its COVID-19 guidance more quickly and efficiently as new evidence is assessed.