When it comes to vaccination campaigns, there is an urgent need for message discipline to be strictly maintained. For example, during the COVID-19 pandemic, it was vital that people understood the types of COVID-19 vaccines that have been developed, the rigorous testing process that has been undertaken, and why it is important that all eligible individuals take the vaccine.
The medical community has always presented a united front when it comes to vaccination campaigns (including infant vaccination schedules). However, there will always be a segment of the population that remains vehemently opposed to vaccines. Some are opposed to vaccines for ideological or religious reasons, while others are simply unconvinced that they are safe.
This presents a delicate balancing act for members of the medical community. For transparency reasons, it is necessary to acknowledge that a very small minority of individuals do experience adverse effects upon taking the vaccine. However, vaccines are indeed safe by any standards of measurement. It is also true that the herd immunity we all crave for can only come about if a substantial percentage of the population is vaccinated.
The question of whose voices rise above the rest has very real public health repercussions. During the campaign to get the world vaccinated against COVID-19, we had to opportunity to witness this tug-of-war between public trust and public skepticism play out, country by country.
In the case of one subset of the population, patients with idiopathic pulmonary fibrosis (IPF), scientific journals have published a small number of case reports of patients experiencing acute exacerbations of IPF after receiving a COVID-19 vaccine. Let’s look at 2 of them.
Respiratory Distress Following Vaccination
In a letter to the editor of the European Respiratory Journal, Bando and colleagues presented the case study of a patient with fibrotic interstitial lung disease needing hospital care for acute respiratory failure within 9 days of getting his second mRNA SARS-CoV-2 vaccine. A physical chest examination revealed bilateral lung crackles and a chest high-resolution computed tomography (HRCT) showed newly arising bilateral ground-glass opacities. Upon further investigation, the patient was diagnosed with an acute exacerbation of fibrotic interstitial lung disease.
The patient revealed that his first vaccine dose did not result in any side effects. However, after his second dose, he started to develop malaise and loss of appetite, which did not improve until he visited a nearby hospital.
Read more about IPF epidemiology
The patient was treated with antibiotics but failed to respond. Bronchoalveolar lavage was performed, and cultures of the fluid did not show evidence of bacterial infection. Bando and colleagues wrote, “Since his previous chest HRCT showed subpleural reticulation and honeycomb compatible with idiopathic pulmonary fibrosis (IPF), we diagnosed his condition as acute exacerbation of IPF.”
The patient was treated with intravenous (IV) corticosteroids and his respiratory condition gradually stabilized without supplemental oxygen. He was discharged after 2 weeks of rehabilitation.
In Chest, Ghincea and colleagues presented the case of a 72-year-old man who had an acute exacerbation of IPF after receiving an mRNA COVID-19 vaccination. The patient experienced worsening dyspnea, nonproductive cough, fevers, and chills 1 week after his first vaccine dose.
Three days prior to presentation, the patient tested negative on a COVID-19 nasopharyngeal swab. Upon presentation, he was in acute respiratory failure, requiring 4 liters of oxygen.
His chest x-ray demonstrated worsening pulmonary infiltrates. CT angiography was negative for pulmonary embolism; however, newly developed ground-glass opacities could be observed. He was started on broad-spectrum antibiotics and IV methylprednisolone. He eventually recovered and was discharged home.
An Unclear Relationship
These case studies have one thing in common: physicians observed an acute exacerbation of IPF shortly after the patient received an mRNA COVID-19 vaccine. Conditions such as bacterial or viral infection, surgery, and drug toxicity have been known to cause acute exacerbations of IPF. However, in both cases, there was no clear factor that brought about the acute exacerbation except that they took a COVID-19 vaccine.
Bando and colleagues wrote, “We treated a patient with [interstitial lung disease] who had acute respiratory failure and new [ground glass opacities] soon after receiving the SARS-CoV-2 vaccine . . . It is reasonable to conclude that our patient experienced acute exacerbation of IPF triggered by SARS-CoV-2 vaccination.”
Read more about IPF patient education
Ghincea and colleagues wrote, “In this case, although the patient’s respiratory deterioration cannot be attributed definitively to the vaccine, the temporal association between vaccination and symptoms and the exclusion of identifiable triggers of [acute exacerbations of IPF] suggests a potential relationship.”
Because both cases are isolated and incredibly rare, the mechanisms of how COVID-19 vaccines can possibly trigger acute exacerbations of IPF will likely remain a mystery. Even if clinical studies were to be conducted to examine this relationship more closely in the future, the sample size would probably remain too small for any meaningful conclusions to be drawn.
Ironically, these isolated examples of possible adverse effects from vaccines serve to strengthen the case for vaccines, since they are exceedingly rare. Ghincea et al wrote, “Ultimately, immunization against vaccine-preventable disease is supported widely in chronic lung disease, including IPF.”
Bando T, Takei R, Mutoh Y, et al. Acute exacerbation of idiopathic pulmonary fibrosis after SARS-CoV-2 vaccination. Eur Respir J. 2022;59(3):2102806. doi:10.1183/13993003.02806-2021
Ghincea A, Ryu C, Herzog EL. An acute exacerbation of idiopathic pulmonary fibrosis after BNT162b2 mRNA COVID-19 vaccination: a case report. Chest. 2022;161(2):e71-e73. doi:10.1016/j.chest.2021.07.2160