Background The Pfizer-BioNTech COVID-19 vaccine uses a novel messenger RNA technology to elicit a protective immune response. Short-term physiologic responses to the vaccine have not been studied using wearable devices. Objective We aim to characterize physiologic changes in response to COVID-19 vaccination in a small cohort of participants using a wearable device (WHOOP Strap 3.0). This is a proof of concept for using consumer-grade wearable devices to monitor response to COVID-19 vaccines. Methods In this prospective observational study, physiologic data from 19 internal medicine residents at a single institution that received both doses of the Pfizer-BioNTech COVID-19 vaccine was collected using the WHOOP Strap 3.0. The primary outcomes were percent change from baseline in heart rate variability (HRV), resting heart rate (RHR), and respiratory rate (RR). Secondary outcomes were percent change from baseline in total, rapid eye movement, and deep sleep. Exploratory outcomes included local and systemic reactogenicity following each dose and prophylactic analgesic use. Results In 19 individuals (mean age 28.8, SD 2.2 years; n=10, 53% female), HRV was decreased on day 1 following administration of the first vaccine dose (mean –13.44%, SD 13.62%) and second vaccine dose (mean –9.25%, SD 22.6%). RHR and RR showed no change from baseline after either vaccine dose. Sleep duration was increased up to 4 days post vaccination, after an initial decrease on day 1. Increased sleep duration prior to vaccination was associated with a greater change in HRV. Local and systemic reactogenicity was more severe after dose two. Conclusions This is the first observational study of the physiologic response to any of the novel COVID-19 vaccines as measured using wearable devices. Using this relatively small healthy cohort, we provide evidence that HRV decreases in response to both vaccine doses, with no significant changes in RHR or RR. Sleep duration initially decreased following each dose with a subsequent increase thereafter. Future studies with a larger sample size and comparison to other inflammatory and immune biomarkers such as antibody response will be needed to determine the true utility of this type of continuous wearable monitoring in regards to vaccine responses. Our data raises the possibility that increased sleep prior to vaccination may impact physiologic responses and may be a modifiable way to increase vaccine response. These results may inform future studies using wearables for monitoring vaccine responses. Trial Registration ClinicalTrials.gov NCT04304703; https://www.clinicaltrials.gov/ct2/show/NCT04304703
A 64-year-old woman presented with 24 hours of lethargy, confusion, headache, nausea and vomiting. Examination revealed expressive aphasia, conjunctival suffusion and a tick embedded in her popliteal fossa. Labs revealed hyponatraemia, transaminitis, leucopenia, thrombocytopenia and an elevated C reactive protein. Peripheral blood smear was unremarkable. MRI/magnetic resonance angiogram revealed bilateral frontoparietal subarachnoid haemorrhage which was further confirmed by lumbar puncture which revealed six nucleated cells, 92% lymphocytes, 1460 red blood cells, normal glucose and protein and negative cryptococcal antigen, herpes simplex PCR and Lyme PCR. Serum Lyme IgG/IgM antibodies and PCR, Erlichia chaffeensis serum IgG/IgM antibodies and PCR and anaplasma serum IgG/IgM antibodies were negative. Anaplasmosis serum PCR was positive. The tick was identified as Ixodes scapularis. The patient was diagnosed with anaplasmosis and treated with 21 days of doxycycline resulting in improvement of symptoms, but lingering headaches and word finding difficulties.
BACKGROUND The Pfizer COVID-19 Vaccine employs a novel technology which utilizes messenger Ribonucleic Acid (mRNA) to deliver viral proteins to the host and elicit a protective immune response, but the short-term physiologic response to the vaccine has yet to be studied using wearable devices. OBJECTIVE Using wearable devices, we aim to characterize physiologic changes in response to COVID-19 vaccination in a small cohort of subjects. METHODS In this prospective observational study, physiologic data from 19 internal medicine residents at a single institution who received both doses of the Pfizer COVID-19 vaccine were collected using the WHOOP strap 3.0 to determine participant baseline resting heart rate (RHR), heart rate variability (HRV), respiratory rate (RR), and sleep duration. Primary outcomes included change from baseline in HRV, RHR, RR, and sleep duration. Percent change and standard deviation from baseline (defined as the 30 days of wear prior to vaccination) were calculated for six days after the first and second dose of the Pfizer COVID-19 for all participants who met inclusion and exclusion criteria. Symptom type, severity, and duration were reported as secondary outcomes. RESULTS In 19 individuals, mean age 28.8 (+/- 2.2), 53% female, percent change in HRV was decreased on day 1 (-13.44% +/- 13.62%) following administration of the first vaccine dose, and this response was blunted following dose 2 (-9.25% +/- 22.6%). RHR had a slight initial increase (+2.73% +/- 5.50%, +4.20% +/- 9.42%) after each dose and normalized after one day and RR showed no change compared to baseline after either vaccine dose. Sleep duration was increased up to 6 days post vaccine and peaked on day 3. Increased sleep duration prior to vaccine also demonstrated a more significant change in HRV compared to those who were sleep deprived (as determined by Pearson correlations). A more robust response in terms of symptom severity and duration was seen following dose 2. Arm soreness was the most reported symptom for both doses. CONCLUSIONS This represents the first observational study of the physiologic response in humans to any of the novel COVID-19 vaccines, as measured using wearable devices. We provide evidence that HRV decreases in response to both vaccine doses, with no consequent changes in RHR or RR. Sleep duration initially decreased following each dose and subsequently increased thereafter. Future studies with a larger cohort and comparison to other inflammatory and immune biomarkers, such as antibody response, will be needed to determine the true utility of this type of continuous wearable monitoring in regards to vaccine responses. Our data raises the possibility that increased sleep prior to vaccination may impact physiologic response, which could be used to track immune response to vaccination. CLINICALTRIAL NCT04304703: https://www.clinicaltrials.gov/ct2/show/NCT04304703
Patient: Male, 76-year-old Final Diagnosis: Herpes simplex virus type 1 (HSV-1) encephalitis Symptoms: Encephalopathy Medication: — Clinical Procedure: Lumbar puncture Specialty: Critical Care Medicine Objective: Unusual or unexpected effect of treatment Background: Several cases of herpes simplex virus type 1 meningoencephalitis (HSVE) have been reported in patients receiving steroids, but the exact contribution of steroids to the disorder remains unclear because other risk factors, such as chemotherapy, brain radiation, or surgery, were present in almost all cases. Case Report: We report the case of a 76-year-old man who developed HSVE following the administration of pulse-dose steroids. The patient had occupational asbestos exposure and a chronic interstitial lung disease of unclear etiology (sarcoidosis versus hypersensitivity pneumonitis) and was admitted for acute-on-chronic respiratory failure requiring mechanical ventilation. After a negative infectious workup and several days of antibiotics without improvement, pulse-dose steroids were administered. In the following days, the patient developed a fever and worsening encephalopathy. A lumbar puncture showed elevated nucleated cells and positive polymerase chain reaction for herpes simplex virus 1 in the cerebrospinal fluid, confirming the diagnosis of HSVE. Acyclovir treatment was initiated, but the patient later died as a result of persistent severe encephalopathy and respiratory failure with an inability to wean mechanical ventilation. Conclusions: Clinicians should keep in mind that HSVE is a potential complication of steroids and carefully consider the benefit/risk ratio of pulse-dose steroids, taking into account associated factors of immunosuppression. A high level of awareness should be especially maintained in critically ill patients because of associated risk factors (critical illness immune paralysis) and because neurological signs of HSVE may be missed in mechanically ventilated, sedated patients.
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