ABSTRACT
Introduction: Myocarditis is an inflammatory disease of the myocardium, that might lead to reduced cardiac function and in the most severe cases to mortality. Although uncommon, it is a known adverse event after vaccination with coronavirus disease 2019 (COVID-19) mRNA vaccines. Here, we report the case of myocarditis following vaccination with a viral vector vaccine, ChAdOX1 nCoV-19.Case presentation: A 50-year-old male presented at the emergency department with shortness of breath, general malaise and fever, 5 days after receiving a second dose of the ChAdOx1 vaccine. Biochemical analysis revealed elevated serum CRP and troponin levels. Two weeks after initial presentation, a cardiac MRI showed belated contrast capitation in the left ventricle, confirming the diagnosis of myocarditis.Conclusions: To our knowledge, this is the first report of myocarditis following ChAdOx1 vaccination. Except for some case of myocarditis upon the Ad26COVS1 vaccine, no other cases were reported upon vaccination with the ChAdOX1 viral vector vaccines. With this report we would like to raise awareness about myocarditis as an adverse event following ChAdOx1 vaccination.
ABSTRACT
BACKGROUND: Several randomised clinical trials have studied convalescent plasma for coronavirus disease 2019 (COVID-19) using different protocols, with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralising antibody titres, at different time-points and severities of illness. METHODS: In the prospective multicentre DAWn-plasma trial, adult patients hospitalised with COVID-19 were randomised to 4â units of open-label convalescent plasma combined with standard of care (intervention group) or standard of care alone (control group). Plasma from donors with neutralising antibody titres (50% neutralisation titre (NT50)) ≥1/320 was the product of choice for the study. RESULTS: Between 2 May 2020 and 26 January 2021, 320 patients were randomised to convalescent plasma and 163 patients to the control group according to a 2:1 allocation scheme. A median (interquartile range) volume of 884 (806-906)â mL) convalescent plasma was administered and 80.68% of the units came from donors with neutralising antibody titres (NT50) ≥1/320. Median time from onset of symptoms to randomisation was 7â days. The proportion of patients alive and free of mechanical ventilation on day 15 was not different between both groups (convalescent plasma 83.74% (n=267) versus control 84.05% (n=137)) (OR 0.99, 95% CI 0.59-1.66; p=0.9772). The intervention did not change the natural course of antibody titres. The number of serious or severe adverse events was similar in both study arms and transfusion-related side-effects were reported in 19 out of 320 patients in the intervention group (5.94%). CONCLUSIONS: Transfusion of 4â units of convalescent plasma with high neutralising antibody titres early in hospitalised COVID-19 patients did not result in a significant improvement of clinical status or reduced mortality.