Autoimmune Rheumatic Disease Flares with Myocarditis Following COVID-19 mRNA Vaccination: A Case-Based Review.

Since the introduction of coronavirus disease 2019 (COVID-19) messenger ribonucleic acid (mRNA) vaccines, there have been multiple reports of post-vaccination myocarditis (mainly affecting young healthy males). We report on four patients with active autoimmune rheumatic diseases (ARDs) and probable or confirmed myocarditis following COVID-19 mRNA vaccination managed at a tertiary hospital in Singapore; we reviewed the literature on post-COVID-19 mRNA vaccination-related myocarditis and ARD flares. Three patients had existing ARD flares (two had systemic lupus erythematosus (SLE), one had eosinophilic granulomatosis polyangiitis (EGPA)), and one had new-onset EGPA. All patients recovered well after receiving immunosuppressants comprising high-dose glucocorticoids, cyclophosphamide, and rituximab. Thus far, only one case of active SLE with myocarditis has been reported post-COVID-19 mRNA vaccination in the literature. In contrast to isolated post-COVID-19 mRNA vaccination myocarditis, our older-aged patients had myocarditis associated with ARD flares post-COVID-19 vaccination (that occurred after one dose of an mRNA vaccine), associated with other features of ARD flares, and required increased immunosuppression to achieve myocarditis resolution. This case series serves to highlight the differences in clinical and therapeutic aspects in ARD patients, heighten the vigilance of rheumatologists for this development, and encourage the adoption of risk reduction strategies in this vulnerable population.

Management of SARS-CoV-2 in the Military and Lessons for Future Pandemics.

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in devastating consequences, with high death tolls and significant impact on global health, geopolitics, and socioeconomic aspects of society among others. Militaries around the world have been affected in many ways, in terms of force attrition and disruption to operations. MATERIALS AND METHODS: The Republic of Singapore Air Force (RSAF) had formulated multiple strategies and executed several contingency plans to respond swiftly and effectively to the pandemic. Measures taken by the RSAF included leveraging pandemic drawer plans, continuous medical intelligence gathering on SARS-CoV-2 characteristics, conducting rapid disease testing and contact tracing, formulating a risk assessment matrix for personnel based overseas, enforcing safe management measures and mask-wearing, and ensuring that critical medical functions were sustained. RESULTS: This article summarizes important lessons learnt that may be applied to future pandemics, including the importance of threat assessment, pandemic preparedness, adopting a tiered defense strategy, widespread testing, expeditious contact tracing and isolation, effective communication, and re-defining the new norms for post-pandemic recovery. CONCLUSION: The military remains essential to every country's defense and security. However, its unique construct and nature of operations may render it susceptible to uncontained viral transmission. To minimize manpower attrition and maximize force health in the face of a devastating pandemic, well-thought and tailored management measures must be implemented.