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Wang W, Jia H, Hua X, Song J. New insights gained from cellular landscape changes in myocarditis and inflammatory cardiomyopathy. Heart Fail Rev 2024; 29:883-907. [PMID: 38896377 DOI: 10.1007/s10741-024-10406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
Advances in the etiological classification of myocarditis and inflammatory cardiomyopathy (ICM) have reached a consensus. However, the mechanism of myocarditis/ICM remains unclear, which affects the development of treatment and the improvement of outcome. Cellular transcription and metabolic reprogramming, and the interactions between cardiomyocytes and non-cardiomyocytes, such as the immune cells, contribute to the process of myocarditis/ICM. Recent efforts have been made by multi-omics techniques, particularly in single-cell RNA sequencing, to gain a better understanding of the cellular landscape alteration occurring in disease during the progression. This article aims to provide a comprehensive overview of the latest studies in myocarditis/ICM, particularly as revealed by single-cell sequencing.
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Affiliation(s)
- Weiteng Wang
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10037, China
| | - Hao Jia
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10037, China
| | - Xiumeng Hua
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10037, China
| | - Jiangping Song
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, China.
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10037, China.
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da Silva Alves C, Baptista Pestana R, Morais-Almeida M. Recent insights into the impacts of COVID-19 on pediatric asthma. Expert Rev Clin Immunol 2024:1-20. [PMID: 39136081 DOI: 10.1080/1744666x.2024.2390641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION The emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the subsequent coronavirus disease 2019 (COVID-19) pandemic has raised questions about its impact on pediatric asthma. This review analyzes the latest research to offer a comprehensive understanding of the dynamics between COVID-19 and pediatric asthma. AREAS COVERED This narrative review examines the effects of COVID-19 on pediatric asthma, exploring clinical outcomes, immune responses, recommended treatments, the impact of SARS-CoV-2 strains, and COVID-19 vaccination. Data were sourced from databases (PubMed, Embase, and BioRxiv/MedRxiv) from January 2020 to November 2023. EXPERT OPINION In response to the COVID-19 pandemic, the international scientific community rapidly developed extensive knowledge, demonstrating unprecedented cooperation. Despite these advances, questions remain about SARS-CoV-2 infection and pediatric asthma. Most research consists of epidemiological studies with varying methods, sometimes yielding contradictory results. While asthma generally did not increase the risk of severe COVID-19 in children, uncontrolled asthma was a risk factor, highlighting the importance of maintaining asthma management. Telemedicine has proven effective for asthma control and will continue to grow, despite its limitations. Notably, allergic asthma may have a protective role against severe COVID-19. We recommend COVID-19 vaccination in the pediatric age group, including those with asthma.
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Affiliation(s)
- Carolina da Silva Alves
- Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
- Pulmonology Department, Doutor Fernando da Fonseca Hospital, Amadora, Portugal
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3
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Chinitz JS, Epstein LM. COVID-19 vaccination and atrial fibrillation: When pandemics collide. J Cardiovasc Electrophysiol 2024. [PMID: 39171651 DOI: 10.1111/jce.16404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/03/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Jason S Chinitz
- Department of Cardiology, Northwell, New Hyde Park, New York, USA
- Department of Cardiology, Northwell Cardiovascular Institute, Manhasset, New York, USA
- Department of Cardiology, South Shore University Hospital, Bay Shore, New York, USA
| | - Laurence M Epstein
- Department of Cardiology, Northwell, New Hyde Park, New York, USA
- Department of Cardiology, Northwell Cardiovascular Institute, Manhasset, New York, USA
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
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4
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Bartsch SM, O'Shea KJ, Weatherwax C, Strych U, Velmurugan K, John DC, Bottazzi ME, Hussein M, Martinez MF, Chin KL, Ciciriello A, Heneghan J, Dibbs A, Scannell SA, Hotez PJ, Lee BY. What Is the Economic Benefit of Annual COVID-19 Vaccination From the Adult Individual Perspective? J Infect Dis 2024; 230:382-393. [PMID: 38581432 PMCID: PMC11326810 DOI: 10.1093/infdis/jiae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND With coronavirus disease 2019 (COVID-19) vaccination no longer mandated by many businesses/organizations, it is now up to individuals to decide whether to get any new boosters/updated vaccines going forward. METHODS We developed a Markov model representing the potential clinical/economic outcomes from an individual perspective in the United States of getting versus not getting an annual COVID-19 vaccine. RESULTS For an 18-49 year old, getting vaccinated at its current price ($60) can save the individual on average $30-$603 if the individual is uninsured and $4-$437 if the individual has private insurance, as long as the starting vaccine efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is ≥50% and the weekly risk of getting infected is ≥0.2%, corresponding to an individual interacting with 9 other people in a day under Winter 2023-2024 Omicron SARS-CoV-2 variant conditions with an average infection prevalence of 10%. For a 50-64 year old, these cost-savings increase to $111-$1278 and $119-$1706 for someone without and with insurance, respectively. The risk threshold increases to ≥0.4% (interacting with 19 people/day), when the individual has 13.4% preexisting protection against infection (eg, vaccinated 9 months earlier). CONCLUSIONS There is both clinical and economic incentive for the individual to continue to get vaccinated against COVID-19 each year.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Kelly J O'Shea
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Colleen Weatherwax
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Ulrich Strych
- National School of Tropical Medicine, Department of Pediatrics, and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
| | - Kavya Velmurugan
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Danielle C John
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, Department of Pediatrics, and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mustafa Hussein
- Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
| | - Marie F Martinez
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Kevin L Chin
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Allan Ciciriello
- National School of Tropical Medicine, Department of Pediatrics, and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
| | - Jessie Heneghan
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Alexis Dibbs
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Sheryl A Scannell
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
| | - Peter J Hotez
- National School of Tropical Medicine, Department of Pediatrics, and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
- Pandemic Response Institute, New York City, New York, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
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Lee N, Kim KH, Park JH, Cho JY, Cho SH, Kim DK, Kim SY, Kim EK, Choi EY, Choi JO, Cho S, Choi GH, Park H, Kim HY, Yoon HJ, Ahn Y, Jeong MH. COVID-19 Vaccination-Related Pericarditis: A Korean Nationwide Study. Mayo Clin Proc 2024:S0025-6196(24)00196-4. [PMID: 39093271 DOI: 10.1016/j.mayocp.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To investigate the incidence, characteristics, and outcomes of COVID-19 vaccine-related pericarditis (VRP) without myocarditis, we analyzed nationwide Korean data. PATIENTS AND METHODS This is a retrospective nationwide report including all vaccinated Koreans with COVID-19 vaccine of any platform (BNT162b2, mRNA-1273, ChAdOx1, or Ad26.COV2.S) from February 26 to December 31, 2021. We analyzed the confirmed cases of COVID-19 VRP by the Expert Adjudication Committee. The incidence, clinical characteristics, and outcomes of COVID-19 VRP were analyzed. RESULTS Among 44,322,068 Koreans with least one dose of COVID-19 vaccination, COVID-19 VRP was confirmed in 179 cases, with 1.73 per million shots (95% CI, 1.48 to 2.00 per million shots). The incidence of VRP was significantly higher in males than females (2.01 per 1 million doses vs 1.45 per 1 million doses, respectively; P=.029), in mRNA vaccines than in other vaccines (2.09 per 1 million doses vs 0.36 per 1 million doses, respectively; P<.001), and in those younger than 40 years of age than those older than 40 years of age (3.52 per 1 million doses vs 0.89 per 1 million doses, respectively; P<.001). The incidence of VRP was highest in males between the ages of 12 and 17 years (7.38 per 1 million doses; 95% CI, 2.01 to 16.07). Although there was no case of mortality, hemodynamically significant pericardial effusion requiring pericardial drainage was noted in 10 cases (5.6%). CONCLUSION COVID-19 VRP was very rare and developed mainly in association with mRNA vaccines, especially in males younger than 40 years of age. The clinical course of VRP was excellent, and there were no cases of mortality. However, the development of hemodynamically significant pericardial effusion should be carefully monitored.
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Affiliation(s)
- Nuri Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea; Department of Cardiovascular Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea; Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea.
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, Korea.
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea; Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Hyeon Cho
- COVID-19 Vaccination Task Force Adverse Event Investigation Team, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, Korea
| | - Dong Keun Kim
- COVID-19 Vaccination Task Force Adverse Event Investigation Team, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, Korea
| | - Seung Yun Kim
- COVID-19 Vaccination Task Force Adverse Event Investigation Team, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, Korea
| | - Eun Kyoung Kim
- COVID-19 Vaccination Task Force Adverse Event Investigation Team, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, Korea
| | - Eui-Young Choi
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suji Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ga Hui Choi
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyukjin Park
- Department of Cardiovascular Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea; Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea; Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea; Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
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6
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Chung YS, Lam CY, Tan PH, Tsang HF, Wong SCC. Comprehensive Review of COVID-19: Epidemiology, Pathogenesis, Advancement in Diagnostic and Detection Techniques, and Post-Pandemic Treatment Strategies. Int J Mol Sci 2024; 25:8155. [PMID: 39125722 PMCID: PMC11312261 DOI: 10.3390/ijms25158155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
At present, COVID-19 remains a public health concern due to the ongoing evolution of SARS-CoV-2 and its prevalence in particular countries. This paper provides an updated overview of the epidemiology and pathogenesis of COVID-19, with a focus on the emergence of SARS-CoV-2 variants and the phenomenon known as 'long COVID'. Meanwhile, diagnostic and detection advances will be mentioned. Though many inventions have been made to combat the COVID-19 pandemic, some outstanding ones include multiplex RT-PCR, which can be used for accurate diagnosis of SARS-CoV-2 infection. ELISA-based antigen tests also appear to be potential diagnostic tools to be available in the future. This paper also discusses current treatments, vaccination strategies, as well as emerging cell-based therapies for SARS-CoV-2 infection. The ongoing evolution of SARS-CoV-2 underscores the necessity for us to continuously update scientific understanding and treatments for it.
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Affiliation(s)
| | | | | | | | - Sze-Chuen Cesar Wong
- Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China; (Y.-S.C.); (C.-Y.L.); (P.-H.T.); (H.-F.T.)
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7
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Rico-Mesa JS, Haloot J, Anupama BK, Atluri S, Liu J, Khalid U. The Role and Implications of COVID-19 in Incident and Prevalent Heart Failure. Curr Heart Fail Rep 2024:10.1007/s11897-024-00677-7. [PMID: 39042238 DOI: 10.1007/s11897-024-00677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE OF REVIEW This review examines the pathophysiological interactions between COVID-19 and heart failure, highlighting the exacerbation of heart failure in COVID-19 patients. It focuses on the complex mechanisms driving worse outcomes in these patients. RECENT FINDINGS Patients with pre-existing heart failure experience more severe symptoms and higher mortality rates due to mechanisms such as cytokine storms, myocardial infarction, myocarditis, microvascular dysfunction, thrombosis, and stress cardiomyopathy. Elevated biomarkers like troponin and natriuretic peptides correlate with severe disease. Long-term cardiovascular risks for COVID-19 survivors include increased incidence of heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock. COVID-19 significantly impacts patients with pre-existing heart failure, leading to severe symptoms and higher mortality. Elevated cardiac biomarkers are indicators of severe disease. Acute and long-term cardiovascular complications are common, calling for ongoing research into targeted therapies and improved management strategies to better prevent, diagnose, and treat heart failure in the context of COVID-19.
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Affiliation(s)
| | - Justin Haloot
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - B K Anupama
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Suman Atluri
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jing Liu
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Umair Khalid
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
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8
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Frustaci A, Letizia C, Alfarano M, Marchionni G, Verardo R, Chimenti C. Immunomodulating and Immunosuppressive Therapy for Virus-Negative Immune-Mediated Myocarditis. Biomedicines 2024; 12:1565. [PMID: 39062138 PMCID: PMC11274480 DOI: 10.3390/biomedicines12071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Myocarditis is an inflammatory disease of the myocardium caused by infectious and noninfectious agents. Clinical manifestations range from mildly symptomatic forms to acute heart failure, cardiogenic shock, life-threatening arrhythmias and sudden death. Myocarditis is still a challenging diagnosis because of its wide variability in clinical presentation and unpredictable course. Moreover, a standardized, specific treatment in not yet available. Immunosuppressive treatment for virus-negative lymphocytic myocarditis is still controversial. Conversely, immunosuppression is well established in sarcoidosis, eosinophilic, giant-cell, drug hypersensitivity, and trauma-related myocarditis as well as lymphocytic myocarditis associated with connective tissue diseases or with the rejection of a transplanted heart. Recently, immunosuppressive therapy has been also recognized as an effective treatment in virus-negative inflammatory cardiomyopathy. The aim of this review is to underline the role of immunomodulating and immunosuppressive therapies in patients with immune-mediated myocarditis and illustrate the different treatment strategies depending on the etiology. An endomyocardial biopsy remains the gold standard for the diagnosis of myocarditis as well as for a tailored treatment.
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Affiliation(s)
- Andrea Frustaci
- Cellular and Molecular Cardiology Laboratory, IRCCS Lazzaro Spallanzani, 00149 Rome, Italy;
- IRCCS San Raffaele, 00163 Rome, Italy
| | - Claudio Letizia
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (C.L.); (M.A.); (C.C.)
| | - Maria Alfarano
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (C.L.); (M.A.); (C.C.)
| | - Giulia Marchionni
- Policlinico San Matteo Pavia IRCCS Foundation, University of Pavia, 27100 Pavia, Italy;
| | - Romina Verardo
- Cellular and Molecular Cardiology Laboratory, IRCCS Lazzaro Spallanzani, 00149 Rome, Italy;
| | - Cristina Chimenti
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (C.L.); (M.A.); (C.C.)
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9
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Fisman DN, Simmons AE, Tuite AR. Case-cohort design as an efficient approach to evaluating COVID-19 vaccine effectiveness, waning, heterologous immune effect and optimal dosing interval. Vaccine 2024:S0264-410X(24)00797-7. [PMID: 39004528 DOI: 10.1016/j.vaccine.2024.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
Though widely applied in other epidemiological fields, the case-cohort study design has seen little application in the field of vaccinology. Case-cohort studies use probabilistic sampling and reweighting to draw inferences about effects (in this case vaccine efficacy) at the population level in an efficient manner. The SARS-CoV-2 pandemic was met with high vaccine uptake, and high rates of population testing prior to the emergence of Omicron variants of concern, in Ontario, Canada, providing an ideal environment for application of case-cohort methodology. We combined a population-based case line list and vaccination database for the province of Ontario between December 2020 and October 2021. Risk of infection after vaccination was evaluated in all laboratory-confirmed vaccinated SARS-CoV-2 cases, and a 2 % sample of vaccinated controls, evaluated using survival analytic methods, including construction of Cox proportional hazards models. Vaccination status was treated as a time-varying covariate. First and second doses of SARS-CoV-2 vaccine markedly reduced risk of infection (first dose efficacy 68 %, 95 % CI 67 %-69 %; second dose efficacy 88 %, 95 % CI 87-88 %). In multivariable models, extended dosing intervals were associated with lowest risk of breakthrough infection (HR for redosing 0.64 (95 % CI 0.61-0.67) at 6-8 weeks). Heterologous vaccine schedules that mixed viral vector vaccine first doses with mRNA second doses were significantly more effective than mRNA only vaccines. Risk of infection largely vanished during the time period 4-6 months after the second vaccine dose, but rose markedly thereafter. We conclude that a case-cohort design provided an efficient means to identify strong protective effects associated with SARS-CoV-2 vaccination in real time, and also served to quantify the timing and magnitude of infection breakthrough risk in the same cohort. Heterologous vaccination and extended dosing intervals improved the durability of immune response.
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Affiliation(s)
- David N Fisman
- Institute for Pandemics and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Alison E Simmons
- Institute for Pandemics and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashleigh R Tuite
- Institute for Pandemics and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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10
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Park JK, Davies B. Rationing, Responsibility, and Vaccination during COVID-19: A Conceptual Map. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:66-79. [PMID: 37104661 PMCID: PMC11248994 DOI: 10.1080/15265161.2023.2201188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics.
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11
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Huang JH, Ju KS, Liao TW, Lin YK, Yeh JS, Chen YJ. Adverse Cardiovascular Effects of COVID-19 Vaccination: A Systematic Review. Cardiol Rev 2024; 32:314-319. [PMID: 38848534 DOI: 10.1097/crd.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Several vaccines against coronavirus disease 2019 (COVID-19)-caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-have been developed since the COVID-19 pandemic began. Of these, 7 have been approved in the World Health Organization's Emergency Use Listing. However, these vaccines have been reported to have rare or serious adverse cardiovascular effects. This review presents updated information on the adverse cardiovascular effects of the approved COVID-19 vaccines-including inactivated vaccines, protein subunit vaccines, virus-like particles, nucleic acid vaccines, and viral vector vaccines-and the underlying mechanisms.
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Affiliation(s)
- Jen-Hung Huang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Ke-Shiuan Ju
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Wei Liao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Jong-Shiuan Yeh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
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12
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Padilla‐Flores T, Sampieri A, Vaca L. Incidence and management of the main serious adverse events reported after COVID-19 vaccination. Pharmacol Res Perspect 2024; 12:e1224. [PMID: 38864106 PMCID: PMC11167235 DOI: 10.1002/prp2.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2n first appeared in Wuhan, China in 2019. Soon after, it was declared a pandemic by the World Health Organization. The health crisis imposed by a new virus and its rapid spread worldwide prompted the fast development of vaccines. For the first time in human history, two vaccines based on recombinant genetic material technology were approved for human use. These mRNA vaccines were applied in massive immunization programs around the world, followed by other vaccines based on more traditional approaches. Even though all vaccines were tested in clinical trials prior to their general administration, serious adverse events, usually of very low incidence, were mostly identified after application of millions of doses. Establishing a direct correlation (the cause-effect paradigm) between vaccination and the appearance of adverse effects has proven challenging. This review focuses on the main adverse effects observed after vaccination, including anaphylaxis, myocarditis, vaccine-induced thrombotic thrombocytopenia, Guillain-Barré syndrome, and transverse myelitis reported in the context of COVID-19 vaccination. We highlight the symptoms, laboratory tests required for an adequate diagnosis, and briefly outline the recommended treatments for these adverse effects. The aim of this work is to increase awareness among healthcare personnel about the serious adverse events that may arise post-vaccination. Regardless of the ongoing discussion about the safety of COVID-19 vaccination, these adverse effects must be identified promptly and treated effectively to reduce the risk of complications.
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Affiliation(s)
- Teresa Padilla‐Flores
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Alicia Sampieri
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Luis Vaca
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
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13
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Lee S, Jo H, Lee H, Lee H, Lee J, Kim HJ, Kang J, Jacob L, Smith L, Rahmati M, López Sánchez GF, Dragioti E, Jeon H, Cho JM, Choi Y, Park J, Woo S, Yon DK. Global estimates on the reports of vaccine-associated myocarditis and pericarditis from 1969 to 2023: Findings with critical reanalysis from the WHO pharmacovigilance database. J Med Virol 2024; 96:e29693. [PMID: 38859751 DOI: 10.1002/jmv.29693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024]
Abstract
Due to the limitation of previous studies examining adverse reports of myocarditis and pericarditis associated with vaccines other than the COVID-19 vaccine, there are challenges in establishing a comprehensive understanding of vaccine safety on a global scale. Hence, the objective of this study was to examine the worldwide burden of vaccine-associated pericarditis and myocarditis and the vaccines associated with these indications. This study utilized the World Health Organization international pharmacovigilance database, from which records of vaccine-associated pericarditis and myocarditis between 1969 and 2023 were extracted (over 130 million reports). We calculated global reporting counts, reported odds ratios (RORs), and information components (ICs) to discern the association between 19 vaccines and the occurrence of pericarditis and myocarditis across 156 countries and territories. We identified 49 096 reports (male, n = 30 013) of vaccine-associated pericarditis and myocarditis among 73 590 reports of all-cause pericarditis and myocarditis. There has been a significant increase in reports of vaccine-related cardiac adverse events over time, with a noteworthy surge observed after 2020, attributed to cases of pericarditis associated with COVID-19 mRNA vaccines. Smallpox vaccines were associated with most pericarditis and myocarditis reports (ROR: 73.68 [95% CI, 67.79-80.10]; IC [IC0.25]: 6.05 [5.91]), followed by COVID-19 mRNA vaccine (37.77 [37.00-38.56]; 3.07 [3.05]), anthrax vaccine (25.54 [22.37-29.16]; 4.58 [4.35]), typhoid vaccine (6.17 [5.16-7.38]; 2.59 [2.29]), encephalitis vaccine (2.00 [1.48-2.71]; 0.99 [0.47]), influenza vaccine (1.87 [1.71-2.04]; 0.90 [0.75]), and Ad5-vectored COVID-19 vaccine (1.40 [1.34-1.46]; 0.46 [0.39]). Concerning age and sex-specific risks, reports of vaccine-associated pericarditis and myocarditis were more prevalent among males and in older age groups. The age group between 12 and 17 years exhibited significant sex disproportion. Most of these adverse events had a short time to onset (median time: 1 day) and fatality rate was 0.44%. Our analysis of global data revealed an increase in pericarditis and myocarditis reports associated with vaccines, particularly live vaccines like smallpox and anthrax, notably in young males. While these adverse events are generally rare and mild, caution is warranted, especially for healthcare workers, due to potential myocardial injury-related in-hospital mortality. Further study with validated reporting is crucial to enhance accuracy in evaluating the correlation between vaccines and cardiac conditions for preventive measures.
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Affiliation(s)
- Sooji Lee
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyesu Jo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jiseung Kang
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, Université Paris Cité, Paris, France
- Epidemiology of Ageing and Neurodegenerative Diseases (EpiAgeing), Inserm U1153, Université Paris Cité, Paris, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique Des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Hongki Jeon
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jin-Man Cho
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yujin Choi
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Korean Medicine, Kyung Hee University College of Korean Medicine, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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14
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Zafeiri M, Knott K, Lampejo T. Acute myocarditis: an overview of pathogenesis, diagnosis and management. Panminerva Med 2024; 66:174-187. [PMID: 38536007 DOI: 10.23736/s0031-0808.24.05042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Acute myocarditis encompasses a diverse presentation of inflammatory cardiomyopathies with infectious and non-infectious triggers. The clinical presentation is heterogeneous, from subtle symptoms like mild chest pain to life-threatening fulminant heart failure requiring urgent advanced hemodynamic support. This review provides a comprehensive overview of the current state of knowledge regarding the pathogenesis, diagnostic approach, management strategies, and directions for future research in acute myocarditis. The pathogenesis of myocarditis involves interplay between the inciting factors and the subsequent host immune response. Infectious causes, especially cardiotropic viruses, are the most frequently identified precipitants. However, autoimmune processes independent of microbial triggers, as well as toxic myocardial injury from drugs, chemicals or metabolic derangements also contribute to the development of myocarditis through diverse mechanisms. Furthermore, medications like immune checkpoint inhibitor therapies are increasingly recognized as causes of myocarditis. Elucidating the nuances of viral, autoimmune, hypersensitivity, and toxic subtypes of myocarditis is key to guiding appropriate therapy. The heterogeneous clinical presentation coupled with non-specific symptoms creates diagnostic challenges. A multifaceted approach is required, incorporating clinical evaluation, electrocardiography, biomarkers, imaging studies, and endomyocardial biopsy. Cardiovascular magnetic resonance imaging has become pivotal for non-invasive assessment of myocardial inflammation and fibrosis. However, biopsy remains the gold standard for histological classification and definitively establishing the underlying etiology. Management relies on supportive care, while disease-specific therapies are limited. Although some patients recover well with conservative measures, severe or fulminant myocarditis necessitates aggressive interventions such as mechanical circulatory support devices and transplantation. While immunosuppression is beneficial in certain histological subtypes, clear evidence supporting antiviral or immunomodulatory therapies for the majority of acute viral myocarditis cases remains insufficient. Substantial knowledge gaps persist regarding validated diagnostic biomarkers, optimal imaging surveillance strategies, evidence-based medical therapies, and risk stratification schema. A deeper understanding of the immunopathological mechanisms, rigorous clinical trials of targeted therapies, and longitudinal outcome studies are imperative to advance management and improve the prognosis across the myocarditis spectrum.
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Affiliation(s)
- Marina Zafeiri
- King's College Hospital NHS Foundation Trust, London, UK
- University Hospitals Dorset NHS Foundation Trust, London, UK
| | | | - Temi Lampejo
- King's College Hospital NHS Foundation Trust, London, UK -
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15
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Park JH, Kim KH. COVID-19 Vaccination-Related Myocarditis: What We Learned From Our Experience and What We Need to Do in The Future. Korean Circ J 2024; 54:295-310. [PMID: 38654456 PMCID: PMC11169908 DOI: 10.4070/kcj.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has led to a global health crisis with substantial mortality and morbidity. To combat the COVID-19 pandemic, various vaccines have been developed, but unexpected serious adverse events including vaccine-induced thrombotic thrombocytopenia, carditis, and thromboembolic events have been reported and became a huddle for COVID-19 vaccination. Vaccine-related myocarditis (VRM) is a rare but significant adverse event associated primarily with mRNA vaccines. This review explores the incidence, risk factors, clinical presentation, pathogenesis, management strategies, and outcomes associated with VRM. The incidence of VRM is notably higher in male adolescents and young adults, especially after the second dose of mRNA vaccines. The pathogenesis appears to involve an immune-mediated process, but the precise mechanism remains mostly unknown so far. Most studies have suggested that VRM is mild and self-limiting, and responds well to conventional treatment. However, a recent nationwide study in Korea warns that severe cases, including fulminant myocarditis or death, are not uncommon in patients with COVID-19 VRM. The long-term cardiovascular consequences of VRM have not been well understood and warrant further investigation. This review also briefly addresses the critical balance between the substantial benefits of COVID-19 vaccination and the rare risks of VRM in the coming endemic era. It emphasizes the need for continued surveillance, research to understand the underlying mechanisms, and strategies to mitigate risk. Filling these knowledge gaps would be vital to refining vaccination recommendations and improving patient care in the evolving COVID-19 pandemic landscape.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea.
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16
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Sunita S, Negi MB, Lal M, Kumar C, Kumar M. Insights from assessment for arrhythmia after CoViD-19 vaccination among Indians. Bioinformation 2024; 20:430-433. [PMID: 39132225 PMCID: PMC11309109 DOI: 10.6026/973206300200430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 08/13/2024] Open
Abstract
Post-vaccination myocarditis is usually moderate and transient, recovering quickly with conservative treatment. Therefore, it is of interest to assess for arrhythmia after CoViD-19 vaccination among Indians. We looked for ECG abnormalities in a small cohort of 50 participants after 52 weeks after receiving the Oxford/AstraZeneca CoViD-19 vaccination. Data shows that post-vaccination myocarditis is typically mild and transient, with most cases resolving swiftly through conservative management. Thus, it is unlikely that this vaccine will induce severe arrhythmias or life-threatening cardiac events in the general population.
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Affiliation(s)
- S Sunita
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | | | - Moti Lal
- Lady Hardinge Medical College, New Delhi, India
| | - Chandan Kumar
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Manish Kumar
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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17
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Chen C, Chen C, Cao L, Fang J, Xiao J. Comparative safety profile of bivalent and original COVID-19 mRNA vaccines regarding myocarditis/pericarditis: A pharmacovigilance study. Int Immunopharmacol 2024; 133:112022. [PMID: 38615382 DOI: 10.1016/j.intimp.2024.112022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Bivalent COVID-19 mRNA vaccines, which contain two different components, were authorized to provide protection against both the original strain of SARS-CoV-2 and the Omicron variant as a measure to address the COVID-19 pandemic. Concerns regarding the risk of myocarditis/pericarditis associated with bivalent vaccination have been raised due to the observed superior neutralizing antibody responses. This study aimed to investigate the risk of myocarditis/pericarditis following bivalent COVID-19 mRNA vaccination compared to monovalent vaccination. METHODS The CDC COVID Data Tracker and the Vaccines Adverse Event Reporting System (VAERS) were analyzed between December 13, 2020 to March 8, 2023. Reporting rates were determined by dividing the number of myocarditis/pericarditis cases by the total number of vaccine doses administered. Disproportionality patterns regarding myocarditis/pericarditis were evaluated for various COVID-19 mRNA vaccinations using reporting odds ratios (RORs). RESULTS The reporting rate for myocarditis/pericarditis following original monovalent COVID-19 mRNA vaccination was 6.91 (95 % confidence interval [95 %CI] 6.71-7.12) per million doses, while the reporting rate for bivalent vaccination was significantly lower (1.24, 95%CI 0.96-1.58). Disproportionality analysis revealed a higher reporting of myocarditis/pericarditis following original vaccination with a ROR of 2.21 (95 %CI 2.00-2.43), while bivalent COVID-19 mRNA vaccination was associated with fewer reports of myocarditis/pericarditis (ROR 0.57, 95 %CI 0.45-0.72). Sub-analyses based on symptoms, sex, age and manufacturer further supported these findings. CONCLUSION This population-based study provides evidence that bivalent COVID-19 mRNA vaccination is not associated with risk of myocarditis/pericarditis. These findings provide important insights into the safety profile of bivalent COVID-19 mRNA vaccines and support their continued use as updated boosters.
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Affiliation(s)
- Congqin Chen
- Department of Pharmacy, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen 361000, China
| | - Chunmei Chen
- Department of Pharmacy, Longyan First Hospital, Fujian Medical University, Longyan 364000, China
| | - Longxing Cao
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen 361000, China
| | - Jie Fang
- Department of Pharmacy, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Jie Xiao
- Department of Pharmacy, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen 361000, China.
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18
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Hu WC, Chiu SK, Yang YF, Singh S. COVID-19 Vaccination Reporting and Adverse Event Analysis in Taiwan. Vaccines (Basel) 2024; 12:591. [PMID: 38932320 PMCID: PMC11209125 DOI: 10.3390/vaccines12060591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The COVID-19 pandemic necessitated an urgent global response in vaccine deployment, achieving over 70.6% global vaccination coverage with at least one dose. This study focuses on Taiwan's vaccine administration and adverse event reporting, set against a global backdrop. Using data from Taiwan's Vaccine Adverse Event Reporting System (VAERS) and global vaccination data, this study investigates vaccine safety and the public health implications of vaccination strategies from local and global perspectives. Taiwan's proactive approach, resulting in high vaccination rates, provides a case study for the monitoring and management of vaccine-related adverse events. This study offers insights into the safety profiles of various COVID-19 vaccines and further explores the implications of adverse event reporting rates for vaccine policy and public health strategies. The comparative analysis reveals that, while vaccination has been effective in controlling the virus's spread, safety monitoring remains critical for maintaining public trust. It underscores the necessity of enhanced surveillance and the importance of transparent and tailored risk communication to support informed public health decisions. The findings aim to contribute to the global dialogue on vaccine safety, equitable distribution, evidence-based policy-making, and development of mitigation measures with consideration of local demographics in the ongoing fight against COVID-19.
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Affiliation(s)
- Wan-Chung Hu
- Department of Clinical Pathology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
- Department of Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
- Department of Biotechnology, Ming Chuan University, Taoyuan 333, Taiwan
| | - Sheng-Kang Chiu
- Division of Infection Diseases, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ying-Fei Yang
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Sher Singh
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei 11677, Taiwan
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19
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Latchupatula L, Benayon M, Yang L, Ganame J, Tandon V. COVID-19 mRNA Vaccination-Induced Myopericarditis in an Otherwise Healthy Young Male: An Evidence-Based Approach to Differentiating From Perimyocarditis. Cureus 2024; 16:e59999. [PMID: 38736762 PMCID: PMC11081880 DOI: 10.7759/cureus.59999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 05/14/2024] Open
Abstract
A 29-year-old male, otherwise healthy with no past medical history, presented to the hospital after a two-day history of pleuritic chest pain with a fever. He had received his first dose of the mRNA-1273 coronavirus disease (COVID-19) vaccine (Moderna) two months prior without any adverse reactions. He received his second dose approximately 24 hours before symptom onset and hospital presentation. Work-up was unremarkable for respiratory, autoimmune, and rheumatological etiologies. The patient was found to have electrocardiogram features and symptoms in keeping with pericarditis, C-reactive protein elevation, and a peak high-sensitivity troponin level of 9,992 ng/L suggestive of a component of myocarditis. A dilemma arose regarding whether this patient should be diagnosed with perimyocarditis or myopericarditis, terms often used interchangeably without proper reference to the primary pathology, which can ultimately affect management. A subsequent echocardiogram was unremarkable, with a normal left ventricular systolic function, but cardiac resonance imaging revealed myocardial edema suggestive of myocarditis. Without convincing evidence for an alternative explanation after an extensive work-up of ischemic, autoimmune, rheumatological, and infectious etiologies, this patient was diagnosed with COVID-19 mRNA vaccine-induced myopericarditis. The patient fully recovered after receiving a treatment course of ibuprofen and colchicine. This case explores how the diagnosis of COVID-19 vaccine-induced myopericarditis was made and treated using an evidence-based approach, highlighting its differentiation from perimyocarditis.
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Affiliation(s)
| | - Myles Benayon
- Internal Medicine, McMaster University, Hamilton, CAN
| | - Laurie Yang
- Medical School, McMaster University, Hamilton, CAN
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20
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Roberts CS, Hassan MH, Hasson L, Guileyardo JM, Roberts WC. Fatal Acute Myocardial Infarction With Normal Epicardial Coronary Arteries Shortly Following COVID-19 Vaccination. Am J Cardiol 2024; 218:68-71. [PMID: 38428710 DOI: 10.1016/j.amjcard.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/26/2024] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
Myocarditis and acute myocardial infarction (AMI) have been reported after COVID-19 messenger ribonucleic acid vaccination. Nearly all reported patients with myocarditis or AMI after COVID-19 vaccination have survived and become asymptomatic. Described herein is a previously healthy man who developed severe heart decompensation shortly after receiving a COVID-19 vaccination and died approximately 40 hours later. An autopsy disclosed massive AMI.
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Affiliation(s)
- Charles S Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Murad H Hassan
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Lena Hasson
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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21
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Gulhane A, Soriano B, Stanescu L, Schauer J, Ferguson M, Romberg E, Bhutta S, Otto R, Caris E, Mallenahalli S, Portman M, Litt H, Buddhe S. Objective Comparison of Clinical and Cardiac Magnetic Resonance Biomarkers in Adolescents Presenting With Acute Chest Pain and Elevated Troponins Pre-COVID and Post-COVID Vaccination. J Magn Reson Imaging 2024; 59:1867-1873. [PMID: 37622988 DOI: 10.1002/jmri.28971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Affiliation(s)
- Avanti Gulhane
- Department of Cardiothoracic Radiology, University of Washington, Seattle, Washington, USA
| | - Brian Soriano
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Luana Stanescu
- Department of Pediatric Radiology, University of Washington, Seattle, Washington, USA
| | - Jenna Schauer
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Mark Ferguson
- Department of Pediatric Radiology, University of Washington, Seattle, Washington, USA
| | - Erin Romberg
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Sadaf Bhutta
- Department of Pediatric Radiology, University of Washington, Seattle, Washington, USA
| | - Randolph Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Elizabeth Caris
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Sathish Mallenahalli
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Michael Portman
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sujatha Buddhe
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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22
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Costa C, Moniati F. The Epidemiology of COVID-19 Vaccine-Induced Myocarditis. Adv Med 2024; 2024:4470326. [PMID: 38681683 PMCID: PMC11045291 DOI: 10.1155/2024/4470326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background In December 2019, the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) led to the COVID-19 pandemic, with millions of deaths worldwide. Vaccine breakthroughs in late 2020 resulted in the authorization of COVID-19 vaccines. While these vaccines have demonstrated efficacy, evidence from vaccine safety monitoring systems around the globe supported a causal association between COVID-19 vaccines, in particular those using mRNA technology, i.e., Moderna's mRNA-1273 and Pfizer-BioNTech's BNT162b2, and myocarditis. Objective This paper aims to investigate the epidemiology of mRNA COVID-19 vaccine-induced myocarditis, including age, ethnicity, and gender associations with these vaccines. It also discusses the immunopathophysiological mechanisms of mRNA COVID-19 vaccine-associated myocarditis and outlines principles of diagnosis, clinical presentation, and management. Methods A literature review was conducted using PubMed, Embase, and Queen Mary University of London Library Services databases. Search terms included "myocarditis," "coronavirus disease 2019," "SARS-CoV-2," "mRNA Covid-19 vaccines," "Covid vaccine-associated myocarditis," "epidemiology," "potential mechanisms," "myocarditis diagnosis," and "myocarditis management." Results While the definite mechanism of mRNA COVID-19 vaccine-associated myocarditis remains ambiguous, potential mechanisms include molecular mimicry of spike proteins and activation of the adaptive immune response with dysregulated cytokine expression. Male predominance in COVID-19 vaccine-induced myocarditis may be attributed to sex hormones, variations in inflammatory reactions, coagulation states based on gender, and female-specific protective factors. Moreover, an analysis of diagnostic and management strategies reveals a lack of consensus on acute patient presentation management. Conclusion In contrast to viral infections that stand as the predominant etiological factor for myocarditis with more severe consequences, the mRNA COVID-19 vaccination elicits a mild and self-limiting manifestation of the condition. There is currently insufficient evidence to confirm the definite underlying mechanism of COVID-19 vaccine-associated myocarditis. Further research is needed to develop preventive and therapeutic solutions in this context.
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Affiliation(s)
| | - Foteini Moniati
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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23
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Gee J, Shimabukuro TT, Su JR, Shay D, Ryan M, Basavaraju SV, Broder KR, Clark M, Buddy Creech C, Cunningham F, Goddard K, Guy H, Edwards KM, Forshee R, Hamburger T, Hause AM, Klein NP, Kracalik I, Lamer C, Loran DA, McNeil MM, Montgomery J, Moro P, Myers TR, Olson C, Oster ME, Sharma AJ, Schupbach R, Weintraub E, Whitehead B, Anderson S. Overview of U.S. COVID-19 vaccine safety surveillance systems. Vaccine 2024:S0264-410X(24)00224-X. [PMID: 38631952 DOI: 10.1016/j.vaccine.2024.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
The U.S. COVID-19 vaccination program, which commenced in December 2020, has been instrumental in preventing morbidity and mortality from COVID-19 disease. Safety monitoring has been an essential component of the program. The federal government undertook a comprehensive and coordinated approach to implement complementary safety monitoring systems and to communicate findings in a timely and transparent way to healthcare providers, policymakers, and the public. Monitoring involved both well-established and newly developed systems that relied on both spontaneous (passive) and active surveillance methods. Clinical consultation for individual cases of adverse events following vaccination was performed, and monitoring of special populations, such as pregnant persons, was conducted. This report describes the U.S. government's COVID-19 vaccine safety monitoring systems and programs used by the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the Department of Defense, the Department of Veterans Affairs, and the Indian Health Service. Using the adverse event of myocarditis following mRNA COVID-19 vaccination as a model, we demonstrate how the multiple, complementary monitoring systems worked to rapidly detect, assess, and verify a vaccine safety signal. In addition, longer-term follow-up was conducted to evaluate the recovery status of myocarditis cases following vaccination. Finally, the process for timely and transparent communication and dissemination of COVID-19 vaccine safety data is described, highlighting the responsiveness and robustness of the U.S. vaccine safety monitoring infrastructure during the national COVID-19 vaccination program.
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Affiliation(s)
- Julianne Gee
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
| | - Tom T Shimabukuro
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - John R Su
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - David Shay
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Margaret Ryan
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, United States
| | - Sridhar V Basavaraju
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Karen R Broder
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Matthew Clark
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center and School of Medicine, Nashville, TN, United States
| | - Francesca Cunningham
- Department of Veterans Affairs, Veterans Affairs Center for Medication Safety - Pharmacy Benefit Management Services, Hines, IL, United States
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Harrison Guy
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Kathryn M Edwards
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center and School of Medicine, Nashville, TN, United States
| | - Richard Forshee
- Office of Biologics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
| | - Tanya Hamburger
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Anne M Hause
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ian Kracalik
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Chris Lamer
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - David A Loran
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, United States
| | - Michael M McNeil
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Jay Montgomery
- Defense Health Agency, Immunization Healthcare Division, Bethesda, MD, United States
| | - Pedro Moro
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Tanya R Myers
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Christine Olson
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Matthew E Oster
- National Center for Birth Defects and Developmental Disabilities, CDC, Atlanta GA, United States; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrea J Sharma
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Ryan Schupbach
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Eric Weintraub
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Brett Whitehead
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Steven Anderson
- Office of Biologics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
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24
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Liko J, Cieslak PR. Assessment of Risk for Sudden Cardiac Death Among Adolescents and Young Adults After Receipt of COVID-19 Vaccine - Oregon, June 2021-December 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:317-320. [PMID: 38602888 PMCID: PMC11008789 DOI: 10.15585/mmwr.mm7314a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
COVID-19 vaccination has been associated with myocarditis in adolescents and young adults, and concerns have been raised about possible vaccine-related cardiac fatalities in this age group. In April 2021, cases of myocarditis after COVID-19 vaccination, particularly among young male vaccine recipients, were reported to the Vaccine Adverse Event Reporting System. To assess this possibility, investigators searched death certificates for Oregon residents aged 16-30 years who died during June 2021-December 2022 for cardiac or undetermined causes of death. For identified decedents, records in Oregon's immunization information system were reviewed for documentation of mRNA COVID-19 vaccination received ≤100 days before death. Among 1,292 identified deaths, COVID-19 was cited as the cause for 30. For 101 others, a cardiac cause of death could not be excluded; among these decedents, immunization information system records were available for 88, three of whom had received an mRNA COVID-19 vaccination within 100 days of death. Of 40 deaths that occurred among persons who had received an mRNA COVID-19 vaccine dose, three occurred ≤100 days after vaccination. Two of these deaths were attributed to chronic underlying conditions; the cause was undetermined for one. No death certificate attributed death to vaccination. These data do not support an association between receipt of mRNA COVID-19 vaccine and sudden cardiac death among previously healthy young persons. COVID-19 vaccination is recommended for all persons aged ≥6 months to prevent COVID-19 and complications, including death.
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Affiliation(s)
- Juventila Liko
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | - Paul R. Cieslak
- Public Health Division, Oregon Health Authority, Portland, Oregon
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25
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Hu M, Shoaibi A, Feng Y, Lloyd PC, Wong HL, Smith ER, Amend KL, Kline A, Beachler DC, Gruber JF, Mitra M, Seeger JD, Harris C, Secora A, Obidi J, Wang J, Song J, McMahill-Walraven CN, Reich C, McEvoy R, Do R, Chillarige Y, Clifford R, Cooper DD, Forshee RA, Anderson SA. Safety of Ancestral Monovalent BNT162b2, mRNA-1273, and NVX-CoV2373 COVID-19 Vaccines in US Children Aged 6 Months to 17 Years. JAMA Netw Open 2024; 7:e248192. [PMID: 38656578 PMCID: PMC11043896 DOI: 10.1001/jamanetworkopen.2024.8192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/12/2024] [Indexed: 04/26/2024] Open
Abstract
Importance Active monitoring of health outcomes after COVID-19 vaccination provides early detection of rare outcomes that may not be identified in prelicensure trials. Objective To conduct near-real-time monitoring of health outcomes after COVID-19 vaccination in the US pediatric population. Design, Setting, and Participants This cohort study evaluated 21 prespecified health outcomes after exposure before early 2023 to BNT162b2, mRNA-1273, or NVX-CoV2373 ancestral monovalent COVID-19 vaccines in children aged 6 months to 17 years by applying a near-real-time monitoring framework using health care data from 3 commercial claims databases in the US (Optum [through April 2023], Carelon Research [through March 2023], and CVS Health [through February 2023]). Increased rates of each outcome after vaccination were compared with annual historical rates from January 1 to December 31, 2019, and January 1 to December 31, 2020, as well as between April 1 and December 31, 2020. Exposure Receipt of an ancestral monovalent BNT162b2, mRNA-1273, or NVX-CoV2373 COVID-19 vaccine dose identified through administrative claims data linked with Immunization Information Systems data. Main Outcomes and Measures Twenty-one prespecified health outcomes, of which 15 underwent sequential testing and 6 were only monitored descriptively due to lack of historical rates. Results Among 4 102 016 vaccinated enrollees aged 6 months to 17 years, 2 058 142 (50.2%) were male and 3 901 370 (95.1%) lived in an urban area. Thirteen of 15 sequentially tested outcomes did not meet the threshold for a statistical signal. Statistical signals were detected for myocarditis or pericarditis after BNT162b2 vaccination in children aged 12 to 17 years and seizure after vaccination with BNT162b2 and mRNA-1273 in children aged 2 to 4 or 5 years. However, in post hoc sensitivity analyses, a statistical signal for seizure was observed only after mRNA-1273 when 2019 background rates were selected; no statistical signal was observed when 2022 rates were selected. Conclusions and Relevance In this cohort study of pediatric enrollees across 3 commercial health insurance databases, statistical signals detected for myocarditis or pericarditis after BNT162b2 (ages 12-17 years) were consistent with previous reports, and seizures after BNT162b2 (ages 2-4 years) and mRNA-1273 vaccinations (ages 2-5 years) should be further investigated in a robust epidemiologic study with confounding adjustment. The US Food and Drug Administration concludes that the known and potential benefits of COVID-19 vaccination outweigh the known and potential risks of COVID-19 infection.
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Affiliation(s)
- Mao Hu
- Acumen LLC, Burlingame, California
| | - Azadeh Shoaibi
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | | | | | | | | | - Joyce Obidi
- US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | | | | | - Rose Do
- Acumen LLC, Burlingame, California
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26
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Solaymani-Dodaran M, Kalantari S, Banihashemi SR, Es-haghi A, Nofeli M, Mohazzab A, Mokhberalsafa L, Sadeghi F, Mokaram AR, Moradi MH, Razaz SH, Taghdiri M, Lotfi M, Setarehdan SA, Masoumi S, Ansarifar A, Ebrahimi S, Esmailzadehha N, Boluki Z, Khoramdad M, Molaipour L, Rabiei MH, Amiri FB, Filsoof S, Bani-vaheb B, Derakhshani MR, Bayazidi S, Golmoradizadeh R, Shahsavan M, Safari S, Ghahremanzadeh N, Mohseni V, Erfanpoor S, Fallah Mehrabadi MH. Safety and efficacy of RCP recombinant spike protein covid-19 vaccine compared to Sinopharm BBIBP: A phase III, non-inferiority trial. Heliyon 2024; 10:e27370. [PMID: 38463808 PMCID: PMC10923712 DOI: 10.1016/j.heliyon.2024.e27370] [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: 09/16/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Background We conducted a phase III, non-inferiority trial comparing safety and efficacy of RCP recombinant spike protein Covid-19 vaccine to BBIBP (Sinopharm). Methods Adult Iranian population received RCP or BBIBP in a randomized, double blind and an additional non-randomized open labeled trial arms. Eligible participants signed a written informed consent and received two intramuscular injections three weeks apart. In the randomized arm, an intranasal dose of vaccine or adjuvant-only preparation were given to the RCP and BBIBP recipients at day 51 respectively. Participants were actively followed for up to 4 months for safety and efficacy outcomes. Primary outcome was PCR + symptomatic Covid-19 disease two weeks after the second dose. The non-inferiority margin was 10% of reported BBIBP vaccine efficacy (HR = 1.36). Results We recruited 23,110 participants (7224 in the randomized and 15,886 in the non-randomized arm). We observed 604 primary outcome events during 4 months of active follow-up including 121 and 133 in the randomized and 157 and 193 cases in the non-randomized arms among recipients of RCP and BBIBP respectively. Adjusted hazard ratios for the primary outcome in those receiving RCP compared with BBIBP interval were 0.91 (0.71-1.16) and 0.62 (0.49-0.77) in the randomized and non-randomized arms respectively. The upper boundary of 99.1% confidence interval of HR = 0.91 (0.67-1.22) remained below the margin of non-inferiority in the randomized arm after observing the early stopping rules using O'Brien Fleming method. Conclusion Our study showed that the RCP efficacy is non-inferior and its safety profile is comparable to the BBIBP.
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Affiliation(s)
- Masoud Solaymani-Dodaran
- Clinical Trial Center, Iran University of Medical Science, Tehran, Iran
- Minimally Invasive Surgery Research Center, Hazrat-e-Rasool Hospital, Iran University of Medical Science, Tehran, Iran
| | - Saeed Kalantari
- Departments of Infectious Diseases and Tropical Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Banihashemi
- Department of Research and Development, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Ali Es-haghi
- Department of Physico Chemistry, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Mojtaba Nofeli
- Department of Research and Development, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Arash Mohazzab
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Reproductive Biotechnology Research Center, Avicenna Research Institute Tehran, ACECR, Tehran, Iran
| | - Ladan Mokhberalsafa
- Department of QA, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Fariba Sadeghi
- Department of Quality Control, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Ali Rezae Mokaram
- Department of QA, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Monireh Haji Moradi
- Department of Research and Development, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Seyad Hossein Razaz
- Department of Research and Development, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Maryam Taghdiri
- Department of Research and Development, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Mohsen Lotfi
- Department of Quality Control, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | | | - Safdar Masoumi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Akram Ansarifar
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Ebrahimi
- Department of Infectious Diseases, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Neda Esmailzadehha
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Boluki
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Khoramdad
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Molaipour
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Hassan Rabiei
- Department of Epidemiology, Faculty of Veterinary Medicine, University of Tehran, Iran
| | - Fahimeh Bagheri Amiri
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Sara Filsoof
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Sheno Bayazidi
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Rezvan Golmoradizadeh
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Shahsavan
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Safari
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Vahideh Mohseni
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Erfanpoor
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Fallah Mehrabadi
- Department of Epidemiology, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
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27
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Cezard GI, Denholm RE, Knight R, Wei Y, Teece L, Toms R, Forbes HJ, Walker AJ, Fisher L, Massey J, Hopcroft LEM, Horne EMF, Taylor K, Palmer T, Arab MA, Cuitun Coronado JI, Ip SHY, Davy S, Dillingham I, Bacon S, Mehrkar A, Morton CE, Greaves F, Hyams C, Davey Smith G, Macleod J, Chaturvedi N, Goldacre B, Whiteley WN, Wood AM, Sterne JAC, Walker V. Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study. Nat Commun 2024; 15:2173. [PMID: 38467603 PMCID: PMC10928172 DOI: 10.1038/s41467-024-46497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a 'pre-vaccination' cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and 'vaccinated' and 'unvaccinated' cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4. Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years.
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Affiliation(s)
- Genevieve I Cezard
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Rachel E Denholm
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
| | - Rochelle Knight
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston, Bristol, UK
| | - Yinghui Wei
- Centre for Mathematical Sciences, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Lucy Teece
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Renin Toms
- Population Health Sciences, University of Bristol, Bristol, UK
- Population Wellbeing, School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Harriet J Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene & tropical Medicine, London, UK
| | - Alex J Walker
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Fisher
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jon Massey
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Elsie M F Horne
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Kurt Taylor
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Tom Palmer
- Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Marwa Al Arab
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Samantha H Y Ip
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon Davy
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Iain Dillingham
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sebastian Bacon
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caroline E Morton
- Digital Environment Research Institute, Queen Mary University of London, London, UK
| | - Felix Greaves
- National Institute for Health and Care Excellence, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Catherine Hyams
- Population Health Sciences, University of Bristol, Bristol, UK
| | - George Davey Smith
- Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - John Macleod
- Population Health Sciences, University of Bristol, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston, Bristol, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Ben Goldacre
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Angela M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Cambridge Centre of Artificial Intelligence in Medicine, Cambridge, UK
| | - Jonathan A C Sterne
- Population Health Sciences, University of Bristol, Bristol, UK.
- NIHR Bristol Biomedical Research Centre, Bristol, UK.
- Health Data Research UK South-West, Bristol, UK.
| | - Venexia Walker
- Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Lai D, Lim D, Lu J, Wang H, Huang T, Zhang YD. Risk of myocarditis after three doses of COVID-19 mRNA vaccines in the United States, 2020-2022: A self-controlled case series study. J Evid Based Med 2024; 17:65-77. [PMID: 38494781 DOI: 10.1111/jebm.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
AIM Myocarditis is a recognized safety concern following COVID-19 mRNA vaccination. However, there is limited research quantifying the risk associated with the third dose or comparing the risk between the three doses. The US Vaccine Adverse Event Reporting System (VAERS) is a passive surveillance system that monitors rare adverse events after US-licensed vaccination. However, studies analyzing VAERS data have often faced criticism for underreporting cases and lacking a control group to assess the increase in baseline risk. METHODS The temporal association between myocarditis onset and COVID-19 vaccination was studied. To overcome limitations, a novel modified self-controlled case series method was employed, explicitly modeling the case reporting process in VAERS data. RESULTS We found an increased risk of myocarditis during the 1- to 3-day period following the second and third doses of both the BNT162b2 vaccine and the mRNA-1273 vaccine. Following the second dose, the relative incidence (RI) was 4.89 (95% confidence interval (CI), 2.39-10.08) for the BNT162b2 vaccine and 2.86 (95% CI: 1.18-7.03) for the mRNA-1273 vaccine. Similarly, following the third dose, the RI was 9.04 (95% CI: 2.79-40.99) for the BNT162b2 vaccine and 4.71 (95% CI: 1.42-19.09) for the mRNA-1273 vaccine. No significant increase in risk was observed during other periods. Notably, our analysis also identified a similar increased risk of myocarditis among individuals aged below 30. CONCLUSIONS These findings raise safety concerns regarding COVID-19 mRNA vaccines, provide insights into the quantification of myocarditis risk at different postvaccination periods, and offer a novel approach to interpreting passive surveillance system data.
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Affiliation(s)
- Daoyuan Lai
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China
| | - Dickson Lim
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China
| | - Junfeng Lu
- First Department of Liver Disease, Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - Han Wang
- College of Science, China Agricultural University, Beijing, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Center for Intelligent Public Health, Academy for Artificial Intelligence, Peking University, Beijing, China
| | - Yan Dora Zhang
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China
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Ammirati E, Conti N, Palazzini M, Rocchetti M, Spangaro A, Garascia A, Lupi L, Cereda A. Fulminant Myocarditis Temporally Associated with COVID-19 Vaccination. Curr Cardiol Rep 2024; 26:97-112. [PMID: 38324216 DOI: 10.1007/s11886-024-02021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE OF REVIEW Coronavirus disease-2019 (COVID-19) vaccines have been related to rare cases of acute myocarditis, occurring between 1 in 10,000 and 1 in 100,000 individuals, approximately. Incidence of COVID-19 vaccine-associated myocarditis varies with age, sex, and type of vaccine. Although most patients with acute myocarditis temporally associated with COVID-19 vaccines have an uneventful course, a small subpopulation presents with cardiogenic shock (termed fulminant myocarditis [FM]). This review explored the prevalence, clinical presentation, management, and prognosis of COVID-19 vaccine-associated acute myocarditis, specifically focusing on FM and comparing patients with fulminant versus non-fulminant myocarditis. RECENT FINDINGS Cases of FM represent about 2-4% (0 to 7.5%) of COVID-19 vaccine-associated acute myocarditis cases, and mortality is around 1%, ranging between 0 and 4.4%. First, we identified 40 cases of FM up to February 2023 with sufficient granular data from case reports and case series of COVID-19 vaccine-associated acute myocarditis that occurred within 30 days from the last vaccine injection. This population was compared with 294 cases of non-fulminant acute myocarditis identified in the literature during a similar time. Patients with FM were older (48 vs. 27 years), had a larger proportion of women (58% vs. 9%), and mainly occurred after the first shot compared with non-fulminant cases (58% vs. 16%). The reported mortality was 27% (11 out of 40), in line with non-vaccine-associated fulminant myocarditis. These data were in agreement with 36 cases of FM from a large Korean registry. Herein, we reviewed the clinical features, imaging results, and histological findings of COVID-19 vaccine-associated fulminant myocarditis. In conclusion, COVID-19 vaccine-associated FM differs from non-fulminant forms, suggesting potential specific mechanisms in these rare and severe forms. Mortality in vaccine-associated FM remains high, in line with other forms of FM.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Transplant Center, Milan, Italy.
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy.
| | - Nicolina Conti
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Transplant Center, Milan, Italy
| | - Matteo Palazzini
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Transplant Center, Milan, Italy
| | - Matteo Rocchetti
- Cardiovascular Department, Association Socio Sanitary Territorial Santi Paolo e Carlo, Milan, Italy
| | - Andrea Spangaro
- Cardiovascular Department, Association Socio Sanitary Territorial Santi Paolo e Carlo, Milan, Italy
| | - Andrea Garascia
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Transplant Center, Milan, Italy
| | - Laura Lupi
- Institute of Cardiology, Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Azienda Socio-Sanitaria Territoriale (ASST), University of Brescia, Brescia, Italy
| | - Alberto Cereda
- Cardiovascular Department, Association Socio Sanitary Territorial Santi Paolo e Carlo, Milan, Italy
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Montone RA, Rinaldi R, Masciocchi C, Lilli L, Damiani A, La Vecchia G, Iannaccone G, Basile M, Salzillo C, Caffè A, Bonanni A, De Pascale G, Grieco DL, Tanzarella ES, Buonsenso D, Murri R, Fantoni M, Liuzzo G, Sanna T, Richeldi L, Sanguinetti M, Massetti M, Trani C, Tshomba Y, Gasbarrini A, Valentini V, Antonelli M, Crea F. Vaccines and Myocardial Injury in Patients Hospitalized for COVID-19 Infection: the CardioCOVID-Gemelli Study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024:qcae016. [PMID: 38414273 DOI: 10.1093/ehjqcco/qcae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Myocardial injury is prevalent among patients hospitalized for COVID-19. However, the role of COVID-19 vaccines in modifying the risk of myocardial injury is unknown. OBJECTIVES To assess the role of vaccines in modifying the risk of myocardial injury in COVID-19. METHODS We enrolled COVID-19 patients admitted from March 2021 to February 2022 with known vaccination status and ≥1 assessment of hs-cTnI within 30 days from the admission. The primary endpoint was the occurrence of myocardial injury (hs-cTnI levels >99th percentile upper reference limit). RESULTS 1019 patients were included (mean age 67.7±14.8 years, 60.8% male, 34.5% vaccinated against COVID-19). Myocardial injury occurred in 145 (14.2%) patients. At multivariate logistic regression analysis, advanced age, chronic kidney disease and hypertension, but not vaccination status, were independent predictors of myocardial injury. In the analysis according to age tertiles distribution, myocardial injury occurred more frequently in the III tertile (≥76 years) compared to other tertiles (I tertile:≤60 years;II tertile:61-75 years) (p<0.001). Moreover, in the III tertile, vaccination was protective against myocardial injury (OR 0.57, CI 95% 0.34-0.94; p=0.03), while a previous history of coronary artery disease was an independent positive predictor. In contrast, in the I tertile, chronic kidney disease (OR 6.94, 95% CI 1.31-36.79, p=0.02) and vaccination (OR 4.44, 95% CI 1.28-15.34, p=0.02) were independent positive predictors of myocardial injury. CONCLUSIONS In patients ≥76 years, COVID-19 vaccines were protective for the occurrence of myocardial injury, while in patients ≤60 years, myocardial injury was associated with previous COVID-19 vaccination. Further studies are warranted to clarify the underlying mechanisms.
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Affiliation(s)
- Rocco Antonio Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Livia Lilli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea Damiani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Mattia Basile
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Salzillo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Caffè
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Alice Bonanni
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro De Pascale
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Rome, Italy
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy
| | - Eloisa Sofia Tanzarella
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy
| | - Danilo Buonsenso
- Department of Women's health, child health and public health sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Richeldi
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maurizio Sanguinetti
- Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Yamume Tshomba
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Pastor Pueyo P, Gambó Ruberte E, Gayán Ordás J, Matute Blanco L, Pascual Figal D, Larrañaga Moreira JM, Gómez Barrado JJ, González Calle D, Almenar Bonet L, Alonso Salinas GL, Corbí Pascual MJ, Plaza Martín M, Pons Llinares J, Durante López A, Barreiro Pérez M, Candanedo Ocaña F, Bautista García J, Merchán Ortega G, Domínguez Rodríguez F, Martínez Mateo V, Campreciós Crespo M, Quintás Guzmán M, Jordán Martínez L, Aboal Viñas J, Rodríguez López J, Fernández Santos S, Revilla Martí P, Álvarez Roy L, Gómez Polo JC, García Pinilla JM, Ferré Vallverdú M, García Bueno L, Soriano Colomé T, Worner Diz F. Vaccine-carditis study: Spanish multicenter registry of inflammatory heart disease after COVID-19 vaccination. Clin Res Cardiol 2024; 113:223-234. [PMID: 37368015 DOI: 10.1007/s00392-023-02225-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population. METHODS The Vaccine-Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented. RESULTS From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality). CONCLUSIONS In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.
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Affiliation(s)
- Pablo Pastor Pueyo
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain.
| | - Elena Gambó Ruberte
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain
| | - Jara Gayán Ordás
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain
| | - Lucía Matute Blanco
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain
| | - Domingo Pascual Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | | | | | - David González Calle
- Cardiology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | | | - María Plaza Martín
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | | | - Javier Bautista García
- Cardiology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Virgilio Martínez Mateo
- Cardiology Department, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | - Martín Quintás Guzmán
- Cardiology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Jaime Aboal Viñas
- Cardiology Department, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | | | | | - Pablo Revilla Martí
- Cardiology Department, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | - Laura Álvarez Roy
- Cardiology Department, Hospital Universitario Miguel Servet, Saragossa, Spain
| | | | | | - María Ferré Vallverdú
- Cardiology Department, Servicio de Cardiología, Hospital Sant Joan, Reus, Tarragona, Spain
| | | | - Toni Soriano Colomé
- Cardiology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Fernando Worner Diz
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain
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Salmon DA, Chen RT, Black S, Sharfstein J. Lessons learned from COVID-19, H1N1, and routine vaccine pharmacovigilance in the United States: a path to a more robust vaccine safety program. Expert Opin Drug Saf 2024; 23:161-175. [PMID: 38343204 DOI: 10.1080/14740338.2024.2305707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Vaccine pharmacovigilance is an essential component of vaccine safety programs. Vaccine pharmacovigilance refers to detecting uncommon adverse events following immunization (AEFI), determining whether they are due to the vaccine or are only a coincidence, and, for those AEFI considered related to vaccination, characterizing them further. When AEFI are due to vaccination, it is important to characterize the attributable risk and ascertain the biological mechanism causing the adverse reaction to inform efforts to prevent or mitigate the risk. A robust post-authorization safety system is necessary for vaccine decision-making, clinical recommendations, vaccine compensation, and vaccine communication and confidence. AREAS COVERED This paper describes the key characteristics of vaccine pharmacovigilance programs, reviews US vaccine pharmacovigilance for routine vaccination programs, COVID-19, and H1N1, and makes recommendations for improving future vaccine safety systems. EXPERT OPINION The key characteristics of vaccine pharmacovigilance programs include passive surveillance, active surveillance, clinical investigation and special studies, and causality assessment. Recent examples illustrate the strengths of US pharmacovigilance systems, including systems for passive and active surveillance, as well as areas for improvement, including study of pathogenesis, consistent funding, and leadership. We make recommendations that would, if implemented, further strengthen the vaccine safety system for future routine and pandemic immunizations.
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Affiliation(s)
- Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert T Chen
- Brighton Collaboration, A program of the Task Force for Global Health, Decatur, GA, USA
| | - Steve Black
- Global Vaccine Data Network, Auckland, New Zealand
| | - Joshua Sharfstein
- Department of Health, Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lam LL, Nichols T. Ethics of college vaccine mandates, using reasonable comparisons. JOURNAL OF MEDICAL ETHICS 2024; 50:140-142. [PMID: 36997309 DOI: 10.1136/jme-2022-108852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
In the paper 'COVID-19 vaccine boosters for young adults: a risk-benefit assessment and ethical analysis of mandate policies at universities,' Bardosh et al argued that college mandates of the COVID-19 booster vaccine are unethical. The authors came to this conclusion by performing three different sets of comparisons of benefits versus risks using referenced data and argued that the harm outweighs the risk in all three cases. In this response article, we argue that the authors frame their arguments by comparing values that are not scientifically or reasonably comparable and that the authors used values that represent grossly different risk profiles and grouped them into a set of figures to create an illusion of fair comparisons. We argue that absent the falsely skewed portrayals of a higher level of risk over benefit in their misrepresented figures, the five ethical arguments they presented completely fall apart.
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Affiliation(s)
- Leo L Lam
- CoMotion, University of Washington, Seattle, Washington, USA
| | - Taylor Nichols
- Medicine, University of California San Francisco, San Francisco, California, USA
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Bardosh K, Krug A, Jamrozik E, Lemmens T, Keshavjee S, Prasad V, Makary MA, Baral S, Høeg TB. COVID-19 vaccine boosters for young adults: a risk benefit assessment and ethical analysis of mandate policies at universities. JOURNAL OF MEDICAL ETHICS 2024; 50:126-138. [PMID: 36600579 PMCID: PMC10850707 DOI: 10.1136/jme-2022-108449] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/23/2022] [Indexed: 06/17/2023]
Abstract
In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207-42 836 young adults aged 18-29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least 18.5 serious adverse events from mRNA vaccines, including 1.5-4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430-4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates.
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Affiliation(s)
- Kevin Bardosh
- School of Public Health, University of Washington, Seattle, Washington, USA
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Allison Krug
- Epidemiology, Artemis Biomedical Communications, Virginia Beach, Virginia, USA
| | - Euzebiusz Jamrozik
- University of Oxford Wellcome Centre for Ethics and Humanities, Oxford, UK
| | - Trudo Lemmens
- Faculty of Law and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Vinay Prasad
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Marty A Makary
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stefan Baral
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tracy Beth Høeg
- Clinical Research, Acumen, LLC, Burlingame, California, USA
- Sierra Nevada Memorial Hospital, Grass Valley, California, USA
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Høeg TB, Krug A, Baral S, Jamrozik E, Keshavjee S, Lemmens T, Prasad V, Makary MA, Bardosh K. University-age vaccine mandates: reply to Lam and Nichols. JOURNAL OF MEDICAL ETHICS 2024; 50:143-145. [PMID: 37225414 DOI: 10.1136/jme-2023-109163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Tracy Beth Høeg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Allison Krug
- Artemis Biomedical Communications LLC, Virginia Beach, Virginia, USA
| | - Stefan Baral
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Euzebiusz Jamrozik
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Trudo Lemmens
- Faculty of Law and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kevin Bardosh
- School of Public Health, University of Washington, Seattle, Washington, USA
- Division of Infection Medicine, University of Edinburgh, Edinburgh, UK
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Kong Q, Xu X, Li M, Meng X, Zhao C, Yang X. Global, Regional, and National Burden of Myocarditis in 204 Countries and Territories From 1990 to 2019: Updated Systematic Analysis. JMIR Public Health Surveill 2024; 10:e46635. [PMID: 38206659 PMCID: PMC10811576 DOI: 10.2196/46635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/04/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Myocarditis is characterized by high disability and mortality, and imposes a severe burden on population health globally. However, the latest global magnitude and secular trend of myocarditis burden have not been reported. OBJECTIVE This study aimed to delineate the epidemiological characteristics of myocarditis burden globally for optimizing targeted prevention and research. METHODS Based on the Global Burden of Disease Study 2019, the myocarditis burden from 1990 to 2019 was modeled using the Cause of Death Ensemble tool, DisMod-MR, and spatiotemporal Gaussian regression. We depicted the epidemiology and trends of myocarditis by sex, age, year, region, and sociodemographic index (SDI). R program version 4.2.1 (R Project for Statistical Computing) was applied for all statistical analyses, and a 2-sided P-value of <.05 was considered statistically significant. RESULTS The number of incident cases (1,268,000) and deaths (32,450) associated with myocarditis in 2019 increased by over 1.6 times compared with the values in 1990 globally. On the other hand, the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) decreased slightly from 1990 to 2019. The disability-adjusted life years (DALYs) decreased slightly in the past 3 decades, while the age-standardized DALY rate (ASDR) decreased greatly from 18.29 per 100,000 person-years in 1990 to 12.81 per 100,000 person-years in 2019. High SDI regions always showed a more significant ASIR. The ASIR slightly decreased in all SDI regions between 1990 and 2019. Middle SDI regions had the highest ASMR and ASDR in 2019. Low SDI regions had the lowest ASMR and ASDR in 2019. The age-standardized rates (ASRs) of myocarditis were higher among males than among females from 1990 to 2019 globally. All ASRs among both sexes had a downward trend, except for the ASMR among males, which showed a stable trend, and females had a more significant decrease in the ASDR than males. Senior citizens had high incident cases and deaths among both sexes in 2019. The peak numbers of DALYs for both sexes were noted in the under 1 age group in 2019. At the national level, the estimated annual percentage changes in the ASRs had significant negative correlations with the baseline ASRs in 1990. CONCLUSIONS Globally, the number of incident cases and deaths associated with myocarditis have increased significantly. On the other hand, the ASRs of myocarditis showed decreasing trends from 1990 to 2019. Males consistently showed higher ASRs of myocarditis than females from 1990 to 2019 globally. Senior citizens gradually predominated in terms of myocarditis burden. Policymakers should establish targeted control strategies based on gender, region, age, and SDI; strengthen aging-related health research; and take notice of the changes in the epidemic characteristics of myocarditis.
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Affiliation(s)
- Qingyu Kong
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xue Xu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Meng Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiao Meng
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Cuifen Zhao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Jinan, China
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Kassianos G, MacDonald P, Aloysius I, Pather S. Responses to Common Misconceptions Relating to COVID-19 Variant-Adapted mRNA Vaccines. Vaccines (Basel) 2024; 12:57. [PMID: 38250870 PMCID: PMC10819631 DOI: 10.3390/vaccines12010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the waning of immunity over time has necessitated the use of booster doses of original coronavirus disease 2019 (COVID-19) vaccines. This has also led to the development and implementation of variant-adapted messenger RNA (mRNA) vaccines that include an Omicron sub-lineage component in addition to the antigen based on the wild-type virus spike protein. Subsequent emergence of the recombinant XBB sub-lineages triggered the development of monovalent XBB-based variant-adapted mRNA vaccines, which are available for vaccination campaigns in late 2023. Misconceptions about new variant-adapted vaccines may exacerbate vaccine fatigue and drive the lack of vaccine acceptance. This article aims to address common concerns about the development and use of COVID-19 variant-adapted mRNA vaccines that have emerged as SARS-CoV-2 has continued to evolve.
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Affiliation(s)
- George Kassianos
- Royal College of General Practitioners, London NW1 2FB, UK;
- British Global and Travel Health Association, London NW1 2FB, UK
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Wu HY, Su TH, Liu CJ, Yang HC, Tsai JH, Wei MH, Chen CC, Tung CC, Kao JH, Chen PJ. Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis. J Formos Med Assoc 2024; 123:88-97. [PMID: 37349170 PMCID: PMC10281508 DOI: 10.1016/j.jfma.2023.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/08/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) vaccines were rapidly implemented globally and vaccine-associated immune-related hepatitis was recently reported. We aim to investigate its impact in regions endemic of chronic hepatitis B (CHB). METHODS We retrospectively collected patients who developed hepatitis within 90 days after COVID-19 vaccination in Taiwan. The mechanisms of hepatitis included vaccine induced liver injury (VILI) and immune-related hepatitis, which are direct liver injuries defined as aspartate or alanine aminotransferase (AST or ALT) increased ≥ 5-fold upper limit of normal (ULN) and/or AST or ALT ≥ 3-fold of ULN with concurrent total bilirubin ≥ 2-fold of ULN. Indirect liver injury due to HBV reactivation was defined as HBsAg reverse seroconversion or significant rise in HBV DNA level. The demographics, clinical data, and course of hepatitis were compared statistically. RESULTS Twenty-five patients were included with a median age of 54. The culprit vaccines were ChAdOx1 nCoV-19 (n = 9), mRNA-1273 (n = 12), and BNT162b2 (n = 4). The characteristics of hepatitis were comparable regardless of vaccine subtypes. The median onset of hepatitis was 25 days post vaccination, with a peak of 10-fold ALT-increase. The etiologies included HBV reactivation (n = 10), VILI (n = 10), and immune-related hepatitis (n = 5). HBV reactivation accounts for 90% of vaccine-induced hepatitis in patients of CHB (n = 10), and two patients died. Patients with initial AST levels >500 U/L increased 27-fold risks of liver injury greater than moderate severity compared with those without. CONCLUSION COVID-19 vaccine induced hepatitis is a clinical significant complication, and HBV reactivation may account for a possible mechanism.
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Affiliation(s)
- Hsin-Yun Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tung-Hung Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chun-Jen Liu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Chih Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Huei Tsai
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Han Wei
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, BioMedical Park Hospital, HsinChu, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chih Tung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Jer Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
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Kim KH. The Role of COVID-19 Vaccination for Patients With Atherosclerotic Cardiovascular Disease in the Upcoming Endemic Era. J Lipid Atheroscler 2024; 13:21-28. [PMID: 38299160 PMCID: PMC10825569 DOI: 10.12997/jla.2024.13.1.21] [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: 12/27/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/02/2024] Open
Abstract
COVID-19 vaccination has played a pivotal role in coping with the COVID-19 pandemic by providing a powerful tool to curb the spread of the virus, reduce severe illness and hospitalizations, and ultimately save lives and facilitate a return to normal daily routines. As COVID-19 vaccination has become more widespread and more individuals have recovered from the infection, COVID-19 has entered an endemic disease phase. This phase is characterized by a less severe and more stable pattern of infection within certain regions, similar to the predictability of seasonal influenza. In this endemic era, COVID-19 vaccines may appear to be less important, and many people are reluctant to receive COVID-19 vaccination for various reasons, including the fear of adverse events. However, COVID-19 remains a major public health problem, in that the incidence rate of new COVID-19 infections is still high and the morbidity and mortality in high-risk populations are substantial. Therefore, the role of COVID-19 vaccines in protecting high-risk individuals is crucial, and ongoing research and surveillance are imperative to refine vaccination recommendations in the ever-changing landscape of the COVID-19 endemic era. This review explores the role of COVID-19 vaccination in the upcoming COVID-19 endemic era.
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Affiliation(s)
- Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Ben-Aharon I, Rotem R, Melzer-Cohen C, Twig G, Cercek A, Half E, Goshen-Lago T, Chodik G, Kelsen D. Pharmaceutical Agents as Potential Drivers in the Development of Early-Onset Colorectal Cancer: Case-Control Study. JMIR Public Health Surveill 2023; 9:e50110. [PMID: 37933755 PMCID: PMC10753427 DOI: 10.2196/50110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND The incidence of early-onset colorectal cancer (EOCRC) rose abruptly in the mid 1990s, is continuing to increase, and has now been noted in many countries. By 2030, 25% of American patients diagnosed with rectal cancer will be 49 years or younger. The large majority of EOCRC cases are not found in patients with germline cancer susceptibility mutations (eg, Lynch syndrome) or inflammatory bowel disease. Thus, environmental or lifestyle factors are suspected drivers. Obesity, sedentary lifestyle, diabetes mellitus, smoking, alcohol, or antibiotics affecting the gut microbiome have been proposed. However, these factors, which have been present since the 1950s, have not yet been conclusively linked to the abrupt increase in EOCRC. The sharp increase suggests the introduction of a new risk factor for young people. We hypothesized that the driver may be an off-target effect of a pharmaceutical agent (ie, one requiring regulatory approval before its use in the general population or an off-label use of a previously approved agent) in a genetically susceptible subgroup of young adults. If a pharmaceutical agent is an EOCRC driving factor, regulatory risk mitigation strategies could be used. OBJECTIVE We aimed to evaluate the possibility that pharmaceutical agents serve as risk factors for EOCRC. METHODS We conducted a case-control study. Data including demographics, comorbidities, and complete medication dispensing history were obtained from the electronic medical records database of Maccabi Healthcare Services, a state-mandated health provider covering 26% of the Israeli population. The participants included 941 patients with EOCRC (≤50 years of age) diagnosed during 2001-2019 who were density matched at a ratio of 1:10 with 9410 control patients. Patients with inflammatory bowel disease and those with a known inherited cancer susceptibility syndrome were excluded. An advanced machine learning algorithm based on gradient boosted decision trees coupled with Bayesian model optimization and repeated data sampling was used to sort through the very high-dimensional drug dispensing data to identify specific medication groups that were consistently linked with EOCRC while allowing for synergistic or antagonistic interactions between medications. Odds ratios for the identified medication classes were obtained from a conditional logistic regression model. RESULTS Out of more than 800 medication classes, we identified several classes that were consistently associated with EOCRC risk across independently trained models. Interactions between medication groups did not seem to substantially affect the risk. In our analysis, drug groups that were consistently positively associated with EOCRC included beta blockers and valerian (Valeriana officinalis). Antibiotics were not consistently associated with EOCRC risk. CONCLUSIONS Our analysis suggests that the development of EOCRC may be correlated with prior use of specific medications. Additional analyses should be used to validate the results. The mechanism of action inducing EOCRC by candidate pharmaceutical agents will then need to be determined.
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Affiliation(s)
- Irit Ben-Aharon
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Ran Rotem
- Harvard T Chan School of Public Health, Boston, MA, United States
| | - Cheli Melzer-Cohen
- KSM Research and Innovation Center, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Gilad Twig
- The Institute of Endocrinology Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Andrea Cercek
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth Half
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Tal Goshen-Lago
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Gabriel Chodik
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Kelsen
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Weill Cornell Medical College, New York, NY, United States
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Ng MY, Tam CH, Lee YP, Fong HTA, Wong CK, Ng WKC, Yeung MHY, Ling WHI, Tsao S, Wan EYF, Ferreira V, Yan AT, Siu CW, Yiu KH, Hung IFN. Post-COVID-19 vaccination myocarditis: a prospective cohort study pre and post vaccination using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:74. [PMID: 38057820 PMCID: PMC10702006 DOI: 10.1186/s12968-023-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Concerns about COVID-19 vaccination induced myocarditis or subclinical myocarditis persists in some populations. Cardiac magnetic resonance imaging (CMR) has been used to detect signs of COVID-19 vaccination induced myocarditis. This study aims to: (i) characterise myocardial tissue, function, size before and after COVID-19 vaccination, (ii) determine if there is imaging evidence of subclinical myocardial inflammation or injury after vaccination using CMR. METHODS Subjects aged ≥ 12yrs old without prior COVID-19 or COVID-19 vaccination underwent two CMR examinations: first, ≤ 14 days before the first COVID-19 vaccination and a second time ≤ 14 days after the second COVID-19 vaccination. Biventricular indices, ejection fraction (EF), global longitudinal strain (GLS), late gadolinium enhancement (LGE), left ventricular (LV) myocardial native T1, T2, extracellular volume (ECV) quantification, lactate dehydrogenase (LDH), white cell count (WCC), C-reactive protein (CRP), NT-proBNP, troponin-T, electrocardiogram (ECG), and 6-min walk test were assessed in a blinded fashion. RESULTS 67 subjects were included. First and second CMR examinations were performed a median of 4 days before the first vaccination (interquartile range 1-8 days) and 5 days (interquartile range 3-6 days) after the second vaccination respectively. No significant change in global native T1, T2, ECV, LV EF, right ventricular EF, LV GLS, LGE, ECG, LDH, troponin-T and 6-min walk test was demonstrated after COVID-19 vaccination. There was a significant WCC decrease (6.51 ± 1.49 vs 5.98 ± 1.65, p = 0.003) and CRP increase (0.40 ± 0.22 vs 0.50 ± 0.29, p = 0.004). CONCLUSION This study found no imaging, biochemical or ECG evidence of myocardial injury or inflammation post COVID-19 vaccination, thus providing some reassurance that COVID-19 vaccinations do not typically cause subclinical myocarditis.
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Affiliation(s)
- Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China.
- Department of Medical Imaging, HKU-Shenzhen Hospital, Shenzhen, China.
| | - Cheuk Hang Tam
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Yung Pok Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Ho Tung Ambrose Fong
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Wing Kei Carol Ng
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Maegan Hon Yan Yeung
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Wood-Hay Ian Ling
- Grantham Hospital, 125 Wong Chuk Hang Rd, Aberdeen, Hong Kong SAR, China
| | - Sabrina Tsao
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Vanessa Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford BHF Centre of Research Excellence, Oxford Centre for Clinical Magnetic Resonance Research, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew T Yan
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Chung Wah Siu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Ivan Fan-Ngai Hung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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Okuno S, Higo S, Kondo T, Shiba M, Kameda S, Inoue H, Tabata T, Ogawa S, Morishita Y, Sun C, Ishino S, Honda T, Miyagawa S, Sakata Y. SARS-CoV-2 spike receptor-binding domain is internalized and promotes protein ISGylation in human induced pluripotent stem cell-derived cardiomyocytes. Sci Rep 2023; 13:21397. [PMID: 38049441 PMCID: PMC10696029 DOI: 10.1038/s41598-023-48084-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
Although an increased risk of myocarditis has been observed after vaccination with mRNA encoding severe acute respiratory syndrome coronavirus 2 spike protein, its underlying mechanism has not been elucidated. This study investigated the direct effects of spike receptor-binding domain (S-RBD) on human cardiomyocytes differentiated from induced pluripotent stem cells (iPSC-CMs). Immunostaining experiments using ACE2 wild-type (WT) and knockout (KO) iPSC-CMs treated with purified S-RBD demonstrated that S-RBD was bound to ACE2 and internalized into the subcellular space in the iPSC-CMs, depending on ACE2. Immunostaining combined with live cell imaging using a recombinant S-RBD fused to the superfolder GFP (S-RBD-sfGFP) demonstrated that S-RBD was bound to the cell membrane, co-localized with RAB5A, and then delivered from the endosomes to the lysosomes in iPSC-CMs. Quantitative PCR array analysis followed by single cell RNA sequence analysis clarified that S-RBD-sfGFP treatment significantly upregulated the NF-kβ pathway-related gene (CXCL1) in the differentiated non-cardiomyocytes, while upregulated interferon (IFN)-responsive genes (IFI6, ISG15, and IFITM3) in the matured cardiomyocytes. S-RBD-sfGFP treatment promoted protein ISGylation, an ISG15-mediated post-translational modification in ACE2-WT-iPSC-CMs, which was suppressed in ACE2-KO-iPSC-CMs. Our experimental study demonstrates that S-RBD is internalized through the endolysosomal pathway, which upregulates IFN-responsive genes and promotes ISGylation in the iPSC-CMs.
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Affiliation(s)
- Shota Okuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Shuichiro Higo
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
- Department of Medical Therapeutics for Heart Failure, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
| | - Takumi Kondo
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Mikio Shiba
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Satoshi Kameda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Inoue
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Tomoka Tabata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Shou Ogawa
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yu Morishita
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Congcong Sun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Saki Ishino
- CoMIT Omics Center, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Tomoyuki Honda
- Department of Virology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, 700-8558, Japan
- Department of Virology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Kita-Ku, Okayama, 700-8558, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
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Shu H, Wen Z, Li N, Zhang Z, Ceesay BM, Peng Y, Zhou N, Wang DW. COVID-19 and Cardiovascular Diseases: From Cellular Mechanisms to Clinical Manifestations. Aging Dis 2023; 14:2071-2088. [PMID: 37199573 PMCID: PMC10676802 DOI: 10.14336/ad.2023.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/14/2023] [Indexed: 05/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), quickly spread worldwide and led to over 581 million confirmed cases and over 6 million deaths as 1 August 2022. The binding of the viral surface spike protein to the human angiotensin-converting enzyme 2 (ACE2) receptor is the primary mechanism of SARS-CoV-2 infection. Not only highly expressed in the lung, ACE2 is also widely distributed in the heart, mainly in cardiomyocytes and pericytes. The strong association between COVID-19 and cardiovascular disease (CVD) has been demonstrated by increased clinical evidence. Preexisting CVD risk factors, including obesity, hypertension, and diabetes etc., increase susceptibility to COVID-19. In turn, COVID-19 exacerbates the progression of CVD, including myocardial damage, arrhythmia, acute myocarditis, heart failure, and thromboembolism. Moreover, cardiovascular risks post recovery and the vaccination-associated cardiovascular problems have become increasingly evident. To demonstrate the association between COVID-19 and CVD, this review detailly illustrated the impact of COVID-19 on different cells (cardiomyocytes, pericytes, endothelial cells, and fibroblasts) in myocardial tissue and provides an overview of the clinical manifestations of cardiovascular involvements in the pandemic. Finally, the issues related to myocardial injury post recovery, as well as vaccination-induced CVD, has also been emphasized.
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Affiliation(s)
- Hongyang Shu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Zheng Wen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Na Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Zixuan Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Bala Musa Ceesay
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Yizhong Peng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Ning Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
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Jaiswal V, Mukherjee D, Peng Ang S, Kainth T, Naz S, Babu Shrestha A, Agrawal V, Mitra S, Ee Chia J, Jilma B, Mamas MA, Gebhard C, Postula M, Siller-Matula JM. COVID-19 vaccine-associated myocarditis: Analysis of the suspected cases reported to the EudraVigilance and a systematic review of the published literature. IJC HEART & VASCULATURE 2023; 49:101280. [PMID: 38143781 PMCID: PMC10746454 DOI: 10.1016/j.ijcha.2023.101280] [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: 03/04/2023] [Revised: 08/31/2023] [Accepted: 09/21/2023] [Indexed: 12/26/2023]
Abstract
Background Myocarditis secondary to Coronavirus Disease 2019 (COVID-19) vaccination has been reported in the literature. Objective This study aimed to characterize the reported cases of myocarditis after COVID-19 vaccination based on age, gender, doses, and vaccine type from published literature and the EudraVigilance database. Methods We performed an analysis in the EudraVigilance database (until December 18, 2021) and a systematic review of published literature for reported cases of suspected myocarditis and pericarditis (until 30th June 2022) after the COVID-19 vaccination. Results EudraVigilance database analysis revealed 16,514 reported cases of myocarditis or pericarditis due to the vaccination with COVID-19 vaccines. The cases of myo- or pericarditis were reported predominantly in the age group of 18-64 (n = 12,214), and in males with a male-to-female (M: F) ratio of 1.7:1. The mortality among myocarditis patients was low, with 128 deaths (2 cases per 10.000.000 administered doses) being reported. For the systematic review, 72 studies with 1026 cases of myocarditis due to the vaccination with COVID-19 vaccines were included. The analysis of published cases has revealed that the male gender was primarily affected with myocarditis post-COVID-vaccination. The median (IQR) age of the myocarditis cases was 24.6 [19.5-34.6] years, according to the systematic review of the literature. Myocarditis cases were most frequently published after the vaccination with m-RNA vaccines and after the second vaccination dose. The overall mortality of published cases was low (n = 5). Conclusion Myocarditis is a rare serious adverse event associated with a COVID-19 vaccination. With early recognition and management, the prognosis of COVID-19 vaccine-induced myocarditis is favorable.
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Affiliation(s)
| | | | - Song Peng Ang
- Department of Internal Medicine, Rutgers Health Community Medical Center, Toms River, NJ, USA
| | - Tejasvi Kainth
- Department of Psychiatry, Bronxcare Health System, NY, USA
| | - Sidra Naz
- Department of Internal Medicine, Harvard Medical School/BIDMC, Boston, USA
| | | | | | - Saloni Mitra
- OO Bogomolets National Medical University, Kyiv, Ukraine
| | - Jia Ee Chia
- Department of Internal Medicine, Texas Tech University Health Sciences, El Paso, TX, USA
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Catherine Gebhard
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
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Aviv Y, Shiyovich A, Plakht Y, Witberg G, Weissman M, Shafir G, Kornowski R, Hamdan A. Cardiac Magnetic Resonance Imaging in COVID-19 Vaccine-Associated Myocarditis Compared With Classical Myocarditis. JACC. ADVANCES 2023; 2:100726. [PMID: 38938491 PMCID: PMC11198221 DOI: 10.1016/j.jacadv.2023.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 06/29/2024]
Abstract
Background Studies comparing COVID-19 vaccine-associated and classical myocarditis (CM) are lacking. Objectives The purpose of this study was to compare cardiac magnetic resonance (CMR) imaging findings and short-term clinical outcomes in patients with messenger RNA COVID-19 postvaccination myocarditis (PVM) and CM. Methods This was a retrospective study of patients with myocarditis: 31 with PVM and 46 with CM. Patients underwent a CMR protocol scan including T1 and T2 sequences. Late gadolinium enhancement (LGE) was expressed as percentage of left ventricular myocardial mass and the extracellular volume was calculated based on precontrast and postcontrast T1 images. Clinical outcomes included heart failure hospitalizations and mortality. Results Study patients were predominantly male (81% in PVM vs 89% in CM, P = 0.330). Patients with PVM had lower T1 values compared with CM (1,064.2 ± 67.0 ms vs 1,081.6 ± 41.9 ms, P = 0.032), although T2 and extracellular volume values were similar in both groups. Left ventricular ejection fraction and LGE were similar in both groups. The most frequent location of LGE was the basal inferolateral wall. PVM more commonly demonstrated a mid-wall LGE pattern while CM demonstrated a subepicardial LGE pattern. Compared with CM, patients with PVM were more likely to have a pericardial effusion (42% vs 17%, P = 0.018) and pericardial LGE (38% vs 13%, P = 0.009). During short-term follow-up (median 300 days for PVM, 319 days for CM), there were no deaths or heart failure hospitalizations in either group. Conclusions Our study shows similar CMR imaging findings and short-term outcomes in PVM and CM, although PVM was associated with milder myocardial abnormalities and more frequent pericardial involvement.
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Affiliation(s)
- Yaron Aviv
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ygal Plakht
- Faculty of Health Sciences, Department of Nursing, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Maya Weissman
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gideon Shafir
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Cai H, Lin Y, Liu HH, Su XJ, Zhou CY, Li J, Ungvari GS, Feng Y, Xiang YT. The relationship of intent to be COVID-19 vaccinated with depression, anxiety, insomnia, pain and smoking among Chinese patients with a pacemaker. Prev Med Rep 2023; 36:102394. [PMID: 37766721 PMCID: PMC10520496 DOI: 10.1016/j.pmedr.2023.102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Background This study examined the intent to be COVID-19 vaccinated and its correlates among patients with a pacemaker. Methods This observational study was carried out between July 1, 2021, and May 17, 2022 in Beijing, China. Patients with a pacemaker were consecutively invited by a research physician to participate in the study. Intent to be COVID-19 vaccinated, depression, anxiety, insomnia, pain and smoking were measured with standard scales or questions. Results Of the 206 participating patients, 72.82% (N = 150; 95% confidence interval [CI]: 66.74%-78.89%) expressed an intention to be COVID-19 vaccinated. Intent to be COVID-19 vaccinated was not significantly associated with severity of depression, anxiety, and insomnia. Multiple logistic regression analysis revealed that patients believing that COVID-19 vaccines provided protection and smokers were more likely to express an intention to receive COVID-19 vaccines. In contrast, older patients and those with higher level of physical pain were less likely to express an intention to be vaccinated against COVID-19. Conclusions Specific vaccination promotion strategies should be implemented targeting this vulnerable segment of the population.
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Affiliation(s)
- Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, University of Macau, Macao
- Centre for Cognitive and Brain Sciences, University of Macau, Macao
| | - Yun Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Hong-Hong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Xue-Jian Su
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chen-Yu Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gabor S. Ungvari
- Section of Psychiatry, University of Notre Dame Australia, Fremantle, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, University of Macau, Macao
- Centre for Cognitive and Brain Sciences, University of Macau, Macao
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Baritussio A, Giordani AS, Basso C, Vicenzetto C, Lorenzoni G, Gasparin M, Iliceto S, Scarpa B, Gregori D, Marcolongo R, Caforio ALP. Uneventful COVID-19 Infection and Vaccination in a Cohort of Patients with Prior Myocarditis. Vaccines (Basel) 2023; 11:1742. [PMID: 38140147 PMCID: PMC10747303 DOI: 10.3390/vaccines11121742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Myocarditis has in rare cases been associated with COVID-19 infection and has emerged as a possible rare side effect of vaccination with anti-COVID-19 messenger RNA vaccines. However, little is known about possible COVID-19 infection- and/or vaccination-related myocarditis relapse in patients with previous clinically suspected or biopsy-proven myocarditis. Myocarditis may relapse, particularly in females with immune-mediated/autoimmune features and a predisposing immunogenetic background. We aimed to assess the prevalence of myocarditis relapse during the COVID-19 outbreak and following COVID-19 vaccination in a cohort of patients with prior myocarditis. We included in the analysis myocarditis patients on active follow-up, for whom COVID-19 infection and vaccination statuses were known, and collected data on clinical, laboratory and echocardiographic findings, and myocarditis relapse. We enrolled 409 patients, of whom 114 (28%) reported COVID-19 infection and 347 (85%) completed the vaccination scheme. Only one patient, having COVID-19 infection before the vaccination campaign started, was admitted to hospital because of pneumonia; the remaining patients had an uneventful COVID-19 infection course, with only mild symptoms. No myocarditis relapse was recorded following COVID-19 infection or vaccination. Moreover, the frequency of new myocarditis cases following the COVID-19 outbreak was not different compared to the three-year period preceding the COVID-19 era. In conclusion, in our cohort of patients with prior myocarditis, both COVID-19 infection and vaccination were uneventful.
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Affiliation(s)
- Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Andrea Silvio Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Cristina Basso
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy;
| | - Cristina Vicenzetto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (G.L.); (D.G.)
| | - Matteo Gasparin
- Department of Statistical Sciences, University of Padua, 35121 Padua, Italy; (M.G.); (B.S.)
| | - Sabino Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padua, 35121 Padua, Italy; (M.G.); (B.S.)
- Department of Mathematics “Tullio Levi Civita”, University of Padua, 35131 Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (G.L.); (D.G.)
| | - Renzo Marcolongo
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Alida Linda Patrizia Caforio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
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Maruyama T, Uesako H. Lessons Learnt from Case Series of Out-of-hospital Cardiac Arrest and Unexpected Death after COVID-19 Vaccination. Intern Med 2023; 62:3267-3275. [PMID: 37612082 DOI: 10.2169/internalmedicine.2298-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Vaccination against COVID-19 has raised concerns about myocarditis in young men, as out-of-hospital cardiac arrest (OHCA) or sudden death after vaccination has been reported sporadically. Common features of these cases are occurrence in young men, within a few weeks after vaccination, in patients with no structural heart diseases. Cases of unexplained nocturnal death showed fibrotic or hypertrophied myocardium, and one case of OHCA presented ventricular fibrillation (VF) triggered by a prominent J wave on an automated external defibrillator and histopathologic findings compatible with myocarditis. Both myocarditis and J waves are prevalent in young men, and these cases imply that myocarditis augments J waves, which trigger VFs, and primary electrical disorders are a leading cause of death. To prevent such issues, artificial intelligence (AI)-assisted interpretation of historical electrocardiogram findings may help predict future J wave formation leading to VF, as digital electrocardiogram (ECG) findings are well suited for AI interpretation.
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Affiliation(s)
- Toru Maruyama
- Professor Emeritus in Kyushu University, Kyushu University Hospital, Japan
- Haradoi Hospital, Japan
| | - Hayata Uesako
- Department of Internal Medicine, Suwa Central Hospital, Japan
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49
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Wigner-Jeziorska P, Janik-Karpińska E, Niwald M, Saluk J, Miller E. Effect of SARS-CoV-2 Infection and BNT162b2 Vaccination on the mRNA Expression of Genes Associated with Angiogenesis. Int J Mol Sci 2023; 24:16094. [PMID: 38003287 PMCID: PMC10671623 DOI: 10.3390/ijms242216094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), discovered in December 2019 in Wuhan, China, caused the coronavirus disease 2019 (COVID-19). Due to the rate of spread of this virus, the World Health Organization, in March 2020, recognised COVID-19 as a worldwide pandemic. The disease is multisystemic with varying degrees of severity. Unfortunately, despite intensive research, the molecular changes caused by SARS-CoV-2 remain unclear. Mechanisms affected by the virus infection include endothelial dysfunction and angiogenesis. Similarly, the vaccines developed so far affect the process of angiogenesis, contributing to the development of undesirable effects on part of the cardiovascular system. The presented research aimed to investigate the impact of the SARS-CoV-2 infection and the Pfizer Comirnaty vaccine (BNT162b2) on the molecular aspect of angiogenesis. We found that convalescents vaccinated with one dose of BNT162b2 were characterised by higher MMP-7 (metalloproteinases 7) expression than non-vaccinated convalescents and healthy volunteers vaccinated with one dose of BNT162b2. Moreover, non-vaccinated convalescents showed increased mRNA expression of ADAMTS1 (ADAM metallopeptidase with thrombospondin type 1 motif 1) compared to healthy volunteers vaccinated with one dose of BNT162b2. In addition, we showed significant sex differences in the expression of MMP-7. In conclusion, the results of our study suggest a significant impact of SARS-CoV-2 infection and vaccination on the course of angiogenesis at the molecular level.
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Affiliation(s)
- Paulina Wigner-Jeziorska
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, 90-136 Lodz, Poland; (P.W.-J.); (J.S.)
| | - Edyta Janik-Karpińska
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, 90-136 Lodz, Poland;
| | - Marta Niwald
- Department of Neurological Rehabilitation, Medical University of Lodz, 90-136 Lodz, Poland;
| | - Joanna Saluk
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, 90-136 Lodz, Poland; (P.W.-J.); (J.S.)
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, 90-136 Lodz, Poland;
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50
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Murished GM, Dandachi I, Aljabr W. Side effects of COVID-19 vaccines in the middle eastern population. Front Immunol 2023; 14:1270187. [PMID: 38022593 PMCID: PMC10654979 DOI: 10.3389/fimmu.2023.1270187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The COVID-19 pandemic has caused severe worldwide health concerns since its first description as the SARS-COV-2 virus in December 2019. The wide dissemination of this virus, together with the lack of treatment, prompted vaccine development within a short period of time to elicit a protective immunity against COVID-19. Due to their rapid development, potential subsequent side effects of COVID-19 vaccines were overlooked, which might lead to many health concerns. This is especially true for patients at a greater risk of harm from COVID-19, such as pregnant women, children, and patients with pre-existing chronic diseases. In this review, we provide a summary of common to rare side effects of administrated COVID-19 vaccines in a Middle Eastern population. We have found that the distinction between side effects from COVID-19 vaccines in terms of frequency and severity is attributed to the differences in study populations, gender, and age. Pain at the injection site, fever, headache, fatigue, and muscle pain were the most common reported side effects. Vaccinated subjects with previous COVID-19 infection exhibited an equivalent neutralizing response after just one dose compared to two doses of vaccine. Consequently, individuals who experienced more side effects had significantly higher antibody levels. This indicates that having better immunity correlates with higher antibody levels, leading to a higher frequency of vaccine side effects. Individuals with underlying comorbidities, particularly having known allergies and with illnesses such as diabetes and cancer, might be more prone to post-vaccination side effects. Studies of a high-risk population in Middle Eastern countries are limited. Future studies should be considered to determine long-term side effects, side effects after booster doses, and side effect differences in cases of heterologous and homologous vaccination for better understanding and proper handling of high-risk populations and patients who experience these side effects.
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Affiliation(s)
| | | | - Waleed Aljabr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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