Thai Princess's Coma Due to Infection, Country Not Banning Pfizer's COVID-19 Vaccine

SciCheck Digest

Thai officials attributed the collapse of the king’s eldest daughter in December to a bacterial infection, not to COVID-19 vaccination, as some have baselessly claimed online. Rumors about the country banning Pfizer’s vaccines are also “fake news,” officials said.

More than half a billion doses of COVID-19 vaccines have now been administered in the U.S. and only a few, very rare, safety concerns have emerged. The vast majority of people experience only minor, temporary side effects such as pain at the injection site, fatigue, headache, or muscle pain — or no side effects at all. As the Centers for Disease Control and Prevention has said, these vaccines “have undergone and will continue to undergo the most intensive safety monitoring in U.S. history.”

A small number of severe allergic reactions known as anaphylaxis, which are expected with any vaccine, have occurred with the authorized and approved COVID-19 vaccines. Fortunately, these reactions are rare, typically occur within minutes of inoculation and can be treated. Approximately 5 per million people vaccinated have experienced anaphylaxis after a COVID-19 vaccine, according to the CDC.

To make sure serious allergic reactions can be identified and treated, all people receiving a vaccine should be observed for 15 minutes after getting a shot, and anyone who has experienced anaphylaxis or had any kind of immediate allergic reaction to any vaccine or injection in the past should be monitored for a half hour. People who have had a serious allergic reaction to a previous dose or one of the vaccine ingredients should not be immunized. Also, those who shouldn’t receive one type of COVID-19 vaccine should be monitored for 30 minutes after receiving a different type of vaccine.

There is evidence that the Pfizer/BioNTech and Moderna mRNA vaccines may rarely cause inflammation of the heart muscle (myocarditis) or of the surrounding lining (pericarditis), particularly in male adolescents and young adults.

Based on data collected through August 2021, the reporting rates of either condition in the U.S. are highest in males 16 to 17 years old after the second dose (105.9 cases per million doses of the Pfizer/BioNTech vaccine), followed by 12- to 15-year-old males (70.7 cases per million). The rate for 18- to 24-year-old males was 52.4 cases and 56.3 cases per million doses of Pfizer/BioNTech and Moderna vaccines, respectively.

Health officials have emphasized that vaccine-related myocarditis and pericarditis cases are rare and the benefits of vaccination still outweigh the risks. Early evidence suggests these myocarditis cases are less severe than typical ones. The CDC has also noted that most patients who were treated “responded well to medicine and rest and felt better quickly.”

The Johnson & Johnson vaccine has been linked to an increased risk of rare blood clots combined with low levels of blood platelets, especially in women ages 30 to 49. Early symptoms of the condition, which is known as thrombosis with thrombocytopenia syndrome, or TTS, can appear as late as three weeks after vaccination and include severe or persistent headaches or blurred vision, leg swelling, and easy bruising or tiny blood spots under the skin outside of the injection site.

According to the CDC, TTS has occurred in around 4 people per million doses administered. As of early April, the syndrome has been confirmed in 60 cases, including nine deaths, after more than 18.6 million doses of the J&J vaccine. Although TTS remains rare, because of the availability of mRNA vaccines, which are not associated with this serious side effect, the FDA on May 5 limited authorized use of the J&J vaccine to adults who either couldn’t get one of the other authorized or approved COVID-19 vaccines because of medical or access reasons, or only wanted a J&J vaccine for protection against the disease. Several months earlier, on Dec. 16, 2021, the CDC had recommended the Pfizer/BioNTech and Moderna shots over J&J’s.

The J&J vaccine has also been linked to an increased risk of Guillain-Barré Syndrome, a rare disorder in which the immune system attacks nerve cells. Most people who develop GBS fully recover, although some have permanent nerve damage and the condition can be fatal.

Safety surveillance data suggest that compared with the mRNA vaccines, which have not been linked to GBS, the J&J vaccine is associated with 15.5 additional GBS cases per million doses of vaccine in the three weeks following vaccination. Most reported cases following J&J vaccination have occurred in men 50 years old and older.

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Thailand’s Princess Bajrakitiyabha, the eldest of the king’s children and a potential heir to the throne, collapsed on Dec. 14 while training her dogs for a competition. On Jan. 7, a palace statement said the 44-year-old princess fell into a coma due to a severe arrhythmia, or irregular heartbeat, caused by heart inflammation following a mycoplasma infection.

Mycoplasma is a kind of bacteria that typically affects the lungs, skin or urinary tract, depending on the species responsible for an infection. Most infections are mild, but some can be severe and even fatal. Mycoplasma pneumoniae, for instance, is a common cause of pneumonia, but in rare cases it can spread to other parts of the body, including the heart. Because these bacteria have no cell walls, like most bacteria do, some antibiotics won’t work against them.

The Royal Household Bureau has released three statements about Princess Bajrakitiyabha since her collapse. In the most recent one, from more than a month ago, authorities said the princess remained unconscious and that she was receiving antibiotics and heart, lung, and kidney support.

Despite no mention of COVID-19 vaccination, online articles and social media posts have baselessly claimed that the princess’s condition was caused by a COVID-19 vaccine and that Thai officials were banning Pfizer’s shots.

“Thailand to BAN Pfizer After Thai Princess Falls Into a Coma Following Booster Jab,” reads one Feb. 5 headline from a dubious website.

The claims stem from an interview, widely shared online by anti-vaccine activists, with a retired Thai-German microbiologist named Sucharit Bhakdi. Bhakdi, who has spread misinformation about COVID-19 and the vaccines before, claimed without evidence that the princess collapsed 23 days after a booster. He also said, incorrectly, that a bacterial infection “would never do what she’s suffering from,” and called the diagnosis “so ridiculous.”

Half an hour into the interview, Bhakdi said the vaccine was “deadly” and suggested that Thailand was going to cancel its vaccine contract with Pfizer/BioNTech.

There is no support for these claims. The Pfizer/BioNTech vaccine has been shown to be remarkably safe, both in clinical trials and in subsequent safety surveillance studies. The royal family has not released the princess’s vaccine status, and there’s no evidence that she received a booster before falling into a coma. The claims have also been fact-checked by the Associated Press, Snopes and Lead Stories.

Thailand’s Department of Disease Control publicly denied the claim about the country no longer offering the Pfizer/BioNTech vaccine on Feb. 2 in a Facebook post that included a screenshot of Bhakdi’s interview with the warning, “FAKE NEWS DO NOT SHARE!”

Well-wishers bow in front of an image of Thailand’s Princess Bajrakitiyabha Mahidol at Chulalongkorn Hospital in Bangkok on Dec. 16, 2022. Photo by Lillian Suwanrumpha/AFP via Getty Images.

“The Department of Disease Control, the Ministry of Health, has fact checked and found the issue to be false information. The public is requested not to be fooled and ask for cooperation not to send or share such information on various social media channels,” the post reads, according to a translation by Facebook.

A Pfizer representative told us in a statement that Thailand’s health authorities continue “to recommend vaccination with the Pfizer-BioNTech COVID-19 vaccine for all authorized ages and indications.”

“With hundreds of millions of doses of the original and Omicron BA.4/BA.5-adapted bivalent Pfizer-BioNTech COVID-19 vaccine administered globally, the benefit-risk profile of our vaccines remains positive for all authorized indications and age groups,” the company added.

Bhakdi told the AP in a Feb. 7 story that some online claims had been exaggerated, but that he had spoken with the “highest-ranking advisors to the government and Royal Family” about ending Pfizer’s contract and he hoped “there will be things to report in about 2 weeks.”

An official with Thailand’s National Vaccine Institute, however, confirmed to the AP that the nation was not planning to terminate any COVID-19 vaccine contracts.

“There are no orders to stop or slow down usage or reconsider its use,” the official said of the Pfizer/BioNTech vaccine. “We are still moving forward and using it.”

Because the COVID-19 vaccines do not contain bacteria, there is no reason to think that the vaccines could cause mycoplasma infections, nor is there any indication vaccination could make someone more susceptible to them. The Centers for Disease Control and Prevention has not reported an association between mycoplasma infections and COVID-19 vaccines.

Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, Texas, told us he is not aware of any association either.

“There’s no relationship with the Covid vaccine and mycoplasma infections,” Dr. Amesh Adalja, an infectious disease expert and a senior scholar at the Johns Hopkins Center for Health Security, told us in an email. “However, mycoplasma is a very well established cause of cardiac infection. It can cause myocarditis and pericarditis,” he added, referring to inflammation of the heart muscle and the surrounding tissue.

Contrary to Bhakdi’s comments, mycoplasma infections may be severe and life-threatening, although it’s rare. According to a 2018 study, on top of the pulmonary symptoms, Mycoplasma pneumoniae infections can also involve other organs, such as the heart. “Cardiac symptoms are uncommon” the study says, but can include heart inflammation and arrhythmias.

There is evidence that the Pfizer/BioNTech COVID-19 vaccine may rarely cause myocarditis and pericarditis. But most of those rare cases happen in young males, after a second dose. The conditions can also occur with COVID-19, and evidence suggests those cases are more severe. To date, the benefits of the vaccine outweigh the risks in all populations.

There are reports of patients being coinfected with COVID-19 and Mycoplasma pneumoniae, although it’s rare and the impact on the severity of having both illnesses together is still unknown.

Thailand’s king and queen tested positive for COVID-19 on Dec. 17, three days after their daughter collapsed, but there is no public information regarding the princess’s COVID-19 status.

Editor’s note: SciCheck’s articles providing accurate health information and correcting health misinformation are made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over FactCheck.org’s editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation.

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