Genetic basis of sudden death after COVID-19 vaccination in Thailand

• Published in: Heart rhythm Vol. 19; no. 11; pp. 1874 - 1879
• Main Authors: Ittiwut, Chupong, Mahasirimongkol, Surakameth, Srisont, Smith, Ittiwut, Rungnapa, Chockjamsai, Manoch, Durongkadech, Piya, Sawaengdee, Waritta, Khunphon, Athiwat, Larpadisorn, Kanidsorn, Wattanapokayakit, Sukanya, Wetchaphanphesat, Suppachok, Arunotong, Surachet, Srimahachota, Suphot, Pittayawonganon, Chakrarat, Thammawijaya, Panithee, Sutdan, Derek, Doungngern, Pawinee, Khongphatthanayothin, Apichai, Kerr, Stephen J., Shotelersuk, Vorasuk
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2022; Heart Rhythm Society
• Subjects: Adult; Aged; Australia; ChAdOx1 nCoV-19; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 Vaccines - adverse effects; Death, Sudden - epidemiology; Death, Sudden - etiology; Female; Genetics; Humans; Male; Middle Aged; Pandemics; SCN5A; Sudden unexplained death (SUD); Thailand - epidemiology; Vaccination; Vaccination - adverse effects; Young Adult; Thailand; Australia; COVID-19; Genetics; SCN5A; Sudden unexplained death (SUD); Vaccination
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2022.07.019

Severe acute respiratory syndrome coronavirus 2 vaccination reduces morbidity and mortality associated with coronavirus disease 2019 (COVID-19); unfortunately, it is associated with serious adverse events, including sudden unexplained death (SUD). We aimed to study the genetic basis of SUD after COVID-19 vaccination in Thailand. From April to December 2021, cases with natural but unexplained death within 7 days of COVID-19 vaccination were enrolled for whole exome sequencing. Thirteen were recruited, aged between 23 and 72 years; 10 (77%) were men, 12 were Thai; and 1 was Australian. Eight (61%) died after receiving the first dose of vaccine, and 7 (54%) died after receiving ChAdOx1 nCoV-19; however, there were no significant correlations between SUD and either the number or the type of vaccine. Fever was self-reported in 3 cases. Ten (77%) and 11 (85%) died within 24 hours and 3 days of vaccination, respectively. Whole exome sequencing analysis revealed that 5 cases harbored SCN5A variants that had previously been identified in patients with Brugada syndrome, giving an SCN5A variant frequency of 38% (5 of 13). This is a significantly higher rate than that observed in Thai SUD cases occurring 8–30 days after COVID-19 vaccination during the same period (10% [1 of 10]), in a Thai SUD cohort studied before the COVID-19 pandemic (12% [3 of 25]), and in our in-house exome database (12% [386 of 3231]). These findings suggest that SCN5A variants may be associated with SUD within 7 days of COVID-19 vaccination, regardless of vaccine type, number of vaccine dose, and presence of underlying diseases or postvaccine fever.