Good recovery of immunization stress-related responses presenting as a cluster of stroke-like events following CoronaVac and ChAdOx1 vaccinations

  1. Metha Apiwattanakul
  2. Narupat Suanprasert
  3. Arada Rojana-Udomsart
  4. Thanes Termglinchan
  5. Chaichana Sinthuwong
  6. Tasanee Tantirittisak
  7. Suchat Hanchaiphiboolkul
  8. Pantep Angchaisuksiri
  9. Suphot Srimahachota
  10. Jurai Wongsawat
  11. Somjit Stiudomkajorn
  12. Sasisopin Kiertiburanakul
  13. Chonnamet Techasaensiri
  14. Wannada Laisuan
  15. Weerawat Manosuthi
  16. Pawinee Doungngern
  17. Wereyarmarst Jaroenkunathum
  18. Teeranart Jivapaisarnpong
  19. Apinya Panjangampatthana
  20. Jirapa Chimmanee
  21. Kulkanya Chokephaibulkit

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Abstract

Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand.

Methods

We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site.

Results

Overall, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28–42) years in patients receiving CoronaVac and 46 (33.5–60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16–960) min and 30 (8.8–750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability).

Conclusions

Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.

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  1. Version published to 10.1371/journal.pone.0266118
  2. ScreenIT

    SciScore for 10.1101/2022.03.15.22272434: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIACUC: This study was approved by the Ethical Review Committee for Research in Human Subjects at the Thailand Ministry of Public Health approval No. 15/2564.
    Consent: The requirement for informed consent was waived due to the retrospective nature of the current study and the fact that we conducted a secondary analysis of anonymized and deidentified data.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using GraphPad Prism 9 software (San Diego, CA, USA).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This caveat provides precautionary information and informs the provision of appropriate timely treatment (vs. empirically treating ISRR in the absence of differential diagnosis). We acknowledge several limitations of this report. Specifically, this evaluation was based on a retrospective study within the secondary data and we may have therefore missed some critical information (especially with respect to outcome data). The reported data regarding female predominance could be due to the initial target population of the nationwide vaccine campaign, which initially comprised HCWs who received preferential vaccination at the start of the vaccine campaign, most of whom were young females (e.g., nurses, therapists). Moreover, we were unable to identify the factors associated with ISRR in this descriptive study and instead present a descriptive evaluation only. Future studies should evaluate risk factors and causality more comprehensively using multivariate modeling and a prospective design.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.03.15.22272434v1 on medRxiv