A case of multisystem inflammatory syndrome in an 11-year-old female after COVID-19 inactivated vaccine–2023 Feb 14
Background: Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory, multisystem syndrome temporally associated with SARS-CoV-2, is a rare but serious complication of SARS-CoV-2 infection in children that typically occurs 2–6 weeks after SARS-CoV-2 infection. The pathophysiology of MIS-C is unknown. MIS-C, first recognized in April 2020, is characterized by fever, systemic inflammation, and multi-system organ involvement. Post-vaccination adverse effects have increased with COVID-19 vaccinations, and MIS linked to immunization with COVID-19 vaccines has also been observed.
Case Report: An 11-year-old Chinese girl presented with a high-grade fever, rash, and dry cough for 2 days. She had her 2nd SARS-CoV-2 inactivated vaccination dose five days before hospital admission. On day 3 & 4, she experienced bilateral conjunctivitis, hypotension (66/47 mmHg), and a high CRP level. She was diagnosed with MIS-C. The patient’s condition deteriorated rapidly, necessitating intensive care unit admission. The patient’s symptoms improved after intravenous immunoglobulin, methylprednisolone, and oral aspirin therapy. She was discharged from the hospital after 16 days as her general condition, and laboratory biomarkers returned to normal.
Conclusion: Inactivated Covid-19 vaccination might trigger MIS-C. Further research is needed to evaluate whether a correlation exists between COVID-19 vaccination and MIS-C development
A healthy 11-year-old female presented to the pediatric ward of our hospital 5 days after receiving her second SARS-COV-2 inactivated vaccine (left deltoid) with 3 days of high-grade fever, dry cough, and rash for 2 days. She received her first dose of inactivated SARS-CoV-2 vaccine four weeks before her hospital visit. She denied recent viral infections, previous COVID-19 infection, known contact with patients infected with SARS-COv-2, cutaneous injuries, and international travel., The only medication taken recently was azithromycin, prescribed at the local hospital two days after the onset of the disease. The child’s fever and rash symptoms started before receiving azithromycin. Therefore, a possible adverse drug reaction was not considered. During a physical examination, her body temperature was 39.2 °C, heart rate was 140/min, respiration rate was 26/min, blood pressure was 101/67 mmHg, and oxygen saturation in the ambient atmosphere was 98%. A generalized erythematous pruritic maculopapular rash, cracked lips, strawberry tongue, normal cardiac and lung auscultation; soft abdomen, liver and spleen were not palpable under the ribs; swollen limbs without skin peeling.
The initial laboratory examination upon admission showed a peripheral white blood cell (WBC) count of 5.3*109/l, with neutrophils accounting for 82.2% and lymphocytes for 5.9%; C-Reactive protein (CRP) levels were elevated at 89.8 mg/dl. Nasopharyngeal SARS-CoV-2 RT-PCR was negative; SARS-CoV-2 spike antibody testing was positive; Troponin level and echocardiogram were normal.
On the second day of admission, she experienced bilateral conjunctivitis, enlarged lymph nodes in the neck, edema of both hands and feet. (shown in Figure 1), and abdomen discomfort with nausea. Overall, the patient’s symptoms are similar to those of Kawasaki disease on the third day of hospitalization. We initially suggest diagnosed of Kawasaki disease and the patient received 2 g/kg of intravenous immunoglobulin (IVIG) and 30 mg/kg of oral aspirin. A day later, she was noted to have hypotension (66/47 mmHg), tachycardia, hyperlactatemia, metabolic acidosis, and electrolyte imbalance. In addition, Laboratory tests show her inflammatory markers were increased (Table 1). The white blood cells count was 15.8*109/l, with decreased lymphocyte counts. The CRP level was elevated at 233.3 mg/dl, the troponin (TNI) level was 0.44 ug/l, and the brain natriuretic peptide (BNP) level was 5220 pg/ml. In addition, she had elevated levels of D-dimer, ferritin, interleukin-6 (IL-6), fibrinogen, and hypoproteinemia. An ECG revealed sinus tachycardia and a slight T wave alteration. A transthoracic echocardiogram revealed no abnormality. She was admitted to the pediatric intensive care unit (PICU) for suspected multisystem inflammatory syndrome in children (MIS-C). Potential diagnoses include septic shock, multisystem inflammatory syndrome post COVID-19 vaccine (MIS-V), Mycoplasma pneumonia-induced rash and mucositis/Stevens-Johnson Syndrome (MIRM/SJS), post-viral peri myocarditis, and Macrophage activation syndrome.
What is an Inactivated Vaccine?
There are several types of vaccines that can be used to fight diseases. Inactivated vaccines are composed of dead, or inactivated, viruses and bacteria, and therefore differ from live but attenuated vaccines.
The type of vaccine used can differ depending on the infection in question, how the immune system responds to the pathogen the vaccine will treat, and various practical considerations related to the delivery of the vaccine.
How do inactivated vaccines work?
Many vaccines that are regularly used, such as the MMR vaccines and chickenpox vaccines, are live attenuated vaccines. These vaccines have a weakened version of the live virus, to stop it from causing the disease but to still encourage the production of
How are inactivated vaccines made?
To make an inactivated vaccine, the virus has to be grown in culture media. This can often be an initial limiting step in vaccine production, as producers need to understand what conditions encourage viral growth.
Inactivation of the virus is done with heat. Occasionally, inactivation is done with chemicals such as formalin. When the vaccine under production is fractional, meaning it is protein or polysaccharide-based, the vaccine undergoes further purification so that only the subunits of interest remain.
Inactivated vaccines are another form of vaccine, where the virus is inactivated during the process of making the vaccine.
Inactivated vaccines are not strongly influenced by antibodies in the host body, compared to live vaccines. This means that they can be administered when antibodies are present in the blood, such as during infancy or after being given medication containing antibodies.
Inactivated vaccines cannot replicate and always require repeated doses for immunity to be achieved. The first dose is the one that prepares the immune system to respond, but a protective immune response does not develop until the second or later doses.
Because the virus is dead during the making of the vaccine, they interact with the immune system differently than live, attenuated vaccines. The immune response to live vaccines is similar to encountering the virus itself, whereas inactivated vaccines show little or no cellular immunity. This also means that inactivated vaccines can be used to boost to supplement previous vaccinations.
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Source: PUBMED, Frontiersin,
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