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More on Transient Myocarditis and COVID Vaccines

The issue of transient myocarditis and COVID vaccines is rightfully getting extra attention these days.

Hundreds of kids die with a 99.9% recovery rate...
Hundreds of kids die with a 99.9% recovery rate…

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!

Nearly 14 million teens and young adults are fully vaccinated against COVID!
Nearly 14 million teens and young adults are fully vaccinated against COVID!

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.

There have been no deaths from myocarditis after COVID vaccination.
There have been no deaths from myocarditis after COVID vaccination.

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…

Many kids with COVID have been hospitalized.
Many kids with COVID have been hospitalized.

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.

When you think about the possible risk of myocarditis from a COVID vaccine, remember that many kids, teens, and young adults have died with COVID.
When you think about the possible risk of myocarditis from a COVID vaccine, remember that many kids, teens, and young adults have died with COVID.

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?

ACIP has another meeting to discuss COVID vaccine safety, especially the possible risk of myocarditis.

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 are seeing an uncharacteristic surge in viral infections this Spring, after a long lull during the COVID pandemic...
We are seeing an uncharacteristic surge in viral infections this Spring, after a long lull during the COVID pandemic…

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

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