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kakape's profile
Kai Kupferschmidt
Kai Kupferschmidt
Kai Kupferschmidt
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@kakape

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Kai KupferschmidtVerified account

@kakape

science journalist. molecular biologist. curious. contributing correspondent at @sciencemagazine part of @pandemiapodcast, all things #blue

Berlin, Germany
sciencemag.org/author/kai-kup…
Joined June 2009

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    Kai Kupferschmidt‏Verified account @kakape Apr 14

    Most fascinating bit of ACIP meeting so far is a detail on the 25-year old male in J&J trial, who developed CVST with hemorrhage after 8 days. J&J representative says it was retrospectively determined that he was negative for anti-PF4 antibodies before vaccination, positive after

    11:20 AM - 14 Apr 2021
    • 438 Retweets
    • 1,359 Likes
    • hanis hanum zulkifly Lucy Carroll kokodavila Nick Stucky Zina, Jewish Space Laser Mary Jane Reyes vavah fiase Becca Kowalski cacouteau
    48 replies 438 retweets 1,359 likes
      1. New conversation
      2. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Case reports are fascinating. Here are some details on the case from previous tweet. (Short sentence on anti-PF4 antibodies is a bit misleading here: he was negative at baseline, positive post-vaccination according to the presentation)pic.twitter.com/1FrdQwQ9SY

        11 replies 58 retweets 244 likes
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      3. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Helpful timeline here:pic.twitter.com/BfsrNO18UZ

        3 replies 30 retweets 151 likes
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      4. Kai Kupferschmidt‏Verified account @kakape Apr 14

        And here is a comparison of the three vaccines in use in the US for CVST. As you can see there are no cases of CVST with thrombocytopenia reported for the two mRNA vaccines.pic.twitter.com/AeQMWnOzMu

        13 replies 77 retweets 281 likes
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      5. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Some characteristics of the six reported cases of CVST with thrombocytopenia after J&J vaccine. Only one patient was using estrogen/progesterone, none had reported coagulation disorders.pic.twitter.com/zVdDd77o6X

        7 replies 87 retweets 286 likes
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      6. Kai Kupferschmidt‏Verified account @kakape Apr 14

        “The important thing to note here is these initial features are largely nonspecific symptoms… I do think it's important in the setting we are right now, that healthcare providers maintain a high index of suspicion for possible CVST”pic.twitter.com/UH2CpuqDBw

        4 replies 69 retweets 273 likes
        Show this thread
      7. Kai Kupferschmidt‏Verified account @kakape Apr 14

        “We think it's important to look for substantial blood clots in individuals with thrombocytopenia regardless of whether they're in the CNS or not.”pic.twitter.com/ONGFecs9Fc

        3 replies 38 retweets 180 likes
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      8. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Here we go. Was hoping to hear about anti-PF antibodies: At least 5 patients did have these antibodies.pic.twitter.com/t5KFkLTy9O

        2 replies 34 retweets 174 likes
        Show this thread
      9. Kai Kupferschmidt‏Verified account @kakape Apr 14

        And here is a comparison of cases expected and observed in women aged 20-50 (for different assumed background rates). This, basically, is the safety signal.pic.twitter.com/2WjONyxHki

        4 replies 70 retweets 198 likes
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      10. Kai Kupferschmidt‏Verified account @kakape Apr 14

        (Notes afterwards that these expected numbers are based on CVST in general, not CVST with thrombocytopenia. So expected numbers here are very possibly an overestimate, making safety signal even stronger.)

        1 reply 22 retweets 166 likes
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      11. Kai Kupferschmidt‏Verified account @kakape Apr 14

        And I’ll just post the summary slides here as well: (Emphasizes again not to use heparin in patients with thromboses after J&J vaccination, unless HIT test is negative. Also emphasizes how important the reporting of adverse events via VAERS is.)pic.twitter.com/sw1n9LzC64

        5 replies 78 retweets 270 likes
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      12. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Side note: There was a lot of criticism yesterday of CDC/FDA for their decision. Won’t get into that here. But after following essentially the same debate in Europe on AZ for a month now (EMA/PEI mostly), this meeting is next level in terms of transparency. We need more of this.

        10 replies 109 retweets 612 likes
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      13. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Some very important background data now presented by Sara Oliver as we come to benefit/risk debate. Most importantly: - About 1,5 million doses administered to women 18-50 years of age - About 1/2 of 7 million doses administered before end of March (so CVST likely seen already)pic.twitter.com/DV5s48cTvq

        2 replies 26 retweets 141 likes
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      14. Kai Kupferschmidt‏Verified account @kakape Apr 14

        And here is the background in terms of vaccine supply considerations:pic.twitter.com/v7KUEcV4R3

        2 replies 24 retweets 102 likes
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      15. Kai Kupferschmidt‏Verified account @kakape Apr 14

        And two good slides outlining what IS known and what is NOT known. We often talk about decisions having to be made amid uncertainty in situations like this. Absolutely fascinating to see this play out in public in real life.pic.twitter.com/39UKvXo0rG

        3 replies 71 retweets 271 likes
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      16. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Basic policy options now are: - stop using J&J - use it only in some populations (only men, only people aged 50+) - restart use in all adults (@DrPaulOffit outlined this in our story yesterday too: https://www.sciencemag.org/news/2021/04/concerns-over-rare-clotting-disorders-halt-use-johnson-johnson-s-covid-19-vaccine …)pic.twitter.com/k0V99SgyUt

        9 replies 47 retweets 201 likes
        Show this thread
      17. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Interesting point raised in the debate just now is that most US hospitals probably do not have the ability to test for HIT in-house, so would have to send out for this (and demand for these tests may well rise).

        8 replies 21 retweets 141 likes
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      18. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Public comments now. First person called was antivaxxer DelBigtree (read @deerbrian’s great book on Wakefield for more) but didn’t answer, so moved on to next.

        3 replies 10 retweets 70 likes
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      19. Kai Kupferschmidt‏Verified account @kakape Apr 14

        (One more side note: I get annoyed at US centric view of issues sometimes and was impressed that in outlining possible impact of restricting/stopping J&J, global repercussions were included)pic.twitter.com/4mBUysZu5G

        3 replies 19 retweets 189 likes
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      20. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Antivaxxer DelBigtree now, unsurprisingly: “Please do the CDC a favor, do this nation a favor, and lead by erring on the side of caution for the citizens, and not the pharmaceutical industry, and pull Johnson and Johnson immediately."

        6 replies 9 retweets 53 likes
        Show this thread
      21. Kai Kupferschmidt‏Verified account @kakape Apr 14

        (While there is a lot of worry that anti-vaxxers will use this safety signal for their aims, this whole process - for anyone who actually follows it - should reassure people that these safety signals are picked up and are taken seriously. Important to report the process here!)

        8 replies 43 retweets 310 likes
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      22. Kai Kupferschmidt‏Verified account @kakape Apr 14

        So questions now for voting members: Is there enough information to make interim age or risk-factor based recommendations for this vaccine? What recommendation does ACIP feel is appropriate today given current available information for use of the Janssen vaccine?pic.twitter.com/4FQtRyaMHI

        3 replies 12 retweets 86 likes
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      23. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Sounds like a lot of support for the option of continuing the J&J immunization pause while more data is gathered.

        6 replies 14 retweets 101 likes
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      24. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Important point raised by @KottonNelson: At least in Massachusetts this “one-and-done” shot was to be used "for our vulnerable inpatient populations, often with many comorbidities and at high risk for disease but who haven't been able to get vaccinated otherwise"

        2 replies 17 retweets 103 likes
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      25. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Echoed by @nirav_mainecdc: “not making a decision is tantamount to making a decision, and the extension of the pause will invariably result in the fact that the most vulnerable individuals in United States who were prime candidates of J&J vaccine will remain vulnerable"

        5 replies 39 retweets 182 likes
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      26. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Interesting point by Helen Keipp Talbot: Those who are most vulnerable may also be at special risk from severe clotting and may not get care on time, so “a double-edged sword”.

        4 replies 20 retweets 126 likes
        Show this thread
      27. Kai Kupferschmidt‏Verified account @kakape Apr 14

        It’s over! Decision is not to vote on any changes to the recommendations today and to continue the pause while more data is gathered and then to meet again in a week or ten days. (Technically, I think, they are simply not making any recommendation to CDC director.)

        2 replies 23 retweets 108 likes
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      28. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Not the most exciting RESULT and this will lead to a lot of debate, but I have to say that this was an amazing display of the PROCESS of vaccine safety (and yes, we journalists are terrible at writing about/explaining process in an engaging way, though it is so important.)

        3 replies 27 retweets 217 likes
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      29. Kai Kupferschmidt‏Verified account @kakape Apr 14

        Sorry everyone for a thread, that was a bit denser than usual. Hard to break down information while listening and live-tweeting. I do think the data presented here give us a lot of context we were missing.

        8 replies 7 retweets 125 likes
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      30. Kai Kupferschmidt‏Verified account @kakape Apr 14

        About risk: For now a lot depends on the denominator you choose. 
You can say 6 out of more than 6 million vaccines, so 1 in a million
. Or if you use female vaccinees aged 18-50 and vaccinated more than 2 weeks ago, it’s more like 6 out of 700,000, so closer to 1 in 100,000

        11 replies 64 retweets 283 likes
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      31. Kai Kupferschmidt‏Verified account @kakape Apr 14

        And remember: -some people vaccinated in last two weeks may only present with symptoms in next days and - there may be “stimulated reporting”, so cases found because of the attention drawn to this So reasonable to expect numbers to go up and those cases will add data to evaluate

        10 replies 20 retweets 179 likes
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      32. Show replies

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