1
|
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
|
2
|
Yeo SZJ, Ho CL. COVID-19 mRNA vaccine-related myocarditis: A PRISMA systematic review, imaging approach and differential diagnoses. Radiol Case Rep 2024; 19:1008-1019. [PMID: 38226053 PMCID: PMC10788373 DOI: 10.1016/j.radcr.2023.11.070] [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: 10/13/2023] [Accepted: 11/28/2023] [Indexed: 01/17/2024] Open
Abstract
We present a case involving a young individual who developed acute myocarditis on the fourth day following administration of a COVID-19 mRNA vaccine. The patient's condition was managed conservatively, resulting in a favorable outcome. This paper extensively discusses the pathogenesis, clinical manifestations, imaging characteristics of COVID-19 mRNA vaccine-related myocarditis and includes a comprehensive review of pertinent literature. Additionally, a systematic review of COVID-19 mRNA vaccine-related myocarditis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) principles, is presented. Healthcare professionals should maintain a clinical suspicion for COVID-19 mRNA vaccine-related myocarditis when encountering patients with confirmed myocarditis who have received recent COVID-19 mRNA vaccination, after ruling out other potential causes. The diagnosis of acute myocarditis primarily relies on adherence to the Lake Louise Criteria (LLC) for cardiac magnetic resonance (CMR). Nevertheless, specific CMR features or distinctive patterns indicative of COVID-19 mRNA vaccine-related myocarditis are currently undefined. Among patients with vaccine-related myocarditis, common CMR findings encompass subepicardial late gadolinium enhancement and T2-based myocardial edema, although these findings lack specificity and may resemble other medical conditions. Supportive care involving a short-term regimen of NSAIDs, colchicine, and steroids represents the cornerstone of treatment for this variant of myocarditis, which tends to be self-limiting with favorable short-term prognoses. Timely diagnosis is paramount for optimizing patient care.
Collapse
Affiliation(s)
| | - Chi Long Ho
- Sengkang General Hospital, 110, Sengkang Eastway, 544886, Singapore
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
3
|
Del Buono MG, Bonaventura A, Vecchié A, Moroni F, Golino M, Bressi E, De Ponti R, Dentali F, Montone RA, Kron J, Lazzerini PE, Crea F, Abbate A. Pathogenic pathways and therapeutic targets of inflammation in heart diseases: A focus on Interleukin-1. Eur J Clin Invest 2024; 54:e14110. [PMID: 37837616 DOI: 10.1111/eci.14110] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND An exuberant and dysregulated inflammatory response contributes to the development and progression of cardiovascular diseases (CVDs). METHODS This narrative review includes original articles and reviews published over the past 20 years and found through PubMed. The following search terms (or combination of terms) were considered: "acute pericarditis," "recurrent pericarditis," "myocarditis," "cardiac sarcoidosis," "atherosclerosis," "acute myocardial infarction," "inflammation," "NLRP3 inflammasome," "Interleukin-1" and "treatment." RESULTS Recent evidence supports the role of inflammation across a wide spectrum of CVDs including myocarditis, pericarditis, inflammatory cardiomyopathies (i.e. cardiac sarcoidosis) as well as atherosclerotic CVD and heart failure. Interleukins (ILs) are the signalling mediators of the inflammatory response. The NACHT, leucine-rich repeat and pyrin-domain containing protein 3 (NLRP3) inflammasome play a key role in producing IL-1β, the prototypical pro-inflammatory cytokine involved in CVDs. Other pro-inflammatory cytokines (e.g. tumour necrosis factor) have been implicated in cardiac sarcoidosis. As a proof of this, IL-1 blockade has been proven efficacious in pericarditis and chronic coronary syndrome. CONCLUSION Tailored strategies aiming at quenching the inflammatory response have emerged as promising to treat CVDs. In this review article, we summarize recent evidence regarding the role of inflammation across a broad spectrum of CVDs. We also review novel evidence regarding targeted therapeutic strategies.
Collapse
Affiliation(s)
- Marco Giuseppe Del Buono
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Aldo Bonaventura
- Department of Internal Medicine, Medical Center, S.C. Medicina Generale 1, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Alessandra Vecchié
- Department of Internal Medicine, Medical Center, S.C. Medicina Generale 1, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Francesco Moroni
- Robert M. Berne Cardiovascular Research Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Michele Golino
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Edoardo Bressi
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Jordana Kron
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
4
|
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
|
5
|
Tri Saputra PB, Kurniawan RB, Trilistyoati D, Al Farabi MJ, Susilo H, Alsagaff MY, Oktaviono YH, Sutanto H, Gusnanto A, Dyah Kencono Wungu C. Myocarditis and coronavirus disease 2019 vaccination: A systematic review and meta-summary of cases. BIOMOLECULES & BIOMEDICINE 2023; 23:546-567. [PMID: 36803547 PMCID: PMC10351100 DOI: 10.17305/bb.2022.8779] [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: 01/12/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases was male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated (p < 0.01; OR, 5.74; 95% CI, 2.42-13.64) with the risk of myocarditis following the administration of the first dose, indicating that its primary mechanism is immune-mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant noninvasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of <12%, and mortality of <2%. The majority was treated with nonsteroidal anti-inflammatory drugs, colchicine, and steroids. Surprisingly, deceased cases had characteristics of being female, older age, non-chest pain symptoms, first-dose vaccination, left ventricular ejection fraction of <30%, fulminant myocarditis, and eosinophil infiltrate histopathology.
Collapse
Affiliation(s)
- Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | | | - Makhyan Jibril Al Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Henry Sutanto
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | | | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
6
|
Shaheen N, Ramadan A, Shaheen A, Elmasry M, Swed S, Hafez W, Wael M. Myocarditis Following COVID-19 Vaccination: A Systematic Review. Cureus 2023; 15:e37999. [PMID: 37223162 PMCID: PMC10203748 DOI: 10.7759/cureus.37999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
COVID-19 vaccination has significantly reduced both the morbidity and mortality rates associated with SARS-CoV-2 infection. Vaccines, especially mRNA vaccines, have been proposed in several studies to complicate viral myocarditis. Thus, our systematic and meta-analysis review aims to further investigate the possibility of an association between COVID-19 vaccines and myocarditis. We systematically searched PubMed, Web of Science, Scopus, Ovid, and Google Scholar and did a gray search of other databases using the following keywords and terms: "Myocarditis ("Myocarditis" Mesh) OR "Chagas Cardiomyopathy" Mesh) AND "COVID-19 Vaccines" Mesh. The studies were limited to only English articles that reported myocardial inflammation or myocarditis associated with COVID-19 vaccines. Pooled risk ratio with its 95% confidence interval was analyzed by RevMan software (5.4) to perform the meta-analysis. Our study included 671 patients from 44 studies with a mean age of 14-40 years. Nevertheless, myocarditis was noted in a mean of (3.227) days, and 4.19 per million vaccination recipients experienced myocarditis. Most cases were clinically presented with manifestations of cough, chest pain, and fever. Laboratory tests revealed increased C-reactive protein, and troponin with all other cardiac markers in most patients. Cardiac magnetic resonance imaging (MRI) revealed late gadolinium enhancement with myocardial edema and cardiomegaly. Also, electrocardiograms revealed ST-segment elevation in most patients. Furthermore, the incidence of myocarditis was statistically significantly lower in the COVID-19 vaccine group as compared with the control group (RR = 0.15, 95% CI = 0.10-0.23, p-value < 0.00001). No significant association was found between COVID-19 vaccines and the incidence of myocarditis. The study's findings highlight the importance of implementing evidence-based COVID-19 prevention strategies, such as vaccination, to reduce the public health impact of COVID-19 and its associated complications.
Collapse
Affiliation(s)
- Nour Shaheen
- Faculty of Medicine, Alexandria University, Alexandria, EGY
| | | | - Ahmed Shaheen
- Faculty of Medicine, Alexandria University, Alexandria, EGY
| | | | - Sarya Swed
- Medicine, Aleppo University, Aleppo, SYR
| | - Wael Hafez
- Internal Medicine, NMC (New Medical Centre) Royal Hospital, Abu Dhabi, ARE
- Internal Medicine, The National Research Centre, Cairo, EGY
| | - Muhannad Wael
- Faculty of Medicine, An-Najah National University, Jerusalem, PSE
| |
Collapse
|
7
|
Hoption Cann SA. COVID-19 vaccine-related myocarditis: Could antipyretic drugs be a trigger? INFECTIOUS MEDICINE 2023; 2:49-50. [PMID: 38013776 PMCID: PMC9884605 DOI: 10.1016/j.imj.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/12/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Stephen A Hoption Cann
- Faculty of Medicine, School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| |
Collapse
|
8
|
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
|
9
|
Lamprinou M, Sachinidis A, Stamoula E, Vavilis T, Papazisis G. COVID-19 vaccines adverse events: potential molecular mechanisms. Immunol Res 2023; 71:356-372. [PMID: 36607502 PMCID: PMC9821369 DOI: 10.1007/s12026-023-09357-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
COVID-19 is an infectious disease caused by a single-stranded RNA (ssRNA) virus, known as SARS-CoV-2. The disease, since its first outbreak in Wuhan, China, in December 2019, has led to a global pandemic. The pharmaceutical industry has developed several vaccines, of different vector technologies, against the virus. Of note, among these vaccines, seven have been fully approved by WHO. However, despite the benefits of COVID-19 vaccination, some rare adverse effects have been reported and have been associated with the use of the vaccines developed against SARS-CoV-2, especially those based on mRNA and non-replicating viral vector technology. Rare adverse events reported include allergic and anaphylactic reactions, thrombosis and thrombocytopenia, myocarditis, Bell's palsy, transient myelitis, Guillen-Barre syndrome, recurrences of herpes-zoster, autoimmunity flares, epilepsy, and tachycardia. In this review, we discuss the potential molecular mechanisms leading to these rare adverse events of interest and we also attempt an association with the various vaccine components and platforms. A better understanding of the underlying mechanisms, according to which the vaccines cause side effects, in conjunction with the identification of the vaccine components and/or platforms that are responsible for these reactions, in terms of pharmacovigilance, could probably enable the improvement of future vaccines against COVID-19 and/or even other pathological conditions.
Collapse
Affiliation(s)
- Malamatenia Lamprinou
- Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece
| | - Athanasios Sachinidis
- 4th Department of Internal Medicine, School of Medicine, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Stamoula
- Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece
| | - Theofanis Vavilis
- Laboratory of Medical Biology and Genetics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece ,Department of Dentistry, School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Georgios Papazisis
- Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece ,Clinical Research Unit, Special Unit for Biomedical Research and Education (SUBRE), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
10
|
Finsterer J, Hertz D. Self-reported Side Effects of SARS-CoV-2 Vaccination. ACTA MEDICA (HRADEC KRALOVE) 2023; 66:154-157. [PMID: 38588393 DOI: 10.14712/18059694.2024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
SARS-CoV-2 vaccines are often promoted as safe. However, real world data tell a different story. The aim of this study is to investigate the type and frequency of adverse reactions to SARS-CoV-2 vaccination in a randomly selected cohort of unrelated individuals. Adverse reactions to the first/second dose of a SARS-CoV-2 vaccine were recorded using an online reporting system called "Pabbly". Patients were asked via social media to report any symptoms temporarily associated with vaccination. One hundred subjects were enrolled. The mean age was 42.6 years (range: 12-74 years). Ninety-one percent were female. The latency period between vaccination and onset of symptoms ranged from zero to 18 days. The most commonly reported symptoms were tingling/vibration/tremor (79%), numbness (57%), heart problems (53%), muscle weakness/muscle pain (45%), dizziness (44%), headache (44%) and fatigue (43%). Three patients developed small fiber neuropathy. Three patients had COVID-19 prior to vaccination. Of the included subjects, 37% had to be hospitalized. Overall, SARS-CoV-2 vaccination is not without side effects, regardless of the product used. In most cases, the reported side effects were not life-threatening, but one third of study participants experienced serious side effects requiring hospitalization and intensive care. Manufacturers of SARS-CoV-2 vaccines should respond appropriately to reports of adverse reactions associated with SARS-CoV-2 vaccination.
Collapse
|
11
|
Paknahad MH, Yancheshmeh FB, Soleimani A. Cardiovascular complications of COVID-19 vaccines: A review of case-report and case-series studies. Heart Lung 2023; 59:173-180. [PMID: 36842342 PMCID: PMC9905103 DOI: 10.1016/j.hrtlng.2023.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND There are multiple reviews on cardiovascular aspects of COVID-19 disease on cardiovascular system in different population but there is lack of evidence about cardiovascular adverse effects of COVID vaccines. OBJECTIVES The purpose of this study was to compare the cardiac complications of COVID19 vaccines, based on vaccine type (mRNA, vector-based, and inactivated vaccines). METHODS A systematic search was performed covering PubMed for English case-reports and case-series studies, and finally 100 studies were included. RESULTS Myocarditis (with overall rate around 1.62%) was shown to be the most common post-COVID19 immunization cardiac event. More than 90% of post-COVID19 vaccination myocarditis occurred after receiving mRNA vaccines (Moderna & Pfizer-BioNTech), but the report of this event was less in the case of vector-based vaccinations and/or inactivated vaccines. Myocarditis was reported more commonly in men and following the second dose of the immunization. Takotsubo cardiomyopathy (TTC) was reported after mRNA (more commonly) and vector-based vaccinations, with no case report after inactivated vaccines. When mRNA and vector-based vaccinations were used instead of inactivated vaccines, a greater frequency of vaccine-induced thrombotic thrombocytopenia (VITT) and pulmonary emboli (PE) was reported. Myocardial infarction/cardiac arrest was recorded in those beyond the age of 75 years. CONCLUSION The personal and public health benefits of COVID-19 vaccination much outweigh the minor cardiac risks. Reporting bias, regarding more available mRNA vaccines in developed countries, may conflict these results.
Collapse
Affiliation(s)
- Mohammad Hossein Paknahad
- Cardiologist, Cardiology Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatereh Baharlouei Yancheshmeh
- Cardiologist, Cardiology Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Soleimani
- Associate Professor of Cardiology, Echocardiologist, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Echocardiography Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
12
|
Furqan M, Chawla S, Majid M, Mazumdar S, Mahalwar G, Harmon E, Klein A. COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation. Curr Cardiol Rep 2022; 24:2031-2041. [PMID: 36441403 PMCID: PMC9703393 DOI: 10.1007/s11886-022-01801-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To review myocarditis and pericarditis developing after COVID-19 vaccinations and identify the management strategies. RECENT FINDINGS COVID-19 mRNA vaccines are safe and effective. Systemic side effects of the vaccines are usually mild and transient. The incidence of acute myocarditis/pericarditis following COVID-19 vaccination is extremely low and ranges 2-20 per 100,000. The absolute number of myocarditis events is 1-10 per million after COVID-19 vaccination as compared to 40 per million after a COVID-19 infection. Higher rates are reported for pericarditis and myocarditis in COVID-19 infection as compared to COVID-19 vaccines. COVID-19 vaccine-related inflammatory heart conditions are transient and self-limiting in most cases. Patients present with chest pain, shortness of breath, and fever. Most patients have elevated cardiac enzymes and diffuse ST-segment elevation on electrocardiogram. Presence of myocardial edema on T2 mapping and evidence of late gadolinium enhancement on cardiac magnetic resonance imaging are also helpful additional findings. Patients were treated with non-steroidal anti-inflammatory drugs and colchicine with corticosteroids reserved for refractory cases. At least 3-6 months of exercise abstinence is recommended in athletes diagnosed with vaccine-related myocarditis. COVID-19 vaccination is recommended in all age groups for the overall benefits of preventing hospitalizations and severe COVID-19 infection sequela.
Collapse
Affiliation(s)
- Muhammad Furqan
- Department of Internal Medicine, Cleveland Clinic Foundation, Fairview Hospital, Cleveland, OH, USA
| | - Sanchit Chawla
- Department of Internal Medicine, Cleveland Clinic Foundation, Fairview Hospital, Cleveland, OH, USA
| | - Muhammad Majid
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, J1-4, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Samia Mazumdar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, J1-4, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Gauranga Mahalwar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, J1-4, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Evan Harmon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, J1-4, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Allan Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, J1-4, 9500 Euclid Avenue, Cleveland, OH, USA.
| |
Collapse
|
13
|
Samimisedeh P, Jafari Afshar E, Shafiabadi Hassani N, Rastad H. Cardiac MRI Findings in COVID-19 Vaccine-Related Myocarditis: A Pooled Analysis of 468 Patients. J Magn Reson Imaging 2022; 56:971-982. [PMID: 35612967 PMCID: PMC9348186 DOI: 10.1002/jmri.28268] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/11/2022] Open
Abstract
Understanding the pattern and severity of myocarditis caused by the coronavirus disease 2019 (COVID-19) vaccine is imperative for improving the care of the patients, and cardiac evaluation by MRI plays a key role in this regard. Our systematic review and meta-analysis aimed to summarize cardiac MRI findings in COVID-19 vaccine-related myocarditis. We performed a comprehensive systematic review of literature in PubMed, Scopus, and Google Scholar databases using key terms covering COVID-19 vaccine, myocarditis, and cardiac MRI. Individual-level patient data (IPD) and aggregated-level data (AD) studies were pooled through a two-stage analysis method. For this purpose, all IPD were first gathered into a single data set and reduced to AD, and then this AD (from IPD studies) was pooled with existing AD (from the AD studies) using fixed/random effect models. I2 was used to assess the degree of heterogeneity, and the prespecified level of statistical significance (P value for heterogeneity) was <0.1. Based on meta-analysis of 102 studies (n = 468 patients), 79% (95% confidence interval [CI]: 54%-97%) of patients fulfilled Lake Louise criteria (LLC) for diagnosis of myocarditis. Cardiac MRI abnormalities included elevated T2 in 72% (95% CI: 50%-90%), myocardial late gadolinium enhancement (LGE) in 93% (95% CI: 83%-99%; nearly all with a subepicardial and/or midwall pattern), impaired left ventricular ejection fraction (LVEF) (<50%) in 4% (95% CI: 1.0%-9.0%). Moreover, elevated T1 and extracellular volume fraction (ECV) (>30), reported only by some IPD studies, were detected in 74.5% (76/102) and 32% (16/50) of patients, respectively. In conclusion, our findings may suggest that over two-thirds of patients with clinically suspected myocarditis following COVID-19 vaccination meet the LLC. COVID-19 vaccine-associated myocarditis may show a similar pattern compared to other acute myocarditis entities. Notably, preserved LVEF is probably a common finding in these patients. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.
Collapse
Affiliation(s)
- Parham Samimisedeh
- Cardiovascular Research CenterAlborz University of Medical SciencesKarajIran
| | | | | | - Hadith Rastad
- Non‐communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
| |
Collapse
|
14
|
Oueijan RI, Hill OR, Ahiawodzi PD, Fasinu PS, Thompson DK. Rare Heterogeneous Adverse Events Associated with mRNA-Based COVID-19 Vaccines: A Systematic Review. MEDICINES (BASEL, SWITZERLAND) 2022; 9:43. [PMID: 36005648 PMCID: PMC9416135 DOI: 10.3390/medicines9080043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
Background: Since the successful development, approval, and administration of vaccines against SARS-CoV-2, the causative agent of COVID-19, there have been reports in the published literature, passive surveillance systems, and other pharmacovigilance platforms of a broad spectrum of adverse events following COVID-19 vaccination. A comprehensive review of the more serious adverse events associated with the Pfizer-BioNTech and Moderna mRNA vaccines is warranted, given the massive number of vaccine doses administered worldwide and the novel mechanism of action of these mRNA vaccines in the healthcare industry. Methods: A systematic review of the literature was conducted to identify relevant studies that have reported mRNA COVID-19 vaccine-related adverse events. Results: Serious and severe adverse events following mRNA COVID-19 vaccinations are rare. While a definitive causal relationship was not established in most cases, important adverse events associated with post-vaccination included rare and non-fatal myocarditis and pericarditis in younger vaccine recipients, thrombocytopenia, neurological effects such as seizures and orofacial events, skin reactions, and allergic hypersensitivities. Conclusions: As a relatively new set of vaccines already administered to billions of people, COVID-19 mRNA-based vaccines are generally safe and efficacious. Further studies on long-term adverse events and other unpredictable reactions in close proximity to mRNA vaccination are required.
Collapse
Affiliation(s)
- Rana I. Oueijan
- School of Pharmacy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27501, USA
| | - Olivia R. Hill
- School of Pharmacy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27501, USA
| | - Peter D. Ahiawodzi
- Department of Public Health, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27501, USA
| | - Pius S. Fasinu
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Dorothea K. Thompson
- Department of Pharmaceutical and Clinical Sciences, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27501, USA
| |
Collapse
|
15
|
Keshavarz P, Yazdanpanah F, Emad M, Hajati A, Nejati SF, Ebrahimian Sadabad F, Azrumelashvili T, Mizandari M, Raman SS. Myocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 Studies. Tomography 2022; 8:1959-1973. [PMID: 36006062 PMCID: PMC9416085 DOI: 10.3390/tomography8040164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
We reviewed the reported imaging findings of myocarditis in the literature following COVID-19 vaccination on cardiac imaging by a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), and Google Scholar. In total, 532 cases of myocarditis after COVID-19 vaccination were reported (462, 86.8% men and 70, 13.2% women, age range 12 to 80) with the following distribution: Pfizer-BioNTech: 367 (69%), Moderna: 137 (25.8%), AstraZeneca: 12 (2.3%), Janssen/Johnson & Johnson: 6 (1.1%), COVAXIN: 1 (0.1%), and unknown mRNA vaccine: 9 (1.7%). The distribution of patients receiving vaccine dosage was investigated. On cardiac MR Imaging, late intravenous gadolinium enhancement (LGE) was observed mainly in the epicardial/subepicardial segments (90.8%, 318 of 350 enhancing segments), with the dominance of inferolateral segment and inferior walls. Pericardial effusion was reported in 13.1% of cases. The vast majority of patients (94%, 500 of 532) were discharged from the hospital except for 4 (0.7%) cases. Post-COVID-19 myocarditis was most commonly reported in symptomatic men after the second or third dose, with CMRI findings including LGE in 90.8% of inferior and inferolateral epicardial/subepicardial segments. Most cases were self-limited.
Collapse
Affiliation(s)
- Pedram Keshavarz
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (P.K.); (S.S.R.)
- School of Science and Technology, The University of Georgia, Tbilisi 0171, Georgia
| | - Fereshteh Yazdanpanah
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz 5166, Iran;
| | - Maryam Emad
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | - Azadeh Hajati
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | - Seyed Faraz Nejati
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | | | - Tamta Azrumelashvili
- Department of Diagnostic & Interventional Radiology, New Hospitals Ltd., Tbilisi 0114, Georgia;
| | - Malkhaz Mizandari
- Department of Diagnostic & Interventional Radiology, New Hospitals Ltd., Tbilisi 0114, Georgia;
| | - Steven S. Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (P.K.); (S.S.R.)
| |
Collapse
|
16
|
Sharma K, Patel S, Patel Z, Patel KB, Doshi JS, Shah DB, Chokshi P, Parbatani A, Sharma C, Patel A, Konat A. A Comprehensive Analysis of Myocarditis in Formerly Healthy Individuals Following SARS-CoV-2 Vaccination (COVID-19 Immunization). Cureus 2022; 14:e26851. [PMID: 35974860 PMCID: PMC9375127 DOI: 10.7759/cureus.26851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 12/21/2022] Open
Abstract
Due to the rapid development of the coronavirus disease 2019 (COVID-19) pandemic, the Food and Drug Administration (FDA) expedited the authorization of immunizations to counteract life-threatening COVID-19 effects. COVID-19 immunization was seen as an essential component of surviving endemically with COVID-19. Although there were no major adverse event reports that mandated an early authorization of the mass vaccination approval in initial studies, a few significant adverse events were reported after real-world usage. The most prevalent adverse events are regional reactions, such as discomfort at the injection site. Anaphylactic shock and acute responses were quite infrequent. Current evidence strongly convince the community that the advantages of immunization outweigh the risks. The review investigates the potential adverse reaction in the form of myocarditis caused by the COVID-19 vaccine. Age, sexuality, vaccination type, clinical manifestations, and diagnostic modalities were among the confounding factors associated with vaccine-induced myocarditis. This picture depicts COVID-19 immunization-induced myocarditis and the treatment options available to practitioners. Further evaluation is needed to establish the underlying cause of this association. We compiled the most recent data on SARS-CoV-2 vaccine-induced myocarditis after reviewing available research. Information sources including PubMed and Google Scholar were evaluated retrospectively.
Collapse
|
17
|
Ahmed SK, Mohamed MG, Essa RA, Ahmed Rashad EA, Ibrahim PK, Khdir AA, Wsu ZH. Global reports of myocarditis following COVID-19 vaccination: A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102513. [PMID: 35660931 PMCID: PMC9135698 DOI: 10.1016/j.dsx.2022.102513] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/30/2022] [Accepted: 05/17/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Recent media reports of myocarditis after receiving COVID-19 vaccines, particularly the messenger RNA (mRNA) vaccines, are causing public concern. This review summarizes information from published case series and case reports, emphasizing patient and disease characteristics, investigation, and clinical outcomes, to provide a comprehensive picture of the condition. METHODS A systematic literature search of PubMed and Google scholar was conducted from inception to April 27, 2022. Individuals who develop myocarditis after receiving the COVID-19 vaccine, regardless of the type of vaccine and dose, were included in the study. RESULTS Sixty-two studies, including 218 cases, participated in the current systematic review. The median age was 29.2 years; 92.2% were male and 7.8% were female. 72.4% of patients received the Pfizer-BioNTech (BNT162b2) vaccine, 23.8% of patients received the Moderna COVID-19 Vaccine (mRNA-1273), and the rest of the 3.5% received other types of COVID-19 vaccine. Furthermore, most myocarditis cases (82.1%) occurred after the second vaccine dose, after a median time interval of 3.5 days. The most frequently reported symptoms were chest pain, myalgia/body aches and fever. Troponin levels were consistently elevated in 98.6% of patients. The admission ECG was abnormal in 88.5% of cases, and the left LVEF was lower than 50% in 21.5% of cases. Most patients (92.6%) resolved symptoms and recovered, and only three patients died. CONCLUSION These findings may help public health policy to consider myocarditis in the context of the benefits of COVID-19 vaccination.
Collapse
Affiliation(s)
- Sirwan Khalid Ahmed
- Department of Emergency, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq; Department of Adult Nursing, University of Raparin, Rania, Sulaimani, Kurdistan-region, Iraq.
| | - Mona Gamal Mohamed
- Department of Adult Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Rawand Abdulrahman Essa
- Department of Emergency, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
| | - Eman Abdelaziz Ahmed Rashad
- Department of Adult Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Peshraw Khdir Ibrahim
- Department of Adult Nursing, University of Raparin, Rania, Sulaimani, Kurdistan-region, Iraq
| | - Awat Alla Khdir
- Department of Emergency, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
| | - Zhiar Hussen Wsu
- Department of Emergency, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
| |
Collapse
|
18
|
Behers BJ, Patrick GA, Jones JM, Carr RA, Behers BM, Melchor J, Rahl DE, Guerriero TD, Zhang H, Ozkardes C, Thomas ND, Sweeney MJ. Myocarditis Following COVID-19 Vaccination: A Systematic Review of Case Reports. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:237-247. [PMID: 35782472 PMCID: PMC9235262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: COVID-19, the infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), often presents with a spectrum of symptoms at varying levels of severity, ranging from asymptomatic patients to those with fatal complications, such as myocarditis. With increased availability of COVID-19 vaccines, the awareness of possible side effects has expanded as reports surface. This study reviewed cases of myocarditis following COVID-19 vaccination and with existing literature on COVID-19 infection-induced myocarditis to compare clinical courses and analyze possible mechanisms of action. Methods: A systematic review of literature was conducted to identify published case reports (as of February 3, 2022) pertaining to the development of myocarditis following COVID-19 vaccination with either Pfizer or Moderna for an in-depth analysis. Additional subgroup analyses were conducted based on age, past medical history, vaccine manufacturer, and dose number. Results: There were 53 eligible case reports that were included in this study. Patients were mostly male with a median age of 24 years, and the most reported symptom upon presentation was chest pain. Seventy percent of the cases involved the Pfizer vaccine with a majority of myocarditis developing subsequent to second dose. Resolution of symptoms was achieved in all but one patient. Clinical severity, as measured primarily by left ventricular ejection fraction, appeared to be worse among adult patients than pediatric, as well as for patients with comorbidities. Conclusion: This study revealed an observable association between COVID-19 vaccines and myocarditis. However, the clinical course and prognosis seem favorable and less prevalent than those conferred from natural infection.
Collapse
Affiliation(s)
| | | | - Jared M. Jones
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | - Rachel A. Carr
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | - Brett M. Behers
- University of South Florida College of Medicine, Tampa,
FL, USA
| | - Julian Melchor
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | - Delaney E. Rahl
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | | | - Hongyu Zhang
- Florida State University College of Medicine,
Tallahassee, FL, USA
- University of South Florida College of Medicine, Tampa,
FL, USA
| | - Cuneyt Ozkardes
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | | | | |
Collapse
|
19
|
Watanabe K, Ashikaga T, Maejima Y, Tao S, Terui M, Kishigami T, Kaneko M, Nakajima R, Okata S, Lee T, Horie T, Nagase M, Nitta G, Miyazaki R, Nagamine S, Nagata Y, Nozato T, Goya M, Sasano T. Case Report: Importance of MRI Examination in the Diagnosis and Evaluation of COVID-19 mRNA Vaccination Induced Myocarditis: Our Experience and Literature Review. Front Cardiovasc Med 2022; 9:844626. [PMID: 35571222 PMCID: PMC9091592 DOI: 10.3389/fcvm.2022.844626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Acute myocarditis is a rare but serious complication associated with mRNA-based coronavirus disease 2019 (COVID-19) vaccination. In this article, four COVID-19 mRNA vaccination induced myocarditis cases managed at our tertiary Medical Center have been discussed. Three patients had typical myocarditis. One patient suffered from atrioventricular block and heart failure, which required more intensive treatment, but eventually improved. Additionally, a review of cardiac magnetic resonance imaging (MRI) features related to the diagnosis of myocarditis showed that COVID-19 mRNA vaccine-associated myocarditis tend to have more late-gadolinium enhancement (LGE) accumulation in the inferior lateral wall direction. According to a report by the U.S. Centers for Disease Control and Prevention (CDC), the diagnosis of COVID-19 mRNA vaccine-associated myocarditis is based on clinical symptoms, altered myocardial enzymes, cardiac MRI finding, or histopathology. Cardiac MRI is relatively less invasive than myocardial biopsy and plays an important role in the diagnosis of myocarditis. This review may aid in the diagnosis of COVID-19 mRNA vaccine-associated myocarditis.
Collapse
Affiliation(s)
- Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
- *Correspondence: Keita Watanabe
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yasuhiro Maejima
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mao Terui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tetsuya Kishigami
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryota Nakajima
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tomoki Horie
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Sho Nagamine
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
20
|
Woo W, Kim AY, Yon DK, Lee SW, Hwang J, Jacob L, Koyanagi A, Kim MS, Moon DH, Jung JW, Choi JY, Jung SY, Eun LY, Lee S, Shin JI, Smith L. Clinical characteristics and prognostic factors of myocarditis associated with the mRNA COVID-19 vaccine. J Med Virol 2022; 94:1566-1580. [PMID: 34862617 PMCID: PMC9015469 DOI: 10.1002/jmv.27501] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023]
Abstract
To analyze the clinical presentation and outcomes of myocarditis after administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccine. Nine case series and 15 case reports (74 patients) of myocarditis after administration of the BNT162b2 or mRNA-1273 vaccine were reviewed from PubMed, Scopus, Embase, and Web of Science. We analyzed clinical manifestations, diagnostic findings, and outcomes. In addition, we performed a pooled analysis and investigated risk factors leading to admission to the intensive care unit and recovery with conservative care. Most patients were male (94.6%), and the median age (range) was 17.6 (14-70) years. Patients who received the BNT162b2 (n = 58, 78.4%) vaccine presented fewer systemic symptoms and left ventricular dysfunction than mRNA-1273 recipients. Although patients under 20 years experienced more fever and myalgia, they had better ejection fraction and less prominent myocardial inflammation in magnetic resonance imaging than older patients. The clinical course of all patients was favorable without mortality, and one-third of patients resolved with conservative care alone. Risk factor analyses revealed that patients with gastrointestinal symptoms required intensive care (odds ratio: 20.3, 95% confidence interval 1.90-217, p = 0.013). The risk of fatality in myocarditis subjected to mRNA vaccination seems to be low. However, patients with gastrointestinal symptoms received more intensive care, and a significant proportion of patients recovered with conservative management.
Collapse
Affiliation(s)
- Wongi Woo
- Department of Thoracic and Cardiovascular SurgeryGangnam Severance Hospital, Yonsei University College of MedicineSeoulKorea
| | - Ah Y. Kim
- Department of PediatricsYonsei University College of MedicineSeoulKorea
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Dong K. Yon
- Department of PediatricsSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Seung W. Lee
- Department of Data ScienceSejong University College of Software ConvergenceSeoulSouth Korea
| | - Jimin Hwang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
| | - Louis Jacob
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Fundacio Sant Joan de Deu, Sant Boi de LlobregatUniversitat de BarcelonaBarcelonaSpain
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Sungkyunkwan UniversitySeoulRepublic of Korea
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Fundacio Sant Joan de Deu, Sant Boi de LlobregatUniversitat de BarcelonaBarcelonaSpain
- Faculty of Medicine, University of Versailles Saint‐Quentin‐en‐YvelinesMontigny‐le‐BretonneuxFrance
| | - Min S. Kim
- ICREA, Pg. Lluis Companys 23BarcelonaSpain
| | - Duk H. Moon
- Department of Thoracic and Cardiovascular SurgeryGangnam Severance Hospital, Yonsei University College of MedicineSeoulKorea
| | - Jo W. Jung
- Department of PediatricsYonsei University College of MedicineSeoulKorea
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Jae Y. Choi
- Department of PediatricsYonsei University College of MedicineSeoulKorea
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Se Y. Jung
- Department of PediatricsYonsei University College of MedicineSeoulKorea
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Lucy Y. Eun
- Department of PediatricsYonsei University College of MedicineSeoulKorea
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular SurgeryGangnam Severance Hospital, Yonsei University College of MedicineSeoulKorea
| | - Jae Il Shin
- Department of PediatricsYonsei University College of MedicineSeoulKorea
| | - Lee Smith
- Cambridge Centre for Health, Performance, and WellbeingAnglia Ruskin UniversityCambridgeUK
| |
Collapse
|
21
|
Vecchié A, Del Buono MG, Mauro AG, Cremer PC, Imazio M, Klein AL, Abbate A, Dentali F, Bonaventura A. Advances in pharmacotherapy for acute and recurrent pericarditis. Expert Opin Pharmacother 2022; 23:681-691. [DOI: 10.1080/14656566.2022.2054327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | - Marco Giuseppe Del Buono
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Paul C. Cremer
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital “Santa Maria della Misericordia,” ASUFC, Udine, Italy
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Antonio Abbate
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Aldo Bonaventura
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| |
Collapse
|
22
|
Chen JH, Ikwuanusi IA, Bommu VJL, Patel V, Aujla H, Kaushik V, Cheriyath P. COVID-19 Vaccine-Related Myocarditis: A Descriptive Study of 40 Case Reports. Cureus 2022; 14:e21740. [PMID: 35251812 PMCID: PMC8887934 DOI: 10.7759/cureus.21740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 12/21/2022] Open
Abstract
After the surging rise in the Coronavirus disease 2019 (COVID-19) pandemic, the Food and Drug Administration (FDA) approved emergency approval of vaccinations to prevent life-threatening complications of COVID-19 infection. These vaccines are BNT162b2, mRNA-1273. Later, the FDA also approved JNJ-78436735. COVID-19 vaccination does not have major side effects, but there are some concerning adverse events reported right after vaccination. Myocarditis is one of them. Based on our analysis of 40 case reports, we are presenting the epidemiology and clinical picture of myocarditis related to the COVID-19 vaccine. Based on our analysis, we found that the majority of cases were seen in males with 90% predominance, and these cases were seen in the age group of 29.13 years old (mean, SD of 14.39 years). In 65% of cases, patients took the BNT162b2 vaccine; 30% of cases were reported with the mRNA-1273 vaccine; and 5% of cases with JNJ-78436735. Of all the cases, 80% of them are reported after the second dose of the vaccine with either Moderna or Pfizer. The characteristics of COVID-19 vaccine-related myocarditis were analyzed in this study. We identified several findings, ranging from age, gender, type of vaccination, presentation of symptoms, and diagnosis modality. This depicts the picture of COVID-19 vaccine-related myocarditis and what physicians should expect when dealing with the disease. Our analysis showed that more cases were reported after receiving the BNT162b2 vaccine compared to mRNA-1273 and JNJ-78436735 vaccines. Further research needs to be conducted to analyze the underlying cause of this association.
Collapse
Affiliation(s)
- Jia Hong Chen
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | | | | | - Vraj Patel
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | | | - Vishrut Kaushik
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Pramil Cheriyath
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| |
Collapse
|
23
|
Fatima M, Ahmed Cheema H, Ahmed Khan MH, Shahid H, Saad Ali M, Hassan U, Wahaj Murad M, Aemaz Ur Rehman M, Farooq H. Development of myocarditis and pericarditis after COVID-19 vaccination in adult population: A systematic review. Ann Med Surg (Lond) 2022; 76:103486. [PMID: 35291413 PMCID: PMC8912977 DOI: 10.1016/j.amsu.2022.103486] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 12/20/2022] Open
Abstract
Objectives A clear temporal relationship between myocarditis and pericarditis after COVID-19 vaccination has led to the belief that the vaccine may act as a trigger for these cardiologic complications. The aim of this systematic review is to explore the incidence, clinical presentation, management, and association between them. Methods We conducted a systematic literature search on Cochrane, MEDLINE, and EMBASE as per guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews). A total of 41 case reports and case series describing 97 patients, and 5 original articles describing 15,585,309 participants were selected as part of this review. Results Of the 97 reported cases describing vaccine-associated myocarditis/pericarditis, 67 (69%) patients received Pfizer-BioNTech and 25 (25.7%) received Moderna. The mean onset of symptoms after vaccine administration was 3.8 ± 4.5 days with three-quarters developing symptoms after the second dose. Chest pain (n = 88, 90%) and fever (n = 33, 34%) were the most common presenting complaints. Out of 97, 80 (82.5%) patients recovered while 4 (4.1%) patients expired. The pooled incidence of myocarditis and pericarditis extrapolated from original studies is 0.001% and 0.0004%, respectively. In the original studies, nearly all the cases of myocarditis and pericarditis were mild. Chest pain and fever were the most common presenting symptoms. Conclusion Myocarditis and pericarditis after the COVID-19 vaccine have been reported more in young adult males and are most likely to occur after the second dose of mRNA vaccines. The presentation is mild and the majority of the patients recover either completely or partially. Myocarditis and pericarditis have been reported after the COVID-19 vaccine. It is occurs more commonly in males as compared to females. Myocarditis and Pericarditis is more likely to occur after second dose of mRNA vaccine. The presentation is mild, and most of the patients recover either completely or partially. Autoimmunity (molecular mimicry) is thought to be the major pathological mediator.
Collapse
|
24
|
Melatonin: highlighting its use as a potential treatment for SARS-CoV-2 infection. Cell Mol Life Sci 2022; 79:143. [PMID: 35187603 PMCID: PMC8858600 DOI: 10.1007/s00018-021-04102-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
Numerous pharmaceutical drugs have been repurposed for use as treatments for COVID-19 disease. These drugs have not consistently demonstrated high efficacy in preventing or treating this serious condition and all have side effects to differing degrees. We encourage the continued consideration of the use of the antioxidant and anti-inflammatory agent, melatonin, as a countermeasure to a SARS-CoV-2 infection. More than 140 scientific publications have identified melatonin as a likely useful agent to treat this disease. Moreover, the publications cited provide the rationale for the use of melatonin as a prophylactic agent against this condition. Melatonin has pan-antiviral effects and it diminishes the severity of viral infections and reduces the death of animals infected with numerous different viruses, including three different coronaviruses. Network analyses, which compared drugs used to treat SARS-CoV-2 in humans, also predicted that melatonin would be the most effective agent for preventing/treating COVID-19. Finally, when seriously infected COVID-19 patients were treated with melatonin, either alone or in combination with other medications, these treatments reduced the severity of infection, lowered the death rate, and shortened the duration of hospitalization. Melatonin’s ability to arrest SARS-CoV-2 infections may reduce health care exhaustion by limiting the need for hospitalization. Importantly, melatonin has a high safety profile over a wide range of doses and lacks significant toxicity. Some molecular processes by which melatonin resists a SARS-CoV-2 infection are summarized. The authors believe that all available, potentially beneficial drugs, including melatonin, that lack toxicity should be used in pandemics such as that caused by SARS-CoV-2.
Collapse
|
25
|
Bellos I, Karageorgiou V, Viskin D. Myocarditis following mRNA Covid-19 vaccination: a pooled analysis. Vaccine 2022; 40:1768-1774. [PMID: 35153093 PMCID: PMC8818354 DOI: 10.1016/j.vaccine.2022.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/22/2022] [Accepted: 02/02/2022] [Indexed: 12/15/2022]
Abstract
Background Methods Results Conclusions
Collapse
|
26
|
Simnani FZ, Singh D, Kaur R. COVID-19 phase 4 vaccine candidates, effectiveness on SARS-CoV-2 variants, neutralizing antibody, rare side effects, traditional and nano-based vaccine platforms: a review. 3 Biotech 2022; 12:15. [PMID: 34926119 PMCID: PMC8665991 DOI: 10.1007/s13205-021-03076-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has endangered world health and the economy. As the number of cases is increasing, different companies have started developing potential vaccines using both traditional and nano-based platforms to overcome the pandemic. Several countries have approved a few vaccine candidates for emergency use authorization (EUA), showing significant effectiveness and inducing a robust immune response. Oxford-AstraZeneca, Pfizer-BioNTech's BNT162, Moderna's mRNA-1273, Sinovac's CoronaVac, Johnson & Johnson, Sputnik-V, and Sinopharm's vaccine candidates are leading the race. However, the SARS-CoV-2 is constantly mutating, making the vaccines less effective, possibly by escaping immune response for some variants. Besides, some EUA vaccines have been reported to induce rare side effects such as blood clots, cardiac injury, anaphylaxis, and some neurological effects. Although the COVID-19 vaccine candidates promise to overcome the pandemic, a more significant and clear understanding is needed. In this review, we brief about the clinical trial of some leading candidates, their effectiveness, and their neutralizing effect on SARS-CoV-2 variants. Further, we have discussed the rare side effects, different traditional and nano-based platforms to understand the scope of future development.
Collapse
Affiliation(s)
| | - Dibyangshee Singh
- KIIT School of Biotechnology, KIIT University, Bhubaneswar, 751024 India
| | - Ramneet Kaur
- Department of Life Sciences, RIMT University, Ludhiana, Punjab India
| |
Collapse
|
27
|
Fazlollahi A, Zahmatyar M, Noori M, Nejadghaderi SA, Sullman MJM, Shekarriz-Foumani R, Kolahi AA, Singh K, Safiri S. Cardiac complications following mRNA COVID-19 vaccines: A systematic review of case reports and case series. Rev Med Virol 2021; 32:e2318. [PMID: 34921468 DOI: 10.1002/rmv.2318] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 12/21/2022]
Abstract
There have been several local and systemic adverse events associated with mRNA COVID-19 vaccines. Pericarditis, myocarditis and myocardial infarction are examples of cardiac complications related to these vaccines. In this article, we conducted a systematic review of case reports and case series to identify the clinical profile, investigations, and management of reported cardiac complications post-mRNA COVID-19 vaccines. We systematically searched PubMed, Scopus, Web of Science, and Google Scholar, as well as the medRxiv preprint server, with terms including: 'SARS-CoV-2', 'COVID-19', 'messenger RNA vaccine*', 'mRNA-1273 vaccine', 'BNT162 vaccine', 'myocarditis', 'pericarditis', 'stroke' and 'Myocardial Ischemia' up to 25 September 2021. Studies were excluded if they were not case reports or case series, or reported cases from non-mRNA vaccines. Case reports and case series were included that investigated the potential cardiac complications associated with mRNA COVID-19 vaccines. The JBI checklist was used to assess quality and data synthesis was conducted using a qualitative methodology called narrative synthesis. Sixty-nine studies, including 43 case reports and 26 case series, were included. Myocarditis/myopericarditis and pericarditis were the most common adverse events among the 243 reported cardiac complications, post mRNA COVID-19 vaccination. Males with a median age of 21 years had the highest frequency of myocarditis. Almost three quarters (74.4%) of cases with myocarditis had received the BNT162b2 vaccine and 87.7% had received the second dose of the vaccine. Chest pain (96.1%) and fever (38.2%) were the most common presentations. CK-MB, troponin, and NT-proBNP were elevated in 100%, 99.5% and 78.3% of subjects, respectively. ST-segment abnormality was the most common electrocardiogram feature. Cardiac magnetic resonance imaging, which is the gold-standard approach for diagnosing myocarditis, was abnormal in all patients diagnosed with myocarditis. Non-steroidal anti-inflammatory drugs were the most prescribed medication for the management of myocarditis. Apart from inflammatory conditions, some rare cases of Takotsubo cardiomyopathy, myocardial infarction, myocardial infarction with non-obstructive coronary arteries, and isolated tachycardia were also reported following immunisation with mRNA COVID-19 vaccines. We acknowledge that only reviewing case reports and case series studies is one potential limitation of our study. We found that myocarditis was the most commonly reported adverse cardiac event associated with mRNA COVID-19 vaccines, which presented as chest pain with a rise in cardiac biomarkers. Further large-scale observational studies are recommended.
Collapse
Affiliation(s)
- Asra Fazlollahi
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Zahmatyar
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Reza Shekarriz-Foumani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kuljit Singh
- Department of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Saeid Safiri
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|