Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico

Autor: Diego López-Mena, Miguel García-Grimshaw, Sergio Saldivar-Dávila, Laura Elena Hernandez-Vanegas, María del Mar Saniger-Alba, Alonso Gutiérrez-Romero, Roger Carrillo-Mezo, Hector Eduardo Valdez-Ruvalcaba, Vanessa Cano-Nigenda, Fernando Daniel Flores-Silva, Carlos Cantú-Brito, Ana María Santibañez-Copado, Jose-Luis Diaz-Ortega, Santa Elizabeth Ceballos-Liceaga, Luis Manuel Murillo-Bonilla, Ana Isabel Sepulveda-Núñez, Verónica García-Talavera, Eduardo Gonzalez-Guerra, Ricardo Cortes-Alcala, Hugo Lopez-Gatell, Guillermo Carbajal-Sandoval, Gustavo Reyes-Terán, Sergio Iván Valdés-Ferrer, Antonio Arauz
Rok vydání: 2022
Předmět:
Zdroj: Neurology
ISSN: 1526-632X
0028-3878
DOI: 10.1212/wnl.0000000000200388
Popis: Background and ObjectivesInformation on stroke among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines remains scarce. We report stroke incidence as an adverse event following immunization (AEFI) among recipients of 79,399,446 doses of 6 different SARS-CoV-2 vaccines (BNT162b2, ChAdOx1 nCov-19, Gam-COVID-Vac, CoronaVac, Ad5-nCoV, and Ad26.COV2-S) between December 24, 2020, and August 31, 2021, in Mexico.MethodsThis retrospective descriptive study analyzed stroke incidence per million doses among hospitalized adult patients (≥18 years) during an 8-month interval. According to the World Health Organization, AEFIs were defined as clinical events occurring within 30 days after immunization and categorized as either nonserious or serious, depending on severity, treatment, and hospital admission requirements. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral venous thrombosis (CVT) cases were collected through a passive epidemiologic surveillance system in which local health providers report potential AEFI to the Mexican General Board of Epidemiology. Data were captured with standardized case report formats by an ad hoc committee appointed by the Mexican Ministry of Health to evaluate potential neurologic AEFI against SARS-COV-2.ResultsWe included 56 patients (31 female patients [55.5%]) for an overall incidence of 0.71 cases per 1,000,000 administered doses (95% CI 0.54–0.92). Median age was 65 years (interquartile range [IQR] 55–76 years); median time from vaccination to stroke (of any subtype) was 2 days (IQR 1–5 days). In 27 (48.2%) patients, the event was diagnosed within the first 24 hours after immunization. The most frequent subtype was AIS in 43 patients (75%; 0.54 per 1,000,000 doses, 95% CI 0.40–0.73), followed by ICH in 9 (16.1%; 0.11 per 1,000,000 doses, 95% CI 0.06–0.22) and SAH and CVT, each with 2 cases (3.6%; 0.03 per 1,000,000 doses, 95% CI 0.01–0.09). Overall, the most common risk factors were hypertension in 33 (58.9%) patients and diabetes in 22 (39.3%). Median hospital length of stay was 6 days (IQR 4–13 days). At discharge, functional outcome was good (modified Rankin Scale score 0–2) in 41.1% of patients; in-hospital mortality rate was 21.4%.DiscussionStroke is an exceedingly rare AEFI against SARS-CoV-2. Preexisting stroke risk factors were identified in most patients. Further research is needed to evaluate causal associations between SARS-COV-2 vaccines and stroke.
Databáze: OpenAIRE
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