key: cord-0855173-rgz9nh1n
authors: Finsterer, Josef; Matovu, Daniel
title: Consider Transverse Myelitis as a Complication of a SARS-CoV-2 Vaccination
date: 2022-05-04
journal: J Korean Med Sci
DOI: 10.3346/jkms.2022.37.e150
sha: d1da1112fba9983bd160c7b1c1ffaf2d7cb6583f
doc_id: 855173
cord_uid: rgz9nh1n

nan

© 2022 The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https:// creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Overall, the interesting study has limitations which challenge the results and their interpretation. Addressing these issues would strengthen the conclusions and could be more educative. Myelitis as a complication of SARS-CoV-2 vaccinations is not infrequent and treating physicians should be aware of this side effect to diagnose patients thoroughly and treat them adequately in due time. 

Thank you for your interest in our recent report. 1 We appreciate your supportive comments about the case of acute transverse myelitis (ATM) after the coronavirus disease (COVID-19) vaccination. Some reports are available across the world, and you have provided meaningful clinical information by reviewing previous cases. We should be aware of myelitis as an adverse event after COVID-19 vaccination and treat it promptly.

As of January 12, 2022, approximately 58% of the world's population received at least one dose of the COVID-19 vaccine. 2 According to the Korea Disease Control and Prevention Agency (CDC), the cumulative number of recipients who have been vaccinated against COVID-19 at least once in Korea is 44,947,315. 3 Approximately 73% (32,688,629) of these people received booster shots. In the United States, nine cases of transverse myelitis were reported among 51,755,447 individuals who received vaccinations in 2021. 4 In Taiwan, two cases of transverse myelitis were reported among 9,987,157 individuals who received inoculations in 2021. 5 According to the Korean CDC, there were 23 suspected cases of myelitis among 120,296,705 individuals who received vaccinations in 2022. 6 Citing the reports of these countries, its frequency is estimated to be 0.2 per million of those who received COVID-19 vaccination doses. Considering the inoculation size worldwide, we think that myelitis is a relatively rare side effect; therefore, close attention of neurologists is necessary. In addition, a recent study reported that among the healthcare workers who received the BNT162b2 vaccine, approximately 60% complained of malaise or fatigue, and 45% experienced myalgia. 7 These symptoms were common side effects of COVID-19 vaccination; however, no case of ATM has been reported earlier.

This report was the first of its kind in Korea, which is an Asian country, and it is meant to draw the attention of neurologists. Given the number of worldwide vaccinations, dozens of cases of ATM are expected in each country. Since the annual incidence of myelitis is not high in most countries, the estimated number of ATM cases after COVID-19 vaccination is not small, as reported by Dr. Finsterer.

Criteria for rarity would vary; however, we propose that the number of reported ATM cases is relatively small given the number of vaccinations, as compared to common side effects, such as fever, headache, and myalgia. However, in the case of ATM, the severity is higher than that of the common side effects; thus, we suggest that although a rare adverse event, it should be

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