Vaccine-associated enhanced respiratory disease

Short description: Serious adverse event of vaccine candidates

Vaccine-associated enhanced respiratory disease (VAERD), or simply enhanced respiratory disease (ERD), is an adverse event where an exacerbated course of respiratory disease occurs with higher incidence in the vaccinated population than in the control group. It is a barrier against vaccine development that can lead to its failure.[1]

Immunologically, VAERD is characterized with an exaggerated Th2 response and eosinophilic pulmonary infiltrations.[2] It may result from antibody-mediated complement activation followed by weak neutralization.[3]

Historical instances of the phenomenon were seen in vaccine candidates for respiratory syncytial virus (RSV), SARS-CoV, Middle East Respiratory Syndrome (MERS), and some influenza strains.[1][4][5] Thus, COVID-19 vaccine clinical research involved monitoring for VAERD because the vaccine target, SARS-CoV-2, belongs to the same viral subfamily as SARS-CoV and MERS. The effect was not shown in phase III clinical trials for Tozinameran or for the Moderna vaccine.[2][6]

## See also

Antibody-dependent enhancement

## References

1. ↑ 1.0 1.1 Acosta, Patricio L.; Caballero, Mauricio T.; Polack, Fernando P.; Papasian, C. J. (2016). "Brief History and Characterization of Enhanced Respiratory Syncytial Virus Disease". Clinical and Vaccine Immunology 23 (3): 189–195. doi:10.1128/CVI.00609-15. ISSN 1556-6811. PMID 26677198.
2. ↑ 2.0 2.1 Baden, Lindsey R.; El Sahly, Hana M.; Essink, Brandon; Kotloff, Karen; Frey, Sharon; Novak, Rick; Diemert, David; Spector, Stephen A. et al. (2021). "Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine". New England Journal of Medicine 384 (5): 403–416. doi:10.1056/NEJMoa2035389. ISSN 0028-4793. PMID 33378609.
3. ↑ Richard W. Compans; Michael B. A. Oldstone (8 October 2014). Influenza Pathogenesis and Control - Volume I. Springer. pp. 315–320. ISBN 978-3-319-11155-1. https://books.google.com/books?id=aDvBBAAAQBAJ.
4. ↑ Agrawal, Anurodh Shankar; Tao, Xinrong; Algaissi, Abdullah; Garron, Tania; Narayanan, Krishna; Peng, Bi-Hung; Couch, Robert B.; Tseng, Chien-Te K. (2016). "Immunization with inactivated Middle East Respiratory Syndrome coronavirus vaccine leads to lung immunopathology on challenge with live virus". Human Vaccines & Immunotherapeutics 12 (9): 2351–2356. doi:10.1080/21645515.2016.1177688. ISSN 2164-5515. PMID 27269431.
5. ↑ Bottazzi, Maria Elena; Strych, Ulrich; Hotez, Peter J.; Corry, David B. (2020). "Coronavirus vaccine-associated lung immunopathology-what is the significance?". Microbes and Infection 22 (9): 403–404. doi:10.1016/j.micinf.2020.06.007. ISSN 1286-4579. PMID 32599077.
6. ↑ (PDF) ﻿FDA Review of Efficacy and Safety of Pfizer-BioNTech COVID-19 Vaccine Emergency Use Authorization Request﻿ (Report). U.S. Food and Drug Administration (FDA). 10 December 2020. https://www.fda.gov/media/144337/download. Retrieved 11 December 2020.

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