• 大数据在商业分析和市场预测中发挥着关键作用。
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  • 健康饮食和生活方式的推广正在成为社会趋势。
  • 太空探索的商业化为航天产业带来了新的投资和创新。
  • 在线教育的兴起为教育资源的公平分配提供了新途径。
  • 农业科技的进步正在提高粮食生产效率。
  • 随着全球对COVID-19疫苗接种的推进,经济复苏成为各国政府的首要任务。
  • 在线教育的普及使得知识获取更加便捷,但也引发了公平性问题。
  • 随着全球对COVID-19疫苗接种的推进,经济复苏成为各国政府的首要任务。
  • 随着技术的发展,智能家居和自动化生活正在成为现实。
  • 生物技术的进步为疾病治疗和健康管理带来了新的希望。
  • 电子商务的增长推动了物流行业的创新和发展。
  • 太空探索的商业化为航天行业带来了新的机遇。
  • 随着环保意识的提高,可持续消费成为新的消费趋势。
  • 随着人口老龄化,对老年护理服务的需求不断增长。
  • 电动汽车市场的快速增长推动了全球能源结构的转型。
  • 虚拟现实技术在教育和娱乐领域的应用越来越广泛。
  • 在线健身和虚拟健身课程在疫情期间迅速流行。
  • 随着环保意识的提高,可持续消费成为新的消费趋势。
  • 随着自动驾驶技术的发展,交通系统的变革指日可待。
  • 5G技术的推广为智能设备和物联网带来了新的机遇。
  • 气候变化引发的极端天气事件频发,全球减排行动迫在眉睫。
  • 社交媒体的算法透明度问题引起了公众的广泛关注。
  • 随着健康意识的提高,运动科技和穿戴设备市场正在快速增长。
  • 生物技术在医药领域的应用为治疗复杂疾病提供了新的可能性。
  • Arthritis as an adverse event of special interest post COVID-19 vaccine implementation | Teo | Aging Pathobiology and Therapeutics
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    Open Access | Letter to Editor
    This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

    Arthritis as an adverse event of special interest post COVID-19 vaccine implementation


    Shyh Poh Teoa,*

    a Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan, Brunei Darussalam.

    * Corresponding author: Shyh Poh Teo
    Mailing address: Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan, BA1710, Brunei Darussalam.
    E-mail: shyhpoh.teo@moh.gov.bn

    Received: 10 February 2021 / Accepted: 12 March 2021

    DOI: 10.31491/APT.2021.03.050

    COVID-19 vaccines are currently in development or being rolled out as a public health response to manage the pandemic. While vaccines selected for mass public immunization programs would have demonstrated safety and efficacy in Phase 3 trials, vaccine safety monitoring including reporting of adverse events following immunization (AEFI) and investigation of reported cases are still required for safety surveillance. Monitoring of AEFI post COVID-19 vaccination is quite relevant to clinicians. All clinicians play a role in reporting suspected AEFI to national pharmacovigilance centers. These reports are submitted to Vigibase, the World Health Organisation’s database of adverse drug reactions, which is utilized for international safety signal detection. This approach for vaccine safety monitoring is of particular importance for COVID-19 vaccines, given the rapid implementation via Emergency Use Authorisation and the planned administration to large populations over a short period of time [1].
    For some AEFI, it may be intuitive that the adverse event was a direct consequence of the vaccination. For example, a case report described a patient presenting with an acutely painful right shoulder after receiving a Pneumovax injection. The pseudo skeptic arthritis was postulated to have developed from an accidental intra-articular administration, given the proximity of deltoid injections to the glenohumeral joint [2].
    However, some AEFI may not be easily attributable to vaccinations and may manifest as possibly unrelated conditions. Clinicians should have a low threshold to report suspected AEFI, as this may lead to signal detection and trigger further investigations and causality assessment. This was previously experienced with the rubella vaccine. In 1991, the Institute of Medicine reviewed a wide range of information sources and published a report concluding a causal relationship between the rubella vaccine with acute and chronic arthritis in adult women [3]. Subsequent to this, claims for chronic arthropathy post-rubella vaccination were submitted to the National Vaccine Injury Compensation Programme. The majority of the claims were for symptoms between one and six weeks after vaccination, ranging from arthralgia and fibromyalgia to multiple symptoms with minimal arthralgia or myalgia [4].
    While a large retrospective cohort study did not find any associated risk for new-onset chronic arthropathies in women receiving the RA27/3 rubella vaccine [5], idiosyncratic reactions are usually rare and identified during postmarketing surveillance. A systematic review evaluating the association between vaccinations to incident arthritis or worsening of arthritis conditions found that studies were also quite heterogenous and incomplete for rigorous causality assessment to be performed [6].
    Due to this previous experience, acute aseptic arthritis was identified as an Adverse Event of Special Interest (AESI). For clinicians, this means that cases of acute aseptic arthritis warrant reporting to national pharmacovigilance centers, particularly if there is a temporal relationship to receiving a COVID-19 vaccine. The case definition for acute aseptic arthritis and a guideline template for reporting is available from the Brighton Collaboration [7]. In addition to arthritis, there are also frequently reported autoimmune manifestations post-vaccination, such as vasculitis, encephalitis, thrombocytopenia and Guillain-Barre syndrome. However, it should be noted that controlled studies of autoimmunity following viral vaccines did not identify evidence of an association Overall, while the occurrence of arthritis and autoimmune [8].
    conditions after vaccines remain controversial, clinicians should report all suspected AEFI. Acute aseptic arthritis constitutes an AESI, which should be reported as part of vaccine safety surveillance for COVID-19 vaccine recipients. These will contribute towards signal detection and trigger further investigations if warranted.

    Declaration

    Conflict of interest

    The author declares no conflict of interest.

    References

    1. World Health Organization. Covid-19 vaccines: safety surveillance manual. 2020. Available on: https://www. who.int/vaccine_safety/committee/Module_Stakeholders.pdf?ua=1

    2. McColgan B P, Borschke F A. Pseudoseptic arthritis after accidental intra-articular deposition of the pneumococcal polyvalent vaccine: a case report. The American journal of emergency medicine, 2007, 25(7): 864. e1-864. e3.

    3. Howson C P, Fineberg H V. Adverse events following pertussis and rubella vaccines: summary of a report of the Institute of Medicine. Jama, 1992, 267(3): 392-396.

    4. Weibel R E, Benor D E. Chronic arthropathy and musculoskeletal symptoms associated with rubella vaccines. A review of 124 claims submitted to the National Vaccine Injury Compensation Program. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 1996, 39(9): 1529-1534.

    5. Ray P, Black S, Shinefield H, et al. Risk of chronic arthropathy among women after rubella vaccination. Jama, 1997, 278(7): 551-556.

    6. Panozzo C A, Pourmalek F, Pernus Y B, et al. Arthritis and arthralgia as an adverse event following immunization: A systematic literature review. Vaccine, 2019, 37(2): 372-383.

    7. Woerner A, Pourmalek F, Panozzo C, et al. Acute aseptic arthritis: case definition and guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine, 2019, 37(2): 384-391.

    8. Schattner A. Consequence or coincidence?: The occurrence, pathogenesis and significance of autoimmune manifestations after viral vaccines. Vaccine, 2005, 23(30): 3876-3886.




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