The issue of transient myocarditis and COVID vaccines is rightfully getting extra attention these days.
Unfortunately, some folks are taking advantage of this issue to scare parents away from vaccinating and protecting their kids.
More on Transient Myocarditis and COVID Vaccines
That’s not to say that we should dismiss this possible risk of transient myocarditis with COVID vaccines!
First and foremost, several case reports have been published and it is true that the CDC is investigating a possible association between COVID vaccines and myocarditis in teens and young adults.
But considering the risks of COVID, it isn’t time to do anything drastic, like skipping or delaying vaccinations because you are concerned about myocarditis.
“Acute myocarditis (AM), a recent-onset inflammation of the heart, has heterogeneous clinical presentations, varying from minor symptoms to high-risk cardiac conditions with severe heart failure, refractory arrhythmias, and cardiogenic shock.”
Update on acute myocarditis
Especially when most of the cases of myocarditis that have been associated with COVID vaccines have been mild and without complications.
“A recent registry of all Finnish children (<16 years) hospitalized for clinically diagnosed AM from 2004 to 2014 (n=213) estimated an incidence of AM of 1.95/100,000 patients/year. The median age was 14 years, 77% were boys and it was observed that the incidence of AM increased significantly after 7 years of age.”
Update on acute myocarditis
And we know that myocarditis is not unheard of at this age…
Above all, understand that in addition to a higher risk of myocarditis, there is a risk of hospitalizations and death after natural COVID disease, even in teens and young adults.
So unless the COVID pandemic suddenly ends and we don’t need to vaccinate and protect our kids, or we see more severe disease in those who get myocarditis, any benefit vs risk analysis seems to clearly fall on the side of getting vaccinated and protected.
You should also:
- Know that a causal relationship between vaccination and myocarditis has not been established.
- Watch for symptoms of myocarditis, including chest pain, shortness of breath, feelings of having a fast-beating, fluttering, or pounding heart, and seek medical attention if they occur within a week of getting a COVID vaccine (and at other times, especially if they are severe or persistent).
- For initial evaluation of suspected myocarditis, the CDC suggests an ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. In the setting of normal ECG, troponin, and inflammatory markers, myocarditis or pericarditis are unlikely.
- Although most cases have been mild, consider consultation with cardiology for assistance with cardiac evaluation and management for suspected cases of myocarditis after COVID vaccination.
- Report all symptoms of myocarditis that occur after getting vaccinated to VAERS.
- If your child does have myocarditis, while they can usually return to their normal daily activities after their symptoms improve, they should speak with their health care provider/cardiologist about return to exercise or sports, as they will likely need a resting echocardiogram, 24-hour Holter monitoring, and an exercise ECG.
- Remember that experts, including the American Heart Association/American Stroke Association, continue “to urge all adults and children ages 12 and older in the U.S. to receive a COVID vaccine as soon as they can.”
What’s next?
We get more safety data at the next ACIP meeting!
And perhaps recommendations on how to reduce the risk just in case the mRNA COVID vaccines are truly linked to myocarditis.
For example, can we give the second dose a little later?
“The number of reports of myocarditis and pericarditis reported with the vaccines in the UK remains similar or below the expected background rate in different age groups within the general population and does not currently indicate an increased risk following vaccination against COVID-19.”
Coronavirus vaccine – weekly summary of Yellow Card reporting – Updated 10 June 2021
Most of the reports are after the second dose, and interestingly, there are no increased reports of myocarditis in the UK, where they routinely delay the second dose so as to prioritize as many people as possible getting a first dose.
Or we might just need to add a strong warning that these COVID vaccines might be associated with an increased risk for transient myocarditis, with chest pain and a quick recovery. More severe episodes are very rare.
“Uncomplicated acute myocarditis is characterized by a benign course, with a low 1-year mortality or heart transplant rate.”
Update on acute myocarditis
What did they do in Israel, where the possible link was first observed?
“Following our publication from yesterday, it should be noted that the risks for complications of coronavirus diseases outweigh the risks posed by the vaccine’s side effects. Myocarditis cases observed among teenagers aged 16 to 19 occurred in low rates and in most cases passed with no complications.”
Ministry of Health’s Position Regarding the Expansion of the Vaccination Operation to Ages 12-16 Years
The Pfizer COVID vaccine was still authorized, as the risk of COVID was thought to be much greater than the possible risk of transient myocarditis And they have since expanded vaccination down to age 12 years, focusing on high risk groups, but authorizing the vaccine for anyone who wants to be vaccinated.
We also shouldn’t forget that many viral diseases, including parainfluenza virus, enterovirus and RSV, can cause myocarditis. Surprisingly, these have all been surging this Spring!
“What remains unclear, despite all this data, is whether these cases of myocarditis were actually caused by the vaccine or whether they represent the normal background rate of the disease that would have happened anyway. If the risk is real, it appears to be extremely low. In contrast with COVID-19, where the risk is definitely real and anything but negligible.”
Fear of Myocarditis No Reason to Skip COVID Vaccine
And don’t forget that COVID causes myocarditis too!
More on Myocarditis and COVID Vaccines
- Are Kids Dying With COVID-19?
- The Truth About COVID-19 Vaccines
- COVID Vaccine Contraindications
- What Are the COVID-19 Vaccine Side Effects?
- About Those Urgent COVID-19 Vaccine Safety Warnings
- Let’s Recognize Childhood COVID as the Crisis It Is
- Opinion: Coronavirus vaccinations for young children should be an urgent priority
- Fear of Myocarditis No Reason to Skip COVID Vaccine
- COVID-19 vaccines and myocarditis – what are the facts
- What Should I Know About COVID-19 Vaccine and Myocarditis in Teens?
- Widespread vaccination of adults helps protect unvaccinated children, according to a new Israeli study.
- Coronavirus infections dropping where people are vaccinated, rising where they are not, Post analysis finds
- CDC investigating rare myocarditis in teens, young adults; COVID-19 vaccine still advised for all who are eligible
- Update on acute myocarditis
- COVID-19 as a Possible Cause of Myocarditis and Pericarditis
- CDC – Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination
- CDC – Clinical Considerations: Myocarditis and Pericarditis after Receipt of mRNA COVID-19 Vaccines Among Adolescents and Young Adults
- NIH – Heart Inflammation
- EMA – COVID-19 vaccines: update on ongoing evaluation of myocarditis and pericarditis
- WHO – COVID-19 subcommittee of the WHO Global Advisory Committee on Vaccine Safety (GACVS) reviews cases of mild myocarditis reported with COVID-19 mRNA vaccines
- Myocarditis after SARS-CoV-2 Vaccination: True, True, and…Related?
- Surveillance of Myocarditis (Inflammation of the Heart Muscle) Cases Between December 2020 and May 2021 (Including)
- Ministry of Health’s Position Regarding the Expansion of the Vaccination Operation to Ages 12-16 Years
- [Acute myocarditis after administration of the BNT162b2 vaccine against COVID-19]
- Myocarditis following COVID-19 mRNA vaccination
- Myocarditis following COVID-19 vaccination
- Myocarditis after SARS-CoV-2 Vaccination: A Vaccine-induced Reaction?
- Symptomatic Acute Myocarditis in Seven Adolescents Following Pfizer-BioNTech COVID-19 Vaccination
- Coronavirus vaccine – weekly summary of Yellow Card reporting – Updated June 10 2021
- Heart inflammation in young men higher than expected after Pfizer, Moderna vaccines -U.S. CDC
- Possible link between Pfizer second dose and mild heart inflammation in young men
- Texas Influenza Surveillance Report 2020-2021 Season/2021 MMWR Week 22
- FAQ of Types of Viruses and Bacteria that Cause Myocarditis