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Heymans S, Van Linthout S, Kraus SM, Cooper LT, Ntusi NAB. Clinical Characteristics and Mechanisms of Acute Myocarditis. Circ Res 2024; 135:397-411. [PMID: 38963866 DOI: 10.1161/circresaha.124.324674] [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: 07/06/2024]
Abstract
REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05335928.
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Affiliation(s)
- Stephane Heymans
- Centre for Heart Failure Research, Department of Cardiology, Maastricht University, The Netherlands (S.H.)
- Department of Cardiovascular Sciences, University of Leuven, Belgium (S.H.)
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany (S.V.L.)
- German Centre for Cardiovascular Research, partner site Berlin, Germany (S.V.L.)
| | - Sarah Mignon Kraus
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa (S.M.K., N.A.B.N.)
- South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa (S.M.K., N.A.B.N.)
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.)
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa (S.M.K., N.A.B.N.)
- South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa (S.M.K., N.A.B.N.)
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa (N.A.B.N.)
- ARUA/Guild Cluster of Research Excellence on Noncommunicable Diseases and Associated Multiborbidity, South Africa (N.A.B.N.)
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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.
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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
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Caobelli F, Cabrero JB, Galea N, Haaf P, Loewe C, Luetkens JA, Muscogiuri G, Francone M. Cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) imaging in the diagnosis and follow-up of patients with acute myocarditis and chronic inflammatory cardiomyopathy : A review paper with practical recommendations on behalf of the European Society of Cardiovascular Radiology (ESCR). Int J Cardiovasc Imaging 2023; 39:2221-2235. [PMID: 37682416 PMCID: PMC10674005 DOI: 10.1007/s10554-023-02927-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023]
Abstract
Advanced cardiac imaging techniques such as cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) are widely used in clinical practice in patients with acute myocarditis and chronic inflammatory cardiomyopathies (I-CMP). We aimed to provide a review article with practical recommendations from the European Society of Cardiovascular Radiology (ESCR), in order to guide physicians in the use and interpretation of CMR and PET in clinical practice both for acute myocarditis and follow-up in chronic forms of I-CMP.
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Affiliation(s)
- Federico Caobelli
- Department of Nuclear Medicine, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, Bern, 3000, Switzerland.
| | | | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy
| | - Philip Haaf
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, and University of Basel, Petersgraben 4, Basel, CH-4031, Switzerland
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University Vienna, Spitalgasse 9, Vienna, A-1090, Austria
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
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Jeong NY, Kim CJ, Park SM, Kim YJ, Lee J, Choi NK. Active surveillance for adverse events of influenza vaccine safety in elderly cancer patients using self-controlled tree-temporal scan statistic analysis. Sci Rep 2023; 13:13346. [PMID: 37587127 PMCID: PMC10432531 DOI: 10.1038/s41598-023-40091-y] [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: 04/27/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
Both cancer patients and the elderly are at high risk of developing flu complications, so influenza vaccination is recommended. We aimed to evaluate potential adverse events (AEs) following influenza vaccination in elderly cancer patients using the self-controlled tree-temporal scan statistic method. From a large linked database of Korea Disease Control and Prevention Agency vaccination data and the National Health Insurance Service claims data, we identified cancer patients aged over 65 who received flu vaccines during the 2016/2017 and 2017/2018 seasons. We included all the outcomes occurring on 1-84 days post-vaccination and evaluated all temporal risk windows, which started 1-28 days and ended 2-42 days. Patients who were diagnosed with the same disease during a year prior to vaccination were excluded. We used the hierarchy of ICD-10 to identify statistically significant clustering. This study included 431,276 doses of flu vaccine. We detected signals for 1 set: other dorsopathies on 1-15 days (attributable risk 16.5 per 100,000, P = 0.017). Dorsopathy is a known AE of influenza vaccine. No statistically significant clusters were found when analyzed by flu season. Therefore, influenza vaccination is more recommended for elderly patients with cancer and weakened immune systems.
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Affiliation(s)
- Na-Young Jeong
- Department of Health Convergence, College of Science & Industry Convergence, Ewha Womans University, Seoul, Korea
| | - Chung-Jong Kim
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul National University College of Medicine, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joongyub Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, College of Science & Industry Convergence, Ewha Womans University, Seoul, Korea.
- Graduate School of Industrial Pharmaceutical Science, College of Pharmacy, Ewha Womans University, Seoul, Korea.
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Bouchaala A, Nguadi J, Benhlima A, Arfaoui M, Elhamzaoui H, Alilou M. Post-vaccine COVID-19 acute myocarditis: case reports and literature review. Pan Afr Med J 2023; 44:192. [PMID: 37484597 PMCID: PMC10362684 DOI: 10.11604/pamj.2023.44.192.35425] [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: 05/12/2022] [Accepted: 04/06/2023] [Indexed: 07/25/2023] Open
Abstract
COVID-19 vaccines have reduced both lethality and hospitalization rates of the novel coronavirus disease. Nevertheless, multiple side effects have been reported in the literature, most often are harmless. We report two cases of acute myocarditis, hospitalized in the emergency department for chest pain occurring after the second dose of mRNA vaccine AstraZeneca. The SARS-Cov-2 infection was ruled out in both patients with a negative PCR obtained by nasal swabs and normal thoracic CT scans. Both patients had high levels of high-sensitive cardiac troponin I. Acute coronary syndromes were excluded with cardiac catheterization. Cardiac Magnetic resonance imaging (MRI) showed signs in favor of acute myocarditis. The evolution was favorable for both patients after being put on anti-inflammatory treatment. The universality and accumulation of reports concerning acute myocarditis following COVID vaccination, in the absence of any other diagnostic element that could explain the myocardial injury, establish a strong causal link, although the etiopathogenesis of such injury remains poorly elucidated.
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Affiliation(s)
- Abderrahmane Bouchaala
- Emergency Department, Ibn Sina Hospital, Faculty of Medicine and Pharmacy in Rabat, Rabat, Morocco
| | - Jaouad Nguadi
- Emergency Department, Ibn Sina Hospital, Faculty of Medicine and Pharmacy in Rabat, Rabat, Morocco
| | - Abdelakder Benhlima
- Emergency Department, Ibn Sina Hospital, Faculty of Medicine and Pharmacy in Rabat, Rabat, Morocco
| | - Manal Arfaoui
- Emergency Department, Ibn Sina Hospital, Faculty of Medicine and Pharmacy in Rabat, Rabat, Morocco
| | - Hamza Elhamzaoui
- Emergency Department, Ibn Sina Hospital, Faculty of Medicine and Pharmacy in Rabat, Rabat, Morocco
| | - Mustapha Alilou
- Emergency Department, Ibn Sina Hospital, Faculty of Medicine and Pharmacy in Rabat, Rabat, Morocco
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Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology. Vaccines (Basel) 2023; 11:vaccines11020362. [PMID: 36851240 PMCID: PMC9967770 DOI: 10.3390/vaccines11020362] [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: 12/12/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
The COVID-19 pandemic has led to significant loss of life and severe disability, justifying the expedited testing and approval of messenger RNA (mRNA) vaccines. While found to be safe and effective, there have been increasing reports of myocarditis after COVID-19 mRNA vaccine administration. The acute events have been severe enough to require admission to the intensive care unit in some, but most patients fully recover with only rare deaths reported. The pathways involved in the development of vaccine-associated myocarditis are highly dependent on the specific vaccine. COVID-19 vaccine-associated myocarditis is believed to be primarily caused by uncontrolled cytokine-mediated inflammation with possible genetic components in the interleukin-6 signaling pathway. There is also a potential autoimmune component via molecular mimicry. Many of these pathways are similar to those seen in viral myocarditis, indicating a common pathophysiology. There is concern for residual cardiac fibrosis and increased risk for the development of cardiomyopathies later in life. This is of particular interest for patients with congenital heart defects who are already at increased risk for fibrotic cardiomyopathies. Though the risk for vaccine-associated myocarditis is important to consider, the risk of viral myocarditis and other injury is far greater with COVID-19 infection. Considering these relative risks, it is still recommended that the general public receive vaccination against COVID-19, and it is particularly important for congenital heart defect patients to receive vaccination for COVID-19.
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Wang WH, Wei KC, Huang YT, Huang KH, Tsai TH, Chang YC. The Incidence of Myocarditis Following an Influenza Vaccination: A Population-Based Observational Study. Drugs Aging 2023; 40:145-151. [PMID: 36626028 PMCID: PMC9838541 DOI: 10.1007/s40266-022-00997-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Recently, studies have pointed to a link between coronavirus disease 2019 vaccinations and myocarditis. Myocarditis following an influenza vaccine has been sporadically reported. However, it is not known whether this adverse event occurs among elderly individuals who have received influenza vaccines. We used a population-based database and a self-controlled case-series design to estimate the incidence of myocarditis following an influenza vaccination. METHODS Data were extracted from Taiwan's National Health Insurance Research Database. The study population consisted of elderly people aged ≥ 65 years who had de novo myocarditis, which required hospitalization, within 6 months after receiving an influenza vaccination between 2003 and 2017. The first 1-7, 1-14, and 1-42 days after vaccination were defined as risk intervals, and the other periods were defined as control intervals. Poisson regression was used to calculate the incidence rate ratio for myocarditis between the risk and control periods. RESULTS Within 180 days following a vaccination, 191 people were hospitalized for myocarditis among 19,678,904 people. In comparison with control intervals, the incidence rate ratios of an admission for myocarditis for days 1-7, 1-14, and 1-42 were 0.80 (95% confidence interval 0.36-1.81), 0.72 (95% confidence interval 0.39-1.32), and 0.73 (95% confidence interval 0.50-1.05), respectively. Subgroup analyses by sex, age, Charlson Comorbidity Index scores, and comorbidities did not yield significant differences in the incidence rate ratio. CONCLUSIONS Regardless of the post-vaccination time and underlying baseline characteristics, the incidence risk of myocarditis is not significantly increased in the elderly following an influenza vaccination.
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Affiliation(s)
- Wen-Hwa Wang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- College of Management, I-Shou University, Kaohsiung, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Department of Medical Research and Development, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yu-Chia Chang
- Department of Long Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, 892009, Taiwan.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, 41354, Taiwan.
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Chou OHI, Mui J, Chung CT, Radford D, Ranjithkumar S, Evbayekha E, Nam R, Pay L, Satti DI, Garcia-Zamora S, Bazoukis G, Çinier G, Lee S, Vassiliou VS, Liu T, Tse G, Wong ICK, Chou OHI, Liu T, Tse G. COVID-19 vaccination and carditis in children and adolescents: a systematic review and meta-analysis. Clin Res Cardiol 2022; 111:1161-1173. [PMID: 35906423 PMCID: PMC9361966 DOI: 10.1007/s00392-022-02070-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronavirus Disease-2019 (COVID-19) vaccination has been associated with the development of carditis, especially in children and adolescent males. However, the rates of these events in the global setting have not been explored in a systematic manner. The aim of this systematic review and meta-analysis is to investigate the rates of carditis in children and adolescents receiving COVID-19 vaccines. METHODS PubMed, Embase and several Latin American databases were searched for studies. The number of events, and where available, at-risk populations were extracted. Rate ratios were calculated and expressed as a rate per million doses received. Subgroup analysis based on the dose administered was performed. Subjects ≤ 19 years old who developed pericarditis or myocarditis following COVID-19 vaccination were included. RESULTS A total of 369 entries were retrieved. After screening, 39 articles were included. Our meta-analysis found that 343 patients developed carditis after the administration of 12,602,625 COVID-19 vaccination doses (pooled rate per million: 37.76; 95% confidence interval [CI] 23.57, 59.19). The rate of carditis was higher amongst male patients (pooled rate ratio: 5.04; 95% CI 1.40, 18.19) and after the second vaccination dose (pooled rate ratio: 5.60; 95% CI 1.97, 15.89). In 301 cases of carditis (281 male; mean age: 15.90 (standard deviation [SD] 1.52) years old) reported amongst the case series/reports, 261 patients were reported to have received treatment. 97.34% of the patients presented with chest pain. The common findings include ST elevation and T wave abnormalities on electrocardiography. Oedema and late gadolinium enhancement in the myocardium were frequently observed in cardiac magnetic resonance imaging (CMR). The mean length of hospital stay was 3.91 days (SD 1.75). In 298 out of 299 patients (99.67%) the carditis resolved with or without treatment. CONCLUSIONS Carditis is a rare complication after COVID-19 vaccination across the globe, but the vast majority of episodes are self-limiting with rapid resolution of symptoms within days. Central illustration. Balancing the benefits of vaccines on COVID-19-caused carditis and post-vaccination carditis.
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Affiliation(s)
- Oscar Hou In Chou
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Jonathan Mui
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Cheuk To Chung
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Danny Radford
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
- Kent and Medway Medical School, Canterbury Christ Church University, Canterbury, UK
- Kent and Medway Medical School, University of Kent, Canterbury, United Kingdom
| | - Simon Ranjithkumar
- Faculty of Health and Life Sciences, Aston University Medical School, Birmingham, B4 7ET, UK
| | - Endurance Evbayekha
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Ronald Nam
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
- Faculty of Health and Life Sciences, Aston University Medical School, Birmingham, B4 7ET, UK
| | - Levent Pay
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34668, Istanbul, Turkey
| | - Danish Iltaf Satti
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Sebastian Garcia-Zamora
- Cardiac Intensive Care Unit, Department of Cardiology, Delta Clinic, Rosario, Santa Fe, Argentina
| | - George Bazoukis
- Department of Cardiology, Medical School, University of Nicosia, 2408, Nicosia, Cyprus
| | - Göksel Çinier
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34668, Istanbul, Turkey
| | - Sharen Lee
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Vassilios S Vassiliou
- Department of Medicine, Bob Champion Research and Education, Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Rosalind Franklin Rd, Norwich, NR4 7UQ, UK.
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
- Kent and Medway Medical School, University of Kent, Canterbury, United Kingdom.
| | - Ian Chi Kei Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
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Nakamura R, Ando SI, Kato S, Kadokami T. Acute Lymphocyte Myocarditis Associated with Influenza Vaccination. Intern Med 2022; 61:2307-2313. [PMID: 35022355 PMCID: PMC9424099 DOI: 10.2169/internalmedicine.8855-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An elderly patient was admitted to our hospital for acute heart failure soon after receiving influenza vaccination. On admission, chest radiography revealed pulmonary edema. An electrocardiogram showed poor R progression, and echocardiography showed diffuse hypokinesis and myocardial edema. The serum troponin level was elevated. A histopathological evaluation indicated active myocarditis with lymphocyte-predominant infiltrates. A drug-induced lymphocyte stimulation test (DLST) was positive. The patient rapidly recovered from heart failure after treatment with conventional heart failure drugs, such as intravenous diuretics and vasodilators. These experimental data and the clinical course suggest that influenza vaccination was responsible for heart failure due to acute lymphocyte myocarditis.
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Affiliation(s)
- Ryo Nakamura
- Department of Cardiology Division, Saiseikai Futsukaichi Hospital, Japan
| | - Shin-Ichi Ando
- Department of Cardiology Division, Saiseikai Futsukaichi Hospital, Japan
- Sleep Apnea Center, Kyushu University Hospital, Japan
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital, Japan
| | - Toshiaki Kadokami
- Department of Cardiology Division, Saiseikai Futsukaichi Hospital, Japan
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Mahroum N, Lavine N, Ohayon A, Seida R, Alwani A, Alrais M, Zoubi M, Bragazzi NL. COVID-19 Vaccination and the Rate of Immune and Autoimmune Adverse Events Following Immunization: Insights From a Narrative Literature Review. Front Immunol 2022; 13:872683. [PMID: 35865539 PMCID: PMC9294236 DOI: 10.3389/fimmu.2022.872683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022] Open
Abstract
Despite their proven efficacy and huge contribution to the health of humankind, vaccines continue to be a source of concern for some individuals around the world. Vaccinations against COVID-19 increased the number of distressed people and intensified their distrust, particularly as the pandemic was still emerging and the populations were encouraged to be vaccinated under various slogans like “back to normal life” and “stop coronavirus”, goals which are still to be achieved. As fear of vaccination-related adverse events following immunization (AEFIs) is the main reason for vaccine hesitancy, we reviewed immune and autoimmune AEFIs in particular, though very rare, as the most worrisome aspect of the vaccines. Among others, autoimmune AEFIs of the most commonly administered COVID-19 vaccines include neurological ones such as Guillain-Barre syndrome, transverse myelitis, and Bell’s palsy, as well as myocarditis. In addition, the newly introduced notion related to COVID-19 vaccines, “vaccine-induced immune thrombotic thrombocytopenia/vaccine-induced prothrombotic immune thrombotic thrombocytopenia” (VITT/VIPITT)”, is of importance as well. Overviewing recent medical literature while focusing on the major immune and autoimmune AEFIs, demonstrating their rate of occurrence, presenting the cases reported, and their link to the specific type of COVID-19 vaccines represented the main aim of our work. In this narrative review, we illustrate the different vaccine types in current use, their associated immune and autoimmune AEFIs, with a focus on the 3 main COVID-19 vaccines (BNT162b2, mRNA-1273, and ChAdOx1). While the rate of AEFIs is extremely low, addressing the issue in this manner, in our opinion, is the best strategy for coping with vaccine hesitancy.
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Affiliation(s)
- Naim Mahroum
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Noy Lavine
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
- St. George School of Medicine, University of London, London, United Kingdom
| | - Aviran Ohayon
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
- St. George School of Medicine, University of London, London, United Kingdom
| | - Ravend Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Abdulkarim Alwani
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mahmoud Alrais
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Magdi Zoubi
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- *Correspondence: Nicola Luigi Bragazzi,
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Alizadeh LS, Koch V, Yel I, Grünewald LD, Mathies D, Martin S, Vogl TJ, Rauschning D, Booz C. A case of myocarditis after COVID-19 vaccination: incidental or consequential? Heliyon 2022; 8:e09537. [PMID: 35655920 PMCID: PMC9142175 DOI: 10.1016/j.heliyon.2022.e09537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/11/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022] Open
Abstract
Vaccination represents one of the fundamentals in the fight against SARS-CoV-2. Myocarditis has been reported as a rare but possible adverse consequence of different vaccines, and its clinical presentation can range from mild symptoms to acute heart failure. We report a case of a 29-year-old man who presented with fever and retrosternal pain after receiving SARS-CoV-2 vaccine. Cardiac magnetic resonance imaging and laboratory data revealed typical findings of acute myocarditis.
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12
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Roh DE, Na H, Kwon JE, Choi I, Kim YH, Cho HJ. Chest Pain and Suspected Myocarditis Related to COVID-19 Vaccination in Adolescents-A Case Series. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050693. [PMID: 35626870 PMCID: PMC9139654 DOI: 10.3390/children9050693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022]
Abstract
As adolescents started to be vaccinated against coronavirus disease 2019 (COVID-19), suspected myocarditis and pericarditis related to the vaccine were reported in adolescents. According to the Korea Disease Control and Prevention Agency (KDCA), 2,796,270 persons aged 12−18 years were fully vaccinated by December 8. Among these, 9223 adverse events were reported (0.33%). We aimed to elucidate the clinical courses and short-term outcomes for adolescents aged 12−18 with cardiac symptoms and suspected myo- or peri-carditis related to COVID-19 vaccination in South Korea. Methods: We retrospectively collected data on patients ≤ 18 years of age who had suspected myocarditis or pericarditis within 30 days of COVID-19 vaccination, from July 2021 to January 2022. Results: We reported on 40 adolescents in different South Korean provinces at two centers. Twenty-six cases (65%) were male, and the median age was 16 years (range, 13−18; IQR 14.5−17). Twenty-five cases (62.5%) occurred at the first dose, and fifteen (37.5%) occurred after the second dose. Symptoms started at a median of 2 days (range 0−29 days; IQR 1−5 days) after vaccination. The patients were treated with nonsteroidal anti-inflammatory drugs (77.5%), intravenous immunoglobulin (2.5%), glucocorticoids (20%), colchicine (5%), or no therapy (15%). Five patients (12.5%) required intensive care unit admission; one patient needed inotropic/vasoactive support. No patients required extracorporeal membrane oxygenation or died. The median hospital stay was one day (range 0−8 days; IQR 0−2 days). Twenty-one patients (52.5%) had an abnormal electrocardiogram; among these, seven patients had an elevated ST segment, six patients (15%) had decreased ejection fraction (<55%), and LV function was completely recovered in all of them. Conclusions: Most cases of suspected myocarditis after COVID-19 vaccination in adolescents ≤ 18 years had mild symptoms and clinical courses, as well as a complete recovery. Further studies are needed to evaluate long-term outcomes.
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Affiliation(s)
- Da-Eun Roh
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41566, Korea; (D.-E.R.); (J.-E.K.)
- Department of Pediatrics, Busan Baik Hospital, Inje University College of Medicine, Busan 50834, Korea
| | - Hyejin Na
- Department of Pediatrics, Chonnam National University Children’s Hospital, Gwangju 61469, Korea; (H.N.); (I.C.)
- Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju 61469, Korea
| | - Jung-Eun Kwon
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41566, Korea; (D.-E.R.); (J.-E.K.)
| | - Insu Choi
- Department of Pediatrics, Chonnam National University Children’s Hospital, Gwangju 61469, Korea; (H.N.); (I.C.)
- Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju 61469, Korea
| | - Yeo-Hyang Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41566, Korea; (D.-E.R.); (J.-E.K.)
- Correspondence: (Y.-H.K.); (H.-J.C.)
| | - Hwa-Jin Cho
- Department of Pediatrics, Chonnam National University Children’s Hospital, Gwangju 61469, Korea; (H.N.); (I.C.)
- Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju 61469, Korea
- Correspondence: (Y.-H.K.); (H.-J.C.)
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13
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Parmar K, Subramanyam S, Del Rio-Pertuz G, Sethi P, Argueta-Sosa E. Cardiac Adverse Events after Vaccination—A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10050700. [PMID: 35632455 PMCID: PMC9143985 DOI: 10.3390/vaccines10050700] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 01/27/2023] Open
Abstract
The Vaccine Adverse Event Reporting System database has been used to report adverse events following several vaccines. We studied the patient population predisposed to such reactions and how these reactions differ with respect to the vaccine type. We searched the electronic databases PubMed, EMBASE, and Scopus up to 9 July 2021 for any study describing cardiac adverse events attributed to the vaccination. A total of 56 studies met the criteria comprising 340 patients. There were 20 studies describing cardiac adverse events following smallpox vaccination, 11 studies describing adverse events after influenza vaccination, and 18 studies describing adverse events after COVID-19 vaccination. There was a total of six studies describing cardiac adverse events after the pneumococcal vaccine, tetanus toxoid, cholera vaccine, and rabies vaccine. Adverse events following influenza vaccination occurred more commonly in older females within an average duration of four days from vaccination. Pericardial involvement was the most reported adverse event. Adverse events following COVID-19 vaccination happened at a mean age of 42.7 years, more commonly in males, and mostly after a second dose. Adverse events following smallpox vaccination occurred more commonly in younger males, with an average onset of symptoms from vaccination around 16.6 days. Adverse events were mostly myopericarditis; however, the acute coronary syndrome has been reported with some vaccines.
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Affiliation(s)
- Kanak Parmar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
- Correspondence:
| | - Sai Subramanyam
- School of Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore 560048, India;
| | - Gaspar Del Rio-Pertuz
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Pooja Sethi
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (P.S.); (E.A.-S.)
| | - Erwin Argueta-Sosa
- Department of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (P.S.); (E.A.-S.)
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14
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Myocarditis following COVID-19 vaccination in adolescents and adults: a cumulative experience of 2021. Heart Fail Rev 2022; 27:2033-2043. [PMID: 35449353 PMCID: PMC9023259 DOI: 10.1007/s10741-022-10243-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/29/2022]
Abstract
Clinical course and outcomes of myocarditis after COVID-19 vaccination remain variable. We retrospectively collected data on patients > 12 years old from 01/01/2021 to 12/30/2021 who received COVID-19 messenger RNA (mRNA) vaccination and were diagnosed with myocarditis within 60 days of vaccination. Myocarditis cases were based on case definitions by authors. We report on 238 patients of whom most were male (n = 208; 87.1%). The mean age was 27.4 ± 16 (range 12–80) years. Females presented at older ages (41.3 ± 21.5 years) than men 25.7 ± 14 years (p = 0.001). In patients > 20 years of age, the mean duration from vaccination to symptoms was 4.8 days ± 5.5 days, but in < 20, it was 3.0 ± 3.3 days (p = 0.04). Myocarditis occurred most commonly after the Pfizer-BioNTech mRNA vaccine (n = 183; 76.45) and after the second dose (n = 182; 80%). Symptoms started 3.95 ± 4.5 days after vaccination. The commonest symptom was chest pain (n = 221; 93%). Patients were treated with non-steroidal anti-inflammatory drugs (n = 105; 58.3%), colchicine (n = 38; 21.1%), or glucocorticoids (n = 23; 12.7%). About 30% of the patients had left ventricular ejection fraction but more than half recovered the on repeat imaging. Abnormal cardiac MRIs were common; 168 patients (96% of 175 patients that had MRI) had late gadolinium enhancement, while 120 patients (68.5%) had myocardial edema. Heart failure guideline-directed medical therapy use was common (n = 27; 15%). Eleven patients had cardiogenic shock; and 4 patients required mechanical circulatory support. Five patients (1.7%) died; of these, 3 patients had endomyocardial biopsy/autopsy-confirmed myocarditis. Most cases of COVID-19 vaccine myocarditis are mild. Females presented at older ages than men and duration from vaccination to symptoms was longer in patients > 20 years. Cardiogenic shock requiring mechanical circulatory support was seen and mortality was low. Future studies are needed to better evaluate risk factors, and long-term outcomes of COVID-19 mRNA vaccine myocarditis.
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15
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Naghashzadeh F, Shafaghi S, Dorudinia A, Naji SA, Marjani M, Amin A, Mohamadifar A, Noorali S, Kashani BS. Myocarditis following rAd26 and rAd5 vector-based COVID-19 vaccine: case report. ESC Heart Fail 2022; 9:1483-1486. [PMID: 35106967 PMCID: PMC8934948 DOI: 10.1002/ehf2.13821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/29/2021] [Accepted: 01/16/2022] [Indexed: 12/13/2022] Open
Abstract
SARS‐CoV‐2 vaccines provide a safe solution with a major impact on reducing the spread of the virus and mild side effects. Research has shown rare cases of myocarditis after mRNA vaccines. This study presents a 29‐year‐old male with chest pain after 48 h of receiving rAd26 and rAd5 vector‐based COVID‐19 vaccine (Sputnik V vaccine). The electrocardiogram revealed ST‐segment elevation. Also, the laboratory screening was remarkable for elevated cardiac Troponin‐I level, and leukocytosis; and echocardiography depicted severe left ventricular systolic dysfunction. Overall, endomyocardial biopsy proved lymphocytic myocarditis such that the patient was successfully treated with immunosuppressive and guideline‐directed medical treatment.
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Affiliation(s)
- Farah Naghashzadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atosa Dorudinia
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Naji
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Dr. Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arezoo Mohamadifar
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima Noorali
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif Kashani
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Truong DT, Dionne A, Muniz JC, McHugh KE, Portman MA, Lambert LM, Thacker D, Elias MD, Li JS, Toro-Salazar OH, Anderson BR, Atz AM, Bohun CM, Campbell MJ, Chrisant M, D'Addese L, Dummer KB, Forsha D, Frank LH, Frosch OH, Gelehrter SK, Giglia TM, Hebson C, Jain SS, Johnston P, Krishnan A, Lombardi KC, McCrindle BW, Mitchell EC, Miyata K, Mizzi T, Parker RM, Patel JK, Ronai C, Sabati AA, Schauer J, Sexson-Tejtel SK, Shea JR, Shekerdemian LS, Srivastava S, Votava-Smith JK, White S, Newburger JW. Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults. Circulation 2021; 145:345-356. [PMID: 34865500 DOI: 10.1161/circulationaha.121.056583] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding the clinical course and short-term outcomes of suspected myocarditis following COVID-19 vaccination has important public health implications in the decision to vaccinate youth. METHODS We retrospectively collected data on patients <21 years-old presenting before 7/4/2021 with suspected myocarditis within 30 days of COVID-19 vaccination. Lake Louise criteria were used for cardiac magnetic resonance imaging (cMRI) findings. Myocarditis cases were classified as confirmed or probable based on the Centers for Disease Control and Prevention definitions. RESULTS We report on 139 adolescents and young adults with 140 episodes of suspected myocarditis (49 confirmed, 91 probable) at 26 centers. Most patients were male (N=126, 90.6%) and White (N=92, 66.2%); 29 (20.9%) were Hispanic; and median age was 15.8 years (range 12.1-20.3, IQR 14.5-17.0). Suspected myocarditis occurred in 136 patients (97.8%) following mRNA vaccine, with 131 (94.2%) following the Pfizer-BioNTech vaccine; 128 (91.4%) occurred after the 2nd dose. Symptoms started a median of 2 days (range 0-22, IQR 1-3) after vaccination. The most common symptom was chest pain (99.3%). Patients were treated with nonsteroidal anti-inflammatory drugs (81.3%), intravenous immunoglobulin (21.6%), glucocorticoids (21.6%), colchicine (7.9%) or no anti-inflammatory therapies (8.6%). Twenty-six patients (18.7%) were in the ICU, two were treated with inotropic/vasoactive support, and none required ECMO or died. Median hospital stay was 2 days (range 0-10, IQR 2-3). All patients had elevated troponin I (N=111, 8.12 ng/mL, IQR 3.50-15.90) or T (N=28, 0.61 ng/mL, IQR 0.25-1.30); 69.8% had abnormal electrocardiograms and/or arrythmias (7 with non-sustained ventricular tachycardia); and 18.7% had left ventricular ejection fraction (LVEF) <55% on echocardiogram. Of 97 patients who underwent cMRI at median 5 days (range 0-88, IQR 3-17) from symptom onset, 75 (77.3%) had abnormal findings: 74 (76.3%) had late gadolinium enhancement, 54 (55.7%) had myocardial edema, and 49 (50.5%) met Lake Louise criteria. Among 26 patients with LVEF <55% on echocardiogram, all with follow-up had normalized function (N=25). CONCLUSIONS Most cases of suspected COVID-19 vaccine myocarditis occurring in persons <21 years have a mild clinical course with rapid resolution of symptoms. Abnormal findings on cMRI were frequent. Future studies should evaluate risk factors, mechanisms, and long-term outcomes.
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Affiliation(s)
- Dongngan T Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, UT
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics; Harvard Medical School, Boston, MA
| | | | - Kimberly E McHugh
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Michael A Portman
- Seattle Children's, Department of Pediatrics, University of Washington, Seattle, WA
| | - Linda M Lambert
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, UT
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE
| | - Matthew D Elias
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Brett R Anderson
- Division of Pediatric Cardiology; NewYork-Presbyterian / Columbia University Irving Medical Center, New York, NY
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - C Monique Bohun
- Oregon Health & Science University, Division of Pediatric Cardiology, Department of Pediatrics, Portland, OR
| | | | - Maryanne Chrisant
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL
| | - Laura D'Addese
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL
| | - Kirsten B Dummer
- Division of Pediatric Cardiology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, CA
| | - Daniel Forsha
- Division of Pediatric Cardiology, Children's Mercy Kansas City, Kansas City, MO
| | | | - Olivia H Frosch
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Sarah K Gelehrter
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Therese M Giglia
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Camden Hebson
- Children's of Alabama Department of Pediatrics, Division of Pediatric Cardiology; University of Alabama at Birmingham School of Medicine
| | - Supriya S Jain
- Maria Fareri Children's Hospital at Westchester Medical Center / New York Medical College, Valhalla, New York
| | - Pace Johnston
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Kristin C Lombardi
- Warren Alpert Medical School of Brown University, Division of Pediatric Cardiology, Hasbro Children's Hospital, Providence, RI
| | - Brian W McCrindle
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Koichi Miyata
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego, La Jolla, CA and Rady Children's Hospital San Diego, San Diego, CA
| | - Trent Mizzi
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Robert M Parker
- Division of Critical Care. Connecticut Children's. Hartford, CT
| | - Jyoti K Patel
- Division of Pediatric Cardiology, Riley Children's Hospital, Indianapolis, IN
| | - Christina Ronai
- Oregon Health & Science University, Division of Pediatric Cardiology, Department of Pediatrics, Portland, OR
| | - Arash A Sabati
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ
| | - Jenna Schauer
- Seattle Children's, Department of Pediatrics, University of Washington, Seattle, WA
| | | | - J Ryan Shea
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Jodie K Votava-Smith
- Division of Cardiology, Children's Hospital Los Angeles and Keck School of USC, Los Angeles, CA
| | - Sarah White
- Division of Hospital Medicine, Children's Hospital of Los Angeles and Keck School of Medicine of USC, Los Angeles, CA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics; Harvard Medical School, Boston, MA
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17
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Patrignani A, Schicchi N, Calcagnoli F, Falchetti E, Ciampani N, Argalia G, Mariani A. Acute myocarditis following Comirnaty vaccination in a healthy man with previous SARS-CoV-2 infection. Radiol Case Rep 2021; 16:3321-3325. [PMID: 34367386 PMCID: PMC8326008 DOI: 10.1016/j.radcr.2021.07.082] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 01/07/2023] Open
Abstract
Myopericarditis following mRNA Covid-19 vaccination has recently been reported to health authorities in a lot of countries. They can occur in very rare cases after either the Moderna (mRNA-1273 - Spikevax) or Pfizer-BioNTech (BNT162b2 - Comirnaty) vaccination. Cases predominately occur in younger adult men within 14 days following the second dose. In this article, we present a 56 year-old man with no prior medical history, whit the exception of a mild Covid-19 infection 4 months earlier, who experienced an episode of acute epigastric pain, profuse sweating, tachycardia, hypotension 4 days after the first dose of BNT162b2 vaccine. Troponin I level was elevated. Chest X-ray, electrocardiogram, echocardiogram, coronary angiography didn't show significant abnormalities. Cardiac Magnetic Resonance showed a pattern of acute myocarditis. The condition appeared to be self-limited and the patient recovered without specific therapy. No report of acute myocarditis was observed in the BNT162b2 and mRNA-1273 trials and very rare cases, in comparison to given doses, have been reported to pharmacovigilance systems worldwide. Further surveillance and evaluation of this side effect are warranted to establish the correct balance of benefits and risks of Covid-19 mRNA vaccines, above all in children and younger people (categories with the higher reactogenicity and the lower risk of Covid-19 complications). At the present time the benefits of Covid-19 vaccination significantly exceed possible risks.
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Affiliation(s)
- Anna Patrignani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Nicolò Schicchi
- Radiology Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Marche, Italy
| | - Francesca Calcagnoli
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Elena Falchetti
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Nino Ciampani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Giulio Argalia
- Radiology Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Marche, Italy
| | - Antonio Mariani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
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18
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Affiliation(s)
- Salvatore Pepe
- Heart, Lung and Circulation, Sydney, NSW, Australia; Murdoch Children's Research Institute, Heart Research and Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, Melbourne, Vic, Australia
| | | | - A Robert Denniss
- Heart, Lung and Circulation, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, and University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Blacktown Hospital, and Western Sydney University, Sydney, NSW, Australia.
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19
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Wu EY, Campbell MJ. Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19. Curr Cardiol Rep 2021; 23:168. [PMID: 34599465 PMCID: PMC8486157 DOI: 10.1007/s11886-021-01602-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 12/19/2022]
Abstract
Purpose of Review To review the spectrum of cardiac manifestations and treatments of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Recent Findings Studies demonstrate that up to 80% of children with MIS-C may have cardiac involvement on a spectrum of severity. Cardiac manifestations include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. Current treatments, including inotropic support, immunomodulatory therapy, and anti-coagulation, have been effective at resolving these cardiac findings in the majority of patients. COVID-19 can also cause myocarditis in the acute stage of illness and recent descriptions of COVID-19 vaccine myocarditis have occurred. Summary Cardiac manifestations are common in MIS-C and should be assessed for at presentation and during the clinical course as indicated.
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Affiliation(s)
- Eveline Y Wu
- Division of Pediatric Rheumatology, The University of North Carolina at Chapel Hill, 030 MacNider Hall, CB #7231, Chapel Hill, NC, 27599, USA.,Division of Pediatric Allergy/Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Jay Campbell
- Division of Pediatric Cardiology, Duke University Medical Center, 2301 Erwin Road, Children's Health Center 1st Floor, Room 1921, Durham, NC, 27710, USA. .,Duke Cardiovascular Magnetic Resonance Center, Durham, NC, USA.
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20
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Hudson B, Mantooth R, DeLaney M. Myocarditis and pericarditis after vaccination for COVID-19. J Am Coll Emerg Physicians Open 2021; 2:e12498. [PMID: 34337595 PMCID: PMC8313036 DOI: 10.1002/emp2.12498] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022] Open
Abstract
Two previously healthy males presented to the emergency symptoms with signs of pericarditis/myocarditis after being vaccinated with an mRNA vaccine for COVID-19.
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Affiliation(s)
- Blake Hudson
- University of Alabama at BirminghamMantooth is Washington Regional Medical CenterBirminghamAlabamaUSA
| | - Ryan Mantooth
- Washington Regional Medical CenterFayettevilleArkansasUSA
| | - Matthew DeLaney
- University of Alabama at BirminghamMantooth is Washington Regional Medical CenterBirminghamAlabamaUSA
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21
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Kim HW, Jenista ER, Wendell DC, Azevedo CF, Campbell MJ, Darty SN, Parker MA, Kim RJ. Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination. JAMA Cardiol 2021; 6:1196-1201. [PMID: 34185046 DOI: 10.1001/jamacardio.2021.2828] [Citation(s) in RCA: 225] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Vaccine-associated myocarditis is an unusual entity that has been described for the smallpox vaccine, but only anecdotal case reports have been described for other vaccines. Whether COVID-19 vaccination may be linked to the occurrence of myocarditis is unknown. Objective To describe a group of 7 patients with acute myocarditis over 3 months, 4 of whom had recent messenger RNA (mRNA) COVID-19 vaccination. Design, Setting, and Participants All patients referred for cardiovascular magnetic resonance imaging at Duke University Medical Center were asked to participate in a prospective outcomes registry. Two searches of the registry database were performed: first, to identify patients with acute myocarditis for the 3-month period between February 1 and April 30 for 2017 through 2021, and second, to identify all patients with possible vaccine-associated myocarditis for the past 20 years. Once patients with possible vaccine-associated myocarditis were identified, data available in the registry were supplemented by additional data collection from the electronic health record and a telephone interview. Exposures mRNA COVID-19 vaccine. Main Outcomes and Measures Occurrence of acute myocarditis by cardiovascular magnetic resonance imaging. Results In the 3-month period between February 1 and April 30, 2021, 7 patients with acute myocarditis were identified, of which 4 occurred within 5 days of COVID-19 vaccination. Three were younger male individuals (age, 23-36 years) and 1 was a 70-year-old female individual. All 4 had received the second dose of an mRNA vaccine (2 received mRNA-1273 [Moderna], and 2 received BNT162b2 [Pfizer]). All presented with severe chest pain, had biomarker evidence of myocardial injury, and were hospitalized. Coincident testing for COVID-19 and respiratory viruses provided no alternative explanation. Cardiac magnetic resonance imaging findings were typical for myocarditis, including regional dysfunction, late gadolinium enhancement, and elevated native T1 and T2. Conclusions and Relevance In this study, magnetic resonance imaging findings were found to be consistent with acute myocarditis in 7 patients; 4 of whom had preceding COVID-19 vaccination. Further investigation is needed to determine associations of COVID-19 vaccination and myocarditis.
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Affiliation(s)
- Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Michael J Campbell
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Stephen N Darty
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina.,Department of Radiology, Duke University Medical Center, Durham, North Carolina
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22
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Vidula MK, Ambrose M, Glassberg H, Chokshi N, Chen T, Ferrari VA, Han Y. Myocarditis and Other Cardiovascular Complications of the mRNA-Based COVID-19 Vaccines. Cureus 2021; 13:e15576. [PMID: 34277198 PMCID: PMC8270057 DOI: 10.7759/cureus.15576] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Cardiovascular complications following the receipt of mRNA-based (Pfizer-BioNTech and Moderna) coronavirus disease 2019 (COVID-19) vaccines have not yet been described. In this case series, we describe two patients with clinically suspected myocarditis, one patient with stress cardiomyopathy, and two patients with pericarditis after receiving an mRNA-based COVID-19 vaccine. The two patients with clinically suspected myocarditis were otherwise healthy young men who presented with acute substernal chest pressure and/or dyspnea after receiving the second dose of the vaccine and were found to have diffuse ST elevations on electrocardiogram (ECG), elevated cardiac biomarkers and inflammatory markers, and mildly reduced left ventricular (LV) function on echocardiography. Both patients met the modified Lake Louise Criteria for acute myocarditis by cardiac magnetic resonance imaging. We subsequently discuss a case of a 60-year-old woman with known coronary artery disease (CAD) and previously normal LV function, who presented with new exertional symptoms, ECG changes, and apical akinesis following the second dose of the vaccine, and was diagnosed with a stress cardiomyopathy. Finally, we describe two patients with pericarditis who presented with chest pain, elevated inflammatory markers, and pericardial effusions after receiving the vaccine. Overall, this case series describes the first reported cases of myocarditis, stress cardiomyopathy, and pericarditis after receiving an mRNA-based COVID-19 vaccine.
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Affiliation(s)
- Mahesh K Vidula
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Marietta Ambrose
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Helene Glassberg
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Neel Chokshi
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Tiffany Chen
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Victor A Ferrari
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Yuchi Han
- Medicine/Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
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23
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Albert E, Aurigemma G, Saucedo J, Gerson DS. Myocarditis following COVID-19 vaccination. Radiol Case Rep 2021; 16:2142-2145. [PMID: 34025885 PMCID: PMC8130498 DOI: 10.1016/j.radcr.2021.05.033] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) vaccination frequently leads to minor side-effects, that may be more intense after the second dose, but more serious side effects have been reported. We report a case of a 24-year-old man who presented to the hospital with acute substernal chest pain, 4 days after his second COVID-19 Moderna vaccination. Laboratory studies revealed elevated troponins and negative viral serologies. Cardiac magnetic resonance imaging (cMRI) demonstrated edema and delayed gadolinium enhancement of the left ventricle in a midmyocardial and epicardial distribution. The patient was diagnosed with myocarditis following Moderna vaccination. Our case report raises concern that myocarditis is a rare side effect of COVID-19 vaccine. Despite our report, it appears that there is a significantly higher risk of cardiac involvement from COVID-19 infection compared to COVID-19 vaccination.
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Affiliation(s)
- Elisabeth Albert
- Department of Radiology University of Massachusetts Medical School, UMass Memorial Medical Center, 55 Lake avenue North, Worcester, 01655, MA, USA,Corresponding author.
| | - Gerard Aurigemma
- Department of Medicine (Cardiovascular Medicine Division), University of Massachusetts Medical Center, UMass Memorial Medical Center, 55 Lake avenue North Worcester, 01655, MA, USA
| | - Jason Saucedo
- Department of Medicine (Cardiovascular Medicine Division), University of Massachusetts Medical Center, UMass Memorial Medical Center, 55 Lake avenue North Worcester, 01655, MA, USA
| | - David S. Gerson
- Department of Radiology University of Massachusetts Medical School, UMass Memorial Medical Center, 55 Lake avenue North, Worcester, 01655, MA, USA
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24
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Moey MYY, Jiwani RA, Takeda K, Prenshaw K, Kreeger RW, Inzerillo J, Liles DK, Marcu CB, Lebrun-Vignes B, Morris DL, Ardhanari S, Salem JE. Sipuleucel-T associated inflammatory cardiomyopathy: a case report and observations from a large pharmacovigilance database. ESC Heart Fail 2021; 8:3360-3368. [PMID: 33938158 PMCID: PMC8318408 DOI: 10.1002/ehf2.13400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/25/2021] [Accepted: 04/22/2021] [Indexed: 01/13/2023] Open
Abstract
Aims The major cardiovascular (CV) adverse effects observed with sipuleucel‐T from large multi‐institutional clinical trials included thromboembolic events, myocardial infarction, and congestive heart failure in up to 0.3% of patients with CV risk factors. The incidence, outcomes, and mechanisms in real‐world clinical settings of these CV adverse effects to date have not been fully elucidated. Our study identified a patient with sipuleucel‐T‐induced inflammatory cardiomyopathy, which led to the identification of CV adverse effects associated with sipuleucel‐T from a large pharmacovigilance database and elucidation of its potential mechanisms. Methods and results Using the MedDRA term ‘cardiac disorders’ (System Organ Class level), CV adverse events associated with sipuleucel‐T versus all other drugs were reviewed from VigiBase, a large pharmacovigilance database. Disproportionality analysis was calculated by the information component (IC), a Bayesian disproportionality indicator. A positive IC025 (IC 95% lower end credibility interval) value (>0) is the traditional threshold used in statistical signal detection at the Uppsala Monitoring Centre. From VigiBase, the total number of CV adverse drug reaction reported with sipuleucel‐T was 306 out of a total of 22 980 104 adverse drug reactions in VigiBase on 10/25/2020. MedDRA preferred terms levels were grouped into major CV adverse drug reaction categories where we observed significant reports of myocardial ischaemia, supraventricular tachycardia (particularly atrial fibrillation/atrial flutter), congestive heart failure, and valvular disorders. Myocardial ischemia included acute myocardial infarction (IC025 2.3) with n = 4/26 (15%) of these individual case safety reports considered fatal. Among patients with ‘cardiac failure congestive’ (IC025 1.5), 11 of these 43 cases (26%) were fatal with 42 (98%) of these cases considered to be solely due to sipuleucel‐T. Conclusions Patients with CV risk factors who are receiving sipuleucel‐T may be at higher risk for congestive heart failure, myocardial ischemia, and supraventricular tachycardia. Electrocardiograms during weekly sipuleucel‐T infusions and left ventricular function monitoring with echocardiogram should be considered in these patients. Our findings are suggestive of another rare presentation of T‐cell‐mediated CV toxicity with cancer immunotherapy.
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Affiliation(s)
- Melissa Y Y Moey
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Vidant Medical Center/East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA
| | - Rahim A Jiwani
- Department of Internal Medicine, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - Kotaro Takeda
- Department of Pathology and Laboratory Medicine, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - Karyn Prenshaw
- Department of Pathology and Laboratory Medicine, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - R Wayne Kreeger
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Vidant Medical Center/East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA
| | | | - Darla K Liles
- Department of Hematology and Oncology, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - C Bogdan Marcu
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Vidant Medical Center/East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA
| | - Bénédicte Lebrun-Vignes
- Department of Pharmacology, Regional Pharmacovigilance Centre, Pitié-Salpêtrière Hospital, Sorbonne Université, INSERM CIC-1901, AP-HP, Paris, France.,EA Epiderme-Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris-Est Créteil, Créteil, France
| | - D Lynn Morris
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Vidant Medical Center/East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA
| | - Sivakumar Ardhanari
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Vidant Medical Center/East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA
| | - Joe-Elie Salem
- Department of Pharmacology, Regional Pharmacovigilance Centre, Pitié-Salpêtrière Hospital, Sorbonne Université, INSERM CIC-1901, AP-HP, Paris, France.,UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France.,Division of Cardiovascular Medicine, Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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Su JR, McNeil MM, Welsh KJ, Marquez PL, Ng C, Yan M, Cano MV. Myopericarditis after vaccination, Vaccine Adverse Event Reporting System (VAERS), 1990-2018. Vaccine 2021; 39:839-845. [PMID: 33422381 DOI: 10.1016/j.vaccine.2020.12.046] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Myopericarditis after vaccination has been sporadically reported in the medical literature. Here, we present a thorough descriptive analysis of reports to a national passive vaccine safety surveillance system (VAERS) of myopericarditis after vaccines licensed for use in the United States. METHODS We identified U.S. reports of myopericarditis received by VAERS during 1990-2018 that met a published case definition for myopericarditis or were physician-diagnosed. We stratified analysis by age group (<19, 19-49, ≥50 years), describing reports by serious/non-serious status, sex, time to symptom onset after vaccination, vaccine(s) administered, and exposure to other known causes of myopericarditis. We used Empirical Bayesian data mining to detect disproportionate reporting of myopericarditis after vaccination. RESULTS VAERS received 620,195 reports during 1990-2018: 708 (0.1%) met the case definition or were physician-diagnosed as myopericarditis. Most (79%) myopericarditis reports described males; 69% were serious; 72% had symptom onset ≤ 2 weeks postvaccination. Overall, smallpox (59%) and anthrax (23%) vaccines were most commonly reported. By age, among persons aged < 19 years, Haemophilus influenzae type b (22, 22%) and hepatitis B (18, 18%); among persons aged 19-49 years smallpox (387, 79%); among persons aged ≥ 50 years inactivated influenza (31, 36%) and live attenuated zoster (19, 22%) vaccines were most commonly reported. The vaccines most commonly reported remained unchanged when excluding 138 reports describing other known causes of myopericarditis. Data mining revealed disproportionate reporting of myopericarditis only after smallpox vaccine. CONCLUSIONS Despite the introduction of new vaccines over the years, myopericarditis remains rarely reported after vaccines licensed for use in the United States. In this analysis, myopericarditis was most commonly reported after smallpox vaccine, and less commonly after other vaccines.
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Affiliation(s)
- John R Su
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kerry J Welsh
- Center for Biologicals Evaluation and Research, Food and Drug Administration (FDA), United States
| | - Paige L Marquez
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carmen Ng
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ming Yan
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Maria V Cano
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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26
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Nagano N, Yano T, Fujita Y, Koyama M, Hasegawa R, Nakata J, Nishikawa R, Murakami N, Fujito T, Mochizuki A, Kouzu H, Muranaka A, Kokubu N, Miura T. Hemodynamic Collapse After Influenza Vaccination: A Vaccine-Induced Fulminant Myocarditis? Can J Cardiol 2020; 36:1554.e5-1554.e7. [PMID: 32413549 DOI: 10.1016/j.cjca.2020.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 11/26/2022] Open
Abstract
A 14-year-old girl with cardiopulmonary arrest was referred to our hospital. She had received an injection of inactivated influenza vaccine 7 days before the referral. Her cardiac rhythm was pulseless wide QRS tachycardia, and mechanical circulatory support was immediately begun. Results of endomyocardial biopsy showed that there was massive infiltration of CD3- and CD68-positive cells and various degrees of cardiomyocyte necrosis in all of 3 endomyocardial specimens, whereas infiltration of eosinophils or giant cells was not observed. A histologic diagnosis of lymphocytic myocarditis was made. Acute myocarditis is a rare but potentially fatal complication of the influenza vaccination.
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Affiliation(s)
- Nobutaka Nagano
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Yugo Fujita
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masayuki Koyama
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryo Hasegawa
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jun Nakata
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoto Murakami
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takefumi Fujito
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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27
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Saraiya N, Singh S, Corpuz M. Fatal influenza myocarditis with incessant ventricular tachycardia. BMJ Case Rep 2019; 12:e228201. [PMID: 31266755 PMCID: PMC6605955 DOI: 10.1136/bcr-2018-228201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 11/03/2022] Open
Abstract
Influenza myocarditis is an underappreciated and severe complication of influenza infection, estimated to be present in about 10% of all influenza cases. We present a case of a woman who precipitously died of fulminant influenza myocarditis and then review the historical data, literature and expert recommendations for suspecting and managing influenza myocarditis.
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Affiliation(s)
- Nidhi Saraiya
- Pharmacy, Montefiore Wakefield Campus, Bronx, New York, USA
| | | | - Marilou Corpuz
- Infectious Diseases, Montefiore Wakefield Campus, Bronx, New York, USA
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