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Anxiety-driven post-vaccination concerns in the pediatric emergency department

  • Daniel Tsung-Ning Huang
    Correspondence
    No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.
    Affiliations
    Department of Pediatric Infectious Diseases, MacKay Children's Hospital, New Taipei City, Taiwan
    Department of Medicine, MacKay Medicine College, New Taipei City, Taiwan
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Open AccessPublished:October 26, 2022DOI:https://doi.org/10.1016/j.pedneo.2022.10.003
      The Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) received emergency use authorization (EUA) approval from the U.S. Food and Drug Administration in May 2021 for the prevention of coronavirus disease 2019 (COVID-19), which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), to include adolescents aged 12–15 years.
      U.S. Food and Drug Administration
      The United States. Coronavirus (COVID-19) update: FDA authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in adolescents in another important action in fight against pandemic.
      In this age group, the premarketing clinical trial revealed that it had a decent safety profile and 100% vaccination effectiveness (95% CI, 75.3–100).
      • Frenck Jr., R.W.
      • Klein N.P.
      • Kitchin N.
      • Gurtman A.
      • Absalon J.
      • Lockhart S.
      • et al.
      Safety, immunogenicity, and efficacy of the BNT162b2 covid-19 vaccine in adolescents.
      Those who were eligible would get two doses of the BNT162b2 vaccine, each 30 mg, with an interval of at least 21 days.
      Although COVID-19 infections in teenagers are typically less severe than those in adults, serious symptoms can still develop in this population, particularly in individuals with underlying medical issues.
      • Tsabouri S.
      • Makis A.
      • Kosmeri C.
      • Siomou E.
      Risk factors for severity in children with coronavirus disease 2019: a comprehensive literature review.
      Following infection with the SARS-CoV-2, this group is also susceptible to multisystem inflammatory syndrome, which further encourages the requirement for immunization.
      • Radia T.
      • Williams N.
      • Agrawal P.
      • Harman K.
      • Weale J.
      • Cook J.
      • et al.
      Multi-system inflammatory syndrome in children & adolescents (MIS-C): a systematic review of clinical features and presentation.
      Thus, many countries have swiftly included adolescents aged 12–18 years to their BNT162b2 immunization programs, with Singapore being one of the first to do so.
      A few months after the EUA of BNT162b2 for usage in adolescents, Krug et al. reviewed the data from the Vaccine Adverse Event Reporting System in the USA and reported that the incidence of myo/pericarditis following the second dose in male patients were 162.2 (ages 12–15) and 93.0 (ages 16–17) per million.
      • Krug A.
      • Stevenson J.
      • Høeg T.B.
      BNT162b2 vaccine-associated myo/pericarditis in adolescents: a stratified risk-benefit analysis.
      The report stirred up the fear of vaccine side effects. Following the COVID-19 vaccination, there was an increase in the frequency of visits to the pediatric emergency department (PED), along with a few other factors. These visits seem to be brought on by worry or negative effects from the vaccine.
      Ng et al.
      • Ng N.B.H.
      • Appleby G.F.
      • Thong X.Y.
      • Ong S.K.A.
      • Hii S.Z.W.
      • Tan I.K.Z.
      • et al.
      COVID-19 vaccination-related attendance at a pediatric emergency department in Singapore among 12- to 18-year old adolescents.
      describe their findings on the rate of COVID-19 vaccine-related visits to a PED in this issue of Pediatrics and Neonatology to comprehend teenage health behaviors following vaccination. From the start of the teenage vaccination drive until at least 85% of this cohort had received all recommended vaccinations, the authors retrospectively reviewed the electronic medical records across a 4-month period. Of the 291 PED attendances associated with vaccinations, 88% had mild presentations. Moreover, patients with moderate-to-severe presentations tended to be older (+0.7 years, p = 0.030), more likely to have underlying medication allergies (p = 0.048), and more likely to be hospitalized (p = 0.005) than patients with mild presentations. Furthermore, all cases of severe presentations were self-limiting, and patients did not experience any irreversible function loss. Moreover, 171 vaccination-related PED attendances (42.1% women) were complaints of chest pain, but only four patients (all men) were diagnosed with myo/pericarditis. Their data support the safety of the BNT162b2 vaccine in adolescents aged 12–18 years. Common side effects include rash, angioedema, dyspnea, palpitations, chest tightness, fever, light-headedness, and syncope.
      The study is a scaled-down version of the COVID-19 vaccine adverse effects reporting platform, which may detect major adverse events and reflect health-seeking behaviors motivated by anxiety about receiving the immunization for COVID-19. The authors’ phrase “post-vaccine phenomena” refers to the surge in post-vaccination complaints to the PED. Most post-vaccination concerns are related to anxiety, and symptoms resolve on their own. During the study period, the daily incidence of post-vaccination phenomena was as high as 15.4%, which may have had an effect on how well the hospital department operated.
      The author made the argument that the widespread fear was caused by the media's dissemination of false information about the negative effects of COVID-19 vaccines. However, the post-vaccine phenomenon appears to be unavoidable considering the media influence.

      Declaration of competing interest

      I have no conflict of interest to disclose.

      References

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        Safety, immunogenicity, and efficacy of the BNT162b2 covid-19 vaccine in adolescents.
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