While the 2019 coronavirus vaccine (COVID-19) is currently being rolled out, some vaccine recipients are experiencing adverse reactions (AEs), one of which involves a delay large local.
This particular reaction is characterized by pain and swelling in the upper arm located at the site of the injection appearing 7 to 8 days after the injection. Although this side effect is commonly referred to as “COVID arm,” experts warn against this term as the reaction is not caused by COVID-19, but by its vaccine.
Esther Freeman, MD, director of global health dermatology at Massachusetts General Hospital, Boston, Massachusetts spoke Dermatology Times® about her case series recently published in the New England Journal of Medicine (NEJM)1 in terms of these delayed reactions. She suggested calling this delayed reaction “a vaccine arm. ”She added that while most reports of this effect have been seen in Moderna patients (mRNA-1273), this reaction has also been seen in a few people who have received the Pfizer mRNA vaccine.
“People were expecting to see local site injections after vaccinations. What is surprising is that, with Moderna, people see skin reactions to the vaccine arm appear not within hours or days of injection, but instead 8 days after sin. It surprised everyone this delay when it started. “
Freeman said these reactions are not troubling and usually go away on their own. Other treatments recommended for the reaction include topical steroids and oral antihistamines.
In the case series, researchers looked at 12 patients who received a single dose of the mRNA-1273 vaccine and gave a “vaccine arm” with a median start at day 8 (range, 4 to 11 days).
The report said most patients received treatment for their symptoms that included ice and antihistamines. Meanwhile, other patients were treated with glucocorticoids (topical, oral, or both), and 1 patient received antibiotics for cellulitis suspicion. Overall, patient symptoms were resolved within 6 days after onset (range, 2 to 11 days).1
Researchers also performed a biopsy on a patient with a “vaccine arm” who was not part of the other 12 patients for suspected delayed-type or T-cell hypersensitivity, and results were consistent with delayed cutaneous hypersensitivity, according to Freeman .
“I think it’s important for people to know that this is not the only reaction we see in Moderna, but I think this is one of the reactions. most surprising, and I think it was also a subversion in the Moderna test, ”Freeman said.
She said, “I think the other reason it’s important for people to recognize this reaction is that some patients have been treated unnecessarily with antibiotics, because people thought it was this was cellulitis. It’s vital that we can reassure people that this is not a disease, and that it really resolves on its own without antibiotics. ”
GETTING THE SECOND DOSE
Researchers for the case series encouraged all 12 patients to receive a second dose of the mRNA-1273 because there were no local injection site reactions or hypersensitivity reactions of delayed type of vaccination after vaccination. sin.
The report states that half of the patients surveyed did not have recurrence of a “vaccine arm”, and 3 patients had recurrent relapses that were consistent with the reactions. had them after the first dose, and 3 other patients had recurrent reactions that were less severe than the following. the first dose. Researchers also saw an earlier onset of recurrent reactions after the second dose with a median onset of 2 days (range, 1 to 3 days).1
“It really addresses the concern with both patients and providers after seeing this reaction after a single dose,” Freeman said. “I think people were very worried that it was going to lead to anaphylaxis or something harder. With a dose of two, it was completely different, only half of people got it a second time, and if you got it, it wouldn’t be that hard. Therefore, we encourage patients to go ahead and receive a second dose. ”
MANAGING PATIENT RESULTS
When it comes to managing patient expectations at a time when misinformation and conspiracies are running rampant regarding COVID-19 and vaccination, it can be difficult to communicate with patients the importance of vaccinated and express their concerns.
Freeman urges health care professionals (HCPs) to try to understand why the patient is particularly concerned about the vaccine to address their origins.
“There are a lot of good resources around the idea of vaccine hesitancy, both from the CDC and elsewhere. We need to try to understand where patients come from. People have legitimate concerns about vaccines, and it is important to acknowledge that their background or history or that of their friends or family members is a reflection of their concerns, ”said Freeman. “So I think the first step is to understand everyone’s concerns, and why they are concerned, so that you can address it specifically. You may not be able to change their appearance just once, but it can be a way to encourage vaccination. ”
However, when side effects are the patient’s primary concern, such as “vaccine arm,” Freeman suggests that HCPs communicate by balancing the risk of these temporary and uncomfortable side effects compared to the risk of getting COVID which can lead to a bad result.
PEDIATRIC PATIENTS AND THE VACCINE
Moderna recently announced that they had provided their first participants in a phase 2/3 study (KidCOVE) examining the mRNA-1273 vaccine in pediatric patients as young as 6 months his age.2
“We are encouraged by the main study of the COVE Phase 3 study of mRNA-1273 in adults aged 18 and over and this pediatric study will help us assess the potential safety and immunogenicity of our COVID-19 vaccine candidate in this important young age population. , ”Sterphane Bancel, CEO of Moderna said in a press release.2
With the news that a “vaccine arm” is circulating, this may prevent some people from being vaccinated despite the mild side effects.
“I think time with these tests will take time to see what kind of reactions there are and how they differ in children. But I would not expect skin side effects per se to be particularly contraindicated in children, ”said Freeman.
Those receiving any side effects from the vaccine are encouraged to report them to the CDC ‘s Vaccine Adverse Event Reporting System (VAERS) system. For health care providers with patients suffering from cut-off side effects in particular, health care providers are encouraged to enter the vaccine response cases into the AAD / ILDS COVID-19 Dermatology Register.
References:
1. Blumenthal KG, Freeman EE, Saff RR, et al. Delay major local reactions to mrna-1273 vaccine against sars-cov-2. New England Journal of Medicine. 2021; 0 (0): null. doi: 10.1056 / NEJMc2102131
2. Moderna names first dosed participants in phase 2/3 study of covid-19 vaccine candidate in pediatric population | moderna, inc. Accessed 18 March 2021. https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-first-participants-dosed-phase-23-study-0/