Myokardinfarkt nach Influenza-Schutzimpfung

Current evidence of COVID-19 vaccination-related cardiovascular events

Currently, the world is recovering from the shock of the coronavirus disease 2019 (COVID-19) pandemic; however, this situation is still fragile. Health authorities recommend administering COVID-19 vaccines as the safest and most reliable tool for eliminating COVID-19. Subsequent to the extensive administration of the COVID-19 vaccines, a series of cardiovascular adverse effects have been reported. This comprehensive review aimed to provide an update on the etiology, pathophysiology, clinical features, and management of the cardiovascular adverse events associated with COVID-19 vaccines, including myocarditis, pericarditis, thrombosis with thrombocytopenia syndrome, myocardial infarction, cardiac arrhythmias, hypertension, and stress-induced cardiomyopathy. The benefits of COVID-19 vaccination far outweigh the reported adverse events. It would be clinically important to provide diagnostic scoring systems to differentiate COVID-19-related cardiovascular adverse events from other causes and develop therapeutic approaches for their management. Further evaluation of cardiovascular adverse events of the COVID-19 vaccines is crucial for implementing vaccination programs and developing safer and more reliable vaccines.

Surveillance for adverse events following immunization (AEFI) in Switzerland--1991-2001

In Switzerland, reporting of adverse events following immunization (AEFI) has been mandatory by law since 1988. The goal of this study was a detailed analysis of reported AEFI received by the Swiss Federal Office of Public Health between 1991 and 2001. Overall, 1013 AEFI were reported which translates to 2.7 reports per 100,000 vaccine doses distributed during the study period. Most AEFI were classified as general systemic reactions (47%), followed by local (26%), neurological (16%) and allergic reactions (13%). The majority of all reported AEFI (N=513; 51%) had occurred in individuals 16 years and older. Causal relationship between immunization and AEFI was probable in 91 (10%) of 909 assessable reports and very likely or certain in 194 (21%), the majority of which (88%) were local reactions. Vaccines distributed in Switzerland have proven to be generally safe. Limitations of the passive surveillance system, however, warrant improvements in the future.

Plasma fibrinogen levels after vaccination with a native outer membrane vesicle vaccine for Neisseria meningitidis

Several studies have shown plasma fibrinogen increases following some vaccinations, but the specific triggers and the kinetics of this response are not well understood. We conducted a phase I trial of an outer membrane vesicle vaccine for Neisseria meningitidis. Plasma fibrinogen was measured on days 0, 2 and 14 following each of 3 doses. The highest dose of vaccine was associated with the greatest increase in fibrinogen at day 2, which decreased by day 14. The first vaccination caused a greater increase than either subsequent vaccination. These transient increases in fibrinogen are comparable to what occurs with upper respiratory infections and have not been demonstrated to represent an increased risk of adverse vascular events.

Residual adverse changes in arterial endothelial function and LDL oxidation after a mild systemic inflammation induced by influenza vaccination

BACKGROUND

Several clinical studies have suggested possible increase in cardiovascular risk during and in the first weeks after an acute inflammatory disease. Using influenza vaccine as inflammatory stimulus, we investigated whether arterial endothelial dysfunction could persist beyond the inflammatory state, and whether amplified oxidative modification of low-density lipoprotein (LDL) accompanies this vascular disturbance.

METHODS AND SUBJECTS

The brachial artery responses to hyperemia (flow-mediated dilatation (FMD), and to sublingual glyceryl trinitrate (GTN), and the carotid intima-media thickness were assessed by external ultrasound in eight healthy male volunteers (age 17-30 y) before, and 2 and 14 days after intramuscular administration of influenza vaccine. Plasma levels of high-sensitivity C-reactive protein (CRP), fibrinogen, cyclic guanosine monophosphate (cGMP), and antibodies against oxidized LDL (oxLDL) were measured at each time point. Data are means+/-standard errors of the mean (SEM).

RESULTS

Influenza vaccination caused a slight elevation in CRP (from 0.5+/-0.1 at baseline, to 2+/-0.6 mg/L, P = 0.01) and fibrinogen (from 2.3+/-0.1 to 2.7+/-0.1 g/L, P = 0.01) at 2 days, which completely resolved at 14 days (CRP: 0.6+/-0.2 mg/L, P = 0.9, and fibrinogen: 2.3+/-0.1 g/L, P = 0.8 versus baseline). OxLDL antibody levels rose significantly at 2 days (from 1+/-0.1 at baseline to 2+/-0.4, P = 0.04), and remained elevated at 14 days (1.7+/-0.3, P = 0.1 versus baseline). FMD of the brachial artery decreased at 2 days (from 8.3+/-1.2% at baseline, to 5.4+/-1%, P = 0.05) with a further decrease at 14 days (4.9+/-0.8%, P = 0.03 versus baseline). The dilatory responses to GTN and the carotid IMT remained unchanged throughout the study period (P>0.5).

CONCLUSION

Abnormalities in arterial function and LDL oxidation may persist for at least 2 weeks after a slight inflammatory reaction induced by influenza vaccination. These could explain in part the earlier reported increase in cardiovascular risk during the first weeks after an acute inflammatory disorder.

Leukocytoclastic Vasculitis and Acute Renal Failure after Influenza Vaccination in an Elderly Patient with Myelodysplastic Syndrome

BACKGROUND

Influenza vaccination is recommended for individuals over 65 years of age and for all patients with chronic diseases who are at risk. Side effects which are seen in 1-10% of the vaccinated individuals are usually mild and consist of local reactions and constitutional symptoms. Since 1974, about 30 cases of vasculitis following influenza vaccination have been reported.

CASE REPORT

We here describe a 70-year-old male patient with a 5-year history of myelodysplastic syndrome, who had received continuous steroid treatment since 2004 and presented with leukocytoclastic vasculitis and acute renal failure requiring hemodialysis therapy 1 week after influenza vaccination. High-dose steroid treatment was promptly initiated, but hemodialysis was needed for 9 days. Maintained steroid treatment for 2 weeks was associated with complete recovery of renal function and skin lesions.

CONCLUSION

As influenza vaccination is increasingly used, physicians should be aware of the potential serious side effect of leukocytoclastic vasculitis, particularly in patients who are immunocompromised either due to an underlying disorder or as a treatment-related side effect.

Direct percutaneous coronary intervention for NSTEMI in a patient with seropositive Wegener’s granulomatosis

A case of a 49-year-old man who presented with symptoms of generalized classical Wegener's granulomatosis with the exceptional complication of acute non-ST-elevation myocardial infarction (NSTEMI) is reported. Coronary arteriography revealed an extensive arteritis with multi-local stenosis of the left anterior descending coronary artery. The culprit lesion was treated by stent implantation with success while immunosuppressive treatment with cyclophosphamide and prednisolone was continued. Using arteriography, 4 months later we found normal coronary arteries without manifestation of vasculitis. Within 8 months of medical treatment complete remission was achieved and therapy was changed to low-dose methotrexate once a week. Meanwhile medical treatment has been stopped entirely. The patient is in good clinical condition. This case indicates that the adverse event of coronary vasculitis in any patient suffering from primary or secondary vasculitis can occur. Clinically significant myocardial ischemia can occur and can even lead to myocardial infarction.

Influenza, autoimmunity and atherogenesis

It has been observed during influenza epidemics and in a number of population and clinical trials that this prevalent viral infection was associated with increased death rates from cardiovascular diseases. The clinical and experimental data that may explain accelerated coronary atherosclerosis in influenza infection with implications involving autoimmune mechanisms are reviewed in this article. Both cellular and humoral autoimmune mode could be proposed to participate in the onset or progression of atheromatous lesions due to influenza infection.