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Publications

Journal Article Ahead of print

PubMed: 41875690 DOI: 10.1016/j.vaccine.2026.128501

Clinical, psychological and quality of life outcomes up to 12-months following thrombosis with thrombocytopenia syndrome after ChAdOx1-S (AZD1222) vaccination in Australia.

Vaccine 79:128501

Authors: Lucy Deng, Belinda Barton, Philip Choi, Lisa Clarke, Sarah Khanlari, Isis Maitland-Scott, Michael Nissen, Chee Wee Tan, Michael Gold, Pravin Hissaria, Shannon Melody, Sanjeev Chunilal, Jim Buttery, Hazel Clothier, Nigel W Crawford, Linny Phuong, Dominic Pepperell, Paul Effler, Kristine Macartney, Vivien Chen, Huyen Tran, Nicholas Wood

Affiliations

  • National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.
  • The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia.
  • The Canberra Hospital, Canberra, Australian Capital Territory, Australia; The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia.
  • Department of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia; Transfusion Policy and Education, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia.
  • New South Wales Ministry of Health, St Leonards, New South Wales, Australia.
  • The Prince Charles Hospital & University of Queensland Centre for Clinical Research, Herston, Queensland, Australia.
  • Royal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia; South Australia Pathology, Adelaide, South Australia, Australia; University of Adelaide, South Australia, Australia.
  • Department of Allergy and Clinical Immunology, Women's and Children's Health Network, Adelaide, South Australia, Australia; Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
  • Public Health Services, Tasmania Department of Health, Hobart, Tasmania, Australia.
  • Monash Medical Centre, Clayton, Victoria, Australia; Monash University, Melbourne, Victoria, Australia.
  • SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital Melbourne, and Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Centre for Health Analytics, Melbourne Children's Campus, Parkville, Victoria, Australia.
  • SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Health Analytics, Melbourne Children's Campus, Parkville, Victoria, Australia.
  • SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital Melbourne, and Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
  • Fiona Stanley Hospital, Perth, Western Australia, Australia.
  • Western Australian Department of Health, Perth, Western Australia, Australia.
  • National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.
  • Department of Haematology and NSW Health Pathology, Concord Hospital Sydney, New South Wales, Australia; ANZAC Research Institute, University of Sydney, New South Wales, Australia.
  • Monash University, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia.

Abstract

BACKGROUND

Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. However, evidence on long-term clinical and psychosocial outcomes is limited. We report on the 12-month clinical, psychological and health-related quality of life (HRQoL) outcomes of TTS in Australia.

METHODS

In this national cohort study, adults diagnosed with TTS in Australia between 23 March and 31 December 2021 were followed up to 12 months post-discharge. Data were collected on clinical progression, disability, revaccination outcomes, psychological functioning and HRQoL. Psychological functioning and HRQoL were compared between participants with and without persistent clinical symptoms at 12 months.

FINDINGS

Of the 161 TTS surviving cases, 92 (57%) completed 12-month follow-up, with 48% remaining on anticoagulation. Two clinically relevant non-major bleeds, and three new thrombotic events were reported. Most cases (93%) received a subsequent COVID-19 vaccine, with no serious adverse events following immunisation. At 12 months post-discharge, 61% reported persistent symptoms, and had significantly higher levels of psychological distress, including depression, anxiety, and post-traumatic stress, compared to asymptomatic cases. HRQoL scores were significantly poorer than Australian population norms across all physical and mental domains, with only modest improvements in physical and social functioning observed between 6 and 12 months.

CONCLUSION

Recurrent thrombosis and haemorrhagic complications were uncommon; however persistent symptoms at 12-months post-discharge from TTS were frequent and accompanied by substantial functional limitations, psychological distress, and significantly reduced HRQoL. These findings highlight the importance of structured long-term follow-up of TTS, a serious adverse event following immunisation, using a biopsychosocial model of care integrating medical, psychological and functional management and support through a vaccine injury compensation scheme.

MeSH

Quality Of Life, Vaccines, Covid-19 Vaccines, Stress, Physiological, Vaccination, Signs And Symptoms, Drug-Related Side Effects And Adverse Reactions, Psychological Distress, Thrombosis, Thrombocytopenia