Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

Colin R. Simpson; Steven Kerr; Srinivasa Vittal Katikireddi; Colin McCowan; Lewis D. Ritchie; Jiafeng Pan; Sarah J. Stock; Igor Rudan; Ruby S. M. Tsang; Simon de Lusignan; F. D. Richard Hobbs; Ashley Akbari; Ronan A. Lyons; Chris Robertson; Aziz Sheikh

doi:10.1038/s41467-022-32264-6

Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

Colin R. Simpson^*, Steven Kerr, Srinivasa Vittal Katikireddi, Colin McCowan, Lewis D. Ritchie, Jiafeng Pan, Sarah J. Stock, Igor Rudan, Ruby S. M. Tsang, Simon de Lusignan, F. D. Richard Hobbs, Ashley Akbari, Ronan A. Lyons, Chris Robertson, Aziz Sheikh^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

5 Downloads (Pure)

Abstract

We investigated thrombocytopenic, thromboembolic and hemorrhagic events following a second dose of ChAdOx1 and BNT162b2 using a self-controlled case series analysis. We used a national prospective cohort with 2.0 million(m) adults vaccinated with two doses of ChAdOx or 1.6 m with BNT162b2. The incidence rate ratio (IRR) for idiopathic thrombocytopenic purpura (ITP) 14–20 days post-ChAdOx1 second dose was 2.14, 95% confidence interval (CI) 0.90–5.08. The incidence of ITP post-second dose ChAdOx1 was 0.59 (0.37–0.89) per 100,000 doses. No evidence of an increased risk of CVST was found for the 0–27 day risk period (IRR 0.83, 95% CI 0.16 to 4.26). However, few (≤5) events arose within this risk period. It is perhaps noteworthy that these events all clustered in the 7–13 day period (IRR 4.06, 95% CI 0.94 to 17.51). No other associations were found for second dose ChAdOx1, or any association for second dose BNT162b2 vaccination. Second dose ChAdOx1 vaccination was associated with increased borderline risks of ITP and CVST events. However, these events were rare thus providing reassurance about the safety of these vaccines. Further analyses including more cases are required to determine more precisely the risk profile for ITP and CVST after a second dose of ChAdOx1 vaccine.

Original language	English
Article number	4800
Number of pages	7
Journal	Nature Communications
Volume	13
DOIs	https://doi.org/10.1038/s41467-022-32264-6
Publication status	Published - 15 Aug 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1038/s41467-022-32264-6Licence: CC BY

Simpson_2022_NatComms_Second-dose_CC
Copyright © The Author(s) 2022. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Final published version, 754 KBLicence: CC BY

Cite this

Simpson, C. R., Kerr, S., Katikireddi, S. V., McCowan, C., Ritchie, L. D., Pan, J., Stock, S. J., Rudan, I., Tsang, R. S. M., de Lusignan, S., Hobbs, F. D. R., Akbari, A., Lyons, R. A., Robertson, C., & Sheikh, A. (2022). Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nature Communications, 13, Article 4800. https://doi.org/10.1038/s41467-022-32264-6

@article{d89e350a3c0c426d8155bc034ee860f9,

title = "Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland",

abstract = "We investigated thrombocytopenic, thromboembolic and hemorrhagic events following a second dose of ChAdOx1 and BNT162b2 using a self-controlled case series analysis. We used a national prospective cohort with 2.0 million(m) adults vaccinated with two doses of ChAdOx or 1.6 m with BNT162b2. The incidence rate ratio (IRR) for idiopathic thrombocytopenic purpura (ITP) 14–20 days post-ChAdOx1 second dose was 2.14, 95% confidence interval (CI) 0.90–5.08. The incidence of ITP post-second dose ChAdOx1 was 0.59 (0.37–0.89) per 100,000 doses. No evidence of an increased risk of CVST was found for the 0–27 day risk period (IRR 0.83, 95% CI 0.16 to 4.26). However, few (≤5) events arose within this risk period. It is perhaps noteworthy that these events all clustered in the 7–13 day period (IRR 4.06, 95% CI 0.94 to 17.51). No other associations were found for second dose ChAdOx1, or any association for second dose BNT162b2 vaccination. Second dose ChAdOx1 vaccination was associated with increased borderline risks of ITP and CVST events. However, these events were rare thus providing reassurance about the safety of these vaccines. Further analyses including more cases are required to determine more precisely the risk profile for ITP and CVST after a second dose of ChAdOx1 vaccine.",

author = "Simpson, {Colin R.} and Steven Kerr and Katikireddi, {Srinivasa Vittal} and Colin McCowan and Ritchie, {Lewis D.} and Jiafeng Pan and Stock, {Sarah J.} and Igor Rudan and Tsang, {Ruby S. M.} and {de Lusignan}, Simon and Hobbs, {F. D. Richard} and Ashley Akbari and Lyons, {Ronan A.} and Chris Robertson and Aziz Sheikh",

note = "EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004], which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. This research is part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20058). Additional support has been provided through Public Health Scotland and Scottish Government DG Health and Social Care. FDRH acknowledges part support as Director of the NIHR Applied Research Collaboration (ARC) Oxford Thames Valley, and Theme Lead of the NIHR OUH BRC.",

year = "2022",

month = aug,

day = "15",

doi = "10.1038/s41467-022-32264-6",

language = "English",

volume = "13",

journal = "Nature Communications",

issn = "2041-1723",

publisher = "Nature publishing group",

}

Simpson, CR, Kerr, S, Katikireddi, SV, McCowan, C, Ritchie, LD, Pan, J, Stock, SJ, Rudan, I, Tsang, RSM, de Lusignan, S, Hobbs, FDR, Akbari, A, Lyons, RA, Robertson, C & Sheikh, A 2022, 'Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland', Nature Communications, vol. 13, 4800. https://doi.org/10.1038/s41467-022-32264-6

TY - JOUR

T1 - Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

AU - Simpson, Colin R.

AU - Kerr, Steven

AU - Katikireddi, Srinivasa Vittal

AU - McCowan, Colin

AU - Ritchie, Lewis D.

AU - Pan, Jiafeng

AU - Stock, Sarah J.

AU - Rudan, Igor

AU - Tsang, Ruby S. M.

AU - de Lusignan, Simon

AU - Hobbs, F. D. Richard

AU - Akbari, Ashley

AU - Lyons, Ronan A.

AU - Robertson, Chris

AU - Sheikh, Aziz

N1 - EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004], which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. This research is part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20058). Additional support has been provided through Public Health Scotland and Scottish Government DG Health and Social Care. FDRH acknowledges part support as Director of the NIHR Applied Research Collaboration (ARC) Oxford Thames Valley, and Theme Lead of the NIHR OUH BRC.

PY - 2022/8/15

Y1 - 2022/8/15

N2 - We investigated thrombocytopenic, thromboembolic and hemorrhagic events following a second dose of ChAdOx1 and BNT162b2 using a self-controlled case series analysis. We used a national prospective cohort with 2.0 million(m) adults vaccinated with two doses of ChAdOx or 1.6 m with BNT162b2. The incidence rate ratio (IRR) for idiopathic thrombocytopenic purpura (ITP) 14–20 days post-ChAdOx1 second dose was 2.14, 95% confidence interval (CI) 0.90–5.08. The incidence of ITP post-second dose ChAdOx1 was 0.59 (0.37–0.89) per 100,000 doses. No evidence of an increased risk of CVST was found for the 0–27 day risk period (IRR 0.83, 95% CI 0.16 to 4.26). However, few (≤5) events arose within this risk period. It is perhaps noteworthy that these events all clustered in the 7–13 day period (IRR 4.06, 95% CI 0.94 to 17.51). No other associations were found for second dose ChAdOx1, or any association for second dose BNT162b2 vaccination. Second dose ChAdOx1 vaccination was associated with increased borderline risks of ITP and CVST events. However, these events were rare thus providing reassurance about the safety of these vaccines. Further analyses including more cases are required to determine more precisely the risk profile for ITP and CVST after a second dose of ChAdOx1 vaccine.

AB - We investigated thrombocytopenic, thromboembolic and hemorrhagic events following a second dose of ChAdOx1 and BNT162b2 using a self-controlled case series analysis. We used a national prospective cohort with 2.0 million(m) adults vaccinated with two doses of ChAdOx or 1.6 m with BNT162b2. The incidence rate ratio (IRR) for idiopathic thrombocytopenic purpura (ITP) 14–20 days post-ChAdOx1 second dose was 2.14, 95% confidence interval (CI) 0.90–5.08. The incidence of ITP post-second dose ChAdOx1 was 0.59 (0.37–0.89) per 100,000 doses. No evidence of an increased risk of CVST was found for the 0–27 day risk period (IRR 0.83, 95% CI 0.16 to 4.26). However, few (≤5) events arose within this risk period. It is perhaps noteworthy that these events all clustered in the 7–13 day period (IRR 4.06, 95% CI 0.94 to 17.51). No other associations were found for second dose ChAdOx1, or any association for second dose BNT162b2 vaccination. Second dose ChAdOx1 vaccination was associated with increased borderline risks of ITP and CVST events. However, these events were rare thus providing reassurance about the safety of these vaccines. Further analyses including more cases are required to determine more precisely the risk profile for ITP and CVST after a second dose of ChAdOx1 vaccine.

U2 - 10.1038/s41467-022-32264-6

DO - 10.1038/s41467-022-32264-6

M3 - Article

SN - 2041-1723

VL - 13

JO - Nature Communications

JF - Nature Communications

M1 - 4800

ER -

Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

Abstract

UN SDGs

Access to Document

Fingerprint

Cite this