Introduction
Measures for severe infection prevention in patients with diabetes mellitus
Types of COVID-19 vaccines
Vaccine Name | Type | Success Rate | Complications |
---|---|---|---|
ΒΝΤ16b2 (Pfizer-BioNTech) | mRNA vaccine → codes for a protein spike | 95% | Localized pain, fatigue, headache Rare: myocarditis, pericarditis, anaphylaxis |
mRNA-1273 (Moderna) | mRNA vaccine → codes for a protein spike | 94.1% | Temporary localized and systematic symptoms Rare: myocarditis, pericarditis, anaphylaxis |
AZD1222 (Oxford- Astra Zeneca) | Recombinant, chimpanzee adenovirus-vector vaccine, with a protein spike antigen | 70.4% | Severe complications in very few cases |
Sputnik V vaccine (Gamaleya Research Institute, Russia) | Recombinant, adenovirus-vector vaccine rAd, with a protein spike antigen | 91.6% | Flu symptoms, localized reactions, fatigue, headache, no severe complications |
JNJ-78436735 (Johnson & Johnson, Janssen Biotech Inc) | Recombinant, adenovirus-vector Ad26 vaccine, encoding spike protein | 66% | Fever (9%) with no severe complications Rare: Severe allergic reactions, anaphylaxis |
Novavax, Inc USA | Recombinant, with a protein subunit of nanoparticles, wild type of protein spike | 89.3% | Severe complications in very few cases Rare: myocarditis, pericarditis, anaphylaxis |
CoronaVac (Sinovac Biotech China) | Inactivated vaccine | 50.65–91.25% | NA |
The necessity of covid-19 vaccination for patients with diabetes mellitus
Severity of COVID-19 infection in children
Risk factors for severe pediatric COVID-19 infection
• Diabetes Mellitus (both types) |
• Obesity |
• Hypertension |
• Immunosuppression |
• Malignancies |
• Neurological, genetic, and metabolic conditions |
• Cardiovascular, kidney and chronic liver conditions |
• Chronic respiratory problems (cystic fibrosis, asthma) |
• Chronic hematological conditions (β-thalassemia, sickle cell disease). |
Frequency of COVID-19 infection in children with T1D
Increased risk of Diabetic Ketoacidosis (DKA) due to COVID-19 in children and adolescents with T1D
COVID-19 infection and COVID-19 vaccination glycemic effects in patients with and without diabetes
Conclusions on the impact of COVID-19 in patients with DM
The effectiveness of different Covid-19 vaccines
a. Vaccination effectiveness against COVID-19 in patients with T1D: | |
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Vaccine Type | Effectiveness (vs placebo) |
mRNA (n = 48.500) | 94.3% |
Protein Subunit (n = 7.500) | 89.3% |
Adenovirus Vector (n = 40.250) | 79.5% |
Inactivated (n = 5.700) | 73.1% |
b. Factors associated with vaccination effectiveness in patients with T1D | ||
---|---|---|
Vaccination Group | Effectiveness | |
Gender | Males vs Controls | 92.7% |
Females vs Controls | 87.8% | |
Age | 16–55 years | 88.9% |
>55 years | 87.6% | |
Ethnic background | African/African Americans | 93.4% |
Caucasian | 89.8% |
Effectiveness of COVID vaccination in patients with T1D
Safety of different vaccines against SARS-CoV-2
mRNA vaccine safety in adolescents > 12 years of age
Risk factors for severe side-effects in young adults post mRNA vaccination
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Young age:
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21–30 years of age: OR = 2.49
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31–40 years of age: OR = 1.78
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41–50 years of age: OR = 1.47
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Female gender had twice the risk for side-effects (OR = 2.16)
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Low Body Weight had 1.6 times higher risk for mild/severe side-effects (OR = 1.61)
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Comorbidities:
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Diabetes Mellitus had 2.3 times higher risk for side-effects (OR = 2.36).
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Rare/Severe side-effects of the COVID-19 vaccines
Dose 2 (primary series) | 1st booster dose | |||
---|---|---|---|---|
Age group | Male | Female | Male | Female |
5–11 years | 2.5 | 0.7 | 0.0 | 0.0 |
12–15 years | 47.1 | 4.2 | 12.9 | 0.7 |
16–17 years | 78.7 | 7.4 | 21.6 | 0.0 |
18–24 years | 39.3 | 3.9 | 13.1 | 0.6 |
25–29 years | 15.3 | 3.5 | 4.4 | 2.2 |
30–39 years | 7.8 | 1.0 | 1.9 | 0.9 |
40–49 years | 3.3 | 1.6 | 0.2 | 0.6 |
50–64 years | 0.7 | 0.5 | 0.4 | 0.1 |
>65 years | 0.3 | 0.5 | 0.7 | 0.2 |
Rare COVID-19 vaccination side-effects among youth
Myocarditis & pericarditis
Possible pathophysiologic mechanisms of myocarditis and pericarditis
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Molecular mimicry. It is possible that the spike protein of SARS-CoV2 resembles an unidentified protein of the myocardium. Presentation of the spike protein by antigen presenting cells activates autoreactive T cells that bind to both self and non-self antigens and induces myocardium destruction [44].
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Acute toxic effect of spike protein on myocardial cells, which explains the strong association of mRNA vaccines with myocarditis [45].
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Reaction to adjuvant nanoparticles or other components of the vaccine [46].
Concerns about children and adolescents’ Covid-19 vaccination
Pros
Cons
Parental and health professional concerns about childhood vaccination against COVID-19
COVID-19 vaccination rate of children and adolescents with T1D
Is it necessary to vaccinate all children and adolescents against COVID-19?
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First priority: Vaccination of all individuals aged >/65 years and of all adults belonging to high-risk groups,
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Second priority: Vaccination of children and adolescents aged 5–18 years with serious underlying conditions,
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Third priority: Vaccination of healthy children and adolescents 5–18 years old [66].
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People with diabetes should be prioritized and offered SARS-CoV2 vaccines.
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Children and adults with diabetes should receive all age-appropriate vaccinations according to recommendations, as preventing infections reduces hospitalizations, but also reduces the risk of acquiring infections, such as COVID-19.
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In patients with diabetes, impaired glycemic control prior to or during COVID-19 admission have been associated with poor outcomes, including mortality [67]