The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context

Huyen A. Tran; Lucy Deng; Nicholas Wood; Philip Choi; Sally Singleton; Lisa Clarke; Sarah Khanlari; Isis Maitland-Scott; Robert Bird; Scott Brown; Bavahuna Manoharan; Chee Wee Tan; Michael Gold; Pravin Hissaria; Shannon Melody; Sanjeev D. Chunilal S; Jim Buttery; Hazel Clothier; Nigel W. Crawford; Linny Phuong; Dominic Pepperell; Paul Effler; Claire Parker; Nicola Carter; Kristine Macartney; Megan McStea; Todd Miller; Michael Nissen; Claire Larter; Elspeth Kay; Vivien M. Chen

The Lancet Regional Health. Western Pacific (Nov 2023)

The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context

Huyen A. Tran,
Lucy Deng,
Nicholas Wood,
Philip Choi,
Sally Singleton,
Lisa Clarke,
Sarah Khanlari,
Isis Maitland-Scott,
Robert Bird,
Scott Brown,
Bavahuna Manoharan,
Chee Wee Tan,
Michael Gold,
Pravin Hissaria,
Shannon Melody,
Sanjeev D. Chunilal S,
Jim Buttery,
Hazel Clothier,
Nigel W. Crawford,
Linny Phuong,
Dominic Pepperell,
Paul Effler,
Claire Parker,
Nicola Carter,
Kristine Macartney,
Megan McStea,
Todd Miller,
Michael Nissen,
Claire Larter,
Elspeth Kay,
Vivien M. Chen

Affiliations

Huyen A. Tran: The Alfred Hospital, Melbourne, Victoria, Australia; Monash Medical Centre, Clayton, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Corresponding author. The Alfred Hospital, Melbourne, Victoria, Australia.
Lucy Deng: National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
Nicholas Wood: National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
Philip Choi: The Canberra Hospital, Canberra, Australian Capital Territory, Australia; The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
Sally Singleton: ACT Health Directorate, Canberra, Australian Capital Territory, Australia
Lisa Clarke: Department of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia; Transfusion Policy and Education, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
Sarah Khanlari: New South Wales Ministry of Health, St Leonards, New South Wales, Australia
Isis Maitland-Scott: New South Wales Ministry of Health, St Leonards, New South Wales, Australia
Robert Bird: Division of Cancer Services, Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Scott Brown: Queensland Health, Brisbane, Queensland, Australia
Bavahuna Manoharan: Queensland Health, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
Chee Wee Tan: Royal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia; SA Pathology, Adelaide, South Australia, Australia; University of Adelaide, South Australia, Australia
Michael Gold: Department of Allergy and Clinical Immunology, Women's and Children's Health Network, Adelaide, South Australia, Australia; Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
Pravin Hissaria: Royal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia; SA Pathology, Adelaide, South Australia, Australia; University of Adelaide, South Australia, Australia
Shannon Melody: Public Health Services, Tasmania Department of Health, Hobart, Tasmania, Australia
Sanjeev D. Chunilal S: Monash Medical Centre, Clayton, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
Jim Buttery: SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Hazel Clothier: SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Health Analytics, Melbourne Children's Centre, Parkville, Victoria, Australia
Nigel W. Crawford: SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Linny Phuong: SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Dominic Pepperell: Fiona Stanley Hospital, Perth, Western Australia, Australia
Paul Effler: Western Australian Department of Health, Perth, Western Australia, Australia
Claire Parker: Western Australian Department of Health, Perth, Western Australia, Australia
Nicola Carter: National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
Kristine Macartney: National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
Megan McStea: Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
Todd Miller: Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
Michael Nissen: Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
Claire Larter: Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
Elspeth Kay: Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
Vivien M. Chen: Department of Haematology and NSW Health Pathology, Concord Hospital Sydney, New South Wales, Australia; ANZAC Research Institute, Sydney Local Health District, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, Australia

Journal volume & issue: Vol. 40
p. 100894

Abstract

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Summary: Background: Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. We report the clinicopathological features of TTS following ChAdOx1-S vaccination and summarise the case outcomes in Australia. Methods: In this cohort study, patients diagnosed with TTS in Australia between 23 March and 31 December 2021 were identified according to predefined criteria. Cases were included if they met the Therapeutic Goods Administration (TGA) probable and confirmed case definitions and were reclassified using Centres for Disease Control and Prevention (CDC) definition for analysis. Data were collected on patient baseline characteristics, clinicopathological features, risk factors, treatment and outcomes. Findings: A total of 170 TTS cases were identified, with most occurring after the first dose (87%) of ChAdOx1-S. The median time to symptom onset after vaccination and symptom onset to admission was 11 and 2 days respectively. The median age of cases was 66 years (interquartile range 55–74). All except two patients received therapeutic anticoagulation and 66% received intravenous immunoglobulin. Overall, 85.3% of cases were discharged home after a median hospitalisation of 6 days, 9.4% required ongoing rehabilitation and 5.3% died. Eight deaths were related to TTS, with another dying from an unrelated condition while receiving treatment for TTS. Deaths occurred more commonly in those classified as Tier 1 according to the CDC definition and were associated with more severe thrombocytopenia and disease-related haemorrhage. Interpretation: TTS, while rare, can be severe and have catastrophic outcomes in some individuals. In Australia, the mortality rate was low compared to that reported in other high-income countries. Almost all received therapeutic anticoagulation with no bleeding complications and were successfully discharged. This emphasises the importance of community education and an established pathway for early recognition, diagnosis and treatment of TTS. Funding: Australian Commonwealth Department of Health and Aged Care. H.A Tran, N. Wood, J. Buttery, N.W. Crawford, S.D. Chunilal, V.M. Chen are supported by Medical Research Future Funds (MRFF) grant ID 2015305.

Published in The Lancet Regional Health. Western Pacific

ISSN: 2666-6065 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanwpc/home

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