Good recovery of immunization stress-related responses presenting as a cluster of stroke-like events following CoronaVac and ChAdOx1 vaccinations

Metha Apiwattanakul; Narupat Suanprasert; Arada Rojana-Udomsart; Thanes Termglinchan; Chaichana Sinthuwong; Tasanee Tantirittisak; Suchat Hanchaiphiboolkul; Pantep Angchaisuksiri; Suphot Srimahachota; Jurai Wongsawat; Somjit Stiudomkajorn; Sasisopin Kiertiburanakul; Chonnamet Techasaensiri; Wannada Laisuan; Weerawat Manosuthi; Pawinee Doungngern; Wereyarmarst Jaroenkunathum; Teeranart Jivapaisarnpong; Apinya Panjangampatthana; Jirapa Chimmanee; Kulkanya Chokephaibulkit

doi:10.1371/journal.pone.0266118

Good recovery of immunization stress-related responses presenting as a cluster of stroke-like events following CoronaVac and ChAdOx1 vaccinations

PLoS One. 2022 Aug 25;17(8):e0266118. doi: 10.1371/journal.pone.0266118. eCollection 2022.

Authors

Metha Apiwattanakul^{1

2}, Narupat Suanprasert¹, Arada Rojana-Udomsart¹, Thanes Termglinchan¹, Chaichana Sinthuwong¹, Tasanee Tantirittisak¹, Suchat Hanchaiphiboolkul¹, Pantep Angchaisuksiri^{2

3}, Suphot Srimahachota^{2

4}, Jurai Wongsawat^{2

5}, Somjit Stiudomkajorn^{2

6}, Sasisopin Kiertiburanakul^{2

3}, Chonnamet Techasaensiri^{2

7}, Wannada Laisuan^{2

8}, Weerawat Manosuthi^{2

5}, Pawinee Doungngern^{2

9}, Wereyarmarst Jaroenkunathum^{2

10}, Teeranart Jivapaisarnpong^{2

11}, Apinya Panjangampatthana^{2

9}, Jirapa Chimmanee^{2

9}, Kulkanya Chokephaibulkit^{2

12

13}

Affiliations

¹ Department of Neurology, Neurological Institute of Thailand, Ministry of Public Health, Nonthaburi, Thailand.
² Department of Disease Control, the National AEFI Committee, Ministry of Public Health, Nonthaburi, Thailand.
³ Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁴ Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
⁵ Department of Diseases Control, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi, Thailand.
⁶ Division of Neurology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Ministry of Public Health, College of Medicine, Rangsit University, Bangkok, Thailand.
⁷ Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁸ Division of Allergy Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁹ Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
¹⁰ Department of Medical Sciences, Institute of Biological Products, Ministry of Public Health, Nonthaburi, Thailand.
¹¹ National Biopharmaceutical Facility, King Mongkut's University of Technology Thonburi, Bangkok, Thailand.
¹² Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹³ Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Abstract

Background: Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand.

Methods: We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site.

Results: Overall, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28-42) years in patients receiving CoronaVac and 46 (33.5-60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16-960) min and 30 (8.8-750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability).

Conclusions: Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.

MeSH terms

Adult
COVID-19 Vaccines* / adverse effects
COVID-19* / prevention & control
ChAdOx1 nCoV-19
Female
Humans
Male
Middle Aged
Retrospective Studies
Stroke* / chemically induced
Thailand
Vaccination / adverse effects

Substances

COVID-19 Vaccines
CoronaVac vaccine
ChAdOx1 nCoV-19

Grants and funding

This study is funded the National Research Council of Thailand Year 2021 grant No. 74/2564. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.