Vaccine-Associated Disease Enhancement (VADE): Considerations in Postvaccination COVID-19

Rahajeng N Tunjungputri; Erpryta Nurdia Tetrasiwi; Merlinda Veronica; Jacub Pandelaki; Fera Ibrahim; Erni Juwita Nelwan

doi:10.1155/2021/9673453

Vaccine-Associated Disease Enhancement (VADE): Considerations in Postvaccination COVID-19

Case Rep Med. 2021 Oct 29:2021:9673453. doi: 10.1155/2021/9673453. eCollection 2021.

Authors

Rahajeng N Tunjungputri¹, Erpryta Nurdia Tetrasiwi¹, Merlinda Veronica¹, Jacub Pandelaki², Fera Ibrahim³, Erni Juwita Nelwan^{1

4

5}

Affiliations

¹ Department of Internal Medicine, Faculty of Medicine Universitas Indonesia and Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
² Department of Radiology, Faculty of Medicine Universitas Indonesia and Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
³ Microbiology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
⁴ Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia and Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
⁵ Infectious Disease and Immunology Research Center-IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

Abstract

Introduction: The COVID-19 pandemic has entered a new phase with the roll-out of several vaccines worldwide at an accelerated phase. The occurrence of a more severe presentation of COVID-19 after vaccination may affect policymakers' decision-making and vaccine uptake by the public. Vaccine-associated disease enhancement (VADE) is the modified presentation of infections in individuals after having received a prior vaccination. Currently, little is known about the potential of vaccine-associated disease enhancement (VADE) following COVID-19 immunization. Case Illustration. We herewith report two patients admitted with confirmed COVID-19 pneumonia with a history of CoronaVac vaccination. The first patient with a relatively milder course of the disease had received two doses of CoronaVac, whereas the second patient with a more progressive course of the disease received only one dose before developing symptoms and being admitted to the hospital. Our observations suggest that vaccination could act in boosting the inflammatory process and reveal the previously asymptomatic COVID-19 illness. Theoretically, vaccines could induce VADE, where only suboptimal, nonprotective titers of neutralizing antibodies were produced or proinflammatory T-helper type 2 response was induced. Secondly, enhanced respiratory disease (ERD) could manifest, where pulmonary symptoms are more severe due to peribronchial monocytic and eosinophilic infiltration. Understanding VADE is important for the decision-making by the public, clinicians, and policymakers and is warranted for successful vaccination uptake.

Conclusion: We report two cases of patients developing COVID-19 shortly after CoronaVac vaccination in which VADE is likely. We recommend that current vaccination strategies consider the measurement of neutralizing antibody titer as a guide in ensuring the safest strategy for mass immunization. Studies are needed to investigate the true incidence of VADE on vaccinated individuals as well as on how to differentiate between VADE and severe manifestations of COVID-19 that are unrelated to vaccination.

Publication types

Case Reports