Study spotlights persistent daily headaches after COVID-19

News brief

A study based on patients in 11 South American countries shows that new daily persistent headache (NDPH) can be a clinical symptom after COVID.

"Persistent headache, with a prevalence ranging from 8 to 15% in the first six months after COVID-19 remission, is a frequent symptom," the authors of the study write. "However, limited knowledge exists regarding the clinical spectrum and predisposing factors."

The study, based on responses to an online survey conducted from April 15 to April 30, 2022, is published in BMC Infectious Diseases. The 421 participants were 18 years or older, had previously tested positive for COVID-19, and had an NDPH for at least 28 days. The survey contained four different sections assessing demographics, medical history, persistent headache characteristics, and COVID-19 vaccination status.

The mean age was 40 years, and most participants were women (81.5%), with university education (76.2%). More than 90% described their COVID-19 infections as mild to moderate.

Two-thirds had persistent headaches in first 2 weeks

Among participants, 106 met the diagnostic criteria for NDPH. Persistent headache began during the first 2 weeks of COVID-19 in most participants (68.9%) with NDPH. Compared to those who had a non-NDPH headache, the most predominant clinical characteristics were occipital location (43.4% for NDPH vs. 28.3%), severe/unbearable intensity (70.8% vs. 56.8%), burning character (17% vs. 6.7%, and radiating pain (70.8% vs. 60%).

During the acute phase of COVID-19, patients with persistent headache reported neuropsychological spectrum symptoms more frequently.

Most participants were vaccinated against COVID-19 before developing persistent headache (60.3%), with no differences between the two groups, the authors said.

"During the acute phase of COVID-19, patients with persistent headache reported neuropsychological spectrum symptoms more frequently, such as fatigue, sleep problems, anxiety, and mental fog," the authors wrote. "Notably, during the acute phase of COVID-19, a higher proportion of cranial autonomic symptoms were observed in participants with NDPH. These symptoms include sweating of the face or forehead, drooping of the upper eyelid and/or pupillary constriction, and palpebral edema."

The authors concluded that healthcare workers should take a COVID-19 infection history in patients reporting NDPH.

Study shows HPV vaccination gaps in preteens

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Stephanie Soucheray, MA

A research letter yesterday in JAMA Pediatrics study shows that children younger than 13 years still have significant gaps in human papillomavirus (HPV) vaccination coverage, despite the US Centers for Disease Control and Prevention's Advisory Committee for Immunization Practices recommendation for routine HPV vaccination for girls aged 11 to 12 years since 2006, and for boys since 2011.

The researchers used data from the National Immunization Survey (NIS)-Teen from 2018 to 2021 to estimate the annual percent change in vaccination among 11- and 12-year-olds. Overall, vaccine uptake increased during the study period, but a sizable number of US children eligible for vaccination opt out of the routine series.

Progress, but gaps remain

From 2018 to 2021, the researchers note increases in the percentages of girls who initiated HPV vaccination before age 13 years (from 50.5% to 62.7%; prevalence difference [PD], 12.3), and those who completed the series before age 13 years (from 34.2% to 38.6% PD, 4.5). The percentage of boys who initiated HPV vaccination before age 13 also increased in that time span (from 42.6% to 59.0%; PD, 6.5), as did the percentage who completed the series before age 13 (from 27.6% to 35.7%; PD, 8.2).

In 2021, less than half of adolescents aged 13 to 17 years had completed the series before age 13 years.

"In 2021, less than half of adolescents aged 13 to 17 years had completed the series before age 13 years," the authors said. "Increases in HPV vaccine initiation before age 13 years are encouraging, but more progress is needed."

The authors recommended following the American Academy of Pediatrics recommendation to begin routine HPV vaccination at age 9 as a way to increase uptake, as studies have shown earlier initiation of the vaccine series is associated with higher rates of completion.

COVAX winds down with COVID vaccine shift to regular programs

News brief

Lisa Schnirring

The World Health Organization (WHO) today announced that COVAX, a program formed in 2020 to increase equitable distribution of COVID-19 vaccines, will close on December 31 as distribution shifts to regular immunization programs.

COVAX vaccine — Présidence de la République du Bénin / Flickr cc

COVAX was jointly led by Gavi, the Vaccine Alliance, UNICEF, and the WHO. So far, it has distributed nearly 2 billion doses to 146 economies, the WHO said in a statement. The groups estimate that the vaccines distrusted through COVAX averted 2.7 million deaths and helped lower-income countries achieve 57% two-dose coverage, compared to the 67% global average.

Free vaccine doses will still be available

The 92 low-income countries that received free doses through the COVAX program will be eligible for COVID vaccine doses and delivery support through Gavi's regular programs. So far, 58 countries have requested a total of 83 million doses for 2024, which target priority groups, such as healthcare workers, older adults, and community workers.

The WHO said COVAX has been one of the most significant multilateral partnerships of the 21st century. It said the program, however, faced steep challenges, such as a lack of up-front cash reserves that prevented it from signing early contracts with manufacturers. Though it was able to ship 100 million doses in the first 6 weeks of the global vaccine rollout, export bans and other factors meant that large-scale deliveries weren't received until the third quarter of 2021.

Jose Manuel Barroso, who chairs Gavi's board, said, "As we transition COVID-19 into Gavi's routine programming, we do so with deep gratitude for the passion, dedication and sacrifice of so many around the globe who fought tirelessly for three years to try and create a more equitable world—and with an unwavering commitment to improve by transforming learnings into tangible action."