Friday, May 28, 2021

CDC Clinical Considerations : Myocarditis & Pericarditis after Receipt of mRNA COVID-19 Vaccines Among Adolescents and Young Adults



Credit ACIP/CDC 
#15,986

While vaccines - including the COVID vaccines - have an enviable safety record, there is no such thing as a 100% safe drug or medication for 100% of the population.  Even over-the-counter remedies, like NSAIDs or acetaminophen, can sometimes produce adverse - even fatal - reactions (see BMJ Research: NSAIDs & The Risk Of Heart Failure).

Over the years we've looked at a number of adverse events linked to vaccines, and while most were rare, mild and temporary, some were more serious.  





The decision to take any vaccine or medication always involves a risk-reward calculation.  Most of the time, the small risk from a vaccine is justified, given the protection it provides.

Over the past week there have been scattered, rare reports of Myocarditis and Pericarditis presenting in young adults and adolescents who received one of the mRNA vaccines. While it isn't clear yet how big of a problem this is, we do know that COVID infection has been linked to thousands of cases of heart inflammation and heart damage, particularly in children and adolescents. 



While many people assume that COVID is always mild in children and adolescents, the most recent surveillance numbers from the CDC indicate more than 3,740 cases of MIS-C (Multisystem Inflammatory Syndrome in Children ) and 35 deaths.


For now, the CDC continues to recommend children 12 and up receive the COVID vaccine.  They posted the following clinical considerations late yesterday.  


Clinical Considerations: Myocarditis and Pericarditis after Receipt of mRNA COVID-19 Vaccines Among Adolescents and Young Adults

Summary
 
Since April 2021, increased cases of myocarditis and pericarditis have been reported in the United States after mRNA COVID-19 vaccination (Pfizer-BioNTech and Moderna), particularly in adolescents and young adults. There has not been a similar reporting pattern observed after receipt of the Janssen COVID-19 Vaccine (Johnson & Johnson).

In most cases, patients who presented for medical care have responded well to medications and rest and had prompt improvement of symptoms. Reported cases have occurred predominantly in male adolescents and young adults 16 years of age and older. Onset was typically within several days after mRNA COVID-19 vaccination, and cases have occurred more often after the second dose than the first dose. CDC and its partners are investigating these reports of myocarditis and pericarditis following mRNA COVID-19 vaccination.

CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older given the risk of COVID-19 illness and related, possibly severe complications, such as long-term health problems, hospitalization, and even death.

Background

Myocarditis is inflammation of the heart muscle, and pericarditis is inflammation of the lining outside the heart. In both cases, the body’s immune system is causing inflammation in response to an infection or some other trigger. Symptoms can include chest pain, shortness of breath, or palpitations.

The severity of cases of myocarditis and pericarditis can vary. For the cases reported after mRNA COVID-19 vaccination, most who presented to medical care have responded well to medications and rest.

Recommendations for Clinicians

CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older given the greater risk of other serious complications related to COVID-19, such as hospitalization, multisystem inflammatory syndrome in children (MIS-C), or death.

Report all cases of myocarditis and pericarditis post COVID-19 vaccination to VAERS 

Consider myocarditis and pericarditis in adolescents or young adults with acute chest pain, shortness of breath, or palpitations. In this younger population, coronary events are less likely to be a source of these symptoms.

Ask about prior COVID-19 vaccination if you identify these symptoms, as well as relevant other medical, travel, and social history.

For initial evaluation, consider 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.

For suspected cases, consider consultation with cardiology for assistance with cardiac evaluation and management. Evaluation and management may vary depending on the patient age, clinical presentation, potential causes, or practice preference of the provider.

For follow-up of patients with myocarditis, consult the recommendations from the American Heart Association and the American College of Cardiology.

It is important to rule out other potential causes of myocarditis and pericarditis. Consider consultation with infectious disease and/or rheumatology to assist in this evaluation.

Where available, evaluate for potential etiologies of myocarditis and pericarditis, particularly acute COVID-19 infection (e.g., PCR testing), prior SARS-CoV-2 infection (e.g., detection of SARS-CoV-2 nucleocapsid antibodies), and other viral etiologies (e.g., enterovirus PCR and comprehensive respiratory viral pathogen testing).

For more information

NIH materials on myocarditis and pericarditis

Frequently asked questions about VAERS reporting for COVID-19 vaccines VAERS – FAQs (hhs.gov) 

How to report to VAERS 
 
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