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Céleo Ramírez,Ramón Jeremías Soto Hernández,Reyna M. Durón 대한백신학회 2021 Clinical and Experimental Vaccine Research Vol.10 No.3
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is an extremely rare complication associated with the adenovirus-vectored coronavirus disease 2019 (COVID-19) ChAdOx1 nCoV-19 (AZD1222) vaccine. It is characterized by venous thrombosis, mainly cerebral venous sinus thrombosis, moderate to severe thrombocytopenia, and rarely, thrombosis in cerebral arteries. This syndrome is similar to the heparin-induced thrombocytopenia and presents mostly among women aged 18–55 years, without previous exposure to heparin, usually 5 to 20 days after vaccination. However, cases have been reported in men and older adults [1-4]. Unlike COVID-19, this adverse effect might not represent a public health problem in itself, but it is already causing vaccine hesitancy in population groups susceptible to severe COVID-19, and poses a challenge in low resource settings [5]. The first case reports showed evidence that VITT has a mortality around 40% [1-3]. So far, cases have been reported and treated in hospitals of highly developed countries with first-rate health systems that facilitate early detection and treatment of this severe adverse event. VITT is confirmed by using PF4-dependent enzyme-linked immunosorbent assay (ELISA) assay, which allows the differential diagnosis from other causes of thrombosis in patients with a history of ChAdOx1 nCoV-19 vaccination in previous days. However, it is likely that a large number of hospitals in many low-middle income countries do not have approved PF4-dependent ELISA assays for accurate diagnosis, nor immunoglobulins, glucocorticoids, and non-heparin anticoagulants needed for the treatment of this condition [1-4]. In times of this COVID-19 pandemic and precision medicine, problems and solutions should be considered global. Policies related to COVID-19 need to be addressed considering varied public health and socioeconomic contexts. The ChAdOx1 nCoV-19 vaccine is one of the most used vaccines in low-middle income countries, where special testing to confirm VITT is not widely available. Therefore, real figures are unknown, and underreporting of this adverse effect should be considered. Patient information, government, and hospital preparedness in these countries are needed to diagnose and manage VITT adequately, and to reduce morbidity and mortality from this complication. These strategies will have a positive impact on public acceptance and adherence to COVID vaccination.
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