[E-mail: quying1988@126.com]
To the Editor,
We read the recently published article by Kaicker S et
al.1 with great interest and would like to thank the
authors for conducting this important and meaningful study. Whether
coronavirus disease 2019 (COVID-19) vaccines impact platelet counts and
bleeding in children, adolescents, and young adults (C-AYA) with
preexisting immune thrombocytopenia (ITP) is unknown, which caused
concerns among those families of children with preexisting ITP about
vaccinating their children. Through a single-center studies of C-AYA
with ITP, the authors reported that COVID-19 vaccination only had very
limited effect on platelet counts and bleeding in C-AYA with ITP. They
concluded that COVID-19 vaccination was safe for C-AYA with ITP.
However, there are some points deserve further discussions to strengthen
the worth of this article.
As the authors said, the best time to check platelet counts following
COVID-19 vaccination has not been determined in adults, not to mention
C-AYA. According to adult experience, the authors recommend checking
platelet counts at baseline and a week after COVID-19 vaccination.
However, Kuter DJ 2 reported that 12% of chronic ITP
patients had a median platelet count drop of 96% within 2-5 days post
COVID-19 vaccination, and most platelet counts was severe under 10 ×
109/L with new bleeding symptoms. According to this
report, platelet counts within 2-5 days, not just one week or more,
after COVID-19 vaccination seem to be necessary and should be advised to
check in C-AYA with ITP to assess for the exacerbation of their possible
thrombocytopenia.
Furthermore, the effect of vaccine types on C-AYA with ITP was not
analyzed in this study. Only one child opted for the single dose Johnson
& Johnson vaccine and subsequently received a Pfizer booster, all other
received the Pfizer-BioNTech mRNA vaccine in this study. Lee EJ et al3 reported ITP occurred after vaccination with both
the Pfizer and Moderna vaccines. Adverse event rate of platelet count
decreases and bleeding in C-AYA with ITP among Moderna vaccine, Johnson
& Johnson vaccine, AstraZeneca vaccine and other vaccines might be
different with Pfizer vaccine. In addition, too small sample size and
the single center study might also affect the accuracy of the
conclusion. A multi-center and large-scale study containing large sample
size and different types of vaccines is needed to arrive at meaningful
and accurate conclusions.
We appreciate Prof. Kaicker and his colleagues for this contribution. We
believe the benefits of the vaccine outweigh the risks, but we hope our
discussion with the authors will lead to a close surveillance and
precise treatment for these special patients.