Evaluation of COVID-19 Patients Who Developed after COVID-19 Vaccination

Öz

Aim: The aim of this study is to evaluate the sociodemographic and clinical characteristics of patients with COVID-19 that developed after COVID-19 vaccination. Material and Method: The study was conducted at a state hospital between July 5 and August 5, 2021. Patients who received COVID-19 vaccine, whose SARS-CoV-2 positivity was confirmed by molecular methods, and who were hospitalized for COVID-19 were included. Sociodemographic information and clinical observation results of patients were recorded. Results: 49.09% of the patients were female and the median age was 72.00 [62.00-79.00] years. 70.45% of patients had a chronic disease and 37.27% were constantly using medication. 82.73% of patients received the CoronaVac vaccine and 8.18% received COVID-19 mRNA vaccine; 9.09% had received both vaccines. 66.82% of patients received two doses of COVID-19 vaccine, 26.82% received three doses, 5.45% received one dose and 0.91% received four doses of COVID-19 vaccine. When the infection findings at the time of admission to the hospital are evaluated, the most common symptoms in patients are dyspnea (89.55%), cough (45.45%), weakness (37.73%), malaise (22.27%) and fatigue-exhaustion. (20.00%); 95% of them had COVID-19 findings in their lung imaging reports. 99.55% of patients receive oxygen therapy; 62.73% were connected to mechanical ventilation. 91.82% of patients were receiving steroid treatment, 89.09% were receiving faviripavir treatment, and 98.64% were receiving anticoagulant; 96.82% had received antibiotic treatment. 38.64% of patients were discharged; 61.36% died. Conclusion: It has been observed that the average age of patients who contracted COVID-19 disease after the COVID-19 vaccine was high, they had a high rate of chronic disease, they were vaccinated with hight rate CoronaVac vaccine, and they received a maximum of two doses of vaccine and they did not receive a reminder dose. Mortality and morbidity can be reduced by creating successful vaccination programs as well as protective measures in the fight against COVID-19.

Anahtar Kelimeler

• vaccine
• COVID-19 vaccine
• COVID-19 infection
• patient characteristics

COVID 19 aşısı sonrası gelişen COVID 19 hastalarının değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, COVID-19 aşısı sonrası gelişen COVID-19 hastalarının sosyodemografik ve klinik özelliklerini değerlendirmektir. Gereç ve Yöntem: Çalışma, 5 Temmuz-5 Ağustos 2021 tarihleri arasında bir devlet hastanesinde gerçekleştirildi. SARS-CoV-2 pozitifliği moleküler yöntemlerle doğrulanan ve COVID-19 nedeniyle hastaneye yatırılan, COVID-19 aşısı yapılan hastalar dahil edildi. Hastaların sosyodemografik bilgileri ve klinik gözlem sonuçları kaydedildi. Bulgular: Hastaların %49,09'u kadındı ve ortanca yaş 72,00 [62,00-79,00] yıldı. Hastaların %70,45'inin kronik hastalığı vardı ve %37,27'si sürekli ilaç kullanıyordu. Hastaların %82,73'üne CoronaVac aşısı, %8,18'ine ise COVID-19 mRNA aşısı yapıldı; %9,09'u her iki aşıyı da almıştı. Hastaların yüzde 66,82'sine iki doz, yüzde 26,82'sine üç doz, yüzde 5,45'ine tek doz ve yüzde 0,91'ine dört doz aşı yapıldı. Hastaneye başvuru anındaki enfeksiyon bulguları değerlendirildiğinde hastalarda en sık görülen semptomlar nefes darlığı (%89,55), öksürük (%45,45), halsizlik (%37,73), kırgınlık (%22,27) ve yorgunluk-bitkinlikti. (%20,00). Hastaların %95’inin akciğer görüntüleme raporlarında COVID-19 bulguları vardı. Hastaların %99,55’i oksijen tedavisi alırken; %62,73’ü mekanik ventilasyona bağlanmıştı. Hastaların %91,82’si steroid tedavisi, %89,09’u faviripavir tedavisi, %98,64’ü antikoagülan alırken; %96,82’si antibiyotik tedavisi almıştı. Hastaların %38,64’ü taburcu olurken; %61,36’sı ex oldu. Sonuç: COVID 19 aşısı sonrası COVID 19 hastalığına yakalanan hastaların özelliklerinin yaş ortalaması yüksek olduğu, kronik hastalık varlığı, CoronaVac aşısı oldukları ve en fazla iki doz aşı olup hatırlatma dozu aşı olmadıkları görülmüştür. COVID 19 ile mücadelede korunma önlemlerinin yanında başarılı aşı programlarının oluşturulmasıyla mortalite ve morbidite azaltılabilir.

Anahtar Kelimeler

• Aşı
• COVID 19 aşısı
• COVID 19 enfeksiyonu
• hasta özellikleri

Kaynakça

1. 1. Choy RKM, Bourgeois AL, Ockenhouse CF, et al. Controlled Human Infection Models To Accelerate Vaccine Development. Clin Microbiol Rev. 2022 Sep 21;35(3):e0000821. doi: 10.1128/cmr.00008-21. Epub 2022 Jul 6. PMID: 35862754; PMCID: PMC9491212.
2. 2. WHO COVID-19 dashboard (Internet] Acces link: https://data.who.int/dashboards/covid19/cases Access date: 9.6.24
3. 3. Firouzabadi N, Ghasemiyeh P, Moradishooli F, et al. Update on the effectiveness of COVID-19 vaccines on different variants of SARS-CoV-2. Int Immunopharmacol. 2023 Apr;117:109968. doi: 10.1016/j.intimp.2023.109968. Epub 2023 Mar 2. PMID: 37012880; PMCID: PMC9977625.
4. 4. Rizk JG, Kalantar-Zadeh K, Mehra MR, et al. Pharmaco-Immunomodulatory Therapy in COVID-19. Drugs. 2020 Sep;80(13):1267-1292. doi: 10.1007/s40265-020-01367-z. PMID: 32696108; PMCID: PMC7372203.
5. 5. Hadid T, Kafri Z, Al-Katib A. Coagulation and anticoagulation in COVID-19. Blood Rev. 2021 May;47:100761. doi: 10.1016/j.blre.2020.100761. Epub 2020 Oct 8. PMID: 33067035; PMCID: PMC7543932.
6. 6. Ghasemiyeh P, Mohammadi-Samani S. The necessity of early anti-inflammatory therapy initiation in cases with mild-to-moderate COVID-19: A personal experience from an attending pharmacist and his resident The necessity of early anti-inflammatory therapy in mild-to-moderate COVID-19: A personal experience from an attending pharmacist and his resident. Published online 2024. doi:10.22541/au.170665690.06722778/v1
7. 7. WHO CW. Repurposed Antiviral Drugs for Covid-19 — Interim WHO Solidarity Trial Results. New England Journal of Medicine. 2021;384(6):497-511. doi:10.1056/NEJMoa2023184
8. 8. Cámara M, Sánchez-Mata MC, Fernández-Ruiz V, et al. A Review of the Role of Micronutrients and Bioactive Compounds on Immune System Supporting to Fight against the COVID-19 Disease. Foods. 2021 May 14;10(5):1088. doi: 10.3390/foods10051088. PMID: 34068930; PMCID: PMC8155867.

9. 9. Li Y, Tenchov R, Smoot J, et al. A Comprehensive Review of the Global Efforts on COVID-19 Vaccine Development. ACS Cent Sci. 2021 Apr 28;7(4):512-533. doi: 10.1021/acscentsci.1c00120. Epub 2021 Mar 29. PMID: 34056083; PMCID: PMC8029445.
10. 10. Nagpal D, Nagpal S, Kaushik D, et al. Current clinical status of new COVID-19 vaccines and immunotherapy. Environ Sci Pollut Res Int. 2022 Oct;29(47):70772-70807. doi: 10.1007/s11356-022-22661-1. Epub 2022 Sep 5. PMID: 36063274; PMCID: PMC9442597.
11. 11. Baltas I, Boshier FAT, Williams CA, et al. Post-Vaccination Coronavirus Disease 2019: A Case-Control Study and Genomic Analysis of 119 Breakthrough Infections in Partially Vaccinated Individuals. Clin Infect Dis. 2022 Aug 25;75(2):305-313. doi: 10.1093/cid/ciab714. PMID: 34410361; PMCID: PMC8513403.
12. 12. Kalayci BN, Karahan D. Evaluation of local and systemic side effects of Turkovac vaccine in adults. Turk J Med Sci. 2023;53(4):934-940. doi:10.55730/1300-0144.5657
13. 13. Haghpanah F, Lin G, Levin SA, et al. Analysis of the potential impact of durability, timing, and transmission blocking of COVID-19 vaccine on morbidity and mortality. EClinicalMedicine. 2021 May;35:100863. doi: 10.1016/j.eclinm.2021.100863. Epub 2021 Apr 26. PMID: 33937734; PMCID: PMC8072137.
14. 14. Menni C, Klaser K, May A, et al. Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. Lancet Infect Dis. 2021 Jul;21(7):939-949. doi: 10.1016/S1473-3099(21)00224-3. Epub 2021 Apr 27. PMID: 33930320; PMCID: PMC8078878.
15. 15. Antonelli M, Penfold RS, Merino J, et al. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2022 Jan;22(1):43-55. doi: 10.1016/S1473-3099(21)00460-6. Epub 2021 Sep 1. PMID: 34480857; PMCID: PMC8409907.
16. 16. Egan C, Knight S, Baillie K, et al. Hospitalised Vaccinated Patients during the Second Wave, Update April ’21.
17. 17. Cox LS, Bellantuono I, Lord JM, et al. Tackling immunosenescence to improve COVID-19 outcomes and vaccine response in older adults. Lancet Healthy Longev. 2020 Nov;1(2):e55-e57. doi: 10.1016/S2666-7568(20)30011-8. Epub 2020 Nov 9. PMID: 33521768; PMCID: PMC7834195.
18. 18. Lord JM. The effect of ageing of the immune system on vaccination responses. Hum Vaccin Immunother. 2013 Jun;9(6):1364-7. doi: 10.4161/hv.24696. Epub 2013 Apr 12. PMID: 23584248; PMCID: PMC3901832.
19. 19. Juthani PV, Gupta A, Borges KA, et al. Hospitalisation among vaccine breakthrough COVID-19 infections. Lancet Infect Dis. 2021 Nov;21(11):1485-1486. doi: 10.1016/S1473-3099(21)00558-2. Epub 2021 Sep 7. Erratum in: Lancet Infect Dis. 2022 Jan;22(1):e1. doi: 10.1016/S1473-3099(21)00708-8. PMID: 34506735; PMCID: PMC8423430.
20. 20. Lipsitch M, Krammer F, Regev-Yochay G, et al. SARS-CoV-2 breakthrough infections in vaccinated individuals: measurement, causes and impact. Nat Rev Immunol. 2022 Jan;22(1):57-65. doi: 10.1038/s41577-021-00662-4. Epub 2021 Dec 7. PMID: 34876702; PMCID: PMC8649989.
21. 21. European Medicines Agency. (2022). COVID-19 vaccines: Key facts. Erişim adresi: https://www.ema.europa.eu/en/human-regulatory/overview/public-healththreats/coronavirus-disease-covid-19/treatments-vaccines/vaccines-covid-19/covid19-vaccines-key-facts#immunity-(protection)-section (Erişim tarihi: 11.09.2022).
22. 22. Centers for Disease Control and Prevention, “People with certain medical conditions,” Sep. 2020. [Online]. Available: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
23. 23. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5. Epub 2020 Jan 24. Erratum in: Lancet. 2020 Feb 15;395(10223):496. doi: 10.1016/S0140-6736(20)30252-X. PMID: 31986264; PMCID: PMC7159299.
24. 24. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-1069. doi: 10.1001/jama.2020.1585. Erratum in: JAMA. 2021 Mar 16;325(11):1113. doi: 10.1001/jama.2021.2336. PMID: 32031570; PMCID: PMC7042881.
25. 25. Argenziano MG, Bruce SL, Slater CL, et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ. 2020 May 29;369:m1996. doi: 10.1136/bmj.m1996. PMID: 32471884; PMCID: PMC7256651.
26. 26. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020 Apr 28;323(16):1574-1581. doi: 10.1001/jama.2020.5394. Erratum in: JAMA. 2021 May 25;325(20):2120. doi: 10.1001/jama.2021.5060. PMID: 32250385; PMCID: PMC7136855.
27. 27. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020 May;94:91-95. doi: 10.1016/j.ijid.2020.03.017. Epub 2020 Mar 12. PMID: 32173574; PMCID: PMC7194638.
28. 28. Centers For Disease Control and Prevention (CDC). (2022). COVID-19 vaccines for moderately or severely immunocompromised people. Erişim adresi: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html (Erişim tarihi: 22.04.2024)
29. 29. Hall V, Foulkes S, Insalata F, et al. Protection against SARS-CoV-2 after Covid-19 Vaccination and Previous Infection. N Engl J Med. 2022 Mar 31;386(13):1207-1220. doi: 10.1056/NEJMoa2118691. Epub 2022 Feb 16. PMID: 35172051; PMCID: PMC8908850.
30. 30. Nordström P, Ballin M, Nordström A. Risk of infection, hospitalisation, and death up to 9 months after a second dose of COVID-19 vaccine: a retrospective, total population cohort study in Sweden. Lancet. 2022 Feb 26;399(10327):814-823. doi: 10.1016/S0140-6736(22)00089-7. Epub 2022 Feb 4. PMID: 35131043; PMCID: PMC8816388.
31. 31. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020 May;8(5):475-481. doi: 10.1016/S2213-2600(20)30079-5. Epub 2020 Feb 24. Erratum in: Lancet Respir Med. 2020 Apr;8(4):e26. doi: 10.1016/S2213-2600(20)30103-X. PMID: 32105632; PMCID: PMC7102538.
32. 32. Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020 Apr 28;323(16):1612-1614. doi: 10.1001/jama.2020.4326. PMID: 32191259; PMCID: PMC7082763.
33. 33. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11. Erratum in: Lancet. 2020 Mar 28;395(10229):1038. doi: 10.1016/S0140-6736(20)30606-1. Erratum in: Lancet. 2020 Mar 28;395(10229):1038. doi: 10.1016/S0140-6736(20)30638-3. PMID: 32171076; PMCID: PMC7270627.