Spinal cord injury after covid vaccination

The association between acute transverse myelitis and COVID-19 vaccination in Korea

https://onlinelibrary.wiley.com/doi/10.1111/ene.70020

Acute transverse myelitis (ATM) has been reported as a potential association between COVID-19 vaccination.

https://pubmed.ncbi.nlm.nih.gov/38350768/

Results

368 ATM cases diagnosed after first COVID-19 vaccination during the study period (159 ATM patients were included).

Among them, 82 (51.6%) were male

The incidence rate ratio (IRR) was 2.41,

for the ATM risk within 1–42 days after COVID-19 vaccination.

The IRR (Incidence Rate Ratio)

3.31 for ChAdOx1-S (AZ)

1.99 for BNT162b2 (Pfizer)

2.57 for mRNA-1273 (Moderna)

3.33 for Ad26.COV2.S (Janssen)

Methods

A self-controlled case series study

https://www.bmj.com/content/354/bmj.i4515

Large database that combines the COVID-19 vaccine registry and the national claims database.

The COVID-19 vaccination

Data, information on individuals aged 18 + who received COVID-19 vaccination from February 26, 2021, to August 31, 2022.

Patients who developed acute transverse myelitis

The claims database covered the entire Korean population

Patients who develop ATM within 1–42 days following COVID-19 vaccination

The observation period was 270 days after the first dose of the COVID-19 vaccine.

Conclusion

These findings indicated an increased risk of ATM following COVID-19 vaccination within 42 days.

An association with the risk of ATM was found both for viral vector and mRNA vaccines.

Acute transverse myelitis (ATM)

A rare neurological disorder

Inflammation of the spinal cord

Can lead to sensory and motor deficits, paralysis, severe disability, autonomic loss

The causes of ATM are uncertain; however, it is known to be associated with autoimmunity triggered by various environmental factors, including vaccination.

DISCUSSION

This nationwide population-based SCCS study identified a significant increase in the incidence of ATM within 1–42 days following COVID-19 vaccination.

Our findings contribute to the ongoing debate on the safety profiles of COVID-19 vaccines by providing evidence of potential neurological complications.

The pathogenesis of TM appears to be immune-mediated from infection, para-infection, and autoimmune disease

Post-vaccination TM may be associated with various types of immune pathways, including autoimmune

It is generally accepted that post-vaccinal CNS demyelination occurs after 7 days post-vaccination

In the case of mRNA-based COVID-19 vaccines, an immunological reaction between SARS-CoV-2 spike protein antibodies and tissue proteins may contribute to the development of demyelinating autoimmune disease

Previous literature has not drawn conclusions as clear as our findings because most earlier studies relied on voluntary AE reporting data from countries such as the United States and the UK.

However, these reports often have problems of underreporting, and inconsistencies in data quality, which can lead to bias.

Our analysis benefits from South Korea's robust healthcare infrastructure, which boasts a high density of MRI machines.

This could potentially explain some of the discrepancies observed between our results and those from studies conducted in other settings.

CONCLUSION

Our findings indicate an increased risk of ATM following COVID-19 vaccination regardless of whether it is a viral vector and mRNA vaccine.

Physicians should exercise caution regarding the possibility of ATM following vaccination

An emerging pattern

Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection

https://onlinelibrary.wiley.com/servlet/linkout?suffix=null&dbid=8&doi=10.1111%2Fene.70020&key=34697502&getFTLinkType=true&doiForPubOfPage=10.1111%2Fene.70020&refDoi=10.1038%2Fs41591-021-01556-7&linkType=PMID&linkSource=FULL_TEXT&linkLocation=Reference

Emerging reports of rare neurological complications associated with COVID-19 infection and vaccinations are leading to regulatory, clinical and public health concerns.

Acute Transverse Myelitis after COVID-19 Vaccination

https://pubmed.ncbi.nlm.nih.gov/34684047/#full-view-affiliation-1

The adverse effects of the COVID-19 vaccine have been discovered as the rapid application of the vaccines continues. Neurological complications such as transverse myelitis raise concerns as cases were observed in clinical trials.

Overview of Transverse Myelitis after COVID-19 vaccination

https://www.lareb.nl/Knowledge/FilePreview?id=42797&p=33550

Until January 16th 2023, The Netherlands Pharmacovigilance Centre received 48 reports of TM following COVID-19 vaccination.

Neurological side effects of SARS-CoV-2 vaccinations

https://onlinelibrary.wiley.com/servlet/linkout?suffix=null&dbid=8&doi=10.1111%2Fene.70020&key=34750810&getFTLinkType=true&doiForPubOfPage=10.1111%2Fene.70020&refDoi=10.1111%2Fane.13550&linkType=PMID&linkSource=FULL_TEXT&linkLocation=Reference

The most frequent neurological side effects of SARS-CoV-2 vaccines are headache, Guillain-Barre syndrome (GBS), venous sinus thrombosis (VST), and transverse myelitis.

A systematic review of cases of CNS demyelination following COVID-19 vaccination

https://onlinelibrary.wiley.com/servlet/linkout?suffix=null&dbid=8&doi=10.1111%2Fene.70020&key=34839149&getFTLinkType=true&doiForPubOfPage=10.1111%2Fene.70020&refDoi=10.1016%2Fj.jneuroim.2021.577765&linkType=PMID&linkSource=FULL_TEXT&linkLocation=Reference

Majority of cases (71.8%) occurred after the first dose of the vaccine,

with neurological symptoms manifesting after a median of 9 days.
The most common reported presentation was transverse myelitis

Transverse Myelitis Following SARS-CoV-2 Vaccination: A Pharmacoepidemiological Study in the World Health Organization's Database

https://onlinelibrary.wiley.com/servlet/linkout?suffix=null&dbid=8&doi=10.1111%2Fene.70020&key=36054163&getFTLinkType=true&doiForPubOfPage=10.1111%2Fene.70020&refDoi=10.1002%2Fana.26494&linkType=PMID&linkSource=FULL_TEXT&linkLocation=Reference

TM was significantly associated both with the messenger ribonucleic acid (mRNA) and vector-based SARS-CoV-2 vaccines that are authorized by the FDA or the EMA.