Prevalence of anti-platelet factor 4/polyanionic antibodies after COVID-19 vaccination with ChAdOx1 nCoV-19 and CoronaVac in Thais

Introduction: Vaccine-induced thrombotic thrombocytopenia (VITT) has been reported after vaccination with the adenoviral vector coronavirus disease 2019 (COVID-19) vaccine ChAdOx1 nCoV-19 in European countries. To date, two cases of VITT have been reported in Thais after COVID-19 vaccination. We determined the frequency of anti-platelet factor 4 (PF4)/polyanionic antibodies in the Thai population receiving the COVID-19 vaccines.

Methods: We conducted a cross-sectional study to evaluate the prevalence of anti-PF4/polyanionic antibodies in health care workers who received COVID-19 vaccination with ChAdOx1 nCoV-19 or CoronaVac within 7 to 35 days. A control population who had not been vaccinated was also included. Anti-PF4/polyanionic antibodies were detected using ELISA. Functional assay with platelet aggregation was performed for all positive anti-PF4/polyanionic antibody ELISA tests.

Results: A total of 646 participants were included in the study; 221 received ChAdOx1 nCoV-19, 232 received CoronaVac, and 193 participants were in the control group. The prevalence of anti-PF4 antibodies was 2.3% (95% confidence interval [CI], 0.7-5.2), 1.7% (95% CI, 0.5-4.4) in the ChAdOx1 nCoV-19 and CoronaVac groups, respectively. There was no positive test in the control group. None of the PF4/polyanionic positive sera induced platelet aggregation.

Conclusion: We found a low prevalence of anti-PF4 antibodies in Thais after vaccination with ChAdOx1 nCoV-19 and CoronaVac. None of the antibodies were functional and lacked an association with VITT.