Abstract
Objective: The aim of this study was to present some cases of acute vertigo potentially related to the coronavirus disease 2019 (COVID-19) vaccine and review the available literature about cochleovestibular dysfunction after the COVID-19 vaccination.Methods: In the period from May to July 2021, we evaluated 33 patients (mean age 54.3 ± 14.1) with “acute vertigo” post COVID-19 vaccination. A detailed medical history was taken on comorbidities, types of vaccines received, and symptoms associated. All patients underwent otoneurological evaluation, such as head impulse test, nystagmus evaluation, test of skew (HINTS) examination. Head shaking test-induced nystagmus, hyperventilation-induced nystagmus, and parossistic positional nystagmus were studied to search for vestibular impairment.Results: Symptoms included 16 patients (48.5%) with objective vertigo, 14 patients (42.4%) with subjective vertigo, and 3 patients (9.1%) with dizziness. Of the associated ear, nose, and throat (ENT) symptoms, the most expressed was tinnitus (18.2%). Bedside examination showed absent nystagmus in 7 patients (21.2%), 9 patients (27.3%) had horizontal or rotatory nystagmus, 17 patients (51.5%) had a vertical or oblique nystagmus, negative HST, or “central HINTS.”Discussion and Conclusions: The 9 patients had an evoked nystagmus pathognomonic for benign paroxysmal positional vertigo; in the remaining 17 cases, peripheral vestibular dysfunction could be excluded and central disorder may be suggested. Due to the prevalence of nystagmus of non-peripheral origin, a central nervous system involvement could not be excluded. However, due to the small sample size, a definite cause–effect relationship between vaccination and vertigo cannot be inferred. In light of expected third dose, large-scale and well-designed studies are needed to better define possible adverse reactions of the COVID-19 vaccine.
Highlights
Severe acute respiratory syndrome coronavirus spike (S) glycoprotein is the main target for current vaccines, since antibodies directed against SARSCoV-2 spike can block the fusion between the virus and host cell membrane, inhibiting the infection [2, 3]
Adverse effects observed in Italy after administration of these vaccines, are recorded in the COVID-19 Vaccine Surveillance Report drawn up by the Italian Medicines Agency (AIFA) [4]
As of August 2021, 91,360 reports of adverse events following vaccination have been entered in the National Pharmacovigilance Network, out of 76,509,846 vaccine doses (119/100,000 administered doses)
Summary
Severe acute respiratory syndrome coronavirus (SARS-COV-2) infection has led to a global pandemic and a public health crisis, resulting in over 4,806,841 deaths at the time of publication [1].The efforts of the scientific community to prevent coronavirus disease 2019 (COVID-19) associated mortality and morbidity have resulted in multiple vaccines worldwide available and approved for use.Severe acute respiratory syndrome coronavirus spike (S) glycoprotein is the main target for current vaccines, since antibodies directed against SARSCoV-2 spike can block the fusion between the virus and host cell membrane, inhibiting the infection [2, 3].Currently, authorized vaccines for COVID-19 include the mRNA vaccines: BNT162b2 (Pfizer/BioNTech) and mRNA-1273 (Moderna) and the adenoviral-vectored vaccines: ChAdOx1 nCoV-19 (University of Oxford/AstraZeneca) and Ad26.COV2.S (Janssen).Pfizer/BioNTech is currently the most widely used vaccine in the Italian vaccination campaign (71%), followed by AstraZeneca (16%), Moderna (11%), and COVID-19 Janssen vaccine (2%).Adverse effects observed in Italy after administration of these vaccines, are recorded in the COVID-19 Vaccine Surveillance Report drawn up by the Italian Medicines Agency (AIFA) [4]. Severe acute respiratory syndrome coronavirus (SARS-COV-2) infection has led to a global pandemic and a public health crisis, resulting in over 4,806,841 deaths at the time of publication [1]. Severe acute respiratory syndrome coronavirus spike (S) glycoprotein is the main target for current vaccines, since antibodies directed against SARSCoV-2 spike can block the fusion between the virus and host cell membrane, inhibiting the infection [2, 3]. Authorized vaccines for COVID-19 include the mRNA vaccines: BNT162b2 (Pfizer/BioNTech) and mRNA-1273 (Moderna) and the adenoviral-vectored vaccines: ChAdOx1 nCoV-19 (University of Oxford/AstraZeneca) and Ad26.COV2.S (Janssen). Pfizer/BioNTech is currently the most widely used vaccine in the Italian vaccination campaign (71%), followed by AstraZeneca (16%), Moderna (11%), and COVID-19 Janssen vaccine (2%). 86.1% of adverse effects reports entered refer to non-serious events, and 13.8% to serious adverse events
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