1
|
Goldberg JF, Spinner JA, Soslow JH. Myocarditis in children 2024, new themes and continued questions. Curr Opin Cardiol 2024; 39:315-322. [PMID: 38661130 DOI: 10.1097/hco.0000000000001151] [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: 04/26/2024]
Abstract
PURPOSE OF REVIEW While pediatric myocarditis incidence has increased since the coronavirus disease 2019 (COVID-19) pandemic, there remain questions regarding diagnosis, risk stratification, and optimal therapy. This review highlights recent publications and continued unanswered questions related to myocarditis in children. RECENT FINDINGS Emergence from the COVID-19 era has allowed more accurate description of the incidence and prognosis of myocarditis adjacent to COVID-19 infection and vaccine administration as well that of multi-system inflammatory disease in children (MIS-C). As cardiac magnetic resonance technology has shown increased availability and evidence in pediatric myocarditis, it is important to understand conclusions from adult imaging studies and define the use of this imaging biomarker in children. Precision medicine has begun to allow real-time molecular evaluations to help diagnose and risk-stratify cardiovascular diseases, with emerging evidence of these modalities in myocarditis. SUMMARY Recent information regarding COVID-19 associated myocarditis, cardiac magnetic resonance, and molecular biomarkers may help clinicians caring for children with myocarditis and identify needs for future investigations.
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Zhang B, Thacker D, Zhou T, Zhang D, Lei Y, Chen J, Chrischilles E, Christakis DA, Fernandez S, Garg V, Kim S, Mosa ASM, Sills MR, Taylor BW, Williams DA, Wu Q, Forrest CB, Chen Y. Post-Acute Cardiovascular Outcomes of COVID-19 in Children and Adolescents: An EHR Cohort Study from the RECOVER Project. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.14.24307380. [PMID: 38798448 PMCID: PMC11118642 DOI: 10.1101/2024.05.14.24307380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Background The risk of cardiovascular outcomes in the post-acute phase of SARS-CoV-2 infection has been quantified among adults and children. This paper aimed to assess a multitude of cardiac signs, symptoms, and conditions, as well as focused on patients with and without congenital heart defects (CHDs), to provide a more comprehensive assessment of the post-acute cardiovascular outcomes among children and adolescents after COVID-19. Methods This retrospective cohort study used data from the RECOVER consortium comprising 19 US children's hospitals and health institutions between March 2020 and September 2023. Every participant had at least a six-month follow-up after cohort entry. Absolute risks of incident post-acute COVID-19 sequelae were reported. Relative risks (RRs) were calculated by contrasting COVID-19-positive with COVID-19-negative groups using a Poisson regression model, adjusting for demographic, clinical, and healthcare utilization factors through propensity scoring stratification. Results A total of 1,213,322 individuals under 21 years old (mean[SD] age, 7.75[6.11] years; 623,806 male [51.4%]) were included. The absolute rate of any post-acute cardiovascular outcome in this study was 2.32% in COVID-19 positive and 1.38% in negative groups. Patients with CHD post-SARS-CoV-2 infection showed increased risks of any cardiovascular outcome (RR, 1.63; 95% confidence interval (CI), 1.47-1.80), including increased risks of 11 of 18 post-acute sequelae in hypertension, arrhythmias (atrial fibrillation and ventricular arrhythmias), myocarditis, other cardiac disorders (heart failure, cardiomyopathy, and cardiac arrest), thrombotic disorders (thrombophlebitis and thromboembolism), and cardiovascular-related symptoms (chest pain and palpitations). Those without CHDs also experienced heightened cardiovascular risks after SARS-CoV-2 infection (RR, 1.63; 95% CI, 1.57-1.69), covering 14 of 18 conditions in hypertension, arrhythmias (ventricular arrhythmias and premature atrial or ventricular contractions), inflammatory heart disease (pericarditis and myocarditis), other cardiac disorders (heart failure, cardiomyopathy, cardiac arrest, and cardiogenic shock), thrombotic disorders (pulmonary embolism and thromboembolism), and cardiovascular-related symptoms (chest pain, palpitations, and syncope). Conclusions Both children with and without CHDs showed increased risks for a variety of cardiovascular outcomes after SARS-CoV-2 infection, underscoring the need for targeted monitoring and management in the post-acute phase.
Collapse
Affiliation(s)
- Bingyu Zhang
- The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA
- The Graduate Group in Applied Mathematics and Computational Science, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Children’s Health System, Wilmington, DE, USA
| | - Ting Zhou
- The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dazheng Zhang
- The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yuqing Lei
- The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jiajie Chen
- The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Elizabeth Chrischilles
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Dimitri A. Christakis
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Soledad Fernandez
- Department of Biomedical Informatics and Center for Biostatistics, Ohio State University, Columbus, OH, USA
| | - Vidu Garg
- Heart Center and Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Susan Kim
- Division of Pediatric Rheumatology, Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Abu S. M. Mosa
- Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Marion R. Sills
- Department of Research, OCHIN, Inc., Portland, OR, USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Bradley W. Taylor
- Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David A. Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Qiong Wu
- The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christopher B. Forrest
- Applied Clinical Research Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yong Chen
- The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA
- The Graduate Group in Applied Mathematics and Computational Science, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
- Penn Medicine Center for Evidence-based Practice (CEP), Philadelphia, PA, USA
- Penn Institute for Biomedical Informatics (IBI), Philadelphia, PA, USA
| |
Collapse
|
4
|
Rao S, Gross RS, Mohandas S, Stein CR, Case A, Dreyer B, Pajor NM, Bunnell HT, Warburton D, Berg E, Overdevest JB, Gorelik M, Milner J, Saxena S, Jhaveri R, Wood JC, Rhee KE, Letts R, Maughan C, Guthe N, Castro-Baucom L, Stockwell MS. Postacute Sequelae of SARS-CoV-2 in Children. Pediatrics 2024; 153:e2023062570. [PMID: 38321938 PMCID: PMC10904902 DOI: 10.1542/peds.2023-062570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 02/08/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.
Collapse
Affiliation(s)
- Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Rachel S. Gross
- Departments of Pediatrics
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Sindhu Mohandas
- Division of Infectious Diseases
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheryl R. Stein
- Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Abigail Case
- Department of Pediatrics and Rehabilitation Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benard Dreyer
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nathan M. Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. Timothy Bunnell
- Biomedical Research Informatics Center, Nemours Children’s Health, Nemours Children’s Hospital, Delaware, Wilmington, Delaware
| | - David Warburton
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth Berg
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan B. Overdevest
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Mark Gorelik
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Joshua Milner
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Sejal Saxena
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, California
| | - Rebecca Letts
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Christine Maughan
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Nick Guthe
- Population Health, NYU Grossman School of Medicine, New York, New York
| | | | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Kitano T, Salmon DA, Dudley MZ, Thompson DA, Engineer L. Benefit-Risk Assessment of mRNA COVID-19 Vaccines in Children Aged 6 Months to 4 Years in the Omicron Era. J Pediatric Infect Dis Soc 2024; 13:129-135. [PMID: 38236136 DOI: 10.1093/jpids/piae002] [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: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There is no risk and benefit assessment of COVID-19 vaccination for children younger than 5 years using a single health outcomes scale. The objective of this study is to compare the expected risk and benefits of the mRNA primary series of COVID-19 vaccines for children aged 6 months to 4 years in the United States using a single health outcome scale in the Omicron era. METHODS The expected benefits and risks of the primary two-dose series of mRNA COVID-19 vaccines for children aged 6 months to 4 years were stratified by sex, the presence of underlying medical conditions, the presence of infection-induced immunity, and the type of mRNA vaccine (BNT162b2 or mRNA-1273). A scoping literature review was conducted to identify the indicators in the decision tree model. The benefit-risk ratio was the outcome of interest. RESULTS The benefit-risk ratios ranged from 200.4 in BNT162b2 for males aged 6-11 months with underlying medical conditions and without infection-induced immunity to 3.2 in mRNA-1273 for females aged 1-4 years without underlying medical conditions and with infection-induced immunity. CONCLUSIONS The expected benefit of receiving the primary series of mRNA vaccines outweighed the risk among children ages 6 months to 4 years regardless of sex, presence of underlying medical conditions, presence of infection-induced immunity, or type of mRNA vaccines. However, the continuous monitoring of the COVID-19 epidemiology as well as vaccine effectiveness and safety is important.
Collapse
Affiliation(s)
- Taito Kitano
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pediatrics, Nara Prefecture General Medical Center, Nara, Japan
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David A Thompson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lilly Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Fan M, Peng K, Zhang Y, Lai FTT, Chui CSL, Wan EYF, Wong CKH, Chan EWY, Li X, Wong ICK. Risk of carditis among adolescents after extending the interdose intervals of BNT162b2. NPJ Vaccines 2024; 9:31. [PMID: 38355656 PMCID: PMC10866879 DOI: 10.1038/s41541-023-00789-6] [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: 03/01/2023] [Accepted: 12/01/2023] [Indexed: 02/16/2024] Open
Abstract
Previous studies indicate an increased carditis risk among adolescents following the two-dose messenger RNA COVID-19 vaccine. Several jurisdictions have extended the interdose interval between the first and second doses to reduce the risk. However, the effectiveness of such an extension policy remains inconclusive. Using the territory-wide vaccine record-linked electronic health records in Hong Kong, we conducted a nested case-control study from February 23, 2021 to August 15, 2022. Adolescents aged between 12 and 17 who received two-dose BNT162b2 were included for comparing risks between standard interdose interval (21-27 days) versus extended interdose interval ( ≥ 56 days). The carditis cumulative incidence within 28 days following the second dose was calculated. The adjusted odds ratio was estimated from multivariable conditional logistic regression. We identified 49 adolescents with newly diagnosed carditis within 28 days following the second dose. The crude cumulative incidence is 37.41 [95% confidence interval (CI): 27.68-49.46] per million vaccinated adolescents. Compared to the standard interdose interval group, adolescents with an extended interval had a significantly lower risk of carditis [adjusted odds ratio (aOR) 0.34 (95% CI: 0.16-0.73)]. Sensitivity analysis of carditis occurring within 14 days following the second dose yielded a similar estimate [aOR 0.30 (95% CI: 0.13-0.73)]. Extending the interdose interval of the BNT162b2 vaccine from 21 to 27 days to 56 days or longer is associated with 66% lower risk of incident carditis among adolescents. Our findings contribute towards an evidence-based vaccination strategy for a vulnerable population and potentially informs product label updates.
Collapse
Affiliation(s)
- Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Kuan Peng
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Yin Zhang
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China.
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China.
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China.
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.
- Aston Pharmacy School, Aston University, Birmingham, UK.
| |
Collapse
|
8
|
Minato H, Yoshikawa A, Tsuyama S, Katayanagi K, Hachiya S, Ohta K, Myojo Y. Fatal arrythmia in a young man after COVID-19 vaccination: An autopsy report. Medicine (Baltimore) 2024; 103:e37196. [PMID: 38306524 PMCID: PMC10843519 DOI: 10.1097/md.0000000000037196] [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: 11/08/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
RATIONALE The benefits of COVID-19 mRNA vaccination are claimed to be substantial; however, vaccination-related myocarditis and pericarditis have also been observed globally, particularly among young men. In most cases, the symptoms are mild and resolve on their own; however, fatal cases have rarely been described. PATIENT CONCERNS A healthy 40-year-old Japanese man suddenly experienced tachycardia and lost consciousness 2 days after vaccination. Continued resuscitation recovered the spontaneous heartbeat; however, the patient did not regain consciousness and died 9 days later. Electrocardiography after resuscitation showed marked ST-segment depression and incomplete right bundle branch block. Influenza antigen and polymerase chain reaction tests for SARS-CoV-2 were negative. DIAGNOSES Fatal arrhythmia after a second COVID-19 mRNA vaccination. INTERVENTIONS We performed an autopsy and studied the material morphologically and immunohistochemically. OUTCOMES At autopsy, several small inflammatory foci with cardiomyocytic necrosis were scattered in the right and left ventricles, with a propensity for the right side. Some inflammatory foci were located near the atrioventricular nodes and His bundles. The infiltrating cells predominantly consisted of CD68-positive histiocytes, with a small number of CD8-positive and CD4-positive T cells. In this case, myocarditis was focal and mild, as is mostly observed following COVID-19 mRNA vaccination. However, the inflammatory foci were close to the conduction system and were considered the cause of fatal arrhythmia. LESSONS Although the benefits of COVID-19 vaccination appear to outweigh the side effects, it should be noted that fatal arrhythmias may rarely occur, and caution should be taken if individuals, particularly young men, complain of any symptoms after vaccination.
Collapse
Affiliation(s)
- Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Akane Yoshikawa
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Sho Tsuyama
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Satoaki Hachiya
- Department of Emergency and Critical Care, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Keisuke Ohta
- Department of Emergency and Critical Care, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Yasuhiro Myojo
- Department of Emergency and Critical Care, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| |
Collapse
|
9
|
Hsu WF, Hsu CH, Jeng MJ. Reply to: "To conclude that BNT162b2 does not worsen echocardiographic indices, well-powered multicenter studies are required". J Chin Med Assoc 2024; 87:243. [PMID: 38145399 DOI: 10.1097/jcma.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Affiliation(s)
- Wan-Fu Hsu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Hsiung Hsu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- Health Service and Readiness Section, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, ROC
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
10
|
Hsu WF, Hsu CH, Jeng MJ. Echocardiographic function evaluation in adolescents following BNT162b2 Pfizer-BioNTech mRNA vaccination: A preliminary prospective study. J Chin Med Assoc 2024; 87:88-93. [PMID: 37882061 DOI: 10.1097/jcma.0000000000001013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Vaccination against coronavirus disease 2019 (COVID-19) is crucial for preventing and minimizing illness. Myocarditis and pericarditis after messenger RNA (mRNA) COVID-19 vaccination in adolescents and young adult males have been reported. Most of the studies in this area rely on retrospective symptom reporting, especially for adolescents experiencing myocarditis as a potential side effect. However, prospective postvaccination echocardiographic evaluation is rare. METHODS The study enrolled adolescents aged 12 to 15 years who received the second dose of the BNT162b2 Pfizer-BioNTech mRNA (BNT) vaccine. Serial echocardiographic examinations were conducted at baseline before vaccination, followed by subsequent assessments on days 2, 7, 14, and 28 to identify any notable differences or abnormal changes in cardiac function. Clinical symptom assessments were also recorded during each follow-up. RESULTS The study included 25 adolescents, comprising 14 males and 11 females, who completed the four follow-ups. Their mean age was 14 ± 1 years. The average interval between the first and second BNT vaccine doses was 90 ± 7 days. Ejection fraction values were 73.8% ± 5.2% at baseline, followed by 75.7% ± 5.3%, 75.5% ± 4.6%, 75.7% ± 4.5%, and 77.8% ± 5.8% at day 2, 7, 14, and 28, respectively. The cardiac function remained stable across all time points, with no significant differences observed between male and female participants. Within postvaccination 48 hours, 18 (72%) of the enrolled adolescents experienced temporary discomfort symptoms, which completely resolved by the final follow-up on the 28th day after vaccination. CONCLUSION Although adolescents vaccinated with the second dose of BNT vaccine commonly experienced transient postvaccination discomfort, the serial echocardiographic examinations did not reveal any significant deterioration of cardiac function within 28 days. Further studies are required to investigate the incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA vaccination-associated myocarditis in adolescents and the related mechanisms.
Collapse
Affiliation(s)
- Wan-Fu Hsu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Hsiung Hsu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- Health Service and Readiness Section, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, ROC
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
11
|
Rolfs N, Huber C, Schwarzkopf E, Mentzer D, Keller-Stanislawski B, Opgen-Rhein B, Frede W, Rentzsch A, Hecht T, Boehne M, Grafmann M, Kiski D, Graumann I, Foth R, Voges I, Schweigmann U, Ruf B, Fischer M, Wiegand G, Klingel K, Pickardt T, Friede T, Messroghli D, Schubert S, Seidel F. Clinical course and follow-up of pediatric patients with COVID-19 vaccine-associated myocarditis compared to non-vaccine-associated myocarditis within the prospective multicenter registry-"MYKKE". Am Heart J 2024; 267:101-115. [PMID: 37956921 DOI: 10.1016/j.ahj.2023.11.006] [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: 07/18/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Since the onset of widespread COVID-19 vaccination, increased incidence of COVID-19 vaccine-associated myocarditis (VA-myocarditis) has been noted, particularly in male adolescents. METHODS Patients <18 years with suspected myocarditis following COVID-19 vaccination within 21 days were enrolled in the PedMYCVAC cohort, a substudy within the prospective multicenter registry for pediatric myocarditis "MYKKE." Clinical data at initial admission, 3- and 9-months follow-up were monitored and compared to pediatric patients with confirmed non-vaccine-associated myocarditis (NVA-myocarditis) adjusting for various baseline characteristics. RESULTS From July 2021 to December 2022, 56 patients with VA-myocarditis across 15 centers were enrolled (median age 16.3 years, 91% male). Initially, 11 patients (20%) had mildly reduced left ventricular ejection fraction (LVEF; 45%-54%). No incidents of severe heart failure, transplantation or death were observed. Of 49 patients at 3-months follow-up (median (IQR) 94 (63-118) days), residual symptoms were registered in 14 patients (29%), most commonly atypical intermittent chest pain and fatigue. Diagnostic abnormalities remained in 23 patients (47%). Of 21 patients at 9-months follow-up (259 (218-319) days), all were free of symptoms and diagnostic abnormalities remained in 9 patients (43%). These residuals were mostly residual late gadolinium enhancement in magnetic resonance imaging. Patients with NVA-myocarditis (n=108) more often had symptoms of heart failure (P = .003), arrhythmias (P = .031), left ventricular dilatation (P = .045), lower LVEF (P < .001) and major cardiac adverse events (P = .102). CONCLUSIONS Course of COVID-19 vaccine-associated myocarditis in pediatric patients seems to be mild and differs from non-vaccine-associated myocarditis. Due to a considerable number of residual symptoms and diagnostic abnormalities at follow-up, further studies are needed to define its long-term implications.
Collapse
Affiliation(s)
- Nele Rolfs
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Cynthia Huber
- Medical Statistics, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Eicke Schwarzkopf
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dirk Mentzer
- Paul-Ehrlich-Institut - Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | - Bernd Opgen-Rhein
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wiebke Frede
- Pediatric Cardiology and Congenital Heart Defects, Center for Pediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Axel Rentzsch
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg (Saar), Germany
| | - Tobias Hecht
- Center of Congenital Heart Disease and Pediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Martin Boehne
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Maria Grafmann
- Department of Pediatric Cardiology, Children's Heart Clinic, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Kiski
- Department of Pediatric Cardiology, University Hospital Muenster, Muenster, Germany
| | - Iva Graumann
- Department of Pediatrics, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Rudi Foth
- Department of Pediatric Cardiology, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Luebeck/Kiel, Kiel, Germany
| | | | - Bettina Ruf
- Department of Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - Gesa Wiegand
- Department of Pediatric Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Tim Friede
- Medical Statistics, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Daniel Messroghli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Stephan Schubert
- Center of Congenital Heart Disease and Pediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Franziska Seidel
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| |
Collapse
|
12
|
Johnson JN, Pouraliakbar H, Mahdavi M, Ranjbar A, Pfirman K, Mehra V, Ahmed S, Ba-Atiyah W, Galal MO, Zahr RA, Hussain N, Tadikamalla RR, Farah V, Dzelebdzic S, Muniz JC, Lee M, Williams J, Lee S, Aggarwal SK, Clark DE, Hughes SG, Ganigara M, Nagiub M, Hussain T, Kwok C, Lim HS, Nolan M, Kikuchi DS, Goulbourne CA, Sahu A, Sievers B, Sievers B, Sievers B, Garg R, Armas CR, Paleru V, Agarwal R, Rajagopal R, Bhagirath P, Kozor R, Aneja A, Tunks R, Chen SSM. Society for Cardiovascular Magnetic Resonance 2022 Cases of SCMR case series. J Cardiovasc Magn Reson 2023; 26:100007. [PMID: 38211509 DOI: 10.1016/j.jocmr.2023.100007] [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] [Accepted: 12/10/2023] [Indexed: 01/13/2024] Open
Abstract
"Cases of SCMR" is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation, and the use of cardiovascular magnetic resonance (CMR) in the diagnosis and management of cardiovascular disease. The 2022 digital collection of cases are presented in this manuscript.
Collapse
Affiliation(s)
- Jason N Johnson
- Division of Pediatric Cardiology and Pediatric Radiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolmohammad Ranjbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kristopher Pfirman
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Vishal Mehra
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Shahzad Ahmed
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Wejdan Ba-Atiyah
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed Omar Galal
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Riad Abou Zahr
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Nasir Hussain
- Department of Advanced Cardiac Imaging, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Victor Farah
- Department of Advanced Cardiac Imaging, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | | | - Marc Lee
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jason Williams
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Simon Lee
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Daniel E Clark
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sean G Hughes
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madhusudan Ganigara
- Division of Pediatric Cardiology, The University of Chicago & Biological Sciences, Chicago, IL, USA
| | - Mohamed Nagiub
- Division of Pediatric Cardiology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Cecilia Kwok
- Cardiology Department, Western Health, St Albans, Victoria, Australia
| | - Han S Lim
- Cardiology Department, Austin and Northern Health, University of Melbourne, Victoria, Australia
| | - Mark Nolan
- Cardiology Department, Western Health, St Albans, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Daniel S Kikuchi
- Osler Medical Residency, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Clive A Goulbourne
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Anurag Sahu
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Berge Sievers
- International School Düsseldorf, Düsseldorf, Germany
| | - Berk Sievers
- International School Düsseldorf, Düsseldorf, Germany
| | - Burkhard Sievers
- Department of Internal Medicine, Divisions of Cardiology, Pulmonology, Vascular Medicine, Nephrology and Intensive Care Medicine, Sana Klinikum Remscheid, Germany
| | - Rimmy Garg
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Carlos Requena Armas
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Vijayasree Paleru
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Ritu Agarwal
- Department of Radiology, Eternal Hospital, Jaipur, India
| | - Rengarajan Rajagopal
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pranav Bhagirath
- Department of Cardiology, St. Thomas Hospital, London, England, UK
| | - Rebecca Kozor
- Department of Cardiology, Royal North Shore Hospital, The University of Sydney, St Leonards, Australia
| | - Ashish Aneja
- Department of Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert Tunks
- Division of Pediatric Cardiology, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sylvia S M Chen
- Adult Congenital Heart Disease, The Prince Charles Hospital, Australia.
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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
| | | |
Collapse
|
15
|
Scheim DE, Vottero P, Santin AD, Hirsh AG. Sialylated Glycan Bindings from SARS-CoV-2 Spike Protein to Blood and Endothelial Cells Govern the Severe Morbidities of COVID-19. Int J Mol Sci 2023; 24:17039. [PMID: 38069362 PMCID: PMC10871123 DOI: 10.3390/ijms242317039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Consistent with well-established biochemical properties of coronaviruses, sialylated glycan attachments between SARS-CoV-2 spike protein (SP) and host cells are key to the virus's pathology. SARS-CoV-2 SP attaches to and aggregates red blood cells (RBCs), as shown in many pre-clinical and clinical studies, causing pulmonary and extrapulmonary microthrombi and hypoxia in severe COVID-19 patients. SARS-CoV-2 SP attachments to the heavily sialylated surfaces of platelets (which, like RBCs, have no ACE2) and endothelial cells (having minimal ACE2) compound this vascular damage. Notably, experimentally induced RBC aggregation in vivo causes the same key morbidities as for severe COVID-19, including microvascular occlusion, blood clots, hypoxia and myocarditis. Key risk factors for COVID-19 morbidity, including older age, diabetes and obesity, are all characterized by markedly increased propensity to RBC clumping. For mammalian species, the degree of clinical susceptibility to COVID-19 correlates to RBC aggregability with p = 0.033. Notably, of the five human betacoronaviruses, the two common cold strains express an enzyme that releases glycan attachments, while the deadly SARS, SARS-CoV-2 and MERS do not, although viral loads for COVID-19 and the two common cold infections are similar. These biochemical insights also explain the previously puzzling clinical efficacy of certain generics against COVID-19 and may support the development of future therapeutic strategies for COVID-19 and long COVID patients.
Collapse
Affiliation(s)
- David E Scheim
- US Public Health Service, Commissioned Corps, Inactive Reserve, Blacksburg, VA 24060, USA
| | - Paola Vottero
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, P.O. Box 208063, New Haven, CT 06520, USA
| | | |
Collapse
|
16
|
Mastrolia MV, De Cillia C, Orlandi M, Abu-Rumeileh S, Maccora I, Maniscalco V, Marrani E, Pagnini I, Simonini G. Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2027. [PMID: 38004076 PMCID: PMC10673592 DOI: 10.3390/medicina59112027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
This narrative review aims to report the main clinical manifestations, therapeutic strategies, outcomes, and complications of acute SARS-CoV-2 infection in childhood and to summarize the data relating the SARS-CoV-2 vaccination efficacy and safety in pediatric age. SARS-CoV-2 infection mostly occurs asymptomatically in the pediatric population, while multisystem inflammatory syndrome in children (MIS-C) represents the most severe coronavirus disease 2019 (COVID-19)-related illness, a life-threatening event with a high morbidity rate. After the development of SARS-CoV-2 vaccines and their subsequent approval in children, the rate of infection as well as the number of its related complications have shown a drastic decrease. Fully vaccinated children are protected from the risk of developing a severe disease and a similar protective role has been observed in the reduction of complications, in particular MIS-C. However, long-lasting immunity has not been demonstrated, booster doses have been required, and reinfection has been observed. With regards to vaccine safety, adverse events were generally mild to moderate in all age groups: local adverse events were the most commonly reported. Nevertheless, a potential association between SARS-CoV-2 vaccine and the subsequent development of inflammatory manifestations has been suggested. Myocarditis has rarely been observed following vaccination; it appeared to be more frequent among adolescent males with a mild clinical course leading to a complete recovery. SARS-CoV-2 vaccine-related MIS-C cases have been described, although a univocal definition and an exact time interval with respect to vaccination has not been reported, thus not establishing a direct causal link. Current evidence about COVID-19 vaccination in children and adolescents suggest that benefits outweigh potential risks. Long-term data collection of the post-authorization safety surveillance programs will better define the real incidence of SARS-CoV-2 vaccine-related complications in the pediatric population.
Collapse
Affiliation(s)
- Maria Vincenza Mastrolia
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| | - Camilla De Cillia
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Michela Orlandi
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Sarah Abu-Rumeileh
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Ilaria Maccora
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| | - Valerio Maniscalco
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Edoardo Marrani
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| |
Collapse
|
17
|
Karavanaki K, Karanasios S, Soldatou A, Tsolia M. SARS-CoV-2 vaccination in children and adolescents with and without type 1 diabetes mellitus. Endocrine 2023; 82:226-236. [PMID: 37587391 PMCID: PMC10543146 DOI: 10.1007/s12020-023-03471-y] [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: 04/19/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
Adults with Diabetes Mellitus (DM) have increased risk of severe clinical presentation during COVID-19 infection, while children and adolescents with type 1 diabetes (T1D) have the same mild clinical course as their healthy peers, especially those with optimal glycemic control. The present review focuses on the necessity of COVID-19 vaccination among children and adolescents with T1D, and also in their non-diabetic peers. The efficacy and safety of COVID-19 vaccines are also discussed, as well as their various side-effects, ranging from common mild to very rare and serious ones. Furthermore, the results of COVID-19 vaccination of adolescents with and without T1D are reported, as well as the efficacy and concerns about childhood vaccination. It is concluded that patients with DM of all age groups should maintain optimal diabetic control in order to avoid glycemic deterioration during COVID-19 infection. Furthermore, despite the very rare and serious complications of COVID-19 vaccines, vaccination against COVID-19 is recommended for children and adolescents with T1D to prevent glycemic deterioration and rare but serious complications of COVID-19 infection.
Collapse
Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece.
| | - Maria Tsolia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| |
Collapse
|
18
|
Yen CW, Lee J, Chang YT, Lee EP, Wu CT, Chang YJ. BNT162b2 immunization-related myocarditis in adolescents and consequent hospitalization: Report from a medical center. Pediatr Neonatol 2023; 64:659-666. [PMID: 37302919 PMCID: PMC10205643 DOI: 10.1016/j.pedneo.2023.01.005] [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: 08/16/2022] [Revised: 11/22/2022] [Accepted: 01/18/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND To investigate Pfizer-BioNTech 162b2 mRNA COVID-19 vaccine (BNT162b2) immunization-related myocarditis and describe the risk factors for consequent hospitalization in the pediatric intensive care unit (PICU) in children between 12 and 18 years. METHODS Children and adolescents 12 years of age and older who presented with discomfort after BNT162b2 immunization (BNTI) and visited pediatric emergency room (PER) at Chang Gung Memorial Hospital from September 22, 2021 to March 21, 2022, were included for analysis. RESULTS 681 children presented with discomfort after BNTI and visited our PER. The mean age was 15.1 ± 1.7 years. Three hundred and ninety-four (57.9%) and 287 (42.1%) events were after 1st and 2nd dose, respectively. 58.4% (n = 398) were male. The most common complaints were chest pain (46.7%) and chest tightness (27.0%). The median (interquartile range [IQR]) interval of discomfort after BNTI was 3.0 (1.0-12.0) days. BNTI-related pericarditis, myocarditis and myopericarditis were diagnosed in 15 (2.2%), 12 (1.8%) and 2 (0.3%) patients, respectively. Eleven (1.6%) needed hospitalization in PICU. The median (IQR) hospital stay was 4.0 (3.0-6.0) days. There was no mortality. More patients were diagnosed myocarditis (p = 0.004) after 2nd dose BNTI. PICU admission occurred more commonly after 2nd dose BNTI (p = 0.007). Risk factors associated with hospitalization in PICU were abnormal EKG findings (p = 0.047) and abnormal serum troponin levels (p = 0.003) at PER. CONCLUSION Myocarditis in children aged 12-18 years occurred more commonly following 2nd dose BNTI. Most cases were of mild or intermediate severity without death. Factors predicting BNTI-related myocarditis and consequent hospitalization in PICU were abnormal EKG findings and abnormal serum troponin levels at PER in this study.
Collapse
Affiliation(s)
- Chen-Wei Yen
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatric Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Ting Chang
- Division of Pediatric Cardiology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Gweishan, Taoyuan, Taiwan
| | - Chang-Teng Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Jung Chang
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| |
Collapse
|
19
|
Lin YC, Chang CH, Su WJ, Yang CH, Wang JT. Risk of Coronavirus Disease 2019 Messenger RNA Vaccination-Associated Myocarditis and Pericarditis - A Systematic Review of Population-Based Data. Risk Manag Healthc Policy 2023; 16:2085-2099. [PMID: 37841076 PMCID: PMC10575036 DOI: 10.2147/rmhp.s422372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose Early studies showed that the risks of mRNA vaccine-associated myocarditis and pericarditis are low but with substantial variation across studies. Study characteristics, ethnicity, vaccine types, dose intervals, and SARS-CoV-2 infection prevalence may influence the rates of myocarditis and pericarditis after mRNA vaccination in population-based studies. Methods We comprehensively searched MEDLINE for relevant articles published before November 30, 2022. We also searched the websites of health authorities in several countries for unpublished surveillance data on myocarditis and pericarditis after mRNA vaccination. The outcome of interest was the incidence of myocarditis and pericarditis developed after mRNA vaccination for COVID-19. Results A total of 17 studies form 10 countries were included for review. We noted that considerable heterogeneity in study characteristics, including surveillance method, case definition, and observation period, may partially be responsible for the widely varied reported rates. Studies from countries that adopted active surveillance reported higher rates than those using passive surveillance. Compared to BNT162b2 vaccine, mRNA-1273 may have a higher risk of myocarditis only in young men after the second dose. Our comparison of sex-, age-, vaccine type-, and dose-specific rates of myocarditis across countries did not support the hypothesis that individuals with recent SARS-CoV-2 infection and young Asian males were at higher risk. We also could not find sufficient evidence to conclude whether extending the between-dose interval could reduce myocarditis incidence following mRNA vaccination. Conclusion Differences in the study characteristics must be fully considered when comparing the risks of mRNA vaccine-related myocarditis and pericarditis in different countries.
Collapse
Affiliation(s)
- Yen-Ching Lin
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hsuin Chang
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei-Ju Su
- Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hui Yang
- Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
20
|
Kavgacı A, Incedere F, Terlemez S, Kula S. Successful treatment of two cases of acute myocarditis with colchicine. Cardiol Young 2023; 33:1741-1742. [PMID: 36938910 DOI: 10.1017/s1047951123000483] [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: 03/21/2023]
Abstract
Colchicine is an FDA-approved medicine that has been used for many years to prevent and treat gout flares as well as familial mediterranean fever. It is also used off-label to treat pericarditis, calcium pyrophosphate illness, and Behçet's syndrome. There are additional studies on the use of colchicine, which is accepted as the standard treatment for pericarditis in adults, post-pericardiotomy syndrome, post-operative and post-ablation atrial fibrillation, coronary artery disorders, prior to percutaneous coronary procedures, and myocarditis. Colchicine appears to be a promising oral cardiovascular treatment targeting the inflammatory axis, owing to its low cost and moderate side-effect profile. Our aim is to emphasise that colchicine treatment, which has a strong and effective anti-inflammatory effect profile, should be kept in mind in addition to conventional treatment in childhood myocarditis.
Collapse
Affiliation(s)
- Akif Kavgacı
- Department of Pediatric Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fatma Incedere
- Department of Pediatric Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Semiha Terlemez
- Department of Pediatric Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Serdar Kula
- Department of Pediatric Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
21
|
Montarello NL, Wong HZ, Jeffries A, Perkins GB, Hissaria P, Stokes MB, Raith E, Teo K, Bradley J. Pfizer BNT 162b2 COVID-19 vaccine-induced fulminant myopericarditis: A case study. CRIT CARE RESUSC 2023; 25:155-157. [PMID: 37876367 PMCID: PMC10581261 DOI: 10.1016/j.ccrj.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
The use of mRNA COVID-19 vaccine can on rare occasions cause life-threatening, fulminant myopericarditis. This case report demonstrates previously reported benefit of early use of venoarterial extracorporeal membrane oxygenation mechanical assistance and supports the use of intravenous highly purified immunoglobulin pharmacotherapy to help achieve a good clinical outcome.
Collapse
Affiliation(s)
- Natalie L. Montarello
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Hao Zheng Wong
- Department of Intensive Care, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ashlee Jeffries
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Griffith B. Perkins
- The University of Adelaide, Adelaide, South Australia, Australia
- Immunology Directorate, SA Pathology, Adelaide, South Australia, Australia
| | - Pravin Hissaria
- The University of Adelaide, Adelaide, South Australia, Australia
- Department of Immunology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Immunology Directorate, SA Pathology, Adelaide, South Australia, Australia
| | - Michael B. Stokes
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Eamon Raith
- The University of Adelaide, Adelaide, South Australia, Australia
- Department of Intensive Care, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen Teo
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Julie Bradley
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
22
|
Dove ML, Slesnick TC, Oster ME, Hashemi S, Patel T, Wilson HC. Cardiac Magnetic Resonance Findings of Coronavirus Disease 2019 (COVID-19) Vaccine-Associated Myopericarditis at Intermediate Follow-Up: A Comparison with Classic Myocarditis. J Pediatr 2023; 260:113462. [PMID: 37172812 PMCID: PMC10171891 DOI: 10.1016/j.jpeds.2023.113462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To report intermediate cardiac magnetic resonance (CMR) findings of coronavirus disease 2019 (COVID-19) vaccine-associated myopericarditis (C-VAM) and compare with classic myocarditis. STUDY DESIGN Retrospective cohort study including children diagnosed with C-VAM from May 2021 through December 2021 with early and intermediate CMR. Patients with classic myocarditis from January 2015 through December 2021 and intermediate CMR were included for comparison. RESULTS There were 8 patients with C-VAM and 20 with classic myocarditis. Among those with C-VAM, CMR performed at a median 3 days (IQR 3, 7) revealed 2 of 8 patients with left ventricular ejection fraction <55%, 7 of 7 patients receiving contrast with late gadolinium enhancement (LGE), and 5 of 8 patients with elevated native T1 values. Borderline T2 values suggestive of myocardial edema were present in 6 of 8 patients. Follow-up CMRs performed at a median 107 days (IQR 97, 177) showed normal ventricular systolic function, T1, and T2 values; 3 of 7 patients had LGE. At intermediate follow-up, patients with C-VAM had fewer myocardial segments with LGE than patients with classic myocarditis (4/119 vs 42/340, P = .004). Patients with C-VAM also had a lower frequency of LGE (42.9 vs 75.0%) and lower percentage of left ventricular ejection fraction <55% compared with classic myocarditis (0.0 vs 30.0%), although these differences were not statistically significant. Five patients with classic myocarditis did not receive an early CMR, leading to some selection bias in study design. CONCLUSIONS Patients with C-VAM had no evidence of active inflammation or ventricular dysfunction on intermediate CMR, although a minority had persistent LGE. Intermediate findings in C-VAM revealed less LGE burden compared with classic myocarditis.
Collapse
Affiliation(s)
- Matthew L Dove
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Timothy C Slesnick
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Matthew E Oster
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Sassan Hashemi
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Trisha Patel
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Hunter C Wilson
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
| |
Collapse
|
23
|
Nakahara T, Iwabuchi Y, Miyazawa R, Tonda K, Shiga T, Strauss HW, Antoniades C, Narula J, Jinzaki M. Assessment of Myocardial 18F-FDG Uptake at PET/CT in Asymptomatic SARS-CoV-2-vaccinated and Nonvaccinated Patients. Radiology 2023; 308:e230743. [PMID: 37724969 DOI: 10.1148/radiol.230743] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Background Patients who developed myocarditis following SARS-CoV-2 vaccination show abnormalities on cardiac MRI. However, whether myocardial changes occur in asymptomatic individuals following vaccination is not well established. Purpose To assess myocardial 18Fluorine-fluorodeoxyglucose (18F-FDG) uptake on PET/CT in asymptomatic SARS-CoV-2 vaccinated patients compared to nonvaccinated patients. Materials and Methods This retrospective study included patients who underwent 18F-FDG PET/CT for indications unrelated to myocarditis during the period before (11/1/2020 - 2/16/2021) and after (2/17/20121 - 3/31/2022) SARS-CoV-2 vaccines were available. Myocardial and axillary FDG uptake were quantitatively assessed using maximum standardized uptake value (SUVmax). SUVmax values in all patients and in patients stratified by sex (male/female), age (<40, 41-60, >60 years), and time interval between vaccination and PET/CT were compared using Mann-Whitney U test or Kruskal-Wallis test with post ad -hoc Dwass, Steel, Critchlow-Fligner multiple comparison analysis. Results The study included 303 nonvaccinated patients (mean age, 52.9 years ± 14.9 [SD]; 157 females) and 700 vaccinated patients (mean age, 56.8 years ± 13.7 [SD]; 344 females). Vaccinated patients had overall higher myocardial FDG uptake compared to nonvaccinated patients (median SUVmax, 4.8 [IQR: 3.0-8.5] vs median SUVmax, 3.3 [IQR: 2.5-6.2]; P < .0001). Myocardial SUVmax was higher in vaccinated patients regardless of sex (median range, 4.7-4.9 [IQR: 2.9-8.6]) or patient age (median range, 4.7-5.6 [IQR: 2.9-8.6]) compared to corresponding nonvaccinated groups (sex median range, 3.2-3.9 [IQR: 2.4-7.2]; age median range, 3.3-3.3 [IQR: 2.3-6.1]; P range, <.001-.015). Furthermore, increased myocardial FDG uptake was observed in patients imaged 1-30, 31-60, 61-120, and 121-180 days after their second vaccination (median SUVmax range, 4.6-5.1 [IQR: 2.9-8.6]) and increased ipsilateral axillary uptake was observed in patients imaged 1-30, 31-60, 61-120 days after their 2nd vaccination (median SUVmax range, 1.5-2.0 [IQR: 1.2-3.4]) compared to the nonvaccinated patients (P range, <.001-<.001). Conclusion Compared to nonvaccinated patients, asymptomatic patients who received their 2nd vaccination 1-180 days prior to imaging showed increased myocardial FDG uptake on PET/CT. See also the editorial by Bluemke in this issue.
Collapse
Affiliation(s)
- Takehiro Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yu Iwabuchi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Raita Miyazawa
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Kai Tonda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Tohru Shiga
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
- Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan
| | | | | | - Jagat Narula
- Medicine & Cardiology, McGovern Medical School, Houston, Texas
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
24
|
Marquet Y, Hékimian G, Lebreton G, Kerneis M, Rouvier P, Bay P, Mathian A, Bréchot N, Chommeloux J, Petit M, Gautier M, Lefevre L, Saura O, Levy D, Quentric P, Moyon Q, Ortuno S, Schmidt M, Leprince P, Luyt CE, Combes A, Pineton de Chambrun M. Diagnostic yield, safety and therapeutic consequences of myocardial biopsy in clinically suspected fulminant myocarditis unweanable from mechanical circulatory support. Ann Intensive Care 2023; 13:78. [PMID: 37653258 PMCID: PMC10471530 DOI: 10.1186/s13613-023-01169-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Fulminant myocarditis is a rare and severe disease whose definite and etiological diagnoses rely on pathological examination. Albeit, myocardial biopsy can be associated with significant morbidity and mortality, its therapeutic consequences are unclear. We conducted a study to determine the diagnostic yield, the safety and the therapeutic consequences of myocardial biopsy in patients with fulminant clinically suspected myocarditis unweanable from mechanical circulatory support (MCS). METHODS Monocenter, retrospective, observational cohort study in a 26-bed French tertiary ICU between January 2002 and February 2019. Inclusion of all fulminant clinically suspected myocarditis patients undergoing in-ICU myocardial biopsy while being on MCS. The primary endpoint was the proportion of patients classified as definite myocarditis using Bonaca criteria before and after including myocardial biopsy results. RESULTS Forty-seven patients (median age 41 [30-47], female 53%) were included: 55% died before hospital discharge, 34% could be bridged-to-recovery and 15% bridged-to-transplant. Myocardial biopsy was endomyocardial or surgical in 36% and 64% cases respectively. Tamponade requiring emergency pericardiocentesis occurred in 29% patients after endomyocardial biopsy. After adding the biopsy results in the Bonaca classification algorithm the percentage of definite myocarditis raised from 13 to 55% (p < 0.0001). The rate of biopsy-related treatments modifications was 13%, leading to patients' recovery in only 4% patients. CONCLUSIONS In clinically suspected myocarditis unweanable from MCS, myocardial biopsy increased the rate of definite myocarditis but was associated with a low rate of treatment modification and a significant proportion of adverse events. We believe the benefit/risk ratio of myocardial biopsy should be more carefully weighted in these frail and selected patients than suggested by actual guidelines. Further prospective studies are now needed to determine its value in patients under MCS.
Collapse
Affiliation(s)
- Yann Marquet
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Guillaume Hékimian
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Guillaume Lebreton
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
- Service de Chirurgie Cardio-Thoracique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Mathieu Kerneis
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
- ACTION Study Group, Département de Cardiologie, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Philippe Rouvier
- Service d'Anatomopathologie, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Pierre Bay
- AP-HP, Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation and UPEC (Université Paris Est), INSERM, Unité U955, Équipe 18, 94010, Créteil, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France
| | - Nicolas Bréchot
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Juliette Chommeloux
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Matthieu Petit
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Melchior Gautier
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Lucie Lefevre
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Ouriel Saura
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - David Levy
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Paul Quentric
- Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Quentin Moyon
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
- Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France
| | - Sofia Ortuno
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Pascal Leprince
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
- Service de Chirurgie Cardio-Thoracique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France.
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France.
- Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France.
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.
| |
Collapse
|
25
|
Erbaş İM, Erbaş İC, Kağızmanlı GA, Yüksek Acinikli K, Besci Ö, Demir K, Böber E, Belet N, Abacı A. Adverse Events Associated with COVID-19 Vaccination in Adolescents with Endocrinological Disorders: A Cross-Sectional Study. J Clin Res Pediatr Endocrinol 2023; 15:248-256. [PMID: 36987787 PMCID: PMC10448545 DOI: 10.4274/jcrpe.galenos.2023.2022-9-1] [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: 09/01/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Objective The aim was to evaluate the adverse events seen after Coronavirus disease-2019 (COVID-19) vaccination in pediatric patients with diagnosed endocrinological problems and to compare them with healthy controls. Methods In this cross-sectional study, patients aged 12-18 years who attended a single department between January and May 2022 and were followed up for at least six months due to endocrine diseases, and healthy subjects in the same age group, all of whom had received a COVID-19 vaccine [BNT162b2 mRNA or inactivated vaccine] were included. Adverse events experienced after the vaccination were evaluated by questionnaire. Results A total of 160 subjects (85 patients, 75 healthy controls) with a median (25-75p) age of 15.5 (14.1-16.9) years were included. The frequency of adverse events was higher in those vaccinated with the mRNA vaccine compared to the inactivated one after the first dose (p=0.015). The incidence of adverse events observed after the first and second doses of both COVID-19 vaccines was similar in the patient and control groups (p=0.879 and p=0.495, respectively), with local reactions being the most common. The frequency of adverse events was similar among the patients who did or did not receive any endocrinological treatment (p>0.05). The incidence and severity of systemic reactions were similar to those in healthy subjects for both vaccine doses, regardless of the underlying diagnosis, autoimmunity state, or treatment regimen used in patients with endocrine diseases. Conclusion The incidence and severity of adverse events associated with COVID-19 vaccinations in adolescents with endocrinological disorders were similar to healthy subjects, in the early post-vaccination period.
Collapse
Affiliation(s)
- İbrahim Mert Erbaş
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - İrem Ceren Erbaş
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Gözde Akın Kağızmanlı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Kübra Yüksek Acinikli
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Özge Besci
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Nurşen Belet
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| |
Collapse
|
26
|
Gunale B, Kapse D, Kar S, Bavdekar A, Kohli S, Lalwani S, Meshram S, Raut A, Kulkarni P, Samuel C, Munshi R, Gupta M, Plested JS, Cloney-Clark S, Zhu M, Pryor M, Hamilton S, Thakar M, Shete A, Dharmadhikari A, Bhamare C, Shaligram U, Poonawalla CS, Mallory RM, Glenn GM, Kulkarni PS. Safety and Immunogenicity of SARS-CoV-2 Recombinant Spike Protein Vaccine in Children and Adolescents in India: A Phase 2-3 Randomized Clinical Trial. JAMA Pediatr 2023; 177:2807909. [PMID: 37523166 PMCID: PMC10391359 DOI: 10.1001/jamapediatrics.2023.2552] [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: 01/18/2023] [Accepted: 05/10/2023] [Indexed: 08/01/2023]
Abstract
Importance The recombinant COVID-19 vaccine NVX-CoV2373 has demonstrated efficacy of approximately 90% in adults; however, its safety and efficacy in children is unknown. Objective To assess the noninferiority of SII-NVX-CoV2373 in children and adolescents compared to adults and to evaluate its safety in comparison with placebo. Design, Setting, and Participants This phase 2-3 observer-blind randomized clinical trial was conducted in 2 cohorts, children (aged 2 to 11 years) and adolescents (aged 12 to 17 years) between August 2021 and August 2022. Participants were randomized 3:1 to SII-NVX-CoV2373 or placebo and monitored for 179 days. The participants, study team, and laboratory staff were blinded. This was a multicenter study conducted across 10 tertiary care hospitals in India. Exclusion criteria included previous COVID-19 infection or vaccination, immunocompromised condition, and immunosuppressive medications. Interventions Two doses of 0.5-mL SII-NVX-CoV2373 or placebo were administered intramuscularly on days 1 and 22. Main Outcomes and Measures Primary outcomes were geometric mean titer ratio of both anti-spike (anti-S) IgG and neutralizing antibodies (NAbs) between both pediatric age groups to that of adults on day 36. Noninferiority was concluded if the lower bound of 95% CI of this ratio was greater than 0.67 for each age group. Both the antibodies were assessed for the index strain and for selected variants at various time points. Solicited adverse events (AEs) were recorded for 7 days after each vaccination, unsolicited AEs were recorded for 35 days, and serious AEs and AEs of special interest were recorded for 179 days. Results A total of 460 children in each age cohort were randomized to receive vaccine or placebo. The mean (SD) age was 6.7 (2.7) years in the child cohort and 14.3 (1.6) years in the adolescent cohort; 231 participants (50.2%) in the child cohort and 218 in the adolescent cohort (47.4%) were female. Both anti-S IgG and NAb titers were markedly higher in the SII-NVX-CoV2373 group than in the placebo group on both day 36 and day 180. The geometric mean titer ratios compared to those in adults were 1.20 (95% CI, 1.08-1.34) and 1.52 (95% CI, 1.38-1.67) for anti-S IgG in adolescents and children, respectively; while for NAbs, they were 1.33 (95% CI, 1.17-1.50) and 1.93 (95% CI, 1.70-2.18) in adolescents and children, respectively, indicating noninferiority. SII-NVX-CoV2373 also showed immune responses against variants studied. Injection site reactions, fever, headache, malaise, and fatigue were common solicited AEs. There were no AEs of special interest and no causally related serious AEs. Conclusions and Relevance SII-NVX-CoV2373 was safe and well tolerated in children and adolescents in this study. The vaccine was highly immunogenic and may be used in pediatric vaccination against COVID-19. Trial Registration Clinical Trials Registry of India Identifier: CTRI/2021/02/031554.
Collapse
Affiliation(s)
| | | | - Sonali Kar
- Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashish Bavdekar
- King Edward Memorial Hospital Research Centre, Pune, Maharashtra, India
| | - Sunil Kohli
- Hamdard Institute of Medical Sciences and Research With Centre for Health Research and Development, New Delhi, India
| | - Sanjay Lalwani
- Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, Maharashtra, India
| | - Sushant Meshram
- Super Speciality Hospital, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Abhishek Raut
- Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Praveen Kulkarni
- JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Clarence Samuel
- Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Renuka Munshi
- Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai, Maharashtra, India
| | - Madhu Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | - Madhuri Thakar
- Indian Council of Medical Research, National AIDS Research Institute, Pune, Maharashtra, India
| | - Ashwini Shete
- Indian Council of Medical Research, National AIDS Research Institute, Pune, Maharashtra, India
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Alami A, Villeneuve PJ, Farrell PJ, Mattison D, Farhat N, Haddad N, Wilson K, Gravel CA, Crispo JAG, Perez-Lloret S, Krewski D. Myocarditis and Pericarditis Post-mRNA COVID-19 Vaccination: Insights from a Pharmacovigilance Perspective. J Clin Med 2023; 12:4971. [PMID: 37568373 PMCID: PMC10419493 DOI: 10.3390/jcm12154971] [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: 06/10/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Concerns remain regarding the rare cardiovascular adverse events, myocarditis and pericarditis (myo/pericarditis), particularly in younger individuals following mRNA COVID-19 vaccination. Our study aimed to comprehensively assess potential safety signals related to these cardiac events following the primary and booster doses, with a specific focus on younger populations, including children as young as 6 months of age. Using the Vaccine Adverse Events Reporting System (VAERS), the United States national passive surveillance system, we conducted a retrospective pharmacovigilance study analyzing spontaneous reports of myo/pericarditis. We employed both frequentist and Bayesian methods and conducted subgroup analyses by age, sex, and vaccine dose. We observed a higher reporting rate of myo/pericarditis following the primary vaccine series, particularly in males and mainly after the second dose. However, booster doses demonstrated a lower number of reported cases, with no significant signals detected after the fourth or fifth doses. In children and young adults, we observed notable age and sex differences in the reporting of myo/pericarditis cases. Males in the 12-17 and 18-24-year-old age groups had the highest number of cases, with significant signals for both males and females after the second dose. We also identified an increased reporting for a spectrum of cardiovascular symptoms such as chest pain and dyspnea, which increased with age, and were reported more frequently than myo/pericarditis. The present study identified signals of myo/pericarditis and related cardiovascular symptoms after mRNA COVID-19 vaccination, especially among children and adolescents. These findings underline the importance for continued vaccine surveillance and the need for further studies to confirm these results and to determine their clinical implications in public health decision-making, especially for younger populations.
Collapse
Affiliation(s)
- Abdallah Alami
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Paul J. Villeneuve
- Department of Neuroscience, Faculty of Science, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Patrick J. Farrell
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
| | - Donald Mattison
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Nawal Farhat
- School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada (N.F.)
| | - Nisrine Haddad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Christopher A. Gravel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1Y7, Canada
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - James A. G. Crispo
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Division of Human Sciences, NOSM University, Sudbury, ON P3E2C6, Canada
| | - Santiago Perez-Lloret
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires C1033AAJ, Argentina
- Observatorio de Salud Pública, Pontificia Universidad Católica Argentina, Buenos Aires C1107AAZ, Argentina
- Department of Physiology, Faculty of Medicine, University of Buenos Aires, Buenos Aires C1121ABG, Argentina
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Risk Sciences International, Ottawa, ON K1P 5J6, Canada
| |
Collapse
|
28
|
Mistrulli R, Ferrera A, Muthukkattil ML, Volpe M, Barbato E, Battistoni A. SARS-CoV-2 Related Myocarditis: What We Know So Far. J Clin Med 2023; 12:4700. [PMID: 37510815 PMCID: PMC10380706 DOI: 10.3390/jcm12144700] [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: 05/27/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
A minority of patients with severe acute respiratory syndrome coronavirus 2 (COVID-19) develop cardiovascular complications, such as acute cardiac lesions with elevated troponins, de novo systolic heart failure, pericardial effusion and, rarely, acute myocarditis. The prevalence of COVID-19-related myocarditis ranges from 10 to 105 cases per 100,000 COVID-19-infected individuals, with a male predominance (58%) and a median age of 50 years. The etiopathogenetic mechanism is currently unclear, but may involve direct virus-mediated damage or an exaggerated immune response to the virus. Mortality is high, as fulminant myocarditis (FM) develops very often in the form of cardiogenic shock and ventricular arrhythmias. Hence, medical therapy with ACE inhibitors and beta-blockers may not always be sufficient, in which case inotropic and immunosuppressive drugs, most commonly corticosteroids, may be necessary. In this review we analyze the current data on COVID-19 myocarditis, management strategies and therapy, with a brief description of COVID-19 vaccine-associated myocarditis to help clinicians dealing with this peculiar form of myocarditis.
Collapse
Affiliation(s)
- Raffaella Mistrulli
- Clinical and Molecular Medicine Department, Sapienza University of Rome, 00185 Roma, Italy; (A.F.); (M.V.); (E.B.); (A.B.)
| | - Armando Ferrera
- Clinical and Molecular Medicine Department, Sapienza University of Rome, 00185 Roma, Italy; (A.F.); (M.V.); (E.B.); (A.B.)
| | - Melwyn Luis Muthukkattil
- Clinical and Molecular Medicine Department, Sapienza University of Rome, 00185 Roma, Italy; (A.F.); (M.V.); (E.B.); (A.B.)
| | - Massimo Volpe
- Clinical and Molecular Medicine Department, Sapienza University of Rome, 00185 Roma, Italy; (A.F.); (M.V.); (E.B.); (A.B.)
- IRCCS San Raffaele, 00163 Roma, Italy
| | - Emanuele Barbato
- Clinical and Molecular Medicine Department, Sapienza University of Rome, 00185 Roma, Italy; (A.F.); (M.V.); (E.B.); (A.B.)
| | - Allegra Battistoni
- Clinical and Molecular Medicine Department, Sapienza University of Rome, 00185 Roma, Italy; (A.F.); (M.V.); (E.B.); (A.B.)
| |
Collapse
|
29
|
Kitano T, Thompson DA, Engineer L, Dudley MZ, Salmon DA. Risk and Benefit of mRNA COVID-19 Vaccines for the Omicron Variant by Age, Sex, and Presence of Comorbidity: A Quality-Adjusted Life Years Analysis. Am J Epidemiol 2023; 192:1137-1147. [PMID: 36920222 DOI: 10.1093/aje/kwad058] [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: 06/08/2022] [Revised: 02/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
The development of the mutant omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the coronavirus disease 2019 (COVID-19) pandemic raised the importance of reevaluating the risk and benefit of COVID-19 vaccines. With a decision tree model, we calculated the benefit-risk ratio and the benefit-risk difference of receiving monovalent messenger RNA (mRNA) COVID-19 vaccine (primary 2 doses, a third dose, and a fourth dose) in the 4-5 months after vaccination using quality-adjusted life years. The analysis was stratified by age, sex, and the presence of comorbidity. Evidence from peer-reviewed publications and gray literature was reviewed on September 16, 2022, to inform the study. Benefit-risk ratios for receipt of the BNT162b2 vaccine (Pfizer-BioNTech) ranged from 6.8 for males aged 12-17 years without comorbidity for the primary doses to 221.3 for females aged ≥65 years with comorbidity for the third dose. The benefit-risk ratios for receipt of the mRNA-1273 vaccine (Moderna) ranged from 7.2 for males aged 18-29 years without comorbidity for the primary doses to 101.4 for females aged ≥65 years with comorbidity for the third dose. In all scenarios of the one-way sensitivity analysis, the benefit-risk ratios were more than 1, irrespective of age, sex, comorbidity status, and type of vaccine, for both primary and booster doses. The benefits of mRNA COVID-19 vaccines in protecting against the omicron variant outweigh the risks, irrespective of age, sex, and comorbidity.
Collapse
|
30
|
Park CH, Yang J, Lee HS, Kim TH, Eun LY. Characteristics of Teenagers Presenting with Chest Pain after COVID-19 mRNA Vaccination. J Clin Med 2023; 12:4421. [PMID: 37445457 DOI: 10.3390/jcm12134421] [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: 05/24/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
In this study, we evaluated the clinical and radiological manifestations of teenagers presenting with chest pain after coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccination. We retrospectively enrolled 61 teenage patients, aged 13 to 19 years, who underwent echocardiography and cardiac magnetic resonance imaging (CMR) for chest pain after COVID-19 mRNA vaccination, from November 2021 to April 2022. Medical records, laboratory results, echocardiographic, and CMR findings were analyzed. The mean age of the participants was 14.4 ± 1.9 years, with a male:female ratio of 28:33. Among the sixty-one patients with chest pain after COVID-19 vaccination, only two (3.3%) were diagnosed as confirmed myocarditis, and almost all of them recovered with conservative treatments. However, on CMR, 24 (39.3%) presented with mild myocardial abnormalities; 22 (36.1%) showed myocardial edema, and 19 (31.1%) were found to have a myocardial injury. Multivariate logistic analyses revealed that older age and female sex were significantly associated with myocardial abnormalities. In teenagers who present with chest pain after COVID-19 mRNA vaccination, confirmed myocarditis is uncommon. However, myocardial abnormalities on CMR might occur frequently, and females in their late teens might be more vulnerable to myocardial abnormalities.
Collapse
Affiliation(s)
- Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Lucy Youngmin Eun
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| |
Collapse
|
31
|
Cocco N, Leibundgut G, Pelliccia F, Cammalleri V, Nusca A, Mangiacapra F, Cocco G, Fanale V, Ussia GP, Grigioni F. Arrhythmias after COVID-19 Vaccination: Have We Left All Stones Unturned? Int J Mol Sci 2023; 24:10405. [PMID: 37373551 DOI: 10.3390/ijms241210405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
SARS-CoV-2 vaccination offered the opportunity to emerge from the pandemic and, thereby, worldwide health, social, and economic disasters. However, in addition to efficacy, safety is an important issue for any vaccine. The mRNA-based vaccine platform is considered to be safe, but side effects are being reported more frequently as more and more people around the world become treated. Myopericarditis is the major, but not the only cardiovascular complication of this vaccine; hence it is important not to underestimate other side effects. We report a case series of patients affected by cardiac arrhythmias post-mRNA vaccine from our clinical practice and the literature. Reviewing the official vigilance database, we found that heart rhythm disorders after COVID vaccination are not uncommon and deserve more clinical and scientific attention. Since the COVID vaccine is the only vaccination related to this side effect, questions arose about whether these vaccines could affect heart conduction. Although the risk-benefit ratio is clearly in favor of vaccination, heart rhythm disorders are not a negligible issue, and there are red flags in the literature about the risk of post-vaccination malignant arrhythmias in some predisposed patients. In light of these findings, we reviewed the potential molecular pathways for the COVID vaccine to impact cardiac electrophysiology and cause heart rhythm disorders.
Collapse
Affiliation(s)
- Nino Cocco
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Gregor Leibundgut
- University Heart Center, University Hospital Basel, Petersgraben 4, 4053 Basel, Switzerland
| | - Francesco Pelliccia
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00186 Rome, Italy
| | - Valeria Cammalleri
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Annunziata Nusca
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Fabio Mangiacapra
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, 65122 Chieti, Italy
| | - Valerio Fanale
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| |
Collapse
|
32
|
Crosier R, Kafil TS, Paterson DI. Imaging for Cardiovascular Complications of COVID-19: Cardiac Manifestations in Context. Can J Cardiol 2023; 39:779-792. [PMID: 36731604 PMCID: PMC9886397 DOI: 10.1016/j.cjca.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/29/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023] Open
Abstract
After the first confirmed case in 2019, COVID-19 rapidly spread worldwide and overwhelmed the medical community. In the intervening time, we have learned about COVID-19's clinical manifestations and have developed effective therapies and preventative vaccines. Severe COVID-19 infection is associated with many cardiovascular disorders in the acute phase, and patients recovered from illness can also manifest long-term sequelae, including long COVID syndrome. Furthermore, severe acute respiratory syndrome-related coronavirus-2 messenger RNA (mRNA) vaccination can trigger rare cases of myopericarditis. We have gained significant knowledge of the acute and long-term cardiovascular complications of COVID-19- and mRNA vaccine-associated myocarditis through clinical and investigative studies using cardiac imaging. In this review, we describe how cardiovascular imaging can be used to understand the cardiovascular complications and cardiac injury associated with acute COVID-19 infection, review the imaging findings in patients recovered from illness, and discuss the role and limitations of cardiac imaging in COVID-19 mRNA vaccine-associated myocarditis.
Collapse
Affiliation(s)
- Rebecca Crosier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Tahir S Kafil
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - D Ian Paterson
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| |
Collapse
|
33
|
Lin J, Harahsheh AS, Raghuveer G, Jain S, Choueiter NF, Garrido-Garcia LM, Dahdah N, Portman MA, Misra N, Khoury M, Fabi M, Elias MD, Dionne A, Lee S, Tierney ESS, Ballweg JA, Manlhiot C, McCrindle BW. Emerging Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome Associated With COVID-19 in Children. Can J Cardiol 2023; 39:793-802. [PMID: 36626979 PMCID: PMC9824951 DOI: 10.1016/j.cjca.2023.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) has emerged as a rare delayed hyperinflammatory response to SARS-CoV-2 infection and causes severe morbidity in the pediatric age group. Although MIS-C shares many clinical similarities to Kawasaki disease (KD), important differences in epidemiologic, clinical, immunologic, and potentially genetic factors exist and suggest potential differences in pathophysiology and points to be explored and explained. Epidemiologic features include male predominance, peak age of 6 to12 years, and specific racial or ethnicity predilections. MIS-C is characterized by fever, prominent gastrointestinal symptoms, mucocutaneous manifestations, respiratory symptoms, and neurologic complaints, and patients often present with shock. Cardiac complications are frequent and include ventricular dysfunction, valvular regurgitation, pericardial effusion, coronary artery dilation and aneurysms, conduction abnormalities, and arrhythmias. Emerging evidence regarding potential immunologic mechanisms suggest that an exaggerated T-cell response to a superantigen on the SARS-CoV-2 spike glycoprotein-as well as the formation of autoantibodies against cardiovascular, gastrointestinal, and endothelial antigens-are major contributors to the inflammatory milieu of MIS-C. Further studies are needed to determine both shared and distinct immunologic pathway(s) that underlie the pathogenesis of MIS-C vs both acute SARS-CoV-2 infection and KD. There is evidence to suggest that the rare risk of more benign mRNA vaccine-associated myopericarditis is outweighed by a reduced risk of more severe MIS-C. In the current review, we synthesize the published literature to describe associated factors and potential mechanisms regarding an increased risk of MIS-C and cardiac complications, provide insights into the underlying immunologic pathophysiology, and define similarities and differences with KD.
Collapse
Affiliation(s)
- Justin Lin
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ashraf S Harahsheh
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Supriya Jain
- Division of Pediatric Cardiology, Maria Fareri Children's Hospital of Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Nadine F Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Nagib Dahdah
- Division of Pediatric Cardiology, Sainte Justine University Hospital Center, University of Montreal, Montréal, Québec, Canada
| | | | - Nilanjana Misra
- Cohen Children's Medical Center of New York, Northwell Health, New York, New York, USA
| | - Michael Khoury
- Stollery Children's Hospital, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matthew D Elias
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Simon Lee
- Children's Nationwide Hospital, Columbus, Ohio, USA
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jean A Ballweg
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Cedric Manlhiot
- Johns Hopkins University School of Medicine, Division of Cardiology, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
34
|
Altman NL, Berning AA, Mann SC, Quaife RA, Gill EA, Auerbach SR, Campbell TB, Bristow MR. Vaccination-Associated Myocarditis and Myocardial Injury. Circ Res 2023; 132:1338-1357. [PMID: 37167355 PMCID: PMC10171307 DOI: 10.1161/circresaha.122.321881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
SARS-CoV-2 vaccine-associated myocarditis/myocardial injury should be evaluated in the contexts of COVID-19 infection, other types of viral myocarditis, and other vaccine-associated cardiac disorders. COVID-19 vaccine-associated myocardial injury can be caused by an inflammatory immune cell infiltrate, but other etiologies such as microvascular thrombosis are also possible. The clinical diagnosis is typically based on symptoms and cardiac magnetic resonance imaging. Endomyocardial biopsy is confirmatory for myocarditis, but may not show an inflammatory infiltrate because of rapid resolution or a non-inflammatory etiology. Myocarditis associated with SARS-COVID-19 vaccines occurs primarily with mRNA platform vaccines, which are also the most effective. In persons aged >16 or >12 years the myocarditis estimated crude incidences after the first 2 doses of BNT162b2 and mRNA-1273 are approximately 1.9 and 3.5 per 100 000 individuals, respectively. These rates equate to excess incidences above control populations of approximately 1.2 (BNT162b2) and 1.9 (mRNA-1273) per 100 000 persons, which are lower than the myocarditis rate for smallpox but higher than that for influenza vaccines. In the studies that have included mRNA vaccine and SARS-COVID-19 myocarditis measured by the same methodology, the incidence rate was increased by 3.5-fold over control in COVID-19 compared with 1.5-fold for BNT162b2 and 6.2-fold for mRNA-1273. However, mortality and major morbidity are less and recovery is faster with mRNA vaccine-associated myocarditis compared to COVID-19 infection. The reasons for this include vaccine-associated myocarditis having a higher incidence in young adults and adolescents, typically no involvement of other organs in vaccine-associated myocarditis, and based on comparisons to non-COVID viral myocarditis an inherently more benign clinical course.
Collapse
Affiliation(s)
- Natasha L. Altman
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Amber A. Berning
- Department of Pathology (A.A.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Sarah C. Mann
- Division of Infectious Diseases, Department of Medicine (S.C.M., T.B.C.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Robert A. Quaife
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Edward A. Gill
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Scott R. Auerbach
- Division of Cardiology, Department of Pediatrics (S.R.A.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Thomas B. Campbell
- Division of Infectious Diseases, Department of Medicine (S.C.M., T.B.C.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Michael R. Bristow
- Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
- Research and Development Department, ARCA Biopharma, CO (M.R.B.)
| |
Collapse
|
35
|
Meleis MM, Hahn SB, Carraro MN, Deutsch AB. Extensive longitudinal acute transverse myelitis complicated by pulseless ventricular tachycardia and recent shingles vaccination. Am J Emerg Med 2023; 68:213.e1-213.e3. [PMID: 37120396 DOI: 10.1016/j.ajem.2023.04.033] [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: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023] Open
Abstract
This case describes a 50-year-old male with a history of psoriatic arthritis who presented to the emergency department with a chief complaint of ascending bilateral lower extremity paresthesia one week following a shingles vaccine. MRI of the patient's spine was significant for longitudinally extensive T2 hyperintensity involving the lower cervical spine with extension into the upper thoracic spine suggestive of acute transverse myelitis (ATM). The patient's hospital course was complicated by a self-limiting episode of pulseless ventricular tachycardia accompanied by a brief loss of consciousness. Initial treatment included IV solumedrol, however due to lack of clinical improvement after a 5-day steroid treatment, plasmapheresis was initiated. The patient's condition improved with plasmapheresis and he was subsequently discharged to a rehab facility with a diagnosis of ATM of unclear etiology. Extensive serology, cardiac and CSF studies failed to determine the cause of this patient's myelitis or pulseless ventricular tachycardia. The following case report explores the potential factors that may have contributed to this patient's symptoms.
Collapse
Affiliation(s)
- Mostafa M Meleis
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA.
| | - Su Bin Hahn
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA.
| | - Michelle N Carraro
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA.
| | - Aaron B Deutsch
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA.
| |
Collapse
|
36
|
Sim JY, Kim SY, Kim EK. The incidence and clinical characteristics of myocarditis and pericarditis following mRNA-based COVID-19 vaccination in Republic of Korea adolescents from July 2021 to September 2022. Osong Public Health Res Perspect 2023; 14:76-88. [PMID: 37183328 PMCID: PMC10211448 DOI: 10.24171/j.phrp.2023.0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES Age-specific information regarding myocarditis/pericarditis in adolescents following mRNA-based coronavirus disease 2019 (COVID-19) vaccination in Asia remains insufficient. This study investigated the incidence and clinical characteristics of myocarditis/pericarditis in Republic of Korea adolescents after mRNA-based COVID-19 vaccination. METHODS This retrospective descriptive study utilized patient data from the Korea Immunization Management System. Incidence rates were calculated according to age and sex. Clinical characteristics (symptoms/signs, laboratory values, and imaging results) were compared between mild and severe cases. RESULTS Between July 19, 2021 and September 30, 2022, 3,728,224 individuals aged 12 to 19 years received 6,484,165 mRNA-based COVID-19 vaccines, and 173 cases met the case definition for myocarditis/pericarditis: 151 mild (87.3%) and 22 severe (12.7%). The incidence was 3.8-fold higher in males than in females. Troponin I/ troponin T was elevated in 96% of myocarditis cases, demonstrating higher sensitivity than creatine kinase-myocardial band (67.6%) or C-reactive protein (75.2%). ST-segment or Twave on electrography abnormalities were found in 60.3% (85/141). Paroxysmal/sustained atrial/ventricular arrhythmias were more common in severe than in mild cases (45.5% vs. 16.8%, p=0.008). Edema on T2-weighted magnetic imaging occurred in 21.6% (8/37) and 62.5% (5/8) of mild and severe cases, respectively (p=0.03). Abnormal pericardial fluid collection or pericardial inflammation was found in 75.4% of pericarditis cases (49/65). CONCLUSION Myocarditis/pericarditis occurred in rare cases following mRNA-based COVID-19 vaccination. Most cases were mild, but the incidence was higher in adolescent males and after the second dose. As bivalent severe acute respiratory syndrome coronavirus 2 mRNA vaccination started in Republic of Korea in October 2022, the post-vaccination incidence of myocarditis/pericarditis should be closely monitored, considering clinical characteristics.
Collapse
Affiliation(s)
- Ju-Young Sim
- Division of Healthcare Associated Infection Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Seung-Yun Kim
- Adverse Event Investigation Team, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Eun-Kyoung Kim
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Contrㅊol and Prevention Agency, Cheongju, Republic of Korea
| |
Collapse
|
37
|
Sheth SP, Gandhi R. Ventricular Arrhythmia and COVID-19 Vaccine-associated Myocarditis. Pediatr Infect Dis J 2023; 42:e112-e113. [PMID: 36728022 PMCID: PMC9990478 DOI: 10.1097/inf.0000000000003833] [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] [Accepted: 01/03/2023] [Indexed: 02/03/2023]
Abstract
17-year-old male presented with COVID-19 vaccine-associated myocarditis. Six months later, due to chest discomfort with exercise, the patient underwent an exercise stress test that revealed a 3-beat run of nonsustained ventricular tachycardia at 230 bpm at peak exercise. The long-term outcomes of COVID-19 vaccine-associated myocarditis are unclear. This patient had nonsustained ventricular tachycardia over 6 months after diagnosis.
Collapse
Affiliation(s)
- Saloni P. Sheth
- From the Department of Pediatric Cardiology, Advocate Children’s Hospital, Chicago, Illinois
| | - Rupali Gandhi
- From the Department of Pediatric Cardiology, Advocate Children’s Hospital, Chicago, Illinois
| |
Collapse
|
38
|
Yonker LM, Swank Z, Bartsch YC, Burns MD, Kane A, Boribong BP, Davis JP, Loiselle M, Novak T, Senussi Y, Cheng CA, Burgess E, Edlow AG, Chou J, Dionne A, Balaguru D, Lahoud-Rahme M, Arditi M, Julg B, Randolph AG, Alter G, Fasano A, Walt DR. Circulating Spike Protein Detected in Post-COVID-19 mRNA Vaccine Myocarditis. Circulation 2023; 147:867-876. [PMID: 36597886 PMCID: PMC10010667 DOI: 10.1161/circulationaha.122.061025] [Citation(s) in RCA: 70] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cases of adolescents and young adults developing myocarditis after vaccination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-targeted mRNA vaccines have been reported globally, but the underlying immunoprofiles of these individuals have not been described in detail. METHODS From January 2021 through February 2022, we prospectively collected blood from 16 patients who were hospitalized at Massachusetts General for Children or Boston Children's Hospital for myocarditis, presenting with chest pain with elevated cardiac troponin T after SARS-CoV-2 vaccination. We performed extensive antibody profiling, including tests for SARS-CoV-2-specific humoral responses and assessment for autoantibodies or antibodies against the human-relevant virome, SARS-CoV-2-specific T-cell analysis, and cytokine and SARS-CoV-2 antigen profiling. Results were compared with those from 45 healthy, asymptomatic, age-matched vaccinated control subjects. RESULTS Extensive antibody profiling and T-cell responses in the individuals who developed postvaccine myocarditis were essentially indistinguishable from those of vaccinated control subjects, despite a modest increase in cytokine production. A notable finding was that markedly elevated levels of full-length spike protein (33.9±22.4 pg/mL), unbound by antibodies, were detected in the plasma of individuals with postvaccine myocarditis, whereas no free spike was detected in asymptomatic vaccinated control subjects (unpaired t test; P<0.0001). CONCLUSIONS Immunoprofiling of vaccinated adolescents and young adults revealed that the mRNA vaccine-induced immune responses did not differ between individuals who developed myocarditis and individuals who did not. However, free spike antigen was detected in the blood of adolescents and young adults who developed post-mRNA vaccine myocarditis, advancing insight into its potential underlying cause.
Collapse
Affiliation(s)
- Lael M. Yonker
- Mucosal Immunology and Biology Research Center (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
| | - Zoe Swank
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA (Z.S., Y.S., C.-A.C., D.R.W.)
| | - Yannic C. Bartsch
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA (Y.C.B., E.B., B.J., G.A.)
| | - Madeleine D. Burns
- Mucosal Immunology and Biology Research Center (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
| | - Abigail Kane
- Mucosal Immunology and Biology Research Center (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
| | - Brittany P. Boribong
- Mucosal Immunology and Biology Research Center (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
| | - Jameson P. Davis
- Mucosal Immunology and Biology Research Center (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
| | - Maggie Loiselle
- Mucosal Immunology and Biology Research Center (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
| | - Tanya Novak
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Department of Anesthesiology, Critical Care and Pain Medicine (T.N., A.G.R.), Boston Children’s Hospital, MA
| | - Yasmeen Senussi
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA (Z.S., Y.S., C.-A.C., D.R.W.)
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (Z.S., Y.S., C.-A.C., D.R.W.)
| | - Chi-An Cheng
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA (Z.S., Y.S., C.-A.C., D.R.W.)
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (Z.S., Y.S., C.-A.C., D.R.W.)
| | - Eleanor Burgess
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA (Y.C.B., E.B., B.J., G.A.)
| | - Andrea G. Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (A.G.E.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Vincent Center for Reproductive Biology (A.G.E.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Department of Anesthesiology, Critical Care and Pain Medicine (T.N., A.G.R.), Boston Children’s Hospital, MA
| | - Janet Chou
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Department of Pediatrics, Division of Immunology (J.C.), Boston Children’s Hospital, MA
| | - Audrey Dionne
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Department of Cardiology (A.D.), Boston Children’s Hospital, MA
| | - Duraisamy Balaguru
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
| | - Manuella Lahoud-Rahme
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
| | - Moshe Arditi
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Infectious and Immunologic Diseases Research Center, and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (M.A.)
| | - Boris Julg
- Department of Medicine (B.J.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA (Y.C.B., E.B., B.J., G.A.)
| | - Adrienne G. Randolph
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
| | - Galit Alter
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA (Y.C.B., E.B., B.J., G.A.)
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Department of Pediatrics (L.M.Y., M.D.B., A.K., B.P.B., J.P.D., M.L., D.B., M.L.-R., A.F.), Division of Infectious Disease, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
| | - David R. Walt
- Harvard Medical School, Boston, MA (L.M.Y., Z.S., Y.C.B., B.P.B., T.N., Y.S., C.-A.C., J.C., A.D., D.B., M.L.-R., B.J., A.G.R., G.A., A.F., D.R.W.)
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA (Z.S., Y.S., C.-A.C., D.R.W.)
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA (Z.S., Y.S., C.-A.C., D.R.W.)
| |
Collapse
|
39
|
Short term outcome of myocarditis and pericarditis following COVID-19 vaccines: a cardiac magnetic resonance imaging study. Int J Cardiovasc Imaging 2023; 39:1031-1043. [PMID: 36913155 PMCID: PMC10009344 DOI: 10.1007/s10554-023-02799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/11/2023] [Indexed: 03/14/2023]
Abstract
To evaluate clinical and cardiac magnetic resonance (CMR) short-term follow-up (FU) in patients with vaccine-associated myocarditis, pericarditis or myo-pericarditis (VAMP) following COVID-19 vaccination. We retrospectively analyzed 44 patients (2 women, mean age: 31.7 ± 15.1 years) with clinical and CMR manifestations of VAMP, recruited from 13 large tertiary national centers. Inclusion criteria were troponin raise, interval between the last vaccination dose and onset of symptoms < 25 days and symptoms-to-CMR < 20 days. 29/44 patients underwent a short-term FU-CMR with a median time of 3.3 months. Ventricular volumes and CMR findings of cardiac injury were collected in all exams. Mean interval between the last vaccination dose and the onset of symptoms was 6.2 ± 5.6 days. 30/44 patients received a vaccination with Comirnaty, 12/44 with Spikevax, 1/44 with Vaxzevria and 1/44 with Janssen (18 after the first dose of vaccine, 20 after the second and 6 after the "booster" dose). Chest pain was the most frequent symptom (41/44), followed by fever (29/44), myalgia (17/44), dyspnea (13/44) and palpitations (11/44). At baseline, left ventricular ejection fraction (LV-EF) was reduced in 7 patients; wall motion abnormalities have been detected in 10. Myocardial edema was found in 35 (79.5%) and LGE in 40 (90.9%) patients. Clinical FU revealed symptoms persistence in 8/44 patients. At FU-CMR, LV-EF was reduced only in 2 patients, myocardial edema was present in 8/29 patients and LGE in 26/29. VAMPs appear to have a mild clinical presentation, with self-limiting course and resolution of CMR signs of active inflammation at short-term follow-up in most of the cases.
Collapse
|
40
|
Özen S, Kibar Gül AE, Gülhan B, Işıksalan Özbülbül N, Kanık Yüksek S, Terin H, Mustafaoğlu Ö, Bayraktar P, Ece İ, Çetin İİ, Üçkardeş F, Bayhan Gİ, Özkaya Parlakay A. Admission and follow-up cardiac magnetic resonance imaging findings in BNT162b2 Vaccine-Related myocarditis in adolescents. Infect Dis (Lond) 2023; 55:199-206. [PMID: 36576105 DOI: 10.1080/23744235.2022.2157478] [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] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is limited data on the pattern and severity of myocardial injury in patients with COVID-19 vaccination associated myocarditis. OBJECTIVE We aimed to define the myocardial damage occurring after BNT162b2 vaccination, raise awareness about adverse reactions developing after vaccination, and determine the patterns and scope of Cardiac magnetic resonance imaging (MRI) findings. PATIENTS/METHODS A total of 9 patients diagnosed with vaccine-associated myopericarditis were followed up. RESULTS The mean age of the patient at diagnosis was 15.3 ± 1.0 (range: 14-17) years, and all patients were male. Seven patients presented with myocarditis symptoms after their second vaccine dose, one patient presented with pericarditis symptoms after his first dose, and the other patient presented with myocarditis symptoms after his booster dose. The median time at presenting to the hospital was 3 (range: 2-22) days. Seven (77.7%) patients had abnormal electrocardiography (ECG) findings, and the most prevalent finding was diffuse ST-segment elevation. Initial cardiac MRI results were abnormal in all patients, where 8 (88.8%) patients had late gadolinium enhancement, and 5 (55.5%) had myocardial edoema. Three patients showed local left ventricular wall-motion abnormalities. In their follow-up MRIs 3-6 months later, myocardial edoema was present in 2 (28.5%) patients, while late gadolinium enhancement was present in all patients (7/7, 100%, 2 patients did not have control MRI time). Hypokinetic segments were still present in one of the 3 patients. No negative cardiac events were observed in the short-term follow-up of any patient. CONCLUSION Further follow-up evaluation and larger multicenter studies are needed to determine the clinical significance of persistent cardiac MRI abnormalities.
Collapse
Affiliation(s)
- Seval Özen
- Pediatric Infectious Diseases Unit, Ankara City Hospital, Ankara, Turkey
| | | | - Belgin Gülhan
- Pediatric Infectious Diseases Unit, Ankara City Hospital, Ankara, Turkey
| | | | | | - Harun Terin
- Pediatric Cardiology Unit, Ankara City Hospital, Ankara, Turkey
| | - Özlem Mustafaoğlu
- Pediatric Infectious Diseases Unit, Ankara City Hospital, Ankara, Turkey
| | - Pınar Bayraktar
- Pediatric Infectious Diseases Unit, Ankara City Hospital, Ankara, Turkey
| | - İbrahim Ece
- Pediatric Cardiology Unit, Ankara City Hospital, Ankara, Turkey
| | | | - Fatih Üçkardeş
- Department of Biostatistics and Medical Informatics, Adıyaman University, Adıyaman, Turkey
| | | | | |
Collapse
|
41
|
Buchan SA, Alley S, Seo CY, Johnson C, Kwong JC, Nasreen S, Thampi N, Lu D, Harris TM, Calzavara A, Wilson SE. Myocarditis or Pericarditis Events After BNT162b2 Vaccination in Individuals Aged 12 to 17 Years in Ontario, Canada. JAMA Pediatr 2023; 177:410-418. [PMID: 36848096 PMCID: PMC9972235 DOI: 10.1001/jamapediatrics.2022.6166] [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] [Indexed: 03/01/2023]
Abstract
Importance The risk of myocarditis or pericarditis after COVID-19 messenger RNA vaccines varies by age and sex, and there is some evidence to suggest increasing risk with shorter intervals between dose 1 and 2 (ie, interdose interval). Objective To estimate the incidence of reported myocarditis or pericarditis after BNT162b2 vaccine among adolescents and to describe the clinical information associated with these events. Design, Setting, and Participants This was a population-based cohort study using passive vaccine safety surveillance data linked to the provincial COVID-19 vaccine registry. Included in the study were all adolescents aged 12 to 17 years in Ontario, Canada, who received 1 or more doses of BNT162b2 vaccine between December 14, 2020, and November 21, 2021, and reported an episode of myocarditis or pericarditis. Data were analyzed from December 15, 2021, to April 22, 2022. Exposure Receipt of BNT162b2 (Comirnaty [Pfizer-BioNTech]) vaccine. Main Outcomes and Measure Reported incidence of myocarditis or pericarditis meeting level 1 to 3 of the Brighton Collaboration case definition per 100 000 doses of BNT162b2 administered by age group (12-15 years vs 16-17 years), sex, dose number, and interdose interval. All clinical information associated with symptoms, health care usage, diagnostic test results, and treatment at the time of the acute event were summarized. Results There were approximately 1.65 million doses of BNT162b2 administered and 77 reports of myocarditis or pericarditis among those aged 12 to 17 years, which met the inclusion criteria during the study period. Of the 77 adolescents (mean [SD] age, 15.0 [1.7] years; 63 male individuals [81.8%]), 51 (66.2%) developed myocarditis or pericarditis after dose 2 of BNT162b2. Overall, 74 individuals (96.1%) with an event were assessed in the emergency department, and 34 (44.2%) were hospitalized (median [IQR] length of stay, 1 [1-2] day). The majority of adolescents (57 [74.0%]) were treated with nonsteroidal anti-inflammatory drugs only, and 11 (14.3%) required no treatment. The highest reported incidence was observed among male adolescents aged 16 to 17 years after dose 2 (15.7 per 100 000; 95% CI, 9.7-23.9). Among those aged 16 to 17 years, the reporting rate was highest in those with a short (ie, ≤30 days) interdose interval (21.3 per 100 000; 95% CI, 11.0-37.2). Conclusions and Relevance Results of this cohort study suggest that there was variation in the reported incidence of myocarditis or pericarditis after BNT162b2 vaccine among adolescent age groups. However, the risk of these events after vaccination remains very rare and should be considered in relation to the benefits of COVID-19 vaccination.
Collapse
Affiliation(s)
- Sarah A. Buchan
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Sarah Alley
- Public Health Ontario, Toronto, Ontario, Canada
| | - Chi Yon Seo
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,University Health Network, Toronto, Ontario, Canada
| | - Sharifa Nasreen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Nisha Thampi
- Public Health Ontario, Toronto, Ontario, Canada,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Diane Lu
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - Andrew Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E. Wilson
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Goyal M, Ray I, Mascarenhas D, Kunal S, Sachdeva RA, Ish P. Myocarditis post-SARS-CoV-2 vaccination: a systematic review. QJM 2023; 116:7-25. [PMID: 35238384 PMCID: PMC8903459 DOI: 10.1093/qjmed/hcac064] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 01/07/2023] Open
Abstract
Variable clinical criteria taken by medical professionals across the world for myocarditis following coronavirus disease 2019 (COVID-19) vaccination along with wide variation in treatment necessitates understanding and reviewing the same. A systematic review was conducted to elucidate the clinical findings, laboratory parameters, treatment and outcomes of individuals with myocarditis after COVID-19 vaccination after registering with PROSPERO. Electronic databases including MEDLINE, EMBASE, PubMed, LitCovid, Scopus, ScienceDirect, Cochrane Library, Google Scholar and Web of Science were searched. A total of 85 articles encompassing 2184 patients were analysed. It was a predominantly male (73.4%) and young population (mean age: 25.5 ± 14.2 years) with most having taken an mRNA-based vaccine (99.4%). The mean duration from vaccination to symptom onset was 4.01 ± 6.99 days. Chest pain (90.1%), dyspnoea (25.7%) and fever (11.9%) were the most common symptoms. Only 2.3% had comorbidities. CRP was elevated in 83.3% and cardiac troponin in 97.6% patients. An abnormal ECG was reported in 979/1313 (74.6%) patients with ST-segment elevation being most common (34.9%). Echocardiographic data were available for 1243 patients (56.9%), of whom 288 (23.2%) had reduced left ventricular ejection fraction. Non-steroidal antiinflammatory drugs (76.5%), steroids (14.1%) followed by colchicine (7.3%) were used for treatment. Only 6 patients died among 1317 of whom data were available. Myocarditis following COVID-19 vaccination is often mild, seen more commonly in young healthy males and is followed by rapid recovery with conservative treatment. The emergence of this adverse event calls for harmonizing case definitions and definite treatment guidelines, which require wider research.
Collapse
Affiliation(s)
- Medha Goyal
- Department of Neonatology, Seth GSMC & KEMH, India, Mumbai
| | - Ishita Ray
- Department of Medicine, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | | | - Shekhar Kunal
- Department of Cardiology, ESIC Medical College & Hospital Faridabad, India
| | - Ruchi Arora Sachdeva
- Department of Respiratory Medicine, ESIC Medical College & Hospital Faridabad, India
| | - Pranav Ish
- Corresponding author: Dr Pranav Ish, Assistant Professor, Department of Pulmonary and Critical Care Medicine, Room number 638. Superspeciality Block, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi 110029, India. , Phone- +91-9958356000
| |
Collapse
|
43
|
Miyazaki K, Fujii T, Mori K, Tamimoto R, Nagamatsu H, Murakami T, Cho Y, Goto S, Mori H. Sustained Myocarditis following Messenger RNA Vaccination against Coronavirus Disease 2019: Relation to Neutralizing Antibody and Amelioration by Low-Dose Booster Vaccination. J Clin Med 2023; 12:jcm12041421. [PMID: 36835957 PMCID: PMC9961568 DOI: 10.3390/jcm12041421] [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] [Received: 01/10/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
We recently reported that sub-acute myocarditis occurred following the initial two doses of messenger RNA-based vaccination against coronavirus disease 2019 (0.3 mL Comirnaty®) in elderly Japanese patients with cardiac dysfunction. The present retrospective study of 76 patients revealed that myocarditis following the initial doses persisted for 12 months, was associated with low levels of neutralizing antibodies, and was ameliorated by reducing the third vaccine dose. Low neutralizing antibody levels (<220 U/mL) after the initial doses were an independent predictor of persistent clinical events, defined as death or marked changes in brain natriuretic peptide levels. When the third dose was reduced (0.1 mL), changes in brain natriuretic peptide levels were significantly smaller (p = 0.02, n = 25), no deaths occurred due to heart failure, and neutralizing antibody levels increased 41-fold (p < 0.001) compared with the initial doses. Reduced booster doses could facilitate the worldwide distribution of messenger RNA vaccines.
Collapse
Affiliation(s)
- Koji Miyazaki
- Department of General Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawacho, Hachioji, Tokyo 192-0032, Japan
- Shoju Sagamihara Clinic, 820-1-101 Harataima, Sagamihara 252-0336, Japan
- Correspondence:
| | - Toshiharu Fujii
- Shoju Sagamihara Clinic, 820-1-101 Harataima, Sagamihara 252-0336, Japan
- Department of Cardiovascular Medicine, Tokai University Hachioji Hospital, 1838 Ishikawacho, Hachioji, Tokyo 192-0032, Japan
| | - Kikue Mori
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan
- Mori Clinic, 541-12 Wasedatsurumakicho Shinjuku-ku, Tokyo 259-1143, Japan
| | - Ryuichi Tamimoto
- Department of Cardiovascular Surgery, Tokai University School of Medicine, 143 Simokasuya, Isehara 259-1193, Japan
| | - Hirofumi Nagamatsu
- Shoju Sagamihara Clinic, 820-1-101 Harataima, Sagamihara 252-0336, Japan
- Department of Cardiovascular Medicine, Tokai University Hachioji Hospital, 1838 Ishikawacho, Hachioji, Tokyo 192-0032, Japan
| | - Tsutomu Murakami
- Shoju Sagamihara Clinic, 820-1-101 Harataima, Sagamihara 252-0336, Japan
- Department of Cardiovascular Medicine, Tokai University School of Medicine, 143 Simokasuya, Isehara 259-1193, Japan
| | - Yasunori Cho
- Department of Cardiovascular Surgery, Tokai University School of Medicine, 143 Simokasuya, Isehara 259-1193, Japan
| | - Shinya Goto
- Department of Cardiovascular Medicine, Tokai University School of Medicine, 143 Simokasuya, Isehara 259-1193, Japan
| | - Hidezo Mori
- Shoju Sagamihara Clinic, 820-1-101 Harataima, Sagamihara 252-0336, Japan
- Department of Cardiovascular Medicine, Tokai University Hachioji Hospital, 1838 Ishikawacho, Hachioji, Tokyo 192-0032, Japan
- Mori Clinic, 541-12 Wasedatsurumakicho Shinjuku-ku, Tokyo 259-1143, Japan
| |
Collapse
|
44
|
Kirkpatrick IDC. On Myocarditis and a New Era for Cardiac Magnetic Resonance Imaging. Can Assoc Radiol J 2023; 74:20-21. [PMID: 35959654 DOI: 10.1177/08465371221120034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
|
45
|
Akhtar Z, Trent M, Moa A, Tan TC, Fröbert O, MacIntyre CR. The impact of COVID-19 and COVID vaccination on cardiovascular outcomes. Eur Heart J Suppl 2023; 25:A42-A49. [PMID: 36937372 PMCID: PMC10021497 DOI: 10.1093/eurheartjsupp/suac123] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
COVID-19 is an independent risk factor for cardiovascular disease. COVID-19 vaccination may prevent this, but in some cases, COVID-19 vaccination may cause myocarditis or pericarditis. Patients with COVID-19 may present with non-specific symptoms that have a cardiac origin. This review examines the cardiovascular complications of COVID-19 infection and the impact of COVID-19 vaccination. COVID-19 cardiovascular complications include myocardial injury, pericarditis, coagulopathy, myocardial infarction, heart failure, arrhythmias, and persistent post-acute risk of adverse cardiovascular outcomes. Diagnostic and referral pathways for non-specific symptoms, such as dyspnoea and fatigue, remain unclear. COVID-19 vaccination is cardioprotective overall but is associated with myopericarditis in young males, though at a lower rate than following SARS-CoV-2 infection. Increased awareness among primary care physicians of potential cardiovascular causes of non-specific post-COVID-19 symptoms, including in younger adults, such as fatigue, dyspnoea, and chest pain, is essential. We recommend full vaccination with scheduled booster doses, optimal management of cardiovascular risk factors, rapid treatment of COVID-19, and clear diagnostic, referral, and management pathways for patients presenting with non-specific symptoms to rule out cardiac complications.
Collapse
Affiliation(s)
- Zubair Akhtar
- Biosecurity Program, The Kirby Institute, University of New South Wales (UNSW), 2052, SydneyAustralia
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh 1212
| | - Mallory Trent
- Biosecurity Program, The Kirby Institute, University of New South Wales (UNSW), 2052, SydneyAustralia
| | - Aye Moa
- Biosecurity Program, The Kirby Institute, University of New South Wales (UNSW), 2052, SydneyAustralia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, University of Western Sydney, 2148, Blacktown, NSW, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, 2052, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney University, 2145, Westmead, NSW, Australia
| | | | | |
Collapse
|
46
|
Tanaka A, Fukuoka S, Nagata H. Vasospastic angina following COVID-19 vaccine-related myocarditis: an underlying cause of chest pain. Cardiol Young 2023; 33:1-3. [PMID: 36628632 DOI: 10.1017/s1047951122003389] [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] [Indexed: 01/12/2023]
Abstract
We present a 13-year-old boy who had recurrent chest pain with elevated cardiac enzymes and abnormal ST segments in electrocardiogram 36 hours after the second dose of BNT162b2 vaccination. Cardiac MRI and coronary angiography with acetylcholine provocation confirmed myocarditis and vasospastic angina, respectively. Coronary vasospasm may play a pivotal role in the chest pain in COVID-19 vaccine-related myocarditis.
Collapse
Affiliation(s)
- Atsushi Tanaka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoji Fukuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
47
|
Elias MD, Truong DT, Oster ME, Trachtenberg FL, Mu X, Jone PN, Mitchell EC, Dummer KB, Sexson Tejtel SK, Osakwe O, Thacker D, Su JA, Bradford TT, Burns KM, Campbell MJ, Connors TJ, D’Addese L, Forsha D, Frosch OH, Giglia TM, Goodell LR, Handler SS, Hasbani K, Hebson C, Krishnan A, Lang SM, McCrindle BW, McHugh KE, Morgan LM, Payne RM, Sabati A, Sagiv E, Sanil Y, Serrano F, Newburger JW, Dionne A. Examination of Adverse Reactions After COVID-19 Vaccination Among Patients With a History of Multisystem Inflammatory Syndrome in Children. JAMA Netw Open 2023; 6:e2248987. [PMID: 36595296 PMCID: PMC9857632 DOI: 10.1001/jamanetworkopen.2022.48987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/10/2022] [Indexed: 01/04/2023] Open
Abstract
Importance Data are limited regarding adverse reactions after COVID-19 vaccination in patients with a history of multisystem inflammatory syndrome in children (MIS-C). The lack of vaccine safety data in this unique population may cause hesitancy and concern for many families and health care professionals. Objective To describe adverse reactions following COVID-19 vaccination in patients with a history of MIS-C. Design, Setting, and Participants In this multicenter cross-sectional study including 22 North American centers participating in a National Heart, Lung, and Blood Institute, National Institutes of Health-sponsored study, Long-Term Outcomes After the Multisystem Inflammatory Syndrome in Children (MUSIC), patients with a prior diagnosis of MIS-C who were eligible for COVID-19 vaccination (age ≥5 years; ≥90 days after MIS-C diagnosis) were surveyed between December 13, 2021, and February 18, 2022, regarding COVID-19 vaccination status and adverse reactions. Exposures COVID-19 vaccination after MIS-C diagnosis. Main Outcomes and Measures The main outcome was adverse reactions following COVID-19 vaccination. Comparisons were made using the Wilcoxon rank sum test for continuous variables and the χ2 or Fisher exact test for categorical variables. Results Of 385 vaccine-eligible patients who were surveyed, 185 (48.1%) received at least 1 vaccine dose; 136 of the vaccinated patients (73.5%) were male, and the median age was 12.2 years (IQR, 9.5-14.7 years). Among vaccinated patients, 1 (0.5%) identified as American Indian/Alaska Native, non-Hispanic; 9 (4.9%) as Asian, non-Hispanic; 45 (24.3%) as Black, non-Hispanic; 59 (31.9%) as Hispanic or Latino; 53 (28.6%) as White, non-Hispanic; 2 (1.1%) as multiracial, non-Hispanic; and 2 (1.1%) as other, non-Hispanic; 14 (7.6%) had unknown or undeclared race and ethnicity. The median time from MIS-C diagnosis to first vaccine dose was 9.0 months (IQR, 5.1-11.9 months); 31 patients (16.8%) received 1 dose, 142 (76.8%) received 2 doses, and 12 (6.5%) received 3 doses. Almost all patients received the BNT162b2 vaccine (347 of 351 vaccine doses [98.9%]). Minor adverse reactions were observed in 90 patients (48.6%) and were most often arm soreness (62 patients [33.5%]) and/or fatigue (32 [17.3%]). In 32 patients (17.3%), adverse reactions were treated with medications, most commonly acetaminophen (21 patients [11.4%]) or ibuprofen (11 [5.9%]). Four patients (2.2%) sought medical evaluation, but none required testing or hospitalization. There were no patients with any serious adverse events, including myocarditis or recurrence of MIS-C. Conclusions and Relevance In this cross-sectional study of patients with a history of MIS-C, no serious adverse events were reported after COVID-19 vaccination. These findings suggest that the safety profile of COVID-19 vaccination administered at least 90 days following MIS-C diagnosis appears to be similar to that in the general population.
Collapse
Affiliation(s)
- Matthew D. Elias
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dongngan T. Truong
- Division of Pediatric Cardiology, University of Utah, Primary Children’s Hospital, Salt Lake City
| | - Matthew E. Oster
- Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Children’s Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora
| | | | - Kirsten B. Dummer
- Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Diego, School of Medicine and Rady Children’s Hospital, San Diego, California
| | | | | | | | - Jennifer A. Su
- Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, California
| | | | - Kristin M. Burns
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - M. Jay Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Thomas J. Connors
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children’s Hospital, New York, New York
| | - Laura D’Addese
- The Heart Institute, Joe DiMaggio Children’s Hospital, Hollywood, Florida
| | - Daniel Forsha
- Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Olivia H. Frosch
- Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor
| | - Therese M. Giglia
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lauren R. Goodell
- Heart Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Stephanie S. Handler
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee
| | - Keren Hasbani
- Dell Children’s Medical Center, The University of Texas at Austin
| | - Camden Hebson
- Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham
| | - Anita Krishnan
- Division of Cardiology, Children’s National Hospital, Washington, DC
| | - Sean M. Lang
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - Kimberly E. McHugh
- Department of Pediatrics, Medical University of South Carolina, Charleston
| | | | - R. Mark Payne
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis
| | - Arash Sabati
- Center for Heart Care, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Eyal Sagiv
- Division of Pediatric Cardiology, Seattle Children’s Hospital and the University of Washington School of Medicine, Seattle, Washington
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Faridis Serrano
- Baylor College of Medicine, Texas Children’s Hospital, Houston
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
48
|
Risks of Cardiac Arrhythmia Associated with COVID-19 Vaccination: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:vaccines11010112. [PMID: 36679957 PMCID: PMC9862670 DOI: 10.3390/vaccines11010112] [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] [Received: 10/26/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 01/04/2023] Open
Abstract
This systematic review and meta-analysis aimed to summarize the current evidence regarding the association between coronavirus disease 2019 (COVID-19) vaccination and the risk of cardiac arrhythmia. MEDLINE, via PubMed and OVID, Scopus, CENTRAL, and Web of Science were searched using the relevant keywords to identify the relevant citations. Comprehensive Meta-analysis and Review Manager 5.4.1 were used for all the statistical analyses. Seventeen studies (n = 567,033,087 patients) were included. The pooled analysis showed that the incidence of cardiac arrhythmia post-COVID-19 vaccination with Pfizer, Moderna, AstraZeneca, CoronaVac, and Sinopharm was 0.22%, 95% CI: (0.07% to 0.66%), 0.76%, 95% CI: (0.04% to 12.08%), 0.04%, 95% CI: (0.00% to 0.98%), 0.01%, 95% CI: (0.00% to 0.03%), and 0.03%, 95% CI: (0.00% to 18.48%), respectively. Compared to CoronaVac, Pfizer, Moderna, AstraZeneca, and Sinopharm had a higher incidence ratio rate (IRR; 22-times, 76-times, 4-times, and 3-times higher), respectively. Likewise, Pfizer, Moderna, and AstraZeneca showed a higher IRR than Sinopharm (7.3-times, 25.3-times, and 1.3-times higher). The current evidence shows that the incidence rate (IR) of cardiac arrhythmia post-COVID-19 vaccination is rare and ranges between 1 and 76 per 10,000. mRNA vaccines were associated with a higher IR of arrhythmia compared to vector-based vaccines. Inactivated vaccines showed the lowest IR of arrhythmia.
Collapse
|
49
|
Chang Y, Lv G, Liu C, Huang E, Luo B. Cardiovascular safety of COVID-19 vaccines in real-world studies: a systematic review and meta-analysis. Expert Rev Vaccines 2023; 22:25-34. [PMID: 36413786 DOI: 10.1080/14760584.2023.2150169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the cardiovascular safety of COVID-19 vaccines in the real world. METHODS Studies reported on any COVID-19 vaccine-related cardiovascular events in the population aged ≥12 years between 1 January 2020 and 15 June 2022 were included. RESULTS A total of 42 studies were included in this meta-analysis. Myocarditis risk was mainly seen after the second (risk ratio [RR], 2.09; 95% confidence interval [CI]: 1.59-2.58) and third (RR, 2.02; 95% CI: 1.04-2.91) dose. A total of 5 vaccines were analyzed, among which mRNA-1273 (RR, 3.13; 95% CI: 2.11-4.14) and BNT162b2 (RR, 1.57; 95% CI: 1.30-1.85) vaccines were associated with myocarditis risk. No significant increase in risk of myocardial infarction (RR, 0.96) or arrhythmia (RR, 0.98) events was observed following vaccination. The risk of cardiovascular events (myocarditis, RR, 8.53; myocardial infarction, RR, 2.59; arrhythmia, RR, 4.47) after SARS-CoV-2 infection was much higher than after vaccination. CONCLUSIONS The risk of myocarditis was observed after COVID-19 vaccination, but it was much lower than that following the SARS-CoV-2 infection. No significant increased risk of myocardial infarction or arrhythmia was found after COVID-19 vaccination.
Collapse
Affiliation(s)
- Yafei Chang
- Faculty of Forensic Medicine, Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Guoli Lv
- Guangzhou Forensic Science Institute, Guangzhou, China
| | - Chao Liu
- Faculty of Forensic Medicine, Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Guangzhou Forensic Science Institute, Guangzhou, China
| | - Erwen Huang
- Faculty of Forensic Medicine, Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Bin Luo
- Faculty of Forensic Medicine, Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
50
|
Ruberg FL, Baggish AL, Hays AG, Jerosch-Herold M, Kim J, Ordovas KG, Reddy G, Shenoy C, Weinsaft JW, Woodard PK. Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention Leadership and Endorsed by the Society for Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2023; 16:e014106. [PMID: 36541203 PMCID: PMC9848221 DOI: 10.1161/circimaging.122.014106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The global pandemic of COVID-19 caused by infection with SARS-CoV-2 is now entering its fourth year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. Although pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play) following resolution of infection. A variety of different testing combinations that leverage ECG, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance imaging have been proposed and implemented to mitigate risk. Cardiovascular magnetic resonance in particular affords high sensitivity for myocarditis but has been employed and interpreted nonuniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to return to play. This consensus document synthesizes available evidence to contextualize the appropriate utilization of cardiovascular magnetic resonance in the return to play assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.
Collapse
Affiliation(s)
- Frederick L. Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (F.L.R.)
| | - Aaron L. Baggish
- Cardiac Performance Program, Harvard Medical School/Massachusetts General Hospital, Boston, MA (A.L.B.)
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (A.G.H.)
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Section, Harvard Medical School/Brigham and Women’s Hospital, Boston, MA (M.J.-H.)
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY (J.K., J.W.W.)
| | - Karen G. Ordovas
- Department of Radiology, University of Washington School of Medicine, Seattle, WA (K.G.O., G.R.)
| | - Gautham Reddy
- Department of Radiology, University of Washington School of Medicine, Seattle, WA (K.G.O., G.R.)
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (C.S.)
| | - Jonathan W. Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY (J.K., J.W.W.)
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO (P.K.W.)
| |
Collapse
|