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Sexson Tejtel SK, Munoz FM, Al-Ammouri I, Savorgnan F, Guggilla RK, Khuri-Bulos N, Phillips L, Engler RJM. Myocarditis and pericarditis: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022; 40:1499-1511. [PMID: 35105494 DOI: 10.1016/j.vaccine.2021.11.074] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023]
Abstract
Myocarditis and/or pericarditis (also known as myopericarditis) are inflammatory diseases involving the myocardium (with non-ischemic myocyte necrosis) and/or the pericardial sac. Myocarditis/pericarditis (MPC) may present with variable clinical signs, symptoms, etiologies and outcomes, including acute heart failure, sudden death, and chronic dilated cardiomyopathy. Possible undiagnosed and/or subclinical acute myocarditis, with undefined potential for delayed manifestations, presents further challenges for diagnosing an acute disease and may go undetected in the setting of infection as well as adverse drug/vaccine reactions. The most common causes of MPC are viral, with non-infectious, drug/vaccine associated hypersensitivity and/or autoimmune causes being less well defined and with potentially different inflammatory mechanisms and treatment responses. Potential cardiac adverse events following immunization (AEFIs) encompass a larger scope of diagnoses such as triggering or exacerbating ischemic cardiac events, cardiomyopathy with potential heart failure, arrhythmias and sudden death. The current published experience does not support a potential causal association with vaccines based on epidemiologic evidence of relative risk increases compared with background unvaccinated incidence. The only evidence supporting a possible causal association of MPC with a vaccine comes from case reports. Hypersensitivity MPC as a drug/vaccine induced cardiac adverse event has long been a concern for post-licensure safety surveillance, as well as safety data submission for licensure. Other cardiac adverse events, such as dilated cardiomyopathy, were also defined in the CDC definitions for adverse events after smallpox vaccination in 2006. In addition, several groups have attempted to develop and improve the definition and adjudication of post-vaccination cardiovascular events. We developed the current case definitions for myocarditis and pericarditis as an AEFI building on experience and lessons learnt, as well as a comprehensive literature review. Considerations of other etiologies and causal relationships are outside the scope of this document.
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Affiliation(s)
| | - Flor M Munoz
- Departments of Pediatrics, Section of Infectious Diseases, and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Iyad Al-Ammouri
- Pediatric Cardiology, The University of Jordan. Amman, Jordan
| | - Fabio Savorgnan
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Rama K Guggilla
- Department of Population Medicine and Lifestyle Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, Poland
| | - Najwa Khuri-Bulos
- Pediatric Infectious Diseases, Vaccines, The University of Jordan, Amman, Jordan
| | - Lee Phillips
- Pharmaco-epidemiology, Cardiovascular Drug Safety, USA
| | - Renata J M Engler
- Allergy-Immunology-Immunizations, Department of Medicine, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, and Immunization Healthcare Division, Defense Health Agency, Bethesda, MD, USA
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Bailey JR, Loftus A, Allan RJC. Myopericarditis: recognition and impact in the military population. J ROY ARMY MED CORPS 2018; 165:451-453. [PMID: 30429297 DOI: 10.1136/jramc-2018-001056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 01/02/2023]
Abstract
We present a case of a fit and well British Army officer with sudden-onset chest pain following a viral illness, on a background of arduous skiing over an 8-week period. This resulted in a 6-month downgrade with no clearly defined plan for return to full fitness and deployability. The diagnosis and differentiation of myopericarditis from other causes of chest pain is reviewed. The treatment and management of myopericarditis is summarised and commentary is made on the paucity of evidence underpinning the return to fitness guidelines. The impact of this condition primarily affecting young fit individuals, commonly exacerbated by viral illness and arduous activity, is discussed in the context of individual employability and operational capability in a military setting.
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Affiliation(s)
- Jessica R Bailey
- Department of Critical Care, University Hospital Southampton NHS Trust Foundation, Southampton, UK
| | - A Loftus
- Royal Naval Medical Service, Institute of Naval Medicine, Gosport, UK
| | - R J C Allan
- Royal Army Medical Corps, Aldershot Garrison, Aldershot, UK
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Holdsworth DA, Cox AT, Boos C, Hardman R, Sharma S. Cardiomyopathies and the Armed Forces. J ROY ARMY MED CORPS 2015; 161:259-67. [DOI: 10.1136/jramc-2015-000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 11/04/2022]
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