151
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Raman B, Bluemke DA, Lüscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur Heart J 2022; 43:1157-1172. [PMID: 35176758 PMCID: PMC8903393 DOI: 10.1093/eurheartj/ehac031] [Citation(s) in RCA: 267] [Impact Index Per Article: 133.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
Emerging as a new epidemic, long COVID or post-acute sequelae of coronavirus disease 2019 (COVID-19), a condition characterized by the persistence of COVID-19 symptoms beyond 3 months, is anticipated to substantially alter the lives of millions of people globally. Cardiopulmonary symptoms including chest pain, shortness of breath, fatigue, and autonomic manifestations such as postural orthostatic tachycardia are common and associated with significant disability, heightened anxiety, and public awareness. A range of cardiovascular (CV) abnormalities has been reported among patients beyond the acute phase and include myocardial inflammation, myocardial infarction, right ventricular dysfunction, and arrhythmias. Pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiac diseases which are abundant in those at risk of severe disease. In this review, we discuss the definition of long COVID and its epidemiology, with an emphasis on cardiopulmonary symptoms. We further review the pathophysiological mechanisms underlying acute and chronic CV injury, the range of post-acute CV sequelae, and impact of COVID-19 on multiorgan health. We propose a possible model for referral of post-COVID-19 patients to cardiac services and discuss future directions including research priorities and clinical trials that are currently underway to evaluate the efficacy of treatment strategies for long COVID and associated CV sequelae.
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Affiliation(s)
- Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
| | - Thomas F. Lüscher
- Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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152
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Cau R, Mantini C, Monti L, Mannelli L, Di Dedda E, Mahammedi A, Nicola R, Roubil J, Suri JS, Cerrone G, Fanni D, Faa G, Carriero A, Scuteri A, Francone M, Saba L. Role of imaging in rare COVID-19 vaccine multiorgan complications. Insights Imaging 2022; 13:44. [PMID: 35286509 PMCID: PMC8919150 DOI: 10.1186/s13244-022-01176-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
As of September 18th, 2021, global casualties due to COVID-19 infections approach 200 million, several COVID-19 vaccines have been authorized to prevent COVID-19 infection and help mitigate the spread of the virus. Despite the vast majority having safely received vaccination against SARS-COV-2, the rare complications following COVID-19 vaccination have often been life-threatening or fatal. The mechanisms underlying (multi) organ complications are associated with COVID-19, either through direct viral damage or from host immune response (i.e., cytokine storm). The purpose of this manuscript is to review the role of imaging in identifying and elucidating multiorgan complications following SARS-COV-2 vaccination-making clear that, in any case, they represent a minute fraction of those in the general population who have been vaccinated. The authors are both staunch supporters of COVID-19 vaccination and vaccinated themselves as well.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, 09045, Cagliari, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University, Chieti, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | | | - Emanuele Di Dedda
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Abdelkader Mahammedi
- Department of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, NY, USA
| | - John Roubil
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, NY, USA
| | - Jasjit S Suri
- Stroke Diagnosis and Monitoring Division, Atheropoint LLC, Roseville, CA, USA
| | - Giulia Cerrone
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Cagliari, Italy
| | - Daniela Fanni
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Cagliari, Italy
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Cagliari, Italy
| | - Alessandro Carriero
- Department of Diagnostic and Interventional Radiology, AOU Ospedale Maggiore Della Carità Di Novara, Novara, Italy
| | - Angelo Scuteri
- Department of Diagnostic and Interventional Radiology, AOU Ospedale Maggiore Della Carità Di Novara, Novara, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, 09045, Cagliari, Italy.
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153
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Chow BT, Lai CK. Lymphohistiocytic Myocarditis Possibly Due to Moderna mRNA-1273 Vaccine. Am J Clin Pathol 2022; 158:167-172. [PMID: 35285858 DOI: 10.1093/ajcp/aqac029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/02/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Despite the clear benefits of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in mitigating the impact of the coronavirus disease 2019 pandemic, there are emerging reports of postvaccination myocarditis, the majority of which are diagnosed based on the clinical and radiologic findings without biopsy confirmation. We report a case of biopsy-confirmed lymphohistiocytic myocarditis after Moderna mRNA-1273 vaccination. METHODS We describe a case of a previously healthy 45-year-old woman who had palpitations, exercise intolerance, and syncope 1 week after her first mRNA-1273 vaccine dose. Laboratory tests and cardiac imaging were compatible with myocarditis. Given her unusual clinical presentation, an endomyocardial biopsy was performed to exclude other potential etiologies. RESULTS The endomyocardial biopsy specimen showed patchy endocardial and intramyocardial lymphohistiocytic infiltrates with scattered eosinophils and focal myocyte injury. CD3 and CD68 immunostains confirmed the lymphocytic and histiocytic nature of the infiltrate, respectively. A focal histiocytic collection suggestive of an ill-defined granuloma was present. The histologic and immunohistochemical findings of a lymphohistiocytic myocarditis were highly suggestive of a postvaccination hypersensitivity reaction. CONCLUSIONS Myocarditis following SARS-CoV-2 vaccination is a rare adverse event. The findings of a lymphohistiocytic myocarditis with scattered eosinophils and a possible ill-defined granuloma are highly suggestive of a hypersensitivity reaction. The mechanism by which this inflammation occurs remains uncertain. Despite our findings, the benefits of SARS-CoV-2 vaccination far outweigh the risks.
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Affiliation(s)
| | - Chi K Lai
- Department of Pathology & Laboratory Medicine, Providence Health Care—St Paul’s Hospital, Division of Anatomic Pathology, University of British Columbia, Vancouver, Canada
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154
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Kravchenko D, Isaak A, Mesropyan N, Endler C, Bischoff L, Vollbrecht T, Pieper CC, Sedaghat A, Kuetting D, Hart C, Feisst A, Attenberger U, Luetkens JA. Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination. ROFO-FORTSCHR RONTG 2022; 194:1003-1011. [PMID: 35272355 DOI: 10.1055/a-1752-0951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate cardiac MRI characteristics in patients with suspected hypersensitivity myocarditis following mRNA COVID-19 vaccination. MATERIALS AND METHODS Patients clinically suspected of acute myocarditis after COVID-19 vaccination were retrospectively analyzed and compared against a healthy control group. Cardiac MRI protocol included parameters such as T1 and T2 relaxation times, extracellular volume (ECV), T2 signal intensity ratio, and late gadolinium enhancement (LGE). Lymph node size was assessed in the patient group on the injection side. Student t-test, analyses of variance (ANOVA) with Tukey post-hoc test, and χ2 test were used for statistical analysis. RESULTS 20 patients with clinically suspected post-vaccine myocarditis (28 ± 12 years; 12 men) and 40 controls (31 ± 11 years; 25 men) were evaluated. According to the 2018 Lake Louise criteria (LLC), patients with clinically suspected myocarditis were further subdivided into an LLC-positive group (n = 9) and an LLC-negative group (n = 11). The mean time of symptom onset after vaccination was 1.1 ± 1.2 days (LLC-positive) and 6.5 ± 9.2 days (LLC-negative). Group differences in inflammatory variables between myocarditis patients and control subjects were more pronounced in the LLC-positive group (e. g., T1 relaxation time: 1041 ± 61 ms [LLC positive] vs. 1008 ± 79 ms [LLC-negative] vs. 970 ± 25 ms [control]; p <.001; or T2 signal intensity ratio 2.0 ± 0.3 vs. 1.6 ± 0.3 [LLC-negative] and vs. 1.6 ± 0.3 [control], p = .012). LLC-positive patients were significantly faster in receiving an MRI after initial symptom onset (8.8 ± 6.1 days vs. 52.7 ± 33.4 days; p = .001) and had higher troponin T levels (3938 ± 5850 ng/l vs. 9 ± 11 ng/l; p <.001). LGE lesions were predominantly located at the subepicardium of the lateral wall. Axillary lymphadenopathy was more frequent in the LLC-positive group compared to the LLC-negative group (8/9 [89 %] vs. 0/11 [0 %], p < 0.001). CONCLUSION Vaccine-induced myocarditis should be considered in patients with acute symptom onset after mRNA vaccination, especially if elevated serum troponin T is observed. Imaging findings of vaccine-induced myocarditis are similar to virus-induced myocarditis, allowing for the use of the Lake Louise Criteria for diagnostic purposes. KEY POINTS · Vaccine-induced hypersensitivity myocarditis can be confirmed with cardiac MRI. · Especially patients with sudden onset of symptoms and elevated serum troponin T had positive cardiac MRI findings. · Cardiac MRI characteristics of vaccine-induced myocarditis are similar to those in virus-induced myocarditis. CITATION FORMAT · Kravchenko D, Isaak A, Mesropyan N et al. Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1752-0951.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Leon Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Thomas Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Alexander Sedaghat
- Cardiology, University Hospital Bonn Clinic II of Cardiology Angiology and Pulmonology, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany.,Department of Pediatric Cardiology, Paediatric Heart Center, University Hospital Bonn, Germany
| | - Andreas Feisst
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
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155
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Salleh MZ, Norazmi MN, Deris ZZ. Immunogenicity mechanism of mRNA vaccines and their limitations in promoting adaptive protection against SARS-CoV-2. PeerJ 2022; 10:e13083. [PMID: 35287350 PMCID: PMC8917804 DOI: 10.7717/peerj.13083] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/16/2022] [Indexed: 01/12/2023] Open
Abstract
Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) in late 2019, hundreds of millions of people have been infected worldwide. There have been unprecedented efforts in acquiring effective vaccines to confer protection against the disease. mRNA vaccines have emerged as promising alternatives to conventional vaccines due to their high potency with the capacity for rapid development and low manufacturing costs. In this review, we summarize the currently available vaccines against SARS-CoV-2 in development, with the focus on the concepts of mRNA vaccines, their antigen selection, delivery and optimization to increase the immunostimulatory capability of mRNA as well as its stability and translatability. We also discuss the host immune responses to the SARS-CoV-2 infection and expound in detail, the adaptive immune response upon immunization with mRNA vaccines, in which high levels of spike-specific IgG and neutralizing antibodies were detected after two-dose vaccination. mRNA vaccines have been shown to induce a robust CD8+T cell response, with a balanced CD4+ TH1/TH2 response. We further discuss the challenges and limitations of COVID-19 mRNA vaccines, where newly emerging variants of SARS-CoV-2 may render currently deployed vaccines less effective. Imbalanced and inappropriate inflammatory responses, resulting from hyper-activation of pro-inflammatory cytokines, which may lead to vaccine-associated enhanced respiratory disease (VAERD) and rare cases of myocarditis and pericarditis also are discussed.
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Affiliation(s)
- Mohd Zulkifli Salleh
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Mohd Nor Norazmi
- School of Health Sciences, Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Zakuan Zainy Deris
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
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156
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Shiyovich A, Witberg G, Aviv Y, Kornowski R, Hamdan A. A Case Series of Myocarditis Following Third (Booster) Dose of COVID-19 Vaccination: Magnetic Resonance Imaging Study. Front Cardiovasc Med 2022; 9:839090. [PMID: 35310989 PMCID: PMC8930918 DOI: 10.3389/fcvm.2022.839090] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/31/2022] [Indexed: 01/14/2023] Open
Abstract
Background Myocarditis has been reported following the first two doses of Pfizer-BNT162b2 messenger RNA (mRNA) COVID-19 vaccination. Administration of a third dose (booster) of the vaccine was initiated recently in Israel. Objective The aim of this study was to describe the characteristics of patients referred for cardiac magnetic resonance (CMR) imaging with myocarditis following the booster. Methods Patients referred for CMR imaging with a clinical diagnosis of myocarditis within 21 days following the booster, between July 13 and November 11, 2021, were analyzed. Results Overall, 4 patients were included, 3/4 (75%) were men, and the mean age was 27 ± 10 years. The time from booster administration to the onset of symptoms was 5.75 ± 4.8 days (range 2–14). Obstructive coronary artery disease was excluded in 3 of the patients (75%). CMR was performed 34 ± 15 days (range 8-47 days) following the 3rd vaccination. The mean left ventricular ejection fraction was 61 ± 7% (range 53–71%), and regional wall motion abnormalities were present in one of the patients. Global T1 was increased in one of the patients, while focal T1 values were increased in 3 of the patients. Global T2 was increased in one of the patients, while focal T2 values were increased in all the patients. Global ECV was increased in 3 of the patients, while focal ECV was increased in all the patients. Median late gadolinium enhancement (LGE) was 4 ± 3% (range 1–9%), with the inferolateral segment as the most common location (3 of the 4 patients). All the patients met the Updated Lake Louise Criteria. Conclusions Patient characteristics and CMR imaging findings of myocarditis following the administration of the booster vaccine are relatively mild and consistent with those observed with the first two doses. Although larger-scale prospective studies are necessary, these initial findings are somewhat reassuring.
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157
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Fick TA, Cua CL, Lee S. Imaging Findings in Pediatric COVID-19: A Review of Current Literature. Cardiol Ther 2022; 11:185-201. [PMID: 35233725 PMCID: PMC8888132 DOI: 10.1007/s40119-022-00256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
The recent COVID-19 pandemic has afflicted over 200 million individuals to date, with many different organ systems involved. The pediatric involvement has been variable, but of note is the risk of cardiac disease in pediatric COVID-19 patients. We review here the cardiac involvement in pediatric patients with COVID-19. Several studies highlight a possible cardiotropic nature of SARS-CoV-2, and describe the disease severity in myocarditis, both symptomatic and occult, as well as MIS-C. We describe the expected clinical course of these patients and note the lack of long-term follow-up data and the concerning prevalence of continued abnormal findings on follow-up imaging. With this paucity of long-term cardiac data, we recommend consideration of advanced imaging for pediatric patients with cardiac symptoms and/or elevation of cardiac serum biomarkers.
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Affiliation(s)
- Tyler A Fick
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford L Cua
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Simon Lee
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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158
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Nanoparticle and virus-like particle vaccine approaches against SARS-CoV-2. J Microbiol 2022; 60:335-346. [PMID: 35089583 PMCID: PMC8795728 DOI: 10.1007/s12275-022-1608-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
The global spread of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has provoked an urgent need for prophylactic measures. Several innovative vaccine platforms have been introduced and billions of vaccine doses have been administered worldwide. To enable the creation of safer and more effective vaccines, additional platforms are under development. These include the use of nanoparticle (NP) and virus-like particle (VLP) technology. NP vaccines utilize self-assembling scaffold structures designed to load the entire spike protein or receptor-binding domain of SARS-CoV-2 in a trimeric configuration. In contrast, VLP vaccines are genetically modified recombinant viruses that are considered safe, as they are generally replication-defective. Furthermore, VLPs have indigenous immunogenic potential due to their microbial origin. Importantly, NP and VLP vaccines have shown stronger immunogenicity with greater protection by mimicking the physicochemical characteristics of SARS-CoV-2. The study of NP- and VLP-based coronavirus vaccines will help ensure the development of rapid-response technology against SARS-CoV-2 variants and future coronavirus pandemics.
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159
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Al-Kindi S, Zidar DA. COVID-lateral damage: cardiovascular manifestations of SARS-CoV-2 infection. Transl Res 2022; 241:25-40. [PMID: 34780967 PMCID: PMC8588575 DOI: 10.1016/j.trsl.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023]
Abstract
Early in the pandemic, concern that cardiovascular effects would accompany COVID-19 was fueled by lessons from the first SARS epidemic, knowledge that the SARS-COV2 entry receptor (Angiotensin-converting enzyme 2, ACE2) is highly expressed in the heart, early reports of myocarditis, and first-hand accounts by physicians caring for those with severe COVID-19. Over 18 months, our understanding of the cardiovascular manifestations has expanded greatly, leaving more new questions than those conclusively answered. Cardiac involvement is common (∼20%) but not uniformly observed in those who require treatment in a hospitalized setting. Cardiac MRI studies raise the possibility of manifestations in those with minimal symptoms. Some appear to experience protracted cardiovascular symptoms as part of a larger syndrome of post-acute sequelae of COVID-19. Instances of vaccine induced thrombosis and myocarditis are exceedingly rare but illustrate the need to monitor the cardiovascular safety of interventions that induce inflammation. Here, we will summarize the current understanding of potential cardiovascular manifestations of SARS-COV2. To provide proper context, paradigms of cardiovascular injury due to other inflammatory processes will also be discussed. Ongoing research and a deeper understanding COVID-19 may ultimately reveal new insight into the mechanistic underpinnings of cardiovascular disease. Thus, in this time of unprecedented suffering and risk to global health, there exists the opportunity that well conducted translational research of SARS-COV2 may provide health dividends that outlast the current pandemic.
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Key Words
- ace2, angiotensin-converting enzyme 2
- pasc, post-acute sequelae of covid-19
- cvd, cardiovascular disease
- tnf, tumor necrosis factor
- pamp, pathogen associated molecular patterns
- damps, damage associated molecular patterns
- car-t, chimeric antigen receptor therapy
- dvt, deep venous thrombosis
- tf, tissue factor
- psgl, p-selectin glycoprotein ligand
- nets, neutrophil extracellular traps
- lv, left ventricular
- crp, c-reactive protein
- lge, late gadolinium enhancement
- cbv, coxsackie virus b
- b19v, parvovirus b12
- car, coxsackievirus and adenovirus receptor
- ns1, nonstructural protein 1
- ec, endothelial cells
- scrnaseq, single cell rna sequencing
- embx, endomyocardial biopsy
- tte, transthoracic echocardiograms
- rv, right ventricular
- gls, global longitudinal strain
- hscrp, high sensitivity c-reative protein
- vitt, vaccine-induced immune thrombotic thrombocytopenia
- dtap, diphtheria, tetanus, and polio
- vaers, vaccine adverse event reporting system
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Affiliation(s)
- Sadeer Al-Kindi
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - David A Zidar
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Louis Stokes VA Medical Center, Cleveland, Ohio.
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160
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Hana D, Patel K, Roman S, Gattas B, Sofka S. Clinical Cardiovascular Adverse Events Reported Post-COVID-19 Vaccination: Are They a Real Risk? Curr Probl Cardiol 2022; 47:101077. [PMID: 34902392 PMCID: PMC8662957 DOI: 10.1016/j.cpcardiol.2021.101077] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 12/21/2022]
Abstract
Given the urgent need to control the spread of the novel COVID-19 virus, 13 vaccines have been approved for emergency use before completing all 3 phases of the clinical trials. Thereby a careful monitor of the adverse effects postvaccination is essential. We searched through PubMed and other reporting systems like VAERS for the reported cardiovascular adverse events post-COVID-19 vaccination. Through our review, we determined that the incidence of all the reported cardiovascular events is very rare. Additionally, the vaccine was initially given to the elderly and high-risk populations in which cardiovascular events such as myocardial infarction and arrhythmias are already more prevalent, while other cardiovascular events such as myocarditis or vaccine-induced thrombotic thrombocytopenia were more common in younger populations. Moreover, a direct causal relationship, if any, between vaccination and adverse events is yet to be fully elucidated. Thus, at this time point, the benefits of vaccination far outweigh the risk.
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Affiliation(s)
- David Hana
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV.
| | - Kevin Patel
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Sherif Roman
- Department of Medicine, St Joseph's University Medical Center, Paterson, NJ
| | - Boula Gattas
- Department of Medicine, St Mary Medical Center, Langhorne, PA
| | - Sarah Sofka
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
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161
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Yen KC, Ho CT, Chin SC, Su HC, Lee KT, Chu PH. Self-Limited Myocarditis after the First Dose of Coronavirus Disease 2019 Messenger RNA-1273 Vaccine in a Healthy Male. ACTA CARDIOLOGICA SINICA 2022; 38:210-213. [PMID: 35273443 PMCID: PMC8888318 DOI: 10.6515/acs.202203_38(2).20210912a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/12/2021] [Indexed: 01/24/2023]
Affiliation(s)
- Kun-Chi Yen
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou Branch
| | - Chien-Te Ho
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou Branch
| | - Shy-Chyi Chin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Chi Su
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou Branch
| | - Kuang-Tso Lee
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou Branch
| | - Po-Hsien Chu
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou Branch
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162
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Fronza M, Thavendiranathan P, Chan V, Karur GR, Udell JA, Wald RM, Hong R, Hanneman K. Myocardial Injury Pattern at MRI in COVID-19 Vaccine-associated Myocarditis. Radiology 2022; 304:553-562. [PMID: 35166587 PMCID: PMC8856022 DOI: 10.1148/radiol.212559] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background There are limited data on the pattern and severity of myocardial injury
in patients with COVID-19 vaccination–associated myocarditis. Purpose To describe myocardial injury following COVID-19 vaccination and to
compare these findings to other causes of myocarditis. Materials and Methods In this retrospective cohort study, consecutive adult patients with
myocarditis with at least one T1-based and at least one T2-based
abnormality at cardiac MRI performed at a tertiary referral hospital
from December 2019 to November 2021 were included. Patients were
classified into one of three groups: myocarditis following COVID-19
vaccination, myocarditis following COVID-19 illness, and other
myocarditis not associated with COVID-19 vaccination or illness. Results Of the 92 included patients, 21 (23%) had myocarditis following COVID-19
vaccination (mean age, 31 years ± 14 [SD]; 17 men; messenger
RNA–1273 in 12 [57%] and BNT162b2 in nine [43%]). Ten of 92 (11%)
patients had myocarditis following COVID-19 illness (mean age, 51 years
± 14; three men) and 61 of 92 (66%) patients had other
myocarditis (mean age, 44 years ± 18; 36 men). MRI findings in
the 21 patients with vaccine-associated myocarditis included late
gadolinium enhancement (LGE) in 17 patients (81%) and left ventricular
dysfunction in six (29%). Compared with other causes of myocarditis,
patients with vaccine-associated myocarditis had a higher left
ventricular ejection fraction and less extensive LGE, even after
controlling for age, sex, and time from symptom onset to MRI. The most
frequent location of LGE in all groups was subepicardial at the basal
inferolateral wall, although septal involvement was less common in
vaccine-associated myocarditis. At short-term follow-up (median, 22 days
[IQR, 7–48 days]), all patients with vaccine-associated
myocarditis were asymptomatic with no adverse events. Conclusion Cardiac MRI demonstrated a similar pattern of myocardial injury in
vaccine-associated myocarditis compared with other causes, although
abnormalities were less severe, with less frequent septal involvement
and no adverse events over the short-term follow-up. © RSNA, 2022 Online supplemental material is available for this
article. See also the editorial by Raman and Neubauer in this issue.
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Affiliation(s)
- Matteo Fronza
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto
| | - Victor Chan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
| | - Gauri Rani Karur
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
| | - Jacob A Udell
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto.,Cardiovascular Division, Women's College Hospital, University of Toronto, Toronto
| | - Rachel M Wald
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto
| | - Rachel Hong
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
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163
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Murakami Y, Shinohara M, Oka Y, Wada R, Noike R, Ohara H, Fujino T, Ikeda T. Myocarditis Following a COVID-19 Messenger RNA Vaccination: A Japanese Case Series. Intern Med 2022; 61:501-505. [PMID: 34840235 PMCID: PMC8907764 DOI: 10.2169/internalmedicine.8731-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
COVID-19 vaccine-related myocarditis has been reported worldwide. We herein report two Japanese cases with suspected vaccine-related myocarditis. A 27-year-old man was admitted with chest pain 4 days after the second vaccination. An electrocardiogram (ECG) did not reveal any significant abnormalities. The second patient, a 37-year-old man, was admitted with chest pain 9 days after the first vaccination. His ECG exhibited ST-elevation in multiple leads. In both cases, cardiac magnetic resonance imaging findings were consistent with myocarditis. They recovered with symptomatic relief within a few days. These cases suggest that the benefit of COVID-19 vaccination exceeds the risk of vaccine-related myocarditis.
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Affiliation(s)
- Yoshiki Murakami
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Japan
| | - Masaya Shinohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Japan
| | - Yosuke Oka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Japan
| | - Ryo Wada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Japan
| | - Ryota Noike
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Japan
| | - Hiroshi Ohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Japan
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Japan
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164
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Fadah K, Abolbashari M, Ojha C, Alkhateeb H. Acute Myopericarditis After First Dose of mRNA-1273 SARS-CoV-2 Vaccine in a Young Adult. Cureus 2022; 14:e22111. [PMID: 35308760 PMCID: PMC8918282 DOI: 10.7759/cureus.22111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/05/2022] Open
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165
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Bellos I, Karageorgiou V, Viskin D. Myocarditis following mRNA Covid-19 vaccination: a pooled analysis. Vaccine 2022; 40:1768-1774. [PMID: 35153093 PMCID: PMC8818354 DOI: 10.1016/j.vaccine.2022.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/22/2022] [Accepted: 02/02/2022] [Indexed: 12/15/2022]
Abstract
Background Methods Results Conclusions
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166
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Yoshida K, Sakaki A, Matsuyama Y, Mushino T, Matsumoto M, Sonoki T, Tamura S. Acquired Thrombotic Thrombocytopenic Purpura Following BNT162b2 mRNA Coronavirus Disease Vaccination in a Japanese Patient. Intern Med 2022; 61:407-412. [PMID: 34803105 PMCID: PMC8866790 DOI: 10.2169/internalmedicine.8568-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 57-year-old man without underlying diseases presented with fatigue, loss of appetite, and jaundice 1 week after receiving the first dose of the BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccine and showed hemolytic anemia with fragmented erythrocytes and severe thrombocytopenia 2 weeks after receiving the vaccine. An a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13) activity level of <10% and ADAMTS13 inhibitor positivity confirmed the diagnosis of acquired thrombotic thrombocytopenic purpura (TTP). Combination therapy with plasma exchange, corticosteroid, and rituximab improved the clinical outcome. We herein report the first Japanese case of TTP possibly associated with vaccination. Physicians should be alert for this rare but life-threatening hematological complication following COVID-19 vaccination.
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Affiliation(s)
- Kikuaki Yoshida
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Ayaka Sakaki
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Yoriko Matsuyama
- Department of Hematology/Oncology, Wakayama Medical University, Japan
- Department of General Internal Medicine, Hashimoto Municipal Hospital, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Japan
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University, Japan
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167
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Incidence of Myopericarditis and Myocardial Injury in Coronavirus Disease 2019 Vaccinated Subjects. Am J Cardiol 2022; 164:123-130. [PMID: 34852929 PMCID: PMC8627580 DOI: 10.1016/j.amjcard.2021.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
Several recent publications have described myopericarditis cases after the coronavirus disease 2019 (COVID-19) vaccination. However, it is uncertain if these cases occurred secondary to the vaccination or more common etiologies of myopericarditis. To help determine whether a correlation exists between COVID-19 vaccination and myopericarditis, the present study compared the gender-specific cumulative incidence of myopericarditis and myocardial injury in a cohort of COVID-19 vaccinated patients at a tertiary care center in 2021 with the cumulative incidence of these conditions in the same subjects exactly 2 years earlier. We found that the age-adjusted incidence rate of myopericarditis in men was higher in the vaccinated than the control population, rate ratio 9.7 (p = 0.04). However, the age-adjusted incidence rate of myopericarditis in women was no different between the vaccinated and control populations, rate ratio 1.28 (p = 0.71). We further found that the rate of myocardial injury was higher in both men and women in 2021 than in 2019 both before and after vaccination, suggesting that some of the apparent increase in the diagnosis of myopericarditis after vaccination may be attributable to factors unrelated to the COVID-19 vaccinations. In conclusion, our study reaffirms the apparent increase in the diagnosis of myopericarditis after COVID-19 vaccination in men but not in women, although this finding may be confounded by increased rates of myocardial injury in 2021. The benefits of COVID-19 vaccination to individual and public health clearly outweigh the small potential increased risk of myopericarditis after vaccination.
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168
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Oster ME, Shay DK, Su JR, Gee J, Creech CB, Broder KR, Edwards K, Soslow JH, Dendy JM, Schlaudecker E, Lang SM, Barnett ED, Ruberg FL, Smith MJ, Campbell MJ, Lopes RD, Sperling LS, Baumblatt JA, Thompson DL, Marquez PL, Strid P, Woo J, Pugsley R, Reagan-Steiner S, DeStefano F, Shimabukuro TT. Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021. JAMA 2022; 327:331-340. [PMID: 35076665 PMCID: PMC8790664 DOI: 10.1001/jama.2021.24110] [Citation(s) in RCA: 377] [Impact Index Per Article: 188.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. The risks and outcomes of myocarditis after COVID-19 vaccination are unclear. OBJECTIVE To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US. DESIGN, SETTING, AND PARTICIPANTS Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021. EXPOSURES Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna). MAIN OUTCOMES AND MEASURES Reports of myocarditis to VAERS were adjudicated and summarized for all age groups. Crude reporting rates were calculated across age and sex strata. Expected rates of myocarditis by age and sex were calculated using 2017-2019 claims data. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test results, treatment, and early outcomes. RESULTS Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males comprised 82% of the myocarditis cases for whom sex was reported. The crude reporting rates for cases of myocarditis within 7 days after COVID-19 vaccination exceeded the expected rates of myocarditis across multiple age and sex strata. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). There were 826 cases of myocarditis among those younger than 30 years of age who had detailed clinical information available; of these cases, 792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic resonance imaging results. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%). CONCLUSIONS AND RELEVANCE Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.
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Affiliation(s)
- Matthew E. Oster
- US Centers for Disease Control and Prevention, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - David K. Shay
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R. Su
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julianne Gee
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Karen R. Broder
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Sean M. Lang
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | - Laurence S. Sperling
- US Centers for Disease Control and Prevention, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | | | | | | | - Penelope Strid
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jared Woo
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - River Pugsley
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Frank DeStefano
- US Centers for Disease Control and Prevention, Atlanta, Georgia
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169
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Meng H, Mao J, Ye Q. Booster vaccination strategy: Necessity, Immunization Objectives, Immunization Strategy and Safety. J Med Virol 2022; 94:2369-2375. [PMID: 35028946 DOI: 10.1002/jmv.27590] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/14/2022]
Abstract
At present, the global COVID-19 epidemic has not been completely controlled, and epidemic prevention and control still face severe challenges. As there is no specific treatment for COVID-19, promoting roll-out vaccinations and building herd immunity are still the most effective and economic measures to control the COVID-19 pandemic. However, the neutralizing antibody level in the recipients decreases with time, and the vaccine's protective efficacy gradually weakens. It is still inconclusive whether it is necessary to carry out booster vaccination to strengthen the immune barrier to infection. In this paper, we combined the existing data on the effectiveness and persistence of COVID-19 vaccines. We found that it is necessary to carry out a booster vaccination strategy. However, not all subjects need to receive one more dose of vaccine six months after the initial immunization. Priority should be given to the high-risk groups, such as the elderly and people with immunodeficiency. A heterologous booster can induce higher immune responses and enhance immune protection than homologous vaccinations. However, more scientific data and clinical studies are needed to verify the safety of heterologous vaccination strategies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hanyan Meng
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, 310052, China
| | - Jianhua Mao
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, 310052, China
| | - Qing Ye
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, 310052, China
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170
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Tanacli R, Doeblin P, Götze C, Zieschang V, Faragli A, Stehning C, Korosoglou G, Erley J, Weiss J, Berger A, Pröpper F, Steinbeis F, Kühne T, Seidel F, Geisel D, Cannon Walter-Rittel T, Stawowy P, Witzenrath M, Klingel K, Van Linthout S, Pieske B, Tschöpe C, Kelle S. COVID-19 vs. Classical Myocarditis Associated Myocardial Injury Evaluated by Cardiac Magnetic Resonance and Endomyocardial Biopsy. Front Cardiovasc Med 2022; 8:737257. [PMID: 35004872 PMCID: PMC8739473 DOI: 10.3389/fcvm.2021.737257] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Despite the ongoing global pandemic, the impact of COVID-19 on cardiac structure and function is still not completely understood. Myocarditis is a rare but potentially serious complication of other viral infections with variable recovery, and is, in some cases, associated with long-term cardiac remodeling and functional impairment. Aim: To assess myocardial injury in patients who recently recovered from an acute SARS-CoV-2 infection with advanced cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB). Methods: In total, 32 patients with persistent cardiac symptoms after a COVID-19 infection, 22 patients with acute classic myocarditis not related to COVID-19, and 16 healthy volunteers were included in this study and underwent a comprehensive baseline CMR scan. Of these, 10 patients post COVID-19 and 13 with non-COVID-19 myocarditis underwent a follow-up scan. In 10 of the post-COVID-19 and 15 of the non-COVID-19 patients with myocarditis endomyocardial biopsy (EMB) with histological, immunohistological, and molecular analysis was performed. Results: In total, 10 (31%) patients with COVID-19 showed evidence of myocardial injury, eight (25%) presented with myocardial oedema, eight (25%) exhibited global or regional systolic left ventricular (LV) dysfunction, and nine (28%) exhibited impaired right ventricular (RV) function. However, only three (9%) of COVID-19 patients fulfilled updated CMR–Lake Louise criteria (LLC) for acute myocarditis. Regarding EMB, none of the COVID-19 patients but 87% of the non-COVID-19 patients with myocarditis presented histological findings in keeping with acute or chronic inflammation. COVID-19 patients with severe disease on the WHO scale presented with reduced biventricular longitudinal function, increased RV mass, and longer native T1 times compared with those with only mild or moderate disease. Conclusions: In our cohort, CMR and EMB findings revealed that SARS-CoV-2 infection was associated with relatively mild but variable cardiac involvement. More symptomatic COVID-19 patients and those with higher clinical care demands were more likely to exhibit chronic inflammation and impaired cardiac function compared to patients with milder forms of the disease.
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Affiliation(s)
- Radu Tanacli
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Doeblin
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Collin Götze
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | | | - Alessandro Faragli
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Jennifer Erley
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Jakob Weiss
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Alexander Berger
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Felix Pröpper
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kühne
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Seidel
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Philipp Stawowy
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Sophie Van Linthout
- German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
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171
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Javaid A, Saleh Y, Ahmed AI, Saad JM, Malahfji M, Al-Mallah MH. Noninvasive Imaging for Patients with COVID-19 and Acute Chest Pain. Methodist Debakey Cardiovasc J 2022; 17:5-15. [PMID: 34992719 PMCID: PMC8680163 DOI: 10.14797/mdcvj.1040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 12/19/2022] Open
Abstract
Acute chest pain is a common presentation in patients with COVID-19. Although noninvasive cardiac imaging modalities continue to be important cornerstones of management, the pandemic has brought forth difficult and unprecedented challenges in the provision of timely care while ensuring the safety of patients and providers. Clinical practice has adapted to these challenges, with several recommendations and societal guidelines emerging on the appropriate use of imaging modalities. In this review, we summarize the current evidence base on the use of noninvasive cardiac imaging modalities in COVID-19 patients with acute chest pain, with a focus on acute coronary syndromes.
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Affiliation(s)
- Awad Javaid
- Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas School of Medicine, Las Vegas, NV, US
| | - Yehia Saleh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
| | | | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
| | - Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
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172
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Hajra A, Gupta M, Ghosh B, Ashish K, Patel N, Manek G, Rai D, Sreenivasan J, Goel A, Lavie CJ, Bandyopadhyay D. Proposed Pathogenesis, Characteristics, and Management of COVID-19 mRNA Vaccine-Related Myopericarditis. Am J Cardiovasc Drugs 2022; 22:9-26. [PMID: 34817850 PMCID: PMC8612108 DOI: 10.1007/s40256-021-00511-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/21/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing coronavirus disease 2019 (COVID-19), has affected human lives across the globe. On 11 December 2020, the US FDA granted an emergency use authorization for the first COVID-19 vaccine, and vaccines are now widely available. Undoubtedly, the emergence of these vaccines has led to substantial relief, helping alleviate the fear and anxiety around the COVID-19 illness for both the general public and clinicians. However, recent cases of vaccine complications, including myopericarditis, have been reported after administration of COVID-19 vaccines. This article discusses the cases, possible pathogenesis of myopericarditis, and treatment of the condition. Most cases were mild and should not yet change vaccine policies, although prospective studies are needed to better assess the risk-benefit ratios in different groups.
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Affiliation(s)
- Adrija Hajra
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Binita Ghosh
- Burdwan Medical College, Burdwan, West Bengal India
| | - Kumar Ashish
- Crozer-Chester Medical Center, Upland, PA 19013 USA
| | | | - Gaurav Manek
- Department of Internal Medicine, University of Connecticut, Farmington, CT USA
| | - Devesh Rai
- Rochester General Hospital, Rochester, NY USA
| | | | - Akshay Goel
- New York Medical College at Westchester Medical Center, New York, NY USA
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA USA
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173
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Lu J, Zhang X, Xu H, Li Z. Inspiration to mRNA-based COVID-19 vaccination: Serious adverse case reports with hepatitis B vaccine in real-world. Front Pediatr 2022; 10:888686. [PMID: 36210931 PMCID: PMC9538941 DOI: 10.3389/fped.2022.888686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The hepatitis B vaccine comprises hepatitis B surface antigen (HBsAg) produced by transgenic yeast cells. There are few serious adverse events (SAE) reports after Hepatitis B vaccination. METHODS The authors searched the Chinese legal documents database for all SAE with Hepatitis B vaccination from January 2010 to January 2022. RESULTS All seven patients received yeast-derived recombinant hepatitis B vaccine. Three cases of myocarditis (death), 2 cases of interstitial pneumonia (death), and 2 cases of encephalitis. The mean time of onset of SAE was 8.3 ± 4.3 h after vaccination. CONCLUSION The mechanism of vaccine-induced myocarditis may come from immune protein reactions. Based on the experience of Hepatitis B vaccine adverse events, we present new insights into the mechanism of myocarditis caused by the COVID-19 vaccine.
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Affiliation(s)
- Jinmiao Lu
- Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xunjie Zhang
- Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Xu
- Department of Nephrology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Zhiping Li
- Department of Nephrology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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174
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Fujibayashi K, Kajinami K. A Case of Myopericarditis After the Second Dose of mRNA COVID-19 Vaccine in a Patient With a History of Myopericarditis. CLINICAL MEDICINE INSIGHTS: CASE REPORTS 2022; 15:11795476221138648. [DOI: 10.1177/11795476221138648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/23/2022] [Indexed: 11/23/2022] Open
Abstract
Vaccination is important for the prevention of coronavirus-induced disease 2019 (COVID-19) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and to protect persons with a high risk for complications. There have been reports of myopericarditis following COVID-19 vaccination, especially in adolescent males and young adults. Breakthrough infections, such as the Delta or Omicron variant of SARS-CoV-2, have raised great concern about the necessity for repeated doses of the vaccine. A case of myopericarditis after the second dose of COVID-19 mRNA-1273 (Moderna) vaccine in a 23-year-old man with a prior episode of viral myopericarditis is presented. He received the second dose of the COVID-19 mRNA vaccine, after which he developed persistent midsternal chest pain and he was subsequently transferred to our emergency department. An echocardiogram showed a trivial inferior pericardial effusion with diffuse left ventricular systolic dysfunction. He was treated with colchicine from the first day of hospitalization with a diagnosis of myopericarditis. His chest pain had resolved by the third day, and left ventricular wall motion was dramatically improved by the seventh day of hospitalization. A strong response to the second vaccination in the present case suggests that the prior history of myopericarditis is evidence of strong congenital or acquired immunological features in this individual. Individuals with such a strong immune response may be more likely to develop myopericarditis after mRNA vaccination. Immunization against COVID-19 is currently recommended from a risk-benefit standpoint. We advised the patient to avoid additional COVID-19 mRNA vaccines because of this episode. The risk of COVID-19 weighed against myopericarditis associated with the mRNA vaccination should be considered on a case-by-case basis. This case may help us better understand the mechanism of myopericarditis following COVID-19 mRNA vaccination.
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Affiliation(s)
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
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175
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Nashwan AJ, Yassin MA, Soliman AT, De Sanctis V, Ibrahim MI. mRNA-based COVID-19 Vaccines Booster Dose: Benefits, Risks and Coverage. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022236. [PMID: 35775753 PMCID: PMC9335425 DOI: 10.23750/abm.v93i3.13103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022]
Abstract
The number of COVID-19 vaccine-rich countries that have started COVID-19 third-dose booster programs is growing dramatically despite the lack of robust evidence on the effectiveness, safety, and frequency of the required booster doses that makes the individuals/populations immune to COVID -19 infection. Beyond the ethical dilemma, the scarcity of studies on the optimal timing for offering booster doses, eligibility criteria, and if there is any association between premature or delayed administration and the degree of protection against infection. The aim of this mini- review was to collect and analyze published data on this topic in a trial to answer some questions related to the benefits versus the risks of offering frequent boosters of mRNA vaccines for increasing the population immunity against COVID-19 infection considering the current policy of providing SARS-CoV-2 vaccine booster doses in rich countries versus those in relatively poor countries with limited access to vaccination. (www.actabiomedica.it).
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Affiliation(s)
- Abdulqadir J. Nashwan
- Director of Nursing for Education & Practice Development, Hamad Medical Corporation, PO Box 3050, Doha, Qatar, College of Health Sciences, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Mohamed A. Yassin
- Department of Hematology/Oncology, National Cancer Institute, HMC, Doha, Qatar
| | | | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatients Clinic, Quisisana Hospital, Ferrara, Italy
| | - Mohamed I. Ibrahim
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
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176
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Zilbermint M, Demidowich AP. Severe Diabetic Ketoacidosis After the Second Dose of mRNA-1273 COVID-19 Vaccine. J Diabetes Sci Technol 2022; 16:248-249. [PMID: 34514883 PMCID: PMC8875037 DOI: 10.1177/19322968211043552] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Mihail Zilbermint
- Johns Hopkins Community Physicians at Suburban Hospital, Johns Hopkins Medicine, Bethesda, MD, USA
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University Carey Business School, Baltimore, MD, USA
- Mihail Zilbermint, MD, FACE, Johns Hopkins Community Physicians at Suburban Hospital, Johns Hopkins Medicine, 8600 Old Georgetown Rd, Bethesda, MD 20814, USA.
| | - Andrew P. Demidowich
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians at Howard County General Hospital, Johns Hopkins Medicine, Columbia, MD, USA
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177
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Ghoshouni H, Bagherieh S, Parvizinia M, Askari M, Sadeghi M, Mirmosayyeb O. Unraveling the Mystery of COVID-19 Postvaccination Myocarditis: A Systematic Review of Current Cases. Int J Clin Pract 2022; 2022:2438913. [PMID: 35685560 PMCID: PMC9159134 DOI: 10.1155/2022/2438913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/08/2021] [Accepted: 12/24/2021] [Indexed: 12/14/2022] Open
Abstract
From the early stages of the pandemic, the development and mass production of a safe and effective vaccine seemed like the greatest tool, to win the fight against the virus. In the present study, we comprehensively conducted a systematic review of all current cases worldwide to better understand whether there is a link between COVID-19 vaccination and one of the most devastating complications, cardiac Inflammation. Our search retrieved over 250 results, of which 130 met the inclusion criteria, and their respective data were extracted. The results suggest that postvaccination myocarditis and pericarditis are more likely to be seen in male, younger, and mRNA-vaccinated individuals. Most affected patients experienced symptoms following the second shot, and complaint of chest pain was the most prevalent presentation. Currently, no direct link can be drawn between the vaccines and the risk of cardiac inflammation.
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Affiliation(s)
- Hamed Ghoshouni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Bagherieh
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mozhde Askari
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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178
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mRNA-1273/tozinameran. REACTIONS WEEKLY 2022. [PMCID: PMC8732180 DOI: 10.1007/s40278-022-08117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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179
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CMR Imaging 6 Months After Myocarditis Associated with the BNT162b2 mRNA COVID-19 Vaccine. Pediatr Cardiol 2022; 43:1522-1529. [PMID: 35320390 PMCID: PMC8941830 DOI: 10.1007/s00246-022-02878-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/15/2022] [Indexed: 12/19/2022]
Abstract
Temporal association between BNT162b2 mRNA COVID-19 vaccine and myocarditis (PCVM) has been reported. We herein present early and 6-month clinical follow-up and cardiac magnetic resonance imaging (CMR) of patients with PVCM. A retrospective collection of data from 15 patients with PCVM and abnormal CMR was performed. Clinical manifestation, laboratory data, hospitalizations, treatment protocols, and imaging studies were collected early (up to 2 months) and later. In nine patients, an additional CMR evaluation was performed 6 months after diagnosis. PCVM was diagnosed in 15 patients, mean age 17 ± 1 (median 17.2, range 14.9-19 years) years, predominantly in males. Mean time from vaccination to onset of symptoms was 4.4 ± 6.7 (median 3, range 0-28) days. All patients had CMR post diagnosis at 4 ± 3 (median 3, range 1-9) weeks, 4/5 patients had hyper enhancement on the T2 sequences representing edemaQuery, and 12 pathological Late glandolinium enhancement. A repeat scan performed after 5-6 months was positive for scar formation in 7/9 patients. PCVM is a rare complication, affecting predominantly males and appearing usually within the first week after administration of the second dose of the vaccine. It usually is a mild disease, with clinical resolution with anti-inflammatory treatment. Late CMR follow up demonstrated resolution of the edema in all patients, while some had evidence of residual myocardial scarring.
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180
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Wang AYL. Modified mRNA-Based Vaccines Against Coronavirus Disease 2019. Cell Transplant 2022; 31:9636897221090259. [PMID: 35438579 PMCID: PMC9021518 DOI: 10.1177/09636897221090259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) continuously causes deaths worldwide, representing a considerable challenge to health care and economic systems with a new precedent in human history. Many therapeutic medicines primarily focused on preventing severe organ damage and complications, which can be fatal in some confirmed cases. The synthesized modified mRNA (modRNA) represents a nonviral, integration-free, zero-footprint, efficient, and safe strategy for vaccine discovery. modRNA-based technology has facilitated the rapid development of the first COVID-19 vaccines due to its cost- and time-saving properties, thus initiating a new era of prophylactic vaccines against infectious diseases. Recently, COVID-19 modRNA vaccines were approved, and a large-scale vaccination campaign began worldwide. To date, results suggest that the modRNA vaccines are highly effective against virus infection, which causes COVID-19. Although short-term studies have reported that their safety is acceptable, long-term safety and protective immunity remain unclear. In this review, we describe two major approved modRNA vaccines and discuss their potential myocarditis complications.
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Affiliation(s)
- Aline Yen Ling Wang
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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181
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Al-Ali D, Elshafeey A, Mushannen M, Kawas H, Shafiq A, Mhaimeed N, Mhaimeed O, Mhaimeed N, Zeghlache R, Salameh M, Paul P, Homssi M, Mohammed I, Narangoli A, Yagan L, Khanjar B, Laws S, Elshazly MB, Zakaria D. Cardiovascular and haematological events post COVID-19 vaccination: A systematic review. J Cell Mol Med 2021; 26:636-653. [PMID: 34967105 PMCID: PMC8817142 DOI: 10.1111/jcmm.17137] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022] Open
Abstract
Since COVID‐19 took a strong hold around the globe causing considerable morbidity and mortality, a lot of effort was dedicated to manufacturing effective vaccines against SARS‐CoV‐2. Many questions have since been raised surrounding the safety of the vaccines, and a lot of media attention to certain side effects. This caused a state of vaccine hesitancy that may prove problematic in the global effort to control the virus. This review was undertaken with the aim of putting together all the reported cardiovascular and haematological events post COVID‐19 vaccination in published literature and to suggest possible mechanisms to explain these rare phenomena.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lina Yagan
- Weill Cornell Medicine Qatar, Doha, Qatar
| | | | - Sa'ad Laws
- Weill Cornell Medicine Qatar, Doha, Qatar
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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182
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Megiorni F, Pontecorvi P, Gerini G, Anastasiadou E, Marchese C, Ceccarelli S. Sex-Related Factors in Cardiovascular Complications Associated to COVID-19. Biomolecules 2021; 12:biom12010021. [PMID: 35053169 PMCID: PMC8773922 DOI: 10.3390/biom12010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), the pandemic infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents with an extremely heterogeneous spectrum of symptoms and signs. The clinical manifestations seem to be correlated with disease severity. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality compared to women. Such variability can be ascribed to both sex-related biological factors and gender-related behavioral cues. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Cardiovascular diseases play a central role in determining COVID-19 outcome, whether they are pre-existent or arose upon infection. We will pay particular attention to the impact of sex and gender on cardiovascular manifestations related to COVID-19. Finally, we will discuss the sex-dependent variability in some biomarkers for the evaluation of COVID-19 infection and prognosis. The aim of this work is to highlight the significance of gendered medicine in setting up personalized programs for COVID-19 prevention, clinical evaluation and treatment.
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183
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Kadkhoda K. Post RNA-based COVID vaccines myocarditis: Proposed mechanisms. Vaccine 2021; 40:406-407. [PMID: 34895937 PMCID: PMC8658401 DOI: 10.1016/j.vaccine.2021.11.093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/06/2021] [Accepted: 11/30/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Kamran Kadkhoda
- Immunopathology Laboratory, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, USA.
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184
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Chen CC, Chen HY, Lu CC, Lin SH. Case Report: Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Renal Failure and Pulmonary Hemorrhage May Occur After COVID-19 Vaccination. Front Med (Lausanne) 2021; 8:765447. [PMID: 34859017 PMCID: PMC8632021 DOI: 10.3389/fmed.2021.765447] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/20/2021] [Indexed: 01/14/2023] Open
Abstract
The rare and severe adverse effects associated with coronavirus disease of 2019 (COVID-19) vaccination have been under-appreciated, resulting in many instances of inappropriate management. We describe the case of an elderly woman who developed anti-neutrophil cytoplasmic antibody-associated vasculitis with pulmonary renal syndrome approximately 3 weeks after the first dose of COVID-19 mRNA vaccination (Moderna). Her nasopharyngeal polymerase chain reaction test for the COVID-19 RNA virus was negative. Gross hematuria, heavy proteinuria, acute renal failure (serum creatinine up to 6.5 mg/dL), and hemoptysis coupled with a marked increase in serum anti-myeloperoxidase-O antibody were observed. Renal biopsy showed severe vasculitis with pauci-immune crescent glomerulonephritis. The pulmonary hemorrhage was resolved and renal function improved following combined plasma exchange and the administration of systemic steroids and anti-CD20 therapy. The early examination of urinalysis and renal function may be crucial for identifying glomerulonephritis and acute renal failure in susceptible patients after COVID-19 vaccination.
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Affiliation(s)
- Chien-Chou Chen
- Department of Internal Medicine, Tri-service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Yang Chen
- Division of Nephrology, Department of Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Chi Lu
- Division of Rheumatology, Department of Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
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185
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Simone A, Herald J, Chen A, Gulati N, Shen AYJ, Lewin B, Lee MS. Acute Myocarditis Following COVID-19 mRNA Vaccination in Adults Aged 18 Years or Older. JAMA Intern Med 2021; 181:1668-1670. [PMID: 34605853 PMCID: PMC8491129 DOI: 10.1001/jamainternmed.2021.5511] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This cohort study examines the incidence and clinical outcomes of acute myocarditis among adults following mRNA vaccination in an integrated health care system in the US.
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Affiliation(s)
- Anthony Simone
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - John Herald
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Aiyu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Neil Gulati
- Department of Cardiology, Kaiser Permanente Orange County Medical Center, Irvine, California
| | - Albert Yuh-Jer Shen
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Bruno Lewin
- Department of Family Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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186
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Çınar T, Hayıroçlu MI, Çiçek V, Selçuk M, Yavuz S, Orhan AL. Review of the current literature regarding cardiac adverse events following COVID-19 vaccination. Rev Assoc Med Bras (1992) 2021; 67:1751-1758. [DOI: 10.1590/1806-9282.20210940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 12/27/2022] Open
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187
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Jaffal K, Mascitti H. Grippe et Covid-19. Infect Dis Now 2021. [PMCID: PMC8704829 DOI: 10.1016/s2666-9919(21)00555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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188
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Sanchez Tijmes F, Thavendiranathan P, Udell JA, Seidman MA, Hanneman K. Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 Vaccination. Radiol Cardiothorac Imaging 2021; 3:e210252. [PMID: 34934954 PMCID: PMC8686006 DOI: 10.1148/ryct.210252] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/12/2021] [Accepted: 11/04/2021] [Indexed: 12/29/2022]
Abstract
Myocarditis is a nonischemic inflammatory disease of the myocardium that can be triggered by a multitude of events, including viral infection and toxins. Recently, there has been heightened interest in myocarditis given its association with COVID-19 vaccination. Timely identification of myocarditis can affect patient management and prognosis. Therefore, it is crucial for radiologists and cardiac imagers to understand the role of cardiac imaging to establish a diagnosis and inform treatment decisions. Cardiac MRI is the most important noninvasive imaging modality for evaluation of myocarditis, with typical findings of focal or diffuse myocardial edema and myocardial damage, including presence of late gadolinium enhancement. There are currently limited data available to indicate that the pattern of myocardial injury following COVID-19 vaccination is similar to other causes of myocarditis, although the severity of disease may be relatively mild. A description of the role of imaging and typical imaging features will be reviewed here, with a focus on emerging data in the setting of myocarditis after COVID-19 vaccination. Keywords: MRI, Heart, Inflammation © RSNA, 2021.
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Affiliation(s)
- Felipe Sanchez Tijmes
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
| | - Jacob A. Udell
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
| | - Michael A. Seidman
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
| | - Kate Hanneman
- From the Department of Medical Imaging, Peter Munk Cardiac Centre
(F.S.T., P.T., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (P.T.,
J.A.U.), and Department of Laboratory Medicine & Pathobiology (M.A.S.),
Toronto General Hospital, University Health Network, University of Toronto, 585
University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Department of
Medical Imaging (K.H.) and Cardiovascular Division (J.A.U.), Women’s
College Hospital, University of Toronto, Toronto, Canada)
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189
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Lim Y, Kim MC, Kim KH, Jeong IS, Cho YS, Choi YD, Lee JE. Case Report: Acute Fulminant Myocarditis and Cardiogenic Shock After Messenger RNA Coronavirus Disease 2019 Vaccination Requiring Extracorporeal Cardiopulmonary Resuscitation. Front Cardiovasc Med 2021; 8:758996. [PMID: 34778411 PMCID: PMC8586196 DOI: 10.3389/fcvm.2021.758996] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
Recently, myocarditis following messenger RNA (mRNA) coronavirus disease 2019 (COVID-19) vaccination has become an important social issue worldwide. According to the reports so far, myocarditis related to mRNA COVID-19 vaccination is rare and usually associated with a benign clinical course without intensive care or any sequelae of fulminant myocarditis. Here, we report a case of acute fulminant myocarditis and cardiogenic shock after the mRNA COVID-19 vaccination, requiring extracorporeal cardiopulmonary resuscitation. Clinicians should keep in mind the possibility of progression to fulminant myocarditis in patients who presented with suggestive symptoms or signs of myocarditis after the COVID-19 vaccination.
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Affiliation(s)
- Yongwhan Lim
- Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea
| | - Min Chul Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School/Hospital, Gwangju, South Korea
| | - In-Seok Jeong
- Department of Cardiothoracic Surgery, Chonnam National University Medical School/Hospital, Gwangju, South Korea
| | - Yong Soo Cho
- Department of Emergent Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
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190
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Parmar K, Mekraksakit P, Del Rio-Pertuz G, Sethi P, Motes A, Hughes M, Wischmeyer J, Carbajal L, Sosa EA. Myocarditis following COVID-19 mRNA vaccination. Proc AMIA Symp 2021; 35:209-213. [PMID: 35256821 PMCID: PMC8607537 DOI: 10.1080/08998280.2021.1990743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Messenger RNA vaccines are the main COVID-19 vaccines authorized for use in the United States. Side effects are typically minor and transient. We report a case series of four subjects with an acute myocarditis-like illness following mRNA COVID-19 vaccination who were hospitalized at our hospital in Lubbock, Texas. Three patients were young men who presented with acute chest pain after the second dose of the mRNA-1273 vaccine. Another patient was a 53-year-old white woman who presented with acute left arm pain 3 days after the first dose of the mRNA-1273 vaccine. She was later found to have acute decompensated heart failure, and endomyocardial biopsy revealed eosinophilic injury–mediated myocarditis.
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Affiliation(s)
- Kanak Parmar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Poemlarp Mekraksakit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Gaspar Del Rio-Pertuz
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Pooja Sethi
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Arunee Motes
- Department of Pulmonary and Critical Care, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Megan Hughes
- Department of Pulmonary and Critical Care, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Jason Wischmeyer
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Luis Carbajal
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Erwin Argueta Sosa
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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191
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Multisystem Inflammation and Organ Dysfunction After BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccination. Crit Care Explor 2021; 3:e0578. [PMID: 34765984 PMCID: PMC8575416 DOI: 10.1097/cce.0000000000000578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Supplemental Digital Content is available in the text. The U.S. Food and Drug Administration has to date granted approval or emergency use authorization to three vaccines against severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019. In clinical trials and real-use observational studies, the Pfizer-BioNTech BNT162b2 messenger RNA coronavirus disease 2019 vaccine, as well as the Moderna mRNA-1273 messenger RNA coronavirus disease 2019 vaccine, have demonstrated high efficacy and few adverse events.
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192
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Joob B, Wiwanitkit V. Acute myocarditis after coronavirus disease 2019 vaccination. Anatol J Cardiol 2021; 25:841-842. [PMID: 34734821 DOI: 10.5152/anatoljcardiol.2021.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Beuy Joob
- Private Academic Consultant Center; Bangkok-Thailand
| | - Viroj Wiwanitkit
- Department of Community Medicine, Dr. DY Patil University; Pune-India
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193
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Habedank D, Lagast A, Novoa-Usme M, Atmowihardjo I. A case of myocarditis in a 60-year-old man 48 h after mRNA vaccination against SARS-CoV2. Clin Res Cardiol 2021; 111:230-232. [PMID: 34731321 PMCID: PMC8564591 DOI: 10.1007/s00392-021-01946-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/28/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Dirk Habedank
- DRK Kliniken Berlin Köpenick, Medizinische Klinik Kardiologie, S.-Allende-Str. 2-8, 12555, Berlin, Germany. .,Universitätsmedizin Greifswald, Klinik und Poliklinik für Innere Medizin B, Fleischmannstr. 8, 17475, Greifswald, Germany.
| | - Antonia Lagast
- DRK Kliniken Berlin Köpenick, Medizinische Klinik Kardiologie, S.-Allende-Str. 2-8, 12555, Berlin, Germany
| | - Monica Novoa-Usme
- DRK Kliniken Berlin Köpenick, Medizinische Klinik Kardiologie, S.-Allende-Str. 2-8, 12555, Berlin, Germany
| | - Iskandar Atmowihardjo
- DRK Kliniken Berlin Köpenick, Medizinische Klinik Kardiologie, S.-Allende-Str. 2-8, 12555, Berlin, Germany
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194
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Patrignani A, Schicchi N, Calcagnoli F, Falchetti E, Ciampani N, Argalia G, Mariani A. Acute myocarditis following Comirnaty vaccination in a healthy man with previous SARS-CoV-2 infection. Radiol Case Rep 2021; 16:3321-3325. [PMID: 34367386 PMCID: PMC8326008 DOI: 10.1016/j.radcr.2021.07.082] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 01/07/2023] Open
Abstract
Myopericarditis following mRNA Covid-19 vaccination has recently been reported to health authorities in a lot of countries. They can occur in very rare cases after either the Moderna (mRNA-1273 - Spikevax) or Pfizer-BioNTech (BNT162b2 - Comirnaty) vaccination. Cases predominately occur in younger adult men within 14 days following the second dose. In this article, we present a 56 year-old man with no prior medical history, whit the exception of a mild Covid-19 infection 4 months earlier, who experienced an episode of acute epigastric pain, profuse sweating, tachycardia, hypotension 4 days after the first dose of BNT162b2 vaccine. Troponin I level was elevated. Chest X-ray, electrocardiogram, echocardiogram, coronary angiography didn't show significant abnormalities. Cardiac Magnetic Resonance showed a pattern of acute myocarditis. The condition appeared to be self-limited and the patient recovered without specific therapy. No report of acute myocarditis was observed in the BNT162b2 and mRNA-1273 trials and very rare cases, in comparison to given doses, have been reported to pharmacovigilance systems worldwide. Further surveillance and evaluation of this side effect are warranted to establish the correct balance of benefits and risks of Covid-19 mRNA vaccines, above all in children and younger people (categories with the higher reactogenicity and the lower risk of Covid-19 complications). At the present time the benefits of Covid-19 vaccination significantly exceed possible risks.
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Affiliation(s)
- Anna Patrignani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Nicolò Schicchi
- Radiology Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Marche, Italy
| | - Francesca Calcagnoli
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Elena Falchetti
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Nino Ciampani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Giulio Argalia
- Radiology Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Marche, Italy
| | - Antonio Mariani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
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195
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Schneider J, Sottmann L, Greinacher A, Hagen M, Kasper HU, Kuhnen C, Schlepper S, Schmidt S, Schulz R, Thiele T, Thomas C, Schmeling A. Postmortem investigation of fatalities following vaccination with COVID-19 vaccines. Int J Legal Med 2021; 135:2335-2345. [PMID: 34591186 PMCID: PMC8482743 DOI: 10.1007/s00414-021-02706-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023]
Abstract
Thorough postmortem investigations of fatalities following vaccination with coronavirus disease 2019 (COVID-19) vaccines are of great social significance. From 11.03.2021 to 09.06.2021, postmortem investigations of 18 deceased persons who recently received a vaccination against COVID-19 were performed. Vaxzevria was vaccinated in nine, Comirnaty in five, Spikevax in three, and Janssen in one person. In all cases, full autopsies, histopathological examinations, and virological analyses for the severe acute respiratory syndrome coronavirus 2 were carried out. Depending on the case, additional laboratory tests (anaphylaxis diagnostics, VITT [vaccine-induced immune thrombotic thrombocytopenia] diagnostics, glucose metabolism diagnostics) and neuropathological examinations were conducted. In 13 deceased, the cause of death was attributed to preexisting diseases while postmortem investigations did not indicate a causal relationship to the vaccination. In one case after vaccination with Comirnaty, myocarditis was found to be the cause of death. A causal relationship to vaccination was considered possible, but could not be proven beyond doubt. VITT was found in three deceased persons following vaccination with Vaxzevria and one deceased following vaccination with Janssen. Of those four cases with VITT, only one was diagnosed before death. The synopsis of the anamnestic data, the autopsy results, laboratory diagnostic examinations, and histopathological and neuropathological examinations revealed that VITT was the very likely cause of death in only two of the four cases. In the other two cases, no neuropathological correlate of VITT explaining death was found, while possible causes of death emerged that were not necessarily attributable to VITT. The results of our study demonstrate the necessity of postmortem investigations on all fatalities following vaccination with COVID-19 vaccines. In order to identify a possible causal relationship between vaccination and death, in most cases an autopsy and histopathological examinations have to be combined with additional investigations, such as laboratory tests and neuropathological examinations.
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Affiliation(s)
- Julia Schneider
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | - Lukas Sottmann
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Greinacher
- Institute of Immunology and Transfusion Medicine, University Medicine of Greifswald, Greifswald, Germany
| | - Maximilian Hagen
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | - Hans-Udo Kasper
- Institute of Pathology at Clemens Hospital Münster, Münster, Germany
| | - Cornelius Kuhnen
- Institute of Pathology at Clemens Hospital Münster, Münster, Germany
| | - Stefanie Schlepper
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | - Sven Schmidt
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | - Ronald Schulz
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | - Thomas Thiele
- Institute of Immunology and Transfusion Medicine, University Medicine of Greifswald, Greifswald, Germany
| | - Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany.
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196
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Matta A, Kunadharaju R, Osman M, Jesme C, McMiller Z, Johnson EM, Matta D, Kallamadi R, Bande D. Clinical Presentation and Outcomes of Myocarditis Post mRNA Vaccination: A Meta-Analysis and Systematic Review. Cureus 2021; 13:e19240. [PMID: 34877217 PMCID: PMC8641964 DOI: 10.7759/cureus.19240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Myocarditis is being increasingly reported as a potential complication of both Pfizer-BioNTech and Moderna vaccines for COVID-19. One thousand five hundred and twenty-two cases were reported as of September 02, 2021, as per CDC's (Centers for Disease Control) vaccine adverse event reporting system. Most of the published data is available in the form of case reports and series. There is a need to compile the demographic data, clinical features, and outcomes in these patients. Methods: A systematic search was conducted in PubMed, Embase, Web of science, and google scholar for published literature between January 01, 2020, and July 17, 2021. Individual data of 69 patients were pooled from 25 qualifying case reports and case series. RESULTS The median age of onset was 21 years. 92.7% of the patients were male. 76.8% of patients received the Pfizer-BioNTech vaccine, and 23.2% received the Moderna vaccine. 88.5% developed symptoms after the second dose. Patients were admitted to the hospital a median of three days post-vaccination. All the patients had chest pain and elevated troponin. The myocarditis was confirmed on cardiac MRI in 87% of the patients. Most of the patients had late gadolinium enhancement on MRI. The median length of stay was four days. All the reported patients recovered and were discharged. CONCLUSION Post-mRNA vaccination myocarditis is seen predominantly in young males within a few days after their second dose of vaccination. The pathophysiology of myocarditis is not well known. The prognosis is good as all the reported patients recovered. The presence of late gadolinium enhancement on cardiac MRI indicated myocardial necrosis/fibrosis and further studies are needed to establish the long-term prognosis of the condition.
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Affiliation(s)
- Abhishek Matta
- Internal Medicine, Sanford Health, Fargo, USA
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Rajesh Kunadharaju
- Department of Pulmonary and Critical Care Medicine, University of Buffalo, Buffalo, USA
| | - Marcus Osman
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Christy Jesme
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Zachary McMiller
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Erika M Johnson
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Danielle Matta
- Internal Medicine, Sanford Health, Fargo, USA
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Rekha Kallamadi
- Internal Medicine, Sanford Health, Fargo, USA
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Dinesh Bande
- Internal Medicine, University of North Dakota School of Medicine, Fargo, USA
- Internal Medicine, Sanford Health, Fargo, USA
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197
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McCullough J, McCullough JP, Korlipara G, Kaell A. Myocarditis Post Moderna Vaccination: Review of Criteria for Diagnosis. Cureus 2021; 13:e19633. [PMID: 34956759 PMCID: PMC8675599 DOI: 10.7759/cureus.19633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 12/23/2022] Open
Abstract
Case reports of myocarditis post-coronavirus disease 2019 (COVID-19) mRNA vaccination have not uniformly reported long-term follow-up beyond 90 days. We present a 23-year-old male who is typical of a patient presenting with myocarditis post-COVID-19 mRNA-1273 Moderna vaccination (young males, onset several days after second dose of the mRNA vaccine, and excellent short term complete recovery). Follow-up at 128 days revealed no residual sequelae in our patient. Although a definitive diagnosis of myocarditis requires an endomyocardial biopsy (EMB), diagnosis is usually made clinically and with imaging in most clinical settings unless part of an approved research protocol or if indicated clinically. We recommend active surveillance and reporting for myocarditis post mRNA vaccination and even consider reporting those with symptom onset beyond 90 days.
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Affiliation(s)
- Jocelyn McCullough
- Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Joseph P McCullough
- Hospital Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Giridhar Korlipara
- Interventional Cardiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Alan Kaell
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
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198
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Knowledge, Attitudes and Perception toward COVID-19 Vaccines among Adults in Jazan Province, Saudi Arabia. Vaccines (Basel) 2021; 9:vaccines9111259. [PMID: 34835190 PMCID: PMC8618661 DOI: 10.3390/vaccines9111259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Saudi Arabia is one of the countries that initiated early vaccination programs despite the global challenges concerning the availability of COVID-19 vaccines. Massive vaccination campaigns have been undertaken in the country; however, negative perception and hesitancy toward vaccines may exist which could reduce public response to vaccination. Further, studies evaluating the current perception and attitude toward COVID-19 vaccines are scarce. Thus, this study aims to assess the community attitudes and perceptions toward COVID-19 vaccines in Jazan Province, Saudi Arabia. Methods: A cross-sectional, retrospective study using an online questionnaire was conducted among the public in Jazan, the southern region of Saudi Arabia. General and demographic data were collected, and perception and attitude toward COVID-19 vaccines were evaluated. Results: Most participants in this study were female (67%) with a median age of 23 years. The majority held a bachelor’s degree, and they trusted the Saudi healthcare system. Our survey showed that 67% of the study participants had positive perceptions toward COVID-19 vaccines, a finding that is significantly associated with receiving the influenza vaccine in the past, the existence of trust on the current healthcare system and holding positive beliefs toward the effectiveness of the current COVID-19 vaccines in reducing the risk of infection, complication, and mortality. Conclusions: The proportion of the public in Jazan who believed in the COVID-19 vaccine effectiveness is not inferior from similar international reports. Thus, national awareness programs toward the effectiveness of the vaccine could be enhanced to accelerate vaccination coverage. Further, nationwide surveys are warranted to include larger populations from different communities to assess the overall perception toward COVID-19 vaccines in the whole country.
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199
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Li M, Yuan J, Lv G, Brown J, Jiang X, Lu ZK. Myocarditis and Pericarditis following COVID-19 Vaccination: Inequalities in Age and Vaccine Types. J Pers Med 2021; 11:jpm11111106. [PMID: 34834458 PMCID: PMC8624452 DOI: 10.3390/jpm11111106] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
An increasing number of myocarditis/pericarditis incidences has been reported after coronavirus disease-19 (COVID-19) vaccination in adolescents and young adults. This study was designed to investigate the incidence rate of-and risk for-myocarditis and pericarditis following COVID-19 vaccination in the United States according to age and vaccine type. This study used the Vaccine Adverse Events Reporting System (VAERS) from 11 December 2020 to 13 August 2021. A population-based data mining approach was performed based on the reporting odds ratio (ROR). Adverse events of myocarditis and pericarditis following COVID-19 vaccination were rare, with an incidence rate of 5.98 (95% CI = 5.73-6.24) cases per million doses administered. The incidence rate was higher in adolescents and after the administration of the second dose of messenger RNA (mRNA) vaccines. Overall, two mRNA vaccines were significantly associated with increased risks for myocarditis/pericarditis (mRNA-1273 (Moderna): ROR = 2.91, 95% CI = 2.21-3.83; BNT162b2 (Pfizer-BioNTech): ROR = 5.37, 95% CI = 4.10-7.04) compared to all other vaccines from VAERS. The viral vector vaccine of Ad26.COV2.S (Janssen) was not associated with signals of myocarditis/pericarditis (ROR = 1.39; 95% CI = 0.99-1.97). This study found increased risks for myocarditis/pericarditis following mRNA COVID-19 vaccines. For patients at high risk for myocarditis/pericarditis or with myocardial injuries, the viral vector vaccine may be an alternative for consideration.
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Affiliation(s)
- Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN 38103, USA;
| | - Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai 201203, China;
| | - Gang Lv
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100091, China;
| | - Jacob Brown
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA;
| | - Xiangxiang Jiang
- School of Public Health, Nanjing Medical University, Nanjing 210029, China;
| | - Zhiqiang Kevin Lu
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA;
- Correspondence:
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200
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Abstract
Throughout 2021, the medical and scientific communities have focused on managing the acute morbidity and mortality caused by the coronavirus disease 2019 (COVID-19) pandemic. With the approval of multiple vaccines, there is a light at the end of this dark tunnel and an opportunity to focus on the future, including managing the long-term sequelae in patients who have survived acute COVID-19. In this Perspectives article, we highlight what is known about the cardiovascular sequelae in survivors of COVID-19 and discuss important questions that need to be addressed in prospective studies to understand and mitigate these lasting cardiovascular consequences, including in post-acute COVID-19 syndrome. To provide the greatest benefit to these survivors, prospective studies should begin now, with resources made available to monitor and study this population in the coming years. In this Perspectives article, the authors highlight what is known about cardiovascular sequelae in survivors of COVID-19 and discuss important questions that need to be addressed in prospective studies to understand and mitigate these lasting cardiovascular consequences, including in post-acute COVID-19 syndrome.
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