Objective:To determine the real-world effectiveness of the ChAdOx1 nCoV-19 coronavirus vaccine in preventing severe disease and mortality due to COVID-19.Methods:A case-case design was used to estimate the effect of t...Objective:To determine the real-world effectiveness of the ChAdOx1 nCoV-19 coronavirus vaccine in preventing severe disease and mortality due to COVID-19.Methods:A case-case design was used to estimate the effect of the ChAdOx1 nCoV-19 coronavirus vaccine on severe SARS-CoV-2 outcomes in individuals aged 40 years and above.Cases(n=200)were COVID-19 patients admitted to intensive care unit(ICU)or who died.Controls(n=223)were those with mild COVID-19,fit for home isolation.The logistic regression model was used to estimate adjusted vaccine effectiveness for full vaccination(two doses≥14 d)and partial vaccination status(one dose≥14 d or two doses<14 d).Results:The proportion of fully vaccinated individuals was significantly lower among cases(12,6.0%)compared to controls(30,13.5%).The adjusted effectiveness of a full dose of ChAdOx1 nCoV-19 coronavirus vaccine in preventing ICU admission or death was 81.9%(95%CI:61.3%-91.6%,P=0.001).Subgroup analysis restricted to age group,sex,and comorbidities found that ChAdOx1 nCoV-19 coronavirus vaccine had a significant positive effect in all subgroups and categories.Conclusion:COVID-19 vaccination reduces ICU admissions or death.Therefore,increased vaccine uptake may reduce the severity of the pandemic,more so in the elderly and those with comorbidities.展开更多
Background: Vaccines remain the only viable and safe option to control transmission and minimise disease sequelae during the COVID-19 pandemic. Whilst multiple vaccines are available, evidence has emerged regarding th...Background: Vaccines remain the only viable and safe option to control transmission and minimise disease sequelae during the COVID-19 pandemic. Whilst multiple vaccines are available, evidence has emerged regarding the association between the ChAdOx1 nCoV-19 vaccine, platelets and thrombosis, manifesting in thrombotic thrombocytopaenia. Case Summary: We report a case of recurrent coronary artery thrombosis on triple antithrombotic therapy, namely aspirin, clopidogrel, and continuous intravenous heparin, nine days after the ChAdOx1 nCoV-19 vaccine, in a 63-year-old female with no significant history of cardiovascular disease. Conclusion: This case may suggest that the association between platelets, SARS-CoV-2, the ChAdOx1 nCoV-19 vaccine, and coronary thrombosis may remain incompletely understood and warrants further study. Clinicians should remain on high alert if presented with similar circumstances.展开更多
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia(VITT)is a rare and potentially life-threatening condition after receiving coronavirus disease vaccines.It is characterized by symptom onset at 5 to 30 d po...BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia(VITT)is a rare and potentially life-threatening condition after receiving coronavirus disease vaccines.It is characterized by symptom onset at 5 to 30 d postvaccination,thrombocytopenia,thrombosis,high D-dimer level,and antiplatelet factor 4(anti-PF4)antibody positivity.VITT can progress very fast,requiring urgent management.Only few studies have described its detailed clinical course and imaging changes.We report a typical VITT case in a patient who underwent regular repeated brain imaging examinations.CASE SUMMARY A young woman presented with headaches at 7 d after the ChAdOx1 nCoV-19vaccine(AZD1222)injection.She then showed progressive symptoms of left upper limb clumsiness.Brain computed tomography revealed venous infarction at the right parietal lobe with a hyperacute thrombus in the cortical vein.Two hours later,brain magnetic resonance imaging revealed hemorrhage at the same area.Magnetic resonance venography showed an irregular contour of the right transverse sinus.Laboratory examination revealed a high D-dimer level,thrombocytopenia,and a high titer for anti-PF4 antibodies.She was treated with anticoagulants,intravenous immunoglobulin,and steroids and analgesic agents were administered for pain control.She had a marked improvement on headaches and clumsiness after treatment along with radiological thrombus resolution.During follow-up at the outpatient department,her modified Rankin scale at 90 d was 1.CONCLUSION Clinicians should be alerted whenever patients present with persistent and progressive headaches or focal motor/sensory deficits postvaccination.展开更多
目的分析IgM、IgG抗体双阴性2019冠状病毒病(COVID-19)患者的临床特征,并初步探讨IgM、IgG双阴原因。方法回顾性分析2020年3月23日前出院或死亡的湖北省妇幼保健院光谷院区COVID-19患者临床资料,比较双抗阴性(双阴组)和双抗阳性患者(双...目的分析IgM、IgG抗体双阴性2019冠状病毒病(COVID-19)患者的临床特征,并初步探讨IgM、IgG双阴原因。方法回顾性分析2020年3月23日前出院或死亡的湖北省妇幼保健院光谷院区COVID-19患者临床资料,比较双抗阴性(双阴组)和双抗阳性患者(双阳组)的临床特征差异。结果双阴组共计纳入77例,男34例,女43例,平均年龄(62.34±19.69)岁;随机选取双阳组100例,男39例,女61例,平均年龄(59.72±15.48)岁。两组患者性别及年龄无统计学差异(P>0.05);双阴组无明显主诉症状者多于双阳组[35.06%(27/77) vs 11.00%(11/100),P=0.000],胸部CT无炎症表现者明显多于双阳组[18.18%(14/77) vs 1.00%(1/100),P=0.000];双阴组重危症比例为16.88%(13/77),双阳组为15.00%(15/100),两组临床分型无统计学差异(P=0.447);双阴组死亡率为3.90%(3/77),双阳组为3.00%(3/100),差异无统计学意义(P=0.926)。双阴组从出现症状到行抗体检查的时间明显短于双阳组[(25.89±12.70) d vs (35.53±10.59) d,P=0.000]。两组间其他临床特征及白细胞计数、超敏C反应蛋白等实验室检验指标无统计学差异(P>0.05)。结论双抗阴性患者可能出现了免疫逃逸现象,因此临床症状及胸部影像学表现相对轻微,但抗体表达与否与COVID-19严重程度及预后无明显相关性。展开更多
文摘Objective:To determine the real-world effectiveness of the ChAdOx1 nCoV-19 coronavirus vaccine in preventing severe disease and mortality due to COVID-19.Methods:A case-case design was used to estimate the effect of the ChAdOx1 nCoV-19 coronavirus vaccine on severe SARS-CoV-2 outcomes in individuals aged 40 years and above.Cases(n=200)were COVID-19 patients admitted to intensive care unit(ICU)or who died.Controls(n=223)were those with mild COVID-19,fit for home isolation.The logistic regression model was used to estimate adjusted vaccine effectiveness for full vaccination(two doses≥14 d)and partial vaccination status(one dose≥14 d or two doses<14 d).Results:The proportion of fully vaccinated individuals was significantly lower among cases(12,6.0%)compared to controls(30,13.5%).The adjusted effectiveness of a full dose of ChAdOx1 nCoV-19 coronavirus vaccine in preventing ICU admission or death was 81.9%(95%CI:61.3%-91.6%,P=0.001).Subgroup analysis restricted to age group,sex,and comorbidities found that ChAdOx1 nCoV-19 coronavirus vaccine had a significant positive effect in all subgroups and categories.Conclusion:COVID-19 vaccination reduces ICU admissions or death.Therefore,increased vaccine uptake may reduce the severity of the pandemic,more so in the elderly and those with comorbidities.
文摘Background: Vaccines remain the only viable and safe option to control transmission and minimise disease sequelae during the COVID-19 pandemic. Whilst multiple vaccines are available, evidence has emerged regarding the association between the ChAdOx1 nCoV-19 vaccine, platelets and thrombosis, manifesting in thrombotic thrombocytopaenia. Case Summary: We report a case of recurrent coronary artery thrombosis on triple antithrombotic therapy, namely aspirin, clopidogrel, and continuous intravenous heparin, nine days after the ChAdOx1 nCoV-19 vaccine, in a 63-year-old female with no significant history of cardiovascular disease. Conclusion: This case may suggest that the association between platelets, SARS-CoV-2, the ChAdOx1 nCoV-19 vaccine, and coronary thrombosis may remain incompletely understood and warrants further study. Clinicians should remain on high alert if presented with similar circumstances.
文摘BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia(VITT)is a rare and potentially life-threatening condition after receiving coronavirus disease vaccines.It is characterized by symptom onset at 5 to 30 d postvaccination,thrombocytopenia,thrombosis,high D-dimer level,and antiplatelet factor 4(anti-PF4)antibody positivity.VITT can progress very fast,requiring urgent management.Only few studies have described its detailed clinical course and imaging changes.We report a typical VITT case in a patient who underwent regular repeated brain imaging examinations.CASE SUMMARY A young woman presented with headaches at 7 d after the ChAdOx1 nCoV-19vaccine(AZD1222)injection.She then showed progressive symptoms of left upper limb clumsiness.Brain computed tomography revealed venous infarction at the right parietal lobe with a hyperacute thrombus in the cortical vein.Two hours later,brain magnetic resonance imaging revealed hemorrhage at the same area.Magnetic resonance venography showed an irregular contour of the right transverse sinus.Laboratory examination revealed a high D-dimer level,thrombocytopenia,and a high titer for anti-PF4 antibodies.She was treated with anticoagulants,intravenous immunoglobulin,and steroids and analgesic agents were administered for pain control.She had a marked improvement on headaches and clumsiness after treatment along with radiological thrombus resolution.During follow-up at the outpatient department,her modified Rankin scale at 90 d was 1.CONCLUSION Clinicians should be alerted whenever patients present with persistent and progressive headaches or focal motor/sensory deficits postvaccination.
文摘目的分析IgM、IgG抗体双阴性2019冠状病毒病(COVID-19)患者的临床特征,并初步探讨IgM、IgG双阴原因。方法回顾性分析2020年3月23日前出院或死亡的湖北省妇幼保健院光谷院区COVID-19患者临床资料,比较双抗阴性(双阴组)和双抗阳性患者(双阳组)的临床特征差异。结果双阴组共计纳入77例,男34例,女43例,平均年龄(62.34±19.69)岁;随机选取双阳组100例,男39例,女61例,平均年龄(59.72±15.48)岁。两组患者性别及年龄无统计学差异(P>0.05);双阴组无明显主诉症状者多于双阳组[35.06%(27/77) vs 11.00%(11/100),P=0.000],胸部CT无炎症表现者明显多于双阳组[18.18%(14/77) vs 1.00%(1/100),P=0.000];双阴组重危症比例为16.88%(13/77),双阳组为15.00%(15/100),两组临床分型无统计学差异(P=0.447);双阴组死亡率为3.90%(3/77),双阳组为3.00%(3/100),差异无统计学意义(P=0.926)。双阴组从出现症状到行抗体检查的时间明显短于双阳组[(25.89±12.70) d vs (35.53±10.59) d,P=0.000]。两组间其他临床特征及白细胞计数、超敏C反应蛋白等实验室检验指标无统计学差异(P>0.05)。结论双抗阴性患者可能出现了免疫逃逸现象,因此临床症状及胸部影像学表现相对轻微,但抗体表达与否与COVID-19严重程度及预后无明显相关性。
