Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study
BackgroundCOVID-19 vaccines have been approved due to their excellent safety and efficacy data and their use has also permitted to reduce neurological complications of SARS-CoV-2. However, clinical trials were underpowered to detect rare adverse events. Herein, the aim was to characterize the clinic...
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1344184/full |
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| author | Alberto Vogrig Alberto Vogrig Sara Tartaglia Sara Tartaglia Marta Dentoni Marta Dentoni Martina Fabris Francesco Bax Marco Belluzzo Lorenzo Verriello Daniele Bagatto Matteo Gastaldi Pierluigi Tocco Marco Zoccarato Luigi Zuliani Andrea Pilotto Andrea Pilotto Andrea Pilotto Alessandro Padovani Alessandro Padovani Alessandro Padovani Macarena Villagrán-García Macarena Villagrán-García Vincent Davy Gian Luigi Gigli Gian Luigi Gigli Jérôme Honnorat Jérôme Honnorat Mariarosaria Valente Mariarosaria Valente |
| author_facet | Alberto Vogrig Alberto Vogrig Sara Tartaglia Sara Tartaglia Marta Dentoni Marta Dentoni Martina Fabris Francesco Bax Marco Belluzzo Lorenzo Verriello Daniele Bagatto Matteo Gastaldi Pierluigi Tocco Marco Zoccarato Luigi Zuliani Andrea Pilotto Andrea Pilotto Andrea Pilotto Alessandro Padovani Alessandro Padovani Alessandro Padovani Macarena Villagrán-García Macarena Villagrán-García Vincent Davy Gian Luigi Gigli Gian Luigi Gigli Jérôme Honnorat Jérôme Honnorat Mariarosaria Valente Mariarosaria Valente |
| author_sort | Alberto Vogrig |
| collection | DOAJ |
| description | BackgroundCOVID-19 vaccines have been approved due to their excellent safety and efficacy data and their use has also permitted to reduce neurological complications of SARS-CoV-2. However, clinical trials were underpowered to detect rare adverse events. Herein, the aim was to characterize the clinical spectrum and immunological features of central nervous system (CNS) immune-related events following SARS-CoV-2 vaccination.MethodsMulticenter, retrospective, cohort study (December 1, 2020-April 30, 2022). Inclusion criteria were (1) de novo CNS disorders developing after SARS-CoV-2 vaccination (probable causal relationship as per 2021 Butler criteria) (2); evidence for an immune-mediated etiology, as per (i) 2016 Graus criteria for autoimmune encephalitis (AE); (ii) 2015 Wingerchuk criteria for neuromyelitis optica spectrum disorders; (iii) criteria for myelitis.ResultsNineteen patients were included from 7 tertiary referral hospitals across Italy and France (one of them being a national referral center for AE), over almost 1 year and half of vaccination campaign. Vaccines administered were mRNA-based (63%) and adenovirus-vectored (37%). The median time between vaccination and symptoms onset was 14 days (range: 2-41 days). CSF was inflammatory in 74%; autoantibodies were detected in 5%. CSF cytokine analysis (n=3) revealed increased CXCL-10 (IP-10), suggesting robust T-cell activation. The patients had AE (58%), myelitis (21%), acute disseminated encephalomyelitis (ADEM) (16%), and brainstem encephalitis (5%). All patients but 2 received immunomodulatory treatment. At last follow-up (median 130 days; range: 32-540), only one patient (5%) had a mRS>2.ConclusionCNS adverse events of COVID-19 vaccination appear to be very rare even at reference centers and consist mostly of antibody-negative AE, myelitis, and ADEM developing approximately 2 weeks after vaccination. Most patients improve following immunomodulatory treatment. |
| first_indexed | 2024-03-08T05:37:02Z |
| format | Article |
| id | doaj.art-a21c5378b1674c5eb904139507407818 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-08T05:37:02Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-a21c5378b1674c5eb9041395074078182024-02-05T15:54:02ZengFrontiers Media S.A.Frontiers in Immunology1664-32242024-02-011510.3389/fimmu.2024.13441841344184Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter studyAlberto Vogrig0Alberto Vogrig1Sara Tartaglia2Sara Tartaglia3Marta Dentoni4Marta Dentoni5Martina Fabris6Francesco Bax7Marco Belluzzo8Lorenzo Verriello9Daniele Bagatto10Matteo Gastaldi11Pierluigi Tocco12Marco Zoccarato13Luigi Zuliani14Andrea Pilotto15Andrea Pilotto16Andrea Pilotto17Alessandro Padovani18Alessandro Padovani19Alessandro Padovani20Macarena Villagrán-García21Macarena Villagrán-García22Vincent Davy23Gian Luigi Gigli24Gian Luigi Gigli25Jérôme Honnorat26Jérôme Honnorat27Mariarosaria Valente28Mariarosaria Valente29Department of Medicine (DMED), University of Udine, Udine, ItalyClinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyDepartment of Medicine (DMED), University of Udine, Udine, ItalyClinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyDepartment of Medicine (DMED), University of Udine, Udine, ItalyClinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyInstitute of Clinical Pathology, Department of Laboratory Medicine, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyClinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyNeurology Unit, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyNeurology Unit, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyDepartment of Diagnostic Imaging, Unit of Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyNeuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, ItalyNeurology and Stroke Unit, “Spirito Santo” Hospital of Pescara, Pescara, ItalyUOC Neurologia O.S.A. - Azienda Ospedale Università di Padova, Padua, ItalyNeurology Unit, AULSS8 Berica, San Bortolo Hospital, Vicenza, Italy0Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy1Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia University Hospital, Brescia, Italy2Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy0Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy1Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia University Hospital, Brescia, Italy2Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy3French Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France4MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France5Department of Neurology, Hôpital Pitié Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, FranceDepartment of Medicine (DMED), University of Udine, Udine, ItalyClinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy3French Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France4MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, FranceDepartment of Medicine (DMED), University of Udine, Udine, ItalyClinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, ItalyBackgroundCOVID-19 vaccines have been approved due to their excellent safety and efficacy data and their use has also permitted to reduce neurological complications of SARS-CoV-2. However, clinical trials were underpowered to detect rare adverse events. Herein, the aim was to characterize the clinical spectrum and immunological features of central nervous system (CNS) immune-related events following SARS-CoV-2 vaccination.MethodsMulticenter, retrospective, cohort study (December 1, 2020-April 30, 2022). Inclusion criteria were (1) de novo CNS disorders developing after SARS-CoV-2 vaccination (probable causal relationship as per 2021 Butler criteria) (2); evidence for an immune-mediated etiology, as per (i) 2016 Graus criteria for autoimmune encephalitis (AE); (ii) 2015 Wingerchuk criteria for neuromyelitis optica spectrum disorders; (iii) criteria for myelitis.ResultsNineteen patients were included from 7 tertiary referral hospitals across Italy and France (one of them being a national referral center for AE), over almost 1 year and half of vaccination campaign. Vaccines administered were mRNA-based (63%) and adenovirus-vectored (37%). The median time between vaccination and symptoms onset was 14 days (range: 2-41 days). CSF was inflammatory in 74%; autoantibodies were detected in 5%. CSF cytokine analysis (n=3) revealed increased CXCL-10 (IP-10), suggesting robust T-cell activation. The patients had AE (58%), myelitis (21%), acute disseminated encephalomyelitis (ADEM) (16%), and brainstem encephalitis (5%). All patients but 2 received immunomodulatory treatment. At last follow-up (median 130 days; range: 32-540), only one patient (5%) had a mRS>2.ConclusionCNS adverse events of COVID-19 vaccination appear to be very rare even at reference centers and consist mostly of antibody-negative AE, myelitis, and ADEM developing approximately 2 weeks after vaccination. Most patients improve following immunomodulatory treatment.https://www.frontiersin.org/articles/10.3389/fimmu.2024.1344184/fullneurologic adverse eventsvaccinationneurological complicationsvaccineCOVID-19SARS-CoV-2 |
| spellingShingle | Alberto Vogrig Alberto Vogrig Sara Tartaglia Sara Tartaglia Marta Dentoni Marta Dentoni Martina Fabris Francesco Bax Marco Belluzzo Lorenzo Verriello Daniele Bagatto Matteo Gastaldi Pierluigi Tocco Marco Zoccarato Luigi Zuliani Andrea Pilotto Andrea Pilotto Andrea Pilotto Alessandro Padovani Alessandro Padovani Alessandro Padovani Macarena Villagrán-García Macarena Villagrán-García Vincent Davy Gian Luigi Gigli Gian Luigi Gigli Jérôme Honnorat Jérôme Honnorat Mariarosaria Valente Mariarosaria Valente Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study Frontiers in Immunology neurologic adverse events vaccination neurological complications vaccine COVID-19 SARS-CoV-2 |
| title | Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study |
| title_full | Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study |
| title_fullStr | Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study |
| title_full_unstemmed | Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study |
| title_short | Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study |
| title_sort | central nervous system immune related disorders after sars cov 2 vaccination a multicenter study |
| topic | neurologic adverse events vaccination neurological complications vaccine COVID-19 SARS-CoV-2 |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1344184/full |
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