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1.
Pediatr Infect Dis J ; 41(1): e25-e28, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1566087

ABSTRACT

In this prospective nationwide multicenter study from Denmark, myopericarditis after Pfizer-BioNTech mRNA COVID-19 vaccination was identified in 13 males and 2 females between May 15 and September 15, 2021, among 133,477 vaccinated males and 127,857 vaccinated females 12-17 years of age, equaling 97 males and 16 females per million. In conclusion, the incidence of myopericarditis after COVID-19 vaccination among males appears higher than reports from the United States.


Subject(s)
/adverse effects , Myocarditis/chemically induced , Myocarditis/epidemiology , Pericarditis/chemically induced , Pericarditis/epidemiology , Adolescent , Child , Denmark/epidemiology , Female , Humans , Incidence , Male , Prospective Studies
2.
G Ital Cardiol (Rome) ; 22(11): 891-893, 2021 Nov.
Article in Italian | MEDLINE | ID: covidwho-1496711

ABSTRACT

We report the case of a 20-year-old healthy male who developed acute myopericarditis 2 days after receiving the second dose of the mRNA Pfizer-BioNTech COVID-19 vaccine. The course of the disease was mild and the patient was discharged after a few days of hospitalization.Recently, several case reports involving myopericarditis in patients who received an mRNA vaccine against SARS-CoV-2 have been published and the U.S. Centers for Disease Control and Prevention and the European Medicines Agency pharmacovigilance risk assessment committee are currently investigating an overall increased number of cases. They are also assessing whether there is a higher incidence than expected in vaccinated young adults and teenagers, especially males. Although a clear causal link has not been proven at this time, physicians should be aware of such potential adverse event, taking into account the increasing number of young people that will receive mRNA vaccination over the next few months.


Subject(s)
COVID-19 , Myocarditis , Adolescent , Adult , COVID-19 Vaccines , Humans , Male , Myocarditis/chemically induced , Myocarditis/diagnosis , SARS-CoV-2 , Vaccination/adverse effects , Young Adult
4.
Rev Med Interne ; 42(11): 797-800, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1472159

ABSTRACT

INTRODUCTION: The etiology of myocarditis often remains undetermined. A large variety of infectious agents, systemic diseases, drugs, and toxins can cause the disease. We report the case of a 19-year-old man who developed myocarditis three days after Pfizer-BioNTech COVID-19 booster vaccination. CASE REPORT: A 19-year-old man, presenting with troponin-positive acute chest pain, was referred to our department. He had received the Pfizer-BioNTech COVID-19 vaccine three days prior to his admission. The diagnosis of acute myocarditis was confirmed by cardiovascular magnetic resonance imaging. Patient hemodynamic status remained stable during hospitalization. The left ventricular ejection fraction was preserved during hospital stay and at one-month follow-up. We found no evidence for another infectious or autoimmune etiology. CONCLUSION: Although imputability of the vaccine cannot be formally established on the basis of this case report, the findings raise the possibility of an association between mRNA COVID-19 vaccination and acute myocarditis.


Subject(s)
COVID-19 , Myocarditis , Adult , COVID-19 Vaccines , Humans , Male , Myocarditis/chemically induced , Myocarditis/diagnosis , SARS-CoV-2 , Stroke Volume , Vaccination/adverse effects , Ventricular Function, Left , Young Adult
7.
Vaccine ; 39(42): 6195-6200, 2021 10 08.
Article in English | MEDLINE | ID: covidwho-1386710

ABSTRACT

There have been reports of myocarditis following COVID-19 vaccination. We surveyed all hospitalized military personnel in the Isareli Defense Forces during the period of the COVID-19 vaccination operation (12/28/2021-3/7/2021) for diagnosed myocarditis. We identified 7 cases of myocarditis with symptoms starting in the first week after the second dose of COVID-19 Pfizer-BioNTech vaccine. One case of myocarditis diagnosed 10 days after the second dose of the vaccine was not included. These 8 cases comprise of all events of myocarditis diagnosed in military personnel during this time period. All patients were young and generally healthy. All had mild disease with no sequalae. The incidence of myocarditis in the week following a second dose of the vaccine was 5.07/100,000 people vaccinated. Due to the nature of this report no causality could be established. Clinicians should be aware of the possibility of myocarditis following Pfizer-BioNTech vaccination. True incidence rates should be further investigated.


Subject(s)
COVID-19 , Myocarditis , COVID-19 Vaccines , Humans , Myocarditis/chemically induced , Research , SARS-CoV-2
8.
Curr Oncol Rep ; 23(7): 79, 2021 05 03.
Article in English | MEDLINE | ID: covidwho-1384599

ABSTRACT

PURPOSE OF REVIEW: Immune checkpoint inhibitors (ICIs) have improved the survival of several cancers. However, they may cause a wide range of immune-related adverse events (irAEs). While most irAEs are manageable with temporary cessation of ICI and immunosuppression, cardiovascular toxicity can be associated with high rates of morbidity and mortality. As ICIs evolve to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of ICI-associated cardiotoxicity may be even higher. RECENT FINDINGS: Several cardiovascular toxicities such as myocarditis, stress cardiomyopathy, and pericardial disease have been reported in association with ICIs. Recent findings also suggest an increased risk of atherosclerosis with ICI use. ICI-associated myocarditis usually occurs early after initiation and can be fulminant. A high index of suspicion is required for timely diagnosis. Prompt treatment with high-dose corticosteroids is shown to improve outcomes. Although the overall incidence is rare, ICI cardiotoxicity, particularly myocarditis, is associated with significant morbidity and mortality, making it a major therapy-limiting adverse event. Early recognition and prompt treatment with the cessation of ICI therapy and initiation of high-dose corticosteroids are crucial to improve outcomes. Cardio-oncologists will need to play an important role not just in the management of acute cardiotoxicity but also to reduce the risk of long-term sequelae.


Subject(s)
Atherosclerosis/diagnosis , Cardiotoxicity/diagnosis , Immune Checkpoint Inhibitors/therapeutic use , Myocarditis/diagnosis , Neoplasms/drug therapy , Atherosclerosis/chemically induced , Atherosclerosis/immunology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/virology , Cardiotoxicity/etiology , Cardiotoxicity/immunology , Humans , Immune Checkpoint Inhibitors/adverse effects , Immune Checkpoint Inhibitors/immunology , Myocarditis/chemically induced , Myocarditis/immunology , Neoplasms/immunology , Pandemics , Risk Factors , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology
10.
Circulation ; 144(6): 471-484, 2021 08 10.
Article in English | MEDLINE | ID: covidwho-1365256

ABSTRACT

Myocarditis has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccinations, especially in young adult and adolescent males. According to the US Centers for Disease Control and Prevention, myocarditis/pericarditis rates are ≈12.6 cases per million doses of second-dose mRNA vaccine among individuals 12 to 39 years of age. In reported cases, patients with myocarditis invariably presented with chest pain, usually 2 to 3 days after a second dose of mRNA vaccination, and had elevated cardiac troponin levels. ECG was abnormal with ST elevations in most, and cardiac MRI was suggestive of myocarditis in all tested patients. There was no evidence of acute COVID-19 or other viral infections. In 1 case, a cardiomyopathy gene panel was negative, but autoantibody levels against certain self-antigens and frequency of natural killer cells were increased. Although the mechanisms for development of myocarditis are not clear, molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and self-antigens, trigger of preexisting dysregulated immune pathways in certain individuals, immune response to mRNA, and activation of immunologic pathways, and dysregulated cytokine expression have been proposed. The reasons for male predominance in myocarditis cases are unknown, but possible explanations relate to sex hormone differences in immune response and myocarditis, and also underdiagnosis of cardiac disease in women. Almost all patients had resolution of symptoms and signs and improvement in diagnostic markers and imaging with or without treatment. Despite rare cases of myocarditis, the benefit-risk assessment for COVID-19 vaccination shows a favorable balance for all age and sex groups; therefore, COVID-19 vaccination is recommended for everyone ≥12 years of age.


Subject(s)
Autoantigens/immunology , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Myocarditis/chemically induced , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology , Biomarkers , COVID-19/epidemiology , COVID-19/immunology , COVID-19 Vaccines/immunology , COVID-19 Vaccines/therapeutic use , Female , Humans , Male , Molecular Mimicry/immunology , Myocarditis/immunology , Sex Factors
12.
BMC Cardiovasc Disord ; 21(1): 375, 2021 08 04.
Article in English | MEDLINE | ID: covidwho-1339117

ABSTRACT

BACKGROUND: Half of U.S. adults have received at least one dose of the COVID-19 vaccines produced by either Pfizer, Moderna, or Johnson and Johnson, which represents a major milestone in the ongoing pandemic. Given the emergency use authorizations for these vaccines, their side effects and safety were assessed over a compressed time period. Hence, ongoing monitoring for vaccine-related adverse events is imperative for a full understanding and delineation of their safety profile. CASE PRESENTATION: An 22-year-old Caucasian male presented to our hospital center complaining of pleuritic chest pain. Six months prior he had a mild case of COVID-19, but was otherwise healthy. He had received his first dose of the Moderna vaccine three days prior to developing symptoms. Laboratory analysis revealed a markedly elevated troponin and multiple imaging modalities during his hospitalization found evidence of wall motion abnormalities consistent with a diagnosis of perimyocarditis. He was started on aspirin and colchicine with marked improvement of his symptoms prior to discharge. CONCLUSIONS: We present a case of perimyocarditis that was temporally related to COVID-19 mRNA vaccination in an young male with prior COVID-19 infection but otherwise healthy. Our case report highlights an albeit rare but important adverse event for clinicians to be aware of. It also suggests a possible mechanism for the development of myocardial injury in our patient.


Subject(s)
COVID-19 Vaccines/adverse effects , Myocarditis/chemically induced , Anti-Inflammatory Agents/therapeutic use , Aspirin/therapeutic use , COVID-19 Vaccines/administration & dosage , Colchicine/therapeutic use , Humans , Immunization Schedule , Male , Myocarditis/diagnostic imaging , Myocarditis/drug therapy , Myocarditis/physiopathology , Recovery of Function , Treatment Outcome , Young Adult
13.
Circulation ; 144(6): 471-484, 2021 08 10.
Article in English | MEDLINE | ID: covidwho-1318235

ABSTRACT

Myocarditis has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccinations, especially in young adult and adolescent males. According to the US Centers for Disease Control and Prevention, myocarditis/pericarditis rates are ≈12.6 cases per million doses of second-dose mRNA vaccine among individuals 12 to 39 years of age. In reported cases, patients with myocarditis invariably presented with chest pain, usually 2 to 3 days after a second dose of mRNA vaccination, and had elevated cardiac troponin levels. ECG was abnormal with ST elevations in most, and cardiac MRI was suggestive of myocarditis in all tested patients. There was no evidence of acute COVID-19 or other viral infections. In 1 case, a cardiomyopathy gene panel was negative, but autoantibody levels against certain self-antigens and frequency of natural killer cells were increased. Although the mechanisms for development of myocarditis are not clear, molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and self-antigens, trigger of preexisting dysregulated immune pathways in certain individuals, immune response to mRNA, and activation of immunologic pathways, and dysregulated cytokine expression have been proposed. The reasons for male predominance in myocarditis cases are unknown, but possible explanations relate to sex hormone differences in immune response and myocarditis, and also underdiagnosis of cardiac disease in women. Almost all patients had resolution of symptoms and signs and improvement in diagnostic markers and imaging with or without treatment. Despite rare cases of myocarditis, the benefit-risk assessment for COVID-19 vaccination shows a favorable balance for all age and sex groups; therefore, COVID-19 vaccination is recommended for everyone ≥12 years of age.


Subject(s)
Autoantigens/immunology , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Myocarditis/chemically induced , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology , Biomarkers , COVID-19/epidemiology , COVID-19/immunology , COVID-19 Vaccines/immunology , COVID-19 Vaccines/therapeutic use , Female , Humans , Male , Molecular Mimicry/immunology , Myocarditis/immunology , Sex Factors
16.
Acad Emerg Med ; 28(8): 918-921, 2021 08.
Article in English | MEDLINE | ID: covidwho-1270817

ABSTRACT

We report the case of a previously healthy 16-year-old male who developed myopericarditis following the second dose of his Pfizer-BioNTech COVID-19 vaccine, with no other identified triggers. Adolescents and young adults experiencing chest pain after COVD-19 vaccination should seek emergent medical care, and emergency providers should have a low threshold to consider and evaluate for myopericarditis. More data are needed to better understand the potential association between COVID-19 vaccines and myopericarditis. If a true causal link is identified, the risk must also be viewed in context with the millions of patients who have been safely vaccinated and the known morbidity and mortality from COVID-19 infection. As we see widespread vaccine rollout, it is important that all potential adverse reactions are reported as we continue to monitor for more rare but potentially serious side effects not identified in vaccination trials.


Subject(s)
COVID-19 , Myocarditis , Adolescent , COVID-19 Vaccines , Humans , Male , Myocarditis/chemically induced , SARS-CoV-2 , Vaccination/adverse effects , Young Adult
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