COVID-19 Vaccinated Can Have Severe Anxiety, Not Just Anaphylaxis
Public health officials are suggesting that COVID-19 vaccine providers monitor for more than just anaphylaxis and other severe allergic reactions after administration. Healthcare professionals now are being asked to watch for fainting, especially in young recipients of the J&J (Janssen) vaccine. Here are more details.
ATLANTA – Pharmacists and other healthcare professionals administering COVID-19 vaccines are being asked not just to monitor for severe allergic reactions but also serious anxiety-related responses.
National Centers for Disease Control and Prevention researchers point out that anxiety-related events, including syncope, can occur immediately after vaccination with any vaccine and might be caused by anxiety about receiving an injection. The agency received reports of clusters of anxiety-related events after administration of Johnson & Johnson ( Janssen) COVID-19 vaccine from five mass vaccination sites, all in different states. Overall, 64 anxiety-related events, including 17 reports of syncope, an anxiety-related event, among 8,624 Janssen COVID-19 vaccine recipients, were reported from these sites for vaccines administered during April 7–9, although none were serious.
A recent article in the CDC’s Morbidity & Mortality Weekly Report notes that reports of syncope were approximately 164 times more common after J&J COVID-19 vaccination -- 8.2 per 100,000 -- than after influenza vaccination -- 0.05 per 100,000.
About one-fourth of the syncopal and other anxiety-related events after receipt of Janssen COVID-19 vaccine occurred in those who reported a history of similar events after vaccination. “Because the Janssen COVID-19 vaccine is administered as a single dose, this vaccine might be a more attractive option for persons who have needle aversion,” the authors explained. “Therefore, it is possible that some persons seeking Janssen COVID-19 vaccination could be more highly predisposed to anxiety-related events after being vaccinated. The stress of an ongoing pandemic might also increase anxiety surrounding COVID-19 vaccination.”
The study adds that, in mass vaccination situations, “an anxiety-related event witnessed by others on-site or reported through media coverage might provoke additional anxiety-induced episodes.”
About half of the fainting reports to the Vaccine Adverse Event Reporting System (VAERS) after the J&J COVID-19 vaccination were for young adults 18–29 years. In general, according to the report, adolescents have higher rates of temporary loss of consciousness after a drop in blood pressure than others. It cites a rate of 7.8 syncopal events per 100,000 doses administered after receipt of quadrivalent human papillomavirus vaccine.
Since most VAERS reports of syncope are for children aged 11–18 years (62%), followed by adults aged 19–49 years (25%), the authors caution, “As use of COVID-19 vaccines expands into younger age groups, providers should be aware that younger persons might be more highly predisposed to anxiety-related events after vaccination than are older persons.”
CDC researchers explain that the J&J COVID-19 vaccine was not directly compared with other currently available COVID-19 vaccines – but instead to influenza vaccine administered during the 2019–20 season --because the population that received it during its introduction differed from that of the mRNA COVID-19 vaccines. The reason, according to the report, was prioritization by age group, occupation, or underlying health condition.
Furthermore, the anxiety-related events described in the report were prior to concerns being raised about thrombosis with thrombocytopenia syndrome. The CDC’s Advisory Committee on Immunization Practices reaffirmed its recommendation for the use of the J&J COVID-19 vaccine on April 23, 2021. Still, a warning for rare clotting events, primarily in women aged 18–49 years is now included by the Food and Drug Administration in the emergency use authorization and provider and patient information sheets distributed.
“Anxiety-related events, including syncope, occurring soon after COVID-19 vaccination could raise concern among other vaccine recipients and staff members, particularly in a mass vaccination setting,” the authors emphasize. “All COVID-19 vaccine recipients should be observed for at least 15 minutes after vaccination for anxiety-related and other events (e.g., anaphylaxis or immediate allergic reaction) occurring shortly after vaccination. Increased awareness of anxiety-related events after vaccination will enable vaccination providers to make an informed decision about continuing vaccination.”
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