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  • Uveitis Risk After COVID-19 Vaccination

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, February 2023

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    Some evidence suggests that a tempo­ral relationship exists between uveitis and common vaccinations, including those for influenza, hepatitis B, and measles/mumps/rubella. Although the immunopathologic mechanisms of vaccine-associated uveitis (VAU) are unknown, it has been proposed that the immune response stems from vaccine adjuvants, molecular mimicry between vaccine-peptide fragments and uveal self-peptides delayed hypersensi­tivity, or subsequent immune complex deposition. Reports of uveitis after SARS-CoV-2 have been climbing; as of June 2022, more than 70 studies had been published. To learn more, Singh et al. analyzed data from the CDC’s Vaccine Adverse Event Report­ing System (VAERS). Overall, they found that the rates of postvaccine uveitis were low for all three COVID vaccines approved for use in the United States.

    For this research, the authors mined VAERS data to identify people who received a uveitis diagnosis after inoculation with the Pfizer-BioNTech, Moderna, or Janssen vaccines during the 17-month study period. They performed descriptive analyses of demographic and clinical data, then looked for correlations between each vaccine and continuous and categorical variables. Post hoc one-way analysis of variance was applied to explore the postvaccine time to uveitis in relation to age, vaccine type, and vaccine num­ber. They also calculated 30-day VAU risk.

    Main outcome measures were the estimated global crude reporting rate, observed-to-expected ratio of VAU, ocular and systemic presentations, and the interval between inoculation and uveitis onset.

    More than 2 billion COVID-19 vaccines were administered worldwide during the study period (80.7% Pfizer-BioNTech, 16.8% Moderna, 2.5% Janssen). The overall rate of adverse vaccine-related events was .06%. There were 1,094 cases of VAU; the rates were .57, .44, and .35 per million vaccine doses with the Pfizer-BioNTech, Mod­erna, and Janssen vaccines, respectively. The observed-to-expected VAU ratio was comparable for Pfizer-BioNTech (.023), Moderna (.025), and Janssen (.027).

    The mean age of patients with VAU was 46.2 years, and 68.7% were women. Most cases of VAU were reported after the initial dose (41.32%) and within one week of initial vaccination (54.02%). The mean interval between vaccination and uveitis onset was significantly lon­ger (p < .0001) for recipients of the Moderna vaccine (21.22 days; vs. 11.42 days for Pfizer-BioNTech and 12.69 days for Janssen). Post hoc work showed that VAU onset was much faster after Pfizer-BioNTech, and the 30-day risk also was highest with this vaccine.

    The authors note that the VAERS reporting mechanism is passive and may underreport events. Nonetheless, these results suggest that absolute VAU risk is low after COVID-19 vaccination, said the authors. Although the findings corroborate a possible temporal asso­ciation between VAU and the vaccines studied, the authors emphasized that more research is needed to determine the relevant immunologic mechanisms.

    The original article can be found here.