未经授权:疫苗接种是抗击SARS-CoV-2大流行的最有效工具。现在已经确定COVID-19疫苗对普通人群是安全的;然而,已经描述了一些免疫接种后罕见不良事件的病例,包括中枢神经系统炎性脱髓鞘事件(CIDEs)。尽管观察性研究表明,这些事件是罕见的,疫苗的益处远远超过风险,收集和表征COVID-19疫苗后DEs可能与挑出潜在的危险因素有关,并提出可能的潜在机制。
未经评估:这里我们描述了sixCIDE,包括两个急性横贯性脊髓炎(ATM),三种多发性硬化症(MS),和一种视神经脊髓炎谱系障碍(NMOSD),发生在COVID-19疫苗的8到35天之间。此外,我们对COVID-19疫苗后的DEs进行了系统的文献检索,包括ATM,ADEM,MS,和NMOSD/MOGAD,在2020年12月至2021年12月的全球疫苗接种运动期间发布。从综述的研究中提取临床/MRI和CSF/血清特征并进行汇总分析。
未经评估:49项研究被纳入系统评价,报告总计85个CIDE。考虑到我们另外六个案例,91CIDE进行了总结,包括24台ATM机,11ADEM,47MS,和9个NMOSD/MOGAD。总的来说,CIDEs发生在两种mRNA之后(n=46),腺病毒载体(n=37),和灭活疫苗(n=8)。腺病毒载体疫苗占ADEM(55%)和NMOSD/MOGAD(56%)的大部分,而mRNA疫苗在MS新诊断(87%)和复发(56%)中更常见。年龄不同(19-88),女性普遍存在。从疫苗到症状发作的时间明显可变:ADEM和NMOSD/MOGAD的中位发作时间(12.5天和10天)比ATM和MS(6天和7天)更长,并且在不同疫苗类型后的事件之间观察到进一步的时间差异。mRNA疫苗后的ATM和MS比腺病毒载体疫苗发生得更早。
UNASSIGNED:某些CIDEs疫苗类型的流行和发病时间的异质性表明,不同的机制-具有不同的动态/动力学-可能是这些事件的基础。虽然流行病学研究已经评估了COVID-19疫苗的安全性,对散发性病例的描述和汇总分析对于了解CIDE的病理生理学仍有价值。
UNASSIGNED: Vaccinations provided the most effective tool to fight the SARS-CoV-2 pandemic. It is now well established that COVID-19 vaccines are safe for the general population; however, some cases of rare adverse events following immunization have been described, including CNS Inflammatory Demyelinating Events (CIDEs). Although observational studies are showing that these events are rare and vaccines\' benefits highly outweigh the risks, collecting and characterizing post-COVID-19 vaccine CIDEs might be relevant to single out potential risk factors and suggest possible underlying mechanisms.
UNASSIGNED: Here we describe six CIDEs, including two acute transverse myelitis (ATM), three multiple sclerosis (MS), and one neuromyelitis optica spectrum disorder (NMOSD), occurring between 8 and 35 days from a COVID-19 vaccine. Moreover, we performed a systematic literature search of post-COVID-19 vaccines CIDEs, including ATM, ADEM, MS, and NMOSD/MOGAD, published worldwide between December 2020 and December 2021, during 1 year of the vaccination campaign. Clinical/MRI and CSF/serum characteristics were extracted from reviewed studies and pooled-analyzed.
UNASSIGNED: Forty-nine studies were included in the systematic
review, reporting a total amount of 85 CIDEs. Considering our additional six cases, 91 CIDEs were summarized, including 24 ATM, 11 ADEM, 47 MS, and nine NMOSD/MOGAD. Overall, CIDEs occurred after both mRNA (n = 46), adenoviral-vectored (n = 37), and inactivated vaccines (n = 8). Adenoviral-vectored vaccines accounted for the majority of ADEM (55%) and NMOSD/MOGAD (56%), while mRNA vaccines were more frequent in MS new diagnoses (87%) and relapses (56%). Age was heterogeneous (19-88) and the female sex was prevalent. Time from vaccine to symptoms onset was notably variable: ADEM and NMOSD/MOGAD had a longer median time of onset (12.5 and 10 days) compared to ATM and MS (6 and 7 days) and further timing differences were observed between events following different vaccine types, with ATM and MS after mRNA-vaccines occurring earlier than those following adenoviral-vectored ones.
UNASSIGNED: Both the prevalence of vaccine types for certain CIDEs and the heterogeneity in time of onset suggest that different mechanisms-with distinct dynamic/kinetic-might underly these events. While epidemiological studies have assessed the safety of COVID-19 vaccines, descriptions and pooled analyses of sporadic cases may still be valuable to gain insights into CIDE\'s pathophysiology.