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Goldberg JF, Spinner JA, Soslow JH. Myocarditis in children 2024, new themes and continued questions. Curr Opin Cardiol 2024; 39:315-322. [PMID: 38661130 DOI: 10.1097/hco.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW While pediatric myocarditis incidence has increased since the coronavirus disease 2019 (COVID-19) pandemic, there remain questions regarding diagnosis, risk stratification, and optimal therapy. This review highlights recent publications and continued unanswered questions related to myocarditis in children. RECENT FINDINGS Emergence from the COVID-19 era has allowed more accurate description of the incidence and prognosis of myocarditis adjacent to COVID-19 infection and vaccine administration as well that of multi-system inflammatory disease in children (MIS-C). As cardiac magnetic resonance technology has shown increased availability and evidence in pediatric myocarditis, it is important to understand conclusions from adult imaging studies and define the use of this imaging biomarker in children. Precision medicine has begun to allow real-time molecular evaluations to help diagnose and risk-stratify cardiovascular diseases, with emerging evidence of these modalities in myocarditis. SUMMARY Recent information regarding COVID-19 associated myocarditis, cardiac magnetic resonance, and molecular biomarkers may help clinicians caring for children with myocarditis and identify needs for future investigations.
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Golino M, Harding D, Del Buono MG, Fanti S, Mohiddin S, Toldo S, Smyth J, Sanna T, Marelli-Berg F, Abbate A. Innate and adaptive immunity in acute myocarditis. Int J Cardiol 2024; 404:131901. [PMID: 38403204 DOI: 10.1016/j.ijcard.2024.131901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
Acute myocarditis is an acute inflammatory cardiomyopathy associated with cardiac damage triggered by a virus or a pathological immune activation. It may present with a wide range of clinical presentations, ranging from mild symptoms to severe forms like fulminant myocarditis, characterized by hemodynamic compromise and cardiogenic shock. The immune system plays a central role in the pathogenesis of myocarditis. In fact, while its function is primarily protective, aberrant responses can be detrimental. In this context, both innate and adaptive immunity play pivotal roles; notably, the innate system offers a non-specific and immediate defense, while the adaptive provides specialized protection with immunological memory. However, dysregulation in these systems can misidentify cardiac tissue, triggering autoimmune reactions and possibly leading to significant cardiac tissue damage. This review highlights the importance of innate and adaptive immune responses in the progression and treatment of acute myocarditis.
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Affiliation(s)
- Michele Golino
- Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States of America; Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Daniel Harding
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Fanti
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Saidi Mohiddin
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom; Barts Heart Centre, London, United Kingdom
| | - Stefano Toldo
- Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States of America
| | - James Smyth
- Fralin Biomedical Research Institute at Virginia Tech Carillion, Roanoke, VA, United States of America; Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America; Department of Biological Sciences, College of Science, Virginia Tech, Blacksburg, VA, United States of America
| | - Tommaso Sanna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Marelli-Berg
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
| | - Antonio Abbate
- Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States of America.
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3
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Copland E, Patone M, Saatci D, Handunnetthi L, Hirst J, Hunt DPJ, Mills NL, Moss P, Sheikh A, Coupland CAC, Harnden A, Robertson C, Hippisley-Cox J. Safety outcomes following COVID-19 vaccination and infection in 5.1 million children in England. Nat Commun 2024; 15:3822. [PMID: 38802362 PMCID: PMC11130197 DOI: 10.1038/s41467-024-47745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
The risk-benefit profile of COVID-19 vaccination in children remains uncertain. A self-controlled case-series study was conducted using linked data of 5.1 million children in England to compare risks of hospitalisation from vaccine safety outcomes after COVID-19 vaccination and infection. In 5-11-year-olds, we found no increased risks of adverse events 1-42 days following vaccination with BNT162b2, mRNA-1273 or ChAdOX1. In 12-17-year-olds, we estimated 3 (95%CI 0-5) and 5 (95%CI 3-6) additional cases of myocarditis per million following a first and second dose with BNT162b2, respectively. An additional 12 (95%CI 0-23) hospitalisations with epilepsy and 4 (95%CI 0-6) with demyelinating disease (in females only, mainly optic neuritis) were estimated per million following a second dose with BNT162b2. SARS-CoV-2 infection was associated with increased risks of hospitalisation from seven outcomes including multisystem inflammatory syndrome and myocarditis, but these risks were largely absent in those vaccinated prior to infection. We report a favourable safety profile of COVID-19 vaccination in under-18s.
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Affiliation(s)
- Emma Copland
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Martina Patone
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Defne Saatci
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Lahiru Handunnetthi
- Centre for Human Genetics, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jennifer Hirst
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - David P J Hunt
- UK Dementia Research Institute, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Aziz Sheikh
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carol A C Coupland
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Harnden
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
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4
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Tian Y, Deng Z, Chuai Z, Li C, Chang L, Sun F, Cao R, Yu H, Xiao R, Lu S, Xu Y, Yang P. A combination influenza mRNA vaccine candidate provided broad protection against diverse influenza virus challenge. Virology 2024; 596:110125. [PMID: 38805804 DOI: 10.1016/j.virol.2024.110125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
Influenza viruses present a significant threat to global health. The production of a universal vaccine is considered essential due to the ineffectiveness of current seasonal influenza vaccines against mutant strains. mRNA technology offers new prospects in vaccinology, with various candidates for different infectious diseases currently in development and testing phases. In this study, we encapsulated a universal influenza mRNA vaccine. The vaccine encoded influenza hemagglutinin (HA), nucleoprotein (NP), and three tandem repeats of matrix protein 2 (3M2e). Twice-vaccinated mice exhibited strong humoral and cell-mediated immune responses in vivo. Notably, these immune responses led to a significant reduction in viral load of the lungs in challenged mice, and also conferred protection against future wild-type H1N1, H3N2, or H5N1 influenza virus challenges. Our findings suggest that this mRNA-universal vaccine strategy for influenza virus may be instrumental in mitigating the impact of future influenza pandemics.
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Affiliation(s)
- Yuying Tian
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; School of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Zhuoya Deng
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhengran Chuai
- The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100039, China
| | - Cong Li
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; School of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Liangzheng Chang
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Fang Sun
- The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100039, China
| | - Rui Cao
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; School of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Hongyu Yu
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; School of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Ruixue Xiao
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; School of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Shuai Lu
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yan Xu
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Penghui Yang
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; School of Basic Medicine, Inner Mongolia Medical University, Hohhot, China.
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5
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Lee JS, Choi H, Shin SH, Hwang MJ, Na S, Kim JH, Park S, Yoon Y, Kang HM, Ahn B, Seo K, Choe YJ. Characterization of Brighton Collaboration criteria for myocarditis and pericarditis following COVID-19 vaccine in Korean adolescents. Vaccine 2024; 42:3333-3336. [PMID: 38604914 DOI: 10.1016/j.vaccine.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/28/2024] [Accepted: 04/09/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Vaccines are vital for public health, but concerns about adverse effects, particularly myocarditis and pericarditis linked to COVID-19 vaccines-, persist. This study investigates the application of Brighton Collaboration case definition to national vaccine safety data related to post-COVID-19 vaccine myo/pericarditis, utilizing claims under the Korea National Vaccine Injury Compensation Program (NIVCP). METHODS This study analyzed 190 medical records of individuals who claimed to have developed myo/pericarditis after receiving the COVID-19 vaccine, as reported to the NVICP between specified dates, categorizing cases based on the Brighton criteria for myocarditis or pericarditis. RESULTS Between 2021-2022, NVICP received 190 cases meeting the Brighton criteria for myocarditis or pericarditis at levels 1, 2, or 3. Most cases fell into Level 2 (70%), followed by Level 1 (29%), and one at Level 3 (1%), with Level 1 cases showing a higher hospitalization rate (87.3%) and a notable proportion requiring admission to the Intensive Care Unit (25.5%). Chest pain and Troponin-I/T elevation were common findings in Level 1 cases, while Level 2 cases exhibited similar patterns but at a slightly lower frequency. Electrocardiogram and echocardiography findings differed between the two levels. CONCLUSION The Brighton Collaboration case definition proved valuable for classifying and assessing AEFI data, enhancing our understanding of the potential relationship between myocarditis and the COVID-19 vaccine.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - HyoSug Choi
- Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Seung Hwan Shin
- Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Myung-Jae Hwang
- Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Sara Na
- Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Jong Hee Kim
- Immunization Safety Group, COVID-19 Vaccination Task Force, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Sangshin Park
- Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea
| | - Yoonsun Yoon
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyun Mi Kang
- Department of Pediatrics, The Catholic University of Korea St. Mary's Hospital, Seoul, Republic of Korea
| | - Bin Ahn
- Department of Pediatrics, The Catholic University of Korea Yeouido St. Mary's Hospital, Seoul, Republic of Korea
| | - Kyoungsan Seo
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea.
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Nham E, Noh JY, Park O, Choi WS, Song JY, Cheong HJ, Kim WJ. COVID-19 Vaccination Strategies in the Endemic Period: Lessons from Influenza. Vaccines (Basel) 2024; 12:514. [PMID: 38793765 PMCID: PMC11125835 DOI: 10.3390/vaccines12050514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious zoonotic respiratory disease with many similarities to influenza. Effective vaccines are available for both; however, rapid viral evolution and waning immunity make them virtually impossible to eradicate with vaccines. Thus, the practical goal of vaccination is to reduce the incidence of serious illnesses and death. Three years after the introduction of COVID-19 vaccines, the optimal vaccination strategy in the endemic period remains elusive, and health authorities worldwide have begun to adopt various approaches. Herein, we propose a COVID-19 vaccination strategy based on the data available until early 2024 and discuss aspects that require further clarification for better decision making. Drawing from comparisons between COVID-19 and influenza vaccination strategies, our proposed COVID-19 vaccination strategy prioritizes high-risk groups, emphasizes seasonal administration aligned with influenza vaccination campaigns, and advocates the co-administration with influenza vaccines to increase coverage.
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Affiliation(s)
- Eliel Nham
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Ok Park
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
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Vila-Olives R, Uribarri A, Martínez-Martínez M, Argudo E, Bonilla C, Chiscano L, Herrador L, Gabaldón A, Irene Buera, Vidal M, De la Iglesia A, Díaz MÁ, López E, Font M, Barrabés JA, Riera J, Ferreira-González I, Ferrer R. Fulminant myocarditis following SARS-CoV-2 mRNA vaccination rescued with venoarterial ECMO: A report of two cases. Perfusion 2024; 39:655-659. [PMID: 37075138 PMCID: PMC10126745 DOI: 10.1177/02676591231170480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Cases of myocarditis after COVID-19 messenger RNA (mRNA) vaccines administration have been reported. Although the majority follow a mild course, fulminant presentations may occur. In these cases, cardiopulmonary support with venoarterial extracorporeal membrane oxygenation (V-A ECMO) may be needed. RESULTS We present two cases supported with V-A ECMO for refractory cardiogenic shock due to myocarditis secondary to a mRNA SARS-CoV2 vaccine. One of the cases was admitted for out-of-hospital cardiac arrest. In both, a peripheral V-A ECMO was implanted in the cath lab using the Seldinger technique. An intra-aortic balloon pump was needed in one case for left ventricle unloading. Support could be successfully withdrawn in a mean of five days. No major bleeding or thrombosis complications occurred. Whereas an endomyocardial biopsy was performed in both, a definite microscopic diagnosis just could be reached in one of them. Treatment was the same, using 1000mg of methylprednisolone/day for three days. A cardiac magnetic resonance was performed ten days after admission, showing a significant improvement of the left ventricular ejection fraction and diffuse oedema and subepicardial contrast intake in different segments. Both cases were discharged fully recovered, with CPC 1. CONCLUSIONS COVID-19 vaccine-associated fulminant myocarditis has a high morbidity and mortality but presents a high potential for recovery. V-A ECMO should be established in cases with refractory cardiogenic shock during the acute phase.
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Affiliation(s)
- Rosa Vila-Olives
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
| | - Aitor Uribarri
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
- Centro de Investigación en Red de
Enfermedades Cardiovasculares (CIBERCV), Madrid. Spain
| | - María Martínez-Martínez
- Department of Intensive Care, Vall d’Hebron University
Hospital, Barcelona, Spain
- SODIR, Vall d’Hebron Institut de
Recerca, Barcelona, Spain
| | - Eduard Argudo
- Department of Intensive Care, Vall d’Hebron University
Hospital, Barcelona, Spain
- SODIR, Vall d’Hebron Institut de
Recerca, Barcelona, Spain
| | - Camilo Bonilla
- Department of Intensive Care, Vall d’Hebron University
Hospital, Barcelona, Spain
- SODIR, Vall d’Hebron Institut de
Recerca, Barcelona, Spain
| | - Luis Chiscano
- Department of Intensive Care, Vall d’Hebron University
Hospital, Barcelona, Spain
- SODIR, Vall d’Hebron Institut de
Recerca, Barcelona, Spain
| | - Lorena Herrador
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
| | - Alejandra Gabaldón
- Department of Pathology, Vall
d’Hebron University Hospital, Barcelona, Spain
| | - Irene Buera
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
- Centro de Investigación en Red de
Enfermedades Cardiovasculares (CIBERCV), Madrid. Spain
| | - Maria Vidal
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
| | - Ana De la Iglesia
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
| | - Maria Ángeles Díaz
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
| | - Elena López
- Department of Intensive Care, Vall d’Hebron University
Hospital, Barcelona, Spain
| | - Marta Font
- Department of Intensive Care, Vall d’Hebron University
Hospital, Barcelona, Spain
| | - Jose A. Barrabés
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
- Centro de Investigación en Red de
Enfermedades Cardiovasculares (CIBERCV), Madrid. Spain
| | - Jordi Riera
- Department of Intensive Care, Vall d’Hebron University
Hospital, Barcelona, Spain
- SODIR, Vall d’Hebron Institut de
Recerca, Barcelona, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d’Hebron University
Hospital, Barcelona, Spain
- Centro de Investigación en Red de
Enfermedades Cardiovasculares (CIBERCV), Madrid. Spain
| | - Ricard Ferrer
- Department of Intensive Care, Vall d’Hebron University
Hospital, Barcelona, Spain
- SODIR, Vall d’Hebron Institut de
Recerca, Barcelona, Spain
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Choi MJ, Na Y, Hyun HJ, Nham E, Yoon JG, Seong H, Seo YB, Choi WS, Song JY, Kim DW, Kim YE, Jung J, Cheong HJ. Comparative safety analysis of mRNA and adenoviral vector COVID-19 vaccines: a nationwide cohort study using an emulated target trial approach. Clin Microbiol Infect 2024; 30:646-652. [PMID: 38101473 DOI: 10.1016/j.cmi.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/02/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE This nationwide cohort study compared the incidence of adverse events of special interest (AESIs) between adenoviral vector-based (ChAdOx1) and mRNA-based (BNT162b2 or mRNA-1273) coronavirus disease 2019 (COVID-19) vaccines. METHODS A targeted trial emulation study was conducted using data from the National Health Insurance Service database. Vaccinees aged 18-85 years who had received at least one dose of ChAdOx1 or an mRNA-based vaccine were identified. The 42-day risks of AESIs were calculated. RESULTS A total of 1 767 539 ChAdOx1 vaccinees were matched exactly with mRNA vaccinees according to their risk factors. The 42-day risks of adverse events were low (∼0 to 176 events per 100 000 persons in both vaccine groups), and the incidence rates of AESIs were comparable between the two platforms, except for a higher occurrence of acute cardiac injury (incidence rate ratio [IRR], 1.22; 95% CI, 1.10-1.35), myocarditis or pericarditis (IRR, 2.14; 95% CI, 1.14-4.04), and arrhythmia (IRR, 1.46; 95% CI, 1.24-1.71) in mRNA vaccinees. The incidence of Guillain-Barré syndrome (IRR, 0.20; 95% CI, 0.06-0.69), vasovagal syncope (IRR, 0.77; 95% CI, 0.62-0.97), radiculopathy (IRR = 0.59, 95% CI, 0.41-0.84), and aseptic arthritis (IRR, 0.81; 95% CI, 0.70-0.93) was significantly lower in mRNA-based vaccinees compared with ChAdOx1 vaccinees. DISCUSSION A remarkable platform-dependent difference was observed in the safety profiles of COVID-19 vaccines, particularly for myocarditis or pericarditis and Guillain-Barré syndrome. However, the overall risk of AESIs was low for both vaccine platforms.
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Affiliation(s)
- Min Joo Choi
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Yewon Na
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Artificial Intelligence and Big-data Convergence Center, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hak Jun Hyun
- Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Eliel Nham
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Yoon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Seong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yu Bin Seo
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Won Suk Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Information and Statistics, Research Institute of Natural Science, Gyeongsang National University, Jinju, Republic of Korea; Department of Bio and Medical Bigdata Department, Research Institute of Natural Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Young-Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Republic of Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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9
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Caplanusi I, Szmigiel A, van der Elst M, Schougaard Christiansen ML, Thirstrup S, Zaccaria C, Cappelli B, Genov G, Straus S. The Role of the European Medicines Agency in the Safety Monitoring of COVID-19 Vaccines and Future Directions in Enhancing Vaccine Safety Globally. Drug Saf 2024; 47:405-418. [PMID: 38396269 PMCID: PMC11018685 DOI: 10.1007/s40264-024-01405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
The European Union (EU) regulatory network was at the forefront of the safety monitoring of COVID-19 vaccines during the pandemic. An unprecedented number of case reports of suspected adverse reactions after vaccination called for huge efforts for the assessment of this safety information, to ensure that any possible risks were detected and managed as early as possible, while ruling out coincidental but temporally related adverse health outcomes. We describe the role of the European Medicines Agency alongside the EU regulatory network in the safety monitoring of the COVID-19 vaccines, and provide an insight into challenges, particularities and outcomes of the scientific assessment and regulatory decisions in the complex, dynamic international environment of the pandemic. We discuss the flexible procedural tools that were used to ensure an expedited scientific assessment of safety issues, and subsequent updates of the product information (i.e., labelling) when available evidence (e.g., spontaneous reports, findings from observational studies and/or scientific literature) suggested that causal association is at least a reasonable possibility. The safety monitoring was accompanied by enhanced transparency measures, proactive communication, and easy access to information, which played a key role in public reassurance. The pandemic has been a powerful booster for worldwide collaboration, exchange of information and work-sharing. The safety monitoring of COVID-19 vaccines continues, and the lessons learned will be applied in future safety reviews, as well as future health emergencies.
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Affiliation(s)
- Irina Caplanusi
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
| | - Agnieszka Szmigiel
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Menno van der Elst
- Medicines Evaluation Board, Utrecht, The Netherlands
- Pharmacovigilance Risk Assessment Committee, Amsterdam, The Netherlands
| | | | - Steffen Thirstrup
- Chief Medical Officer, European Medicines Agency, Amsterdam, The Netherlands
| | - Cosimo Zaccaria
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Bénédicte Cappelli
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Georgy Genov
- European Medicines Agency, Pharmacovigilance Office, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Sabine Straus
- Medicines Evaluation Board, Utrecht, The Netherlands
- Pharmacovigilance Risk Assessment Committee, Amsterdam, The Netherlands
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10
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Yamaji T, Harada T, Hashimoto Y, Nakano Y, Kajikawa M, Yoshimura K, Goto C, Han Y, Mizobuchi A, Yusoff FM, Kishimoto S, Maruhashi T, Nakashima A, Higashi Y. Effects of BNT162b2 mRNA Covid-19 vaccine on vascular function. PLoS One 2024; 19:e0302512. [PMID: 38687730 PMCID: PMC11060586 DOI: 10.1371/journal.pone.0302512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
The effects of Covid-19 vaccines on vascular function are still controversial. We evaluated the effects of BNT162b2 vaccine (BioNTech and Pfizer) on endothelial function assessed by flow-mediated vasodilation (FMD) and vascular smooth muscle function assessed by nitroglycerine-induced vasodilation (NID). This study was a prospective observational study. A total of 23 medical staff at Hiroshima University Hospital were enrolled in this study. FMD and NID were measured before vaccination and two weeks and six months after the 2nd dose of vaccination. FMD was significantly smaller two weeks after the 2nd dose of vaccination than before vaccination (6.5±2.4% and 8.2±2.6%, p = 0.03). FMD was significantly larger at six months than at two weeks after the 2nd dose of vaccination (8.2±3.0% and 6.5±2.4%, p = 0.03). There was no significant difference between FMD before vaccination and that at six months after the 2nd dose of vaccination (8.2±2.6% to 8.2±3.0%, p = 0.96). NID values were similar before vaccination and at two weeks, and six months after vaccination (p = 0.89). The BNT162b2 Covid-19 vaccine temporally impaired endothelial function but not vascular smooth muscle function, and the impaired endothelial function returned to the baseline level within six months after vaccination.
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Affiliation(s)
- Takayuki Yamaji
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Takahiro Harada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yu Hashimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenichi Yoshimura
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
- Department of Biostatistics, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Chikara Goto
- Department of Rehabilitation, Faculty of General Rehabilitation, Hiroshima International University, Hiroshima, Japan
| | - Yiming Han
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Aya Mizobuchi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Farina Mohamad Yusoff
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Shinji Kishimoto
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuya Maruhashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Ayumu Nakashima
- Department of Stem Cell Biology and Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yukihito Higashi
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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11
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Boker LK, Fluss R, Dichtiar R, Rosenberg A, Ben-Lassan M, Huppert A. Pfizer COVID19 vaccine is not associated with acute cardiovascular events excluding myocarditis- a national self-controlled case series study. Isr J Health Policy Res 2024; 13:23. [PMID: 38659032 PMCID: PMC11040923 DOI: 10.1186/s13584-024-00609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Despite publications assuring no increased risk for acute cardiovascular events (excluding myocarditis) and sudden death following administration of COVID19 vaccines, these issues still stir much public ado. We assessed the risk for acute cardiovascular events that require hospitalization (excluding myocarditis) and for mortality in the short-term following administration of the second dose of the Pfizer COVID19 vaccine in Israel. METHODS Using a self-controlled case series (SCCS) study design and national databases, all second-dose vaccinees, who had not been diagnosed with COVID19 and who had an acute cardiovascular event (acute myocardial infarction/acute stroke/acute thromboembolic event) that required hospitalization in the 60 days following vaccine administration between Jan 11th, 2021 and Oct 31st 2021, were included. A similar analysis was carried out for mortality. The first 30 days following vaccination were defined as risk period while the next 30 days were defined as control period. The probability for an event between these periods was compared using a conditional logistic regression model, accounting for sex, age group, background morbidity and seasonal risk. RESULTS Out of 5,700,112 second dose vaccinees, 4,163 had an acute cardiovascular event in the 60 days following vaccine administration. Following exclusion of 106 due to technical considerations, 1,979 events occurred during the risk period and 2,078 during the control period: Odds ratio, OR = 0.95, 95% confidence interval, CI 0.90-1.01, p = 0.12. Adjusted OR was similar (OR = 0.88, 95%CI 0.72-1.08). Stratifying by age showed no increased risk in any age group. Mortality assessment indicated low number of events in both periods. These results were consistent in sensitivity analyses. CONCLUSIONS There was no increased risk for acute cardiovascular events (excluding myocarditis) in the risk period compared to the control period following administration of the second dose of Pfizer COVID19 vaccine. Mortality data raised no concerns either, but may have been biased.
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Affiliation(s)
- Lital Keinan Boker
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Gertner bldg, 52621, Tel Hashomer, Ramat Gan, Israel.
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Ronen Fluss
- Gertner Institute for the Study of Epidemiology and Health Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Rita Dichtiar
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Gertner bldg, 52621, Tel Hashomer, Ramat Gan, Israel
| | - Alina Rosenberg
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Gertner bldg, 52621, Tel Hashomer, Ramat Gan, Israel
| | - Maya Ben-Lassan
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Gertner bldg, 52621, Tel Hashomer, Ramat Gan, Israel
| | - Amit Huppert
- Gertner Institute for the Study of Epidemiology and Health Policy, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Watson RA, Ye W, Taylor CA, Jungkurth E, Cooper R, Tong O, James T, Shine B, Hofer M, Jenkins D, Pell R, Ieremia E, Jones S, Maldonado-Perez D, Roberts ISD, Coupe N, Middleton MR, Payne MJ, Fairfax BP. Severe acute myositis and myocarditis on initiation of 6-weekly pembrolizumab post-COVID-19 mRNA vaccination. J Immunother Cancer 2024; 12:e008151. [PMID: 38663935 PMCID: PMC11043765 DOI: 10.1136/jitc-2023-008151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
We describe three cases of critical acute myositis with myocarditis occurring within 22 days of each other at a single institution, all within 1 month of receiving the initial cycle of the anti-PD-1 drug pembrolizumab. Analysis of T cell receptor repertoires from peripheral blood and tissues revealed a high degree of clonal expansion and public clones between cases, with several T cell clones expanded within the skeletal muscle putatively recognizing viral epitopes. All patients had recently received a COVID-19 mRNA booster vaccine prior to treatment and were positive for SARS-CoV2 Spike antibody. In conclusion, we report a series of unusually severe myositis and myocarditis following PD-1 blockade and the COVID-19 mRNA vaccination.
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Affiliation(s)
- Robert A Watson
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
- Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Weiyu Ye
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
- Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chelsea A Taylor
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | - Elsita Jungkurth
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | - Rosalin Cooper
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | - Orion Tong
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | - Tim James
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Brian Shine
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Monika Hofer
- Department of Neuro Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Jenkins
- Department of Clinical Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert Pell
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eleni Ieremia
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephanie Jones
- Oxford Centre for Histopathological Research, Oxford University Hospitals NHS Trust, Oxford, UK
| | - David Maldonado-Perez
- Oxford Centre for Histopathological Research, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ian S D Roberts
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicholas Coupe
- Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Oxford, UK
- Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Miranda J Payne
- Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Benjamin P Fairfax
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
- Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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13
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Costa C, Moniati F. The Epidemiology of COVID-19 Vaccine-Induced Myocarditis. Adv Med 2024; 2024:4470326. [PMID: 38681683 PMCID: PMC11045291 DOI: 10.1155/2024/4470326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background In December 2019, the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) led to the COVID-19 pandemic, with millions of deaths worldwide. Vaccine breakthroughs in late 2020 resulted in the authorization of COVID-19 vaccines. While these vaccines have demonstrated efficacy, evidence from vaccine safety monitoring systems around the globe supported a causal association between COVID-19 vaccines, in particular those using mRNA technology, i.e., Moderna's mRNA-1273 and Pfizer-BioNTech's BNT162b2, and myocarditis. Objective This paper aims to investigate the epidemiology of mRNA COVID-19 vaccine-induced myocarditis, including age, ethnicity, and gender associations with these vaccines. It also discusses the immunopathophysiological mechanisms of mRNA COVID-19 vaccine-associated myocarditis and outlines principles of diagnosis, clinical presentation, and management. Methods A literature review was conducted using PubMed, Embase, and Queen Mary University of London Library Services databases. Search terms included "myocarditis," "coronavirus disease 2019," "SARS-CoV-2," "mRNA Covid-19 vaccines," "Covid vaccine-associated myocarditis," "epidemiology," "potential mechanisms," "myocarditis diagnosis," and "myocarditis management." Results While the definite mechanism of mRNA COVID-19 vaccine-associated myocarditis remains ambiguous, potential mechanisms include molecular mimicry of spike proteins and activation of the adaptive immune response with dysregulated cytokine expression. Male predominance in COVID-19 vaccine-induced myocarditis may be attributed to sex hormones, variations in inflammatory reactions, coagulation states based on gender, and female-specific protective factors. Moreover, an analysis of diagnostic and management strategies reveals a lack of consensus on acute patient presentation management. Conclusion In contrast to viral infections that stand as the predominant etiological factor for myocarditis with more severe consequences, the mRNA COVID-19 vaccination elicits a mild and self-limiting manifestation of the condition. There is currently insufficient evidence to confirm the definite underlying mechanism of COVID-19 vaccine-associated myocarditis. Further research is needed to develop preventive and therapeutic solutions in this context.
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Affiliation(s)
| | - Foteini Moniati
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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14
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Gee J, Shimabukuro TT, Su JR, Shay D, Ryan M, Basavaraju SV, Broder KR, Clark M, Buddy Creech C, Cunningham F, Goddard K, Guy H, Edwards KM, Forshee R, Hamburger T, Hause AM, Klein NP, Kracalik I, Lamer C, Loran DA, McNeil MM, Montgomery J, Moro P, Myers TR, Olson C, Oster ME, Sharma AJ, Schupbach R, Weintraub E, Whitehead B, Anderson S. Overview of U.S. COVID-19 vaccine safety surveillance systems. Vaccine 2024:S0264-410X(24)00224-X. [PMID: 38631952 DOI: 10.1016/j.vaccine.2024.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
The U.S. COVID-19 vaccination program, which commenced in December 2020, has been instrumental in preventing morbidity and mortality from COVID-19 disease. Safety monitoring has been an essential component of the program. The federal government undertook a comprehensive and coordinated approach to implement complementary safety monitoring systems and to communicate findings in a timely and transparent way to healthcare providers, policymakers, and the public. Monitoring involved both well-established and newly developed systems that relied on both spontaneous (passive) and active surveillance methods. Clinical consultation for individual cases of adverse events following vaccination was performed, and monitoring of special populations, such as pregnant persons, was conducted. This report describes the U.S. government's COVID-19 vaccine safety monitoring systems and programs used by the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the Department of Defense, the Department of Veterans Affairs, and the Indian Health Service. Using the adverse event of myocarditis following mRNA COVID-19 vaccination as a model, we demonstrate how the multiple, complementary monitoring systems worked to rapidly detect, assess, and verify a vaccine safety signal. In addition, longer-term follow-up was conducted to evaluate the recovery status of myocarditis cases following vaccination. Finally, the process for timely and transparent communication and dissemination of COVID-19 vaccine safety data is described, highlighting the responsiveness and robustness of the U.S. vaccine safety monitoring infrastructure during the national COVID-19 vaccination program.
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Affiliation(s)
- Julianne Gee
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
| | - Tom T Shimabukuro
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - John R Su
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - David Shay
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Margaret Ryan
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, United States
| | - Sridhar V Basavaraju
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Karen R Broder
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Matthew Clark
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center and School of Medicine, Nashville, TN, United States
| | - Francesca Cunningham
- Department of Veterans Affairs, Veterans Affairs Center for Medication Safety - Pharmacy Benefit Management Services, Hines, IL, United States
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Harrison Guy
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Kathryn M Edwards
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center and School of Medicine, Nashville, TN, United States
| | - Richard Forshee
- Office of Biologics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
| | - Tanya Hamburger
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Anne M Hause
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ian Kracalik
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Chris Lamer
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - David A Loran
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, United States
| | - Michael M McNeil
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Jay Montgomery
- Defense Health Agency, Immunization Healthcare Division, Bethesda, MD, United States
| | - Pedro Moro
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Tanya R Myers
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Christine Olson
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Matthew E Oster
- National Center for Birth Defects and Developmental Disabilities, CDC, Atlanta GA, United States; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrea J Sharma
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Ryan Schupbach
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Eric Weintraub
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Brett Whitehead
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Steven Anderson
- Office of Biologics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
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15
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Cooper LT, Hasin T, Ryan M. Third time's a harm? Cardiac risk of SARS-CoV-2 mRNA booster vaccines in younger men. Eur Heart J 2024; 45:1336-1338. [PMID: 38531026 DOI: 10.1093/eurheartj/ehae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Affiliation(s)
- Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic in Florida, 4500 San Pablo, Jacksonville, FL 32224, USA
| | - Tal Hasin
- Hebrew University and Medical Director of Heart failure Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Margaret Ryan
- DHA Immunization Healthcare, Naval Medical Center San Diego, Building 6, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
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16
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Cacciatore C, Baudet M, Jean E, Presente S, Para M, Sonneville R, Arangalage D, Ait Abdallah N, Sicre de Fontbrune F, Prata PH, Crichi B, Hervier B, Parquet N, Soulat G, Mousseaux E, Burt RK, Farge D. Extracorporeal membrane oxygenation (ECMO) during aplasia: A bridge towards myopericarditis recovery after autologous hematopoietic stem cell transplant for systemic sclerosis and recent Coronarovirus disease (COVID-19) vaccination. Curr Res Transl Med 2024; 72:103449. [PMID: 38636307 DOI: 10.1016/j.retram.2024.103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease (AD), characterised by early diffuse vasculopathy, activation of the immune response and progressive skin and internal organ fibrosis. In severe progressive diffuse SSc (dSSc), autologous hematopoietic stem cell transplantation (aHSCT) improves survival, despite its own risk of complications and transplant related mortality (TRM). We present herein the case of a dSSc patient undergoing aHSCT with low dose cyclophosphamide conditioning and sudden acute myopericarditis and cardiogenic shock, four weeks after a second mRNA SARS-CoV-2 vaccine (Pfizer) injection. Four days of extracorporeal membrane oxygenation (ECMO) support during the aplasia period, allowed to observe full cardiac function recovery and progressive SSc rehabilitation with sustained disease response at 30 months follow-up. This report illustrates, for the first time to our knowledge, that ECMO can be indicated despite aplasia during aHSCT and successfully used as a bridge towards heart function recovery in highly selected and fragile AD patients. We review the factors that may contribute to endothelial and myocardial stunning and acute reversible cardiac failure in SSc and aggravate intrinsic endothelial injury during the aHSCT procedure. These classically include: cyclophosphamide drug toxicity, viral infections and autoimmune activation with disease flair per se. In the COVID-19 pandemic times, acute myocarditis due to recent viral infection or mRNA vaccine per se, must also be considered.
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Affiliation(s)
- Carlotta Cacciatore
- Unité de Médecine Interne (UF04): CRMR MATHEC, Maladies Auto-immunes et Thérapie Cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, F-75010 Paris, France; Université Paris Cité, IRSL, Recherche Clinique en hématologie, immunologie et transplantation, URP3518, F-75010 Paris, France
| | - Mathilde Baudet
- Department of Cardiology, Hospital Saint-Louis, Paris, France
| | - Estelle Jean
- Département de Médecine Interne, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France; Centre de référence des syndromes drépanocytaires majeurs, thalassémies et autres pathologies rares du globule rouge et de l'érythropoïèse, Assistance Publique des hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Simona Presente
- Medical and Infectious Diseases ICU, APHP, Bichat Hospital, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France; Laboratory of Vascular Translational Science, University of Paris-Cité, UMR 1148 Paris, France
| | - Romain Sonneville
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France; Laboratory of Vascular Translational Science, University of Paris-Cité, UMR 1148 Paris, France
| | - Dimitri Arangalage
- Cardiology Department, AP-HP, Bichat Hospital and Université de Paris-Cité, Paris, France
| | - Nassim Ait Abdallah
- Service de Médecine Interne 2, maladies auto-immunes et systémiques, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | | | | | - Benjamin Crichi
- Unité de Médecine interne (UF07), AP-HP, Hôpital St-Louis, F-75010 Paris, France
| | - Baptiste Hervier
- Unité de Médecine interne (UF07), AP-HP, Hôpital St-Louis, F-75010 Paris, France
| | - Nathalie Parquet
- Unité d'Aphérèse Thérapeutique, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Gilles Soulat
- Radiologie, Hôpital Européen Georges Pompidou, APHP, INSERM 970, Université de Paris-Cité, France
| | - Elie Mousseaux
- Radiologie, Hôpital Européen Georges Pompidou, APHP, INSERM 970, Université de Paris-Cité, France
| | - Richard K Burt
- Scripps Health, La Jolla USA,; Genani Corporation, Chicago, USA
| | - Dominique Farge
- Unité de Médecine Interne (UF04): CRMR MATHEC, Maladies Auto-immunes et Thérapie Cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, F-75010 Paris, France; Université Paris Cité, IRSL, Recherche Clinique en hématologie, immunologie et transplantation, URP3518, F-75010 Paris, France; Department of Medicine, McGill University, H3A 1A1, Montreal, Canada.
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17
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Bianchi FP, Rizzi D, Daleno A, Stefanizzi P, Migliore G, Tafuri S. Assessing the temporal and cause-effect relationship between myocarditis and mRNA COVID-19 vaccines. A retrospective observational study. Int J Infect Dis 2024; 141:106960. [PMID: 38365084 DOI: 10.1016/j.ijid.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/20/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE In 2021, the US Centers for Disease Control and Prevention reported increased cases of myocarditis and pericarditis in the United States after mRNA COVID-19 vaccines. Our study aims to estimate the incidence of myocarditis in Apulia (Southern Italy) and the cause-effect relationship between COVID-19 mRNA vaccines and the risk of myocarditis. METHODS The Apulian regional archive of hospital discharge forms was used to define the cases of myocarditis in Apulia, considering data from 2017 to 2022. The overall vaccination status of patients was assessed via data collected from the Regional Immunization Database. The history of SARS-CoV-2 infection was extracted from the Italian Institute of Health platform. RESULTS Since 2017, 5687 cases of myocarditis have been recorded in Apulian subjects; the overall incidence described a decreasing trend, with a slight increase in 0-40 years-old subjects. From 2021 to 2022, 2,930,276 doses of COVID-19 mRNA vaccines were administered; a diagnosis of myocarditis after the second dose of the mRNA vaccine was reported for 894 (0.03%) of Apulian inhabitants, with an incidence rate of 17.9 × 1,000,000 persons-month. The multivariate analysis, adjusted for age, sex, underlying medical conditions, and diagnosis of COVID-19, showed that mRNA vaccination is a protective factor for myocarditis even in younger subjects (aOR = 0.4; 95% CI = 0.3-0.5). CONCLUSION A temporal association between an exposure and an outcome is not equivalent to a causal association. Our study underlines how an approach that considers the other potential causes of myocarditis (primarily COVID-19) and a causality assessment must be prioritized in the study of the topic.
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Affiliation(s)
- Francesco Paolo Bianchi
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy; Azienda Ospedaliero Universitaria Policlinico Giovanni XXIII, Bari, Italy
| | - Donato Rizzi
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Antonio Daleno
- Azienda Ospedaliero Universitaria Policlinico Giovanni XXIII, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Giovanni Migliore
- Azienda Ospedaliero Universitaria Policlinico Giovanni XXIII, Bari, Italy
| | - Silvio Tafuri
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy.
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18
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Aharon A, Benedek G, Barhoum B, Parnasa E, Magadle N, Perzon O, Mevorach D. HLA binding-groove motifs are associated with myocarditis induction after Pfizer-BioNTech BNT162b2 vaccination. Eur J Clin Invest 2024; 54:e14142. [PMID: 38071404 DOI: 10.1111/eci.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND AND AIMS We found a higher incidence of myocarditis in young males who had received at least two Pfizer-BioNTech BNT162b2 vaccinations. The human leukocyte antigens (HLA) are known to play an important role in infectious and autoinflammatory diseases. We hypothesized that certain HLA alleles might be associated with vaccination-induced myocarditis. METHODS HLA typing was performed using next-generation sequencing technology with the Illumina Iseq100 platform. HLA class I and II loci were genotyped in 29 patients with post-vaccination myocarditis and compared with HLA data from 300 healthy controls. RESULTS We demonstrate that the DRB1*14:01, DRB1*15:03 alleles and the motifs in HLA-A - Leu62 and Gln63, which are part of binding pocket B and HLA-DR Tyr47, His60, Arg70 and Glu74, which are part of binding pockets P4, P7 and P9, were significantly associated with disease susceptibility. CONCLUSIONS Our findings suggest that immunogenetic fingerprints in HLA peptide-binding grooves may affect the presentation of peptides derived from the Pfizer-BioNTech BNT162b2 vaccination to T cells and induce an inflammatory process that results in myocarditis.
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Affiliation(s)
- Aviran Aharon
- Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
| | - Gil Benedek
- Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
- Tissue Typing and Immunogenetics Unit, Department of Genetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Barhoum Barhoum
- Institute of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Elchanan Parnasa
- Institute of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nur Magadle
- Institute of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer Perzon
- Institute of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dror Mevorach
- Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
- Institute of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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19
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Park JH, Kim KH. COVID-19 Vaccination-Related Myocarditis: What We Learned From Our Experience and What We Need to Do in The Future. Korean Circ J 2024; 54:54.e35. [PMID: 38654456 DOI: 10.4070/kcj.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has led to a global health crisis with substantial mortality and morbidity. To combat the COVID-19 pandemic, various vaccines have been developed, but unexpected serious adverse events including vaccine-induced thrombotic thrombocytopenia, carditis, and thromboembolic events have been reported and became a huddle for COVID-19 vaccination. Vaccine-related myocarditis (VRM) is a rare but significant adverse event associated primarily with mRNA vaccines. This review explores the incidence, risk factors, clinical presentation, pathogenesis, management strategies, and outcomes associated with VRM. The incidence of VRM is notably higher in male adolescents and young adults, especially after the second dose of mRNA vaccines. The pathogenesis appears to involve an immune-mediated process, but the precise mechanism remains mostly unknown so far. Most studies have suggested that VRM is mild and self-limiting, and responds well to conventional treatment. However, a recent nationwide study in Korea warns that severe cases, including fulminant myocarditis or death, are not uncommon in patients with COVID-19 VRM. The long-term cardiovascular consequences of VRM have not been well understood and warrant further investigation. This review also briefly addresses the critical balance between the substantial benefits of COVID-19 vaccination and the rare risks of VRM in the coming endemic era. It emphasizes the need for continued surveillance, research to understand the underlying mechanisms, and strategies to mitigate risk. Filling these knowledge gaps would be vital to refining vaccination recommendations and improving patient care in the evolving COVID-19 pandemic landscape.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea.
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20
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Albertson TE, Hansen C, Bihari S, Gayed J, Xu X, Simón-Campos JA, Dever ME, Cardona JF, Mitha E, Baker JB, Keep G, Oladipupo I, Mensa FJ, Feng Y, Ma H, Koury K, Mather S, Ianos CA, Anderson AS, Türeci Ö, Şahin U, Gruber WC, Gurtman A, Sabharwal C, Kitchin N. Serum Troponin I Assessments in 5- to 30-Year-Olds After BNT162b2 Vaccination. Infect Dis Ther 2024; 13:699-714. [PMID: 38489117 PMCID: PMC11058143 DOI: 10.1007/s40121-024-00927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/19/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Rare myocarditis and pericarditis cases have occurred in coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccine recipients. Troponin levels, a potential marker of myocardial injury, were assessed in healthy participants before and after BNT162b2 vaccination. METHODS Vaccine-experienced 12- to 30-year-olds in phase 3 crossover C4591031 Substudy B (NCT04955626) who had two or three prior BNT162b2 30-μg doses were randomized to receive BNT162b2 30 μg followed by placebo, or placebo followed by BNT162b2 30 µg, 1 month apart. A participant subset, previously unvaccinated against COVID-19, in the phase 3 C4591007 study (NCT04816643) received up to three vaccinations (BNT162b2 10 μg or placebo [5- to 11-year-olds]) or open-label BNT162b2 30 μg (12- to 15-year-olds). Blood samples collected pre-vaccination, 4 days post-vaccination, and 1-month post-vaccination (C4591031 Substudy B only) were analyzed. Frequencies of elevated troponin I levels (male, > 35 ng/l; female, > 17 ng/l) were assessed. RESULTS Percentages of 12- to 30-year-olds (n = 1485) in C4591031 Substudy B with elevated troponin levels following BNT162b2 or placebo receipt were 0.5% and 0.8% before vaccination, 0.7% and 1.0% at day 4, and 0.7% and 0.5% at 1 month, respectively. In Study C4591007 (n = 1265), elevated troponin I levels were observed in 0.2, 0.4, and 0.2% of 5- to 11-year-old BNT162b2 recipients at baseline and 4 days post-dose 2 and 3, respectively; corresponding values in 12- to 15-year-olds were 0.4, 0.4, and 0.7%. No 5- to 11-year-old placebo recipients had elevated troponin levels. No myocarditis or pericarditis cases or deaths were reported. CONCLUSIONS Among 5- to < 30-year-olds in both studies, troponin levels were rarely elevated (≤ 1.0%) and similar before and post-vaccination; troponin levels were also similar between BNT162b2 and placebo in 12- to 30-year-old and 5- to 11-year-old recipients in the respective studies. No myocarditis or pericarditis cases were reported. These findings did not provide evidence that BNT162b2 causes troponin elevations. No utility of routine measurement of troponin levels in asymptomatic BNT162b2 recipients was identified.
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Affiliation(s)
| | - Caitlin Hansen
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Smiti Bihari
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK
| | - Juleen Gayed
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK.
| | - Xia Xu
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - J Abraham Simón-Campos
- Faculty of Medicine, Köhler and Milstein Research/Autonomous University of Yucatan, Mérida, Yucatan, Mexico
| | | | - Jose F Cardona
- Indago Research and Health Center, Inc, Hialeah, FL, USA
| | - Essack Mitha
- Newtown Clinical Research, Johannesburg, South Africa
| | | | - Georgina Keep
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK
| | | | | | - Ye Feng
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Hua Ma
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Kenneth Koury
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Susan Mather
- Worldwide Safety, Safety Surveillance and Risk Management, Pfizer Inc, Collegeville, PA, USA
| | | | | | | | | | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | - Charu Sabharwal
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
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21
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Chandler RE, Balakrishnan MR, Brasseur D, Bryan P, Espie E, Hartmann K, Jouquelet-Royer C, Milligan J, Nesbitt L, Pal S, Precioso A, Takey P, Chen RT. Collaboration within the global vaccine safety surveillance ecosystem during the COVID-19 pandemic: lessons learnt and key recommendations from the COVAX Vaccine Safety Working Group. BMJ Glob Health 2024; 9:e014544. [PMID: 38453518 PMCID: PMC10921508 DOI: 10.1136/bmjgh-2023-014544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/01/2024] [Indexed: 03/09/2024] Open
Abstract
This analysis describes the successes, challenges and opportunities to improve global vaccine safety surveillance as observed by the Vaccine Safety Working Group from its role as a platform of exchange for stakeholders responsible for monitoring the safety of vaccines distributed through the COVAX mechanism. Three key elements considered to be essential for ongoing and future pandemic preparedness for vaccine developers in their interaction with other members of the vaccine safety ecosystem are (1) the availability of infrastructure and capacity for active vaccine safety surveillance in low-income and middle-income countries (LMICs), including the advancement of concepts of safety surveillance and risk management to vaccine developers and manufacturers from LMICs; (2) more comprehensive mechanisms to ensure timely exchange of vaccine safety data and/or knowledge gaps between public health authorities and vaccine developers and manufacturers; and (3) further implementation of the concept of regulatory reliance in pharmacovigilance. These aims would both conserve valuable resources and allow for more equitable access to vaccine safety information and for benefit/risk decision-making.
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Affiliation(s)
| | | | | | - Philip Bryan
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Linda Nesbitt
- Biovac Institute, Pinelands, Cape Town, South Africa
| | | | | | | | - Robert T Chen
- The Task Force for Global Health, Decatur, Georgia, USA
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22
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Sugrue JA, Duffy D. Systems vaccinology studies - achievements and future potential. Microbes Infect 2024:105318. [PMID: 38460935 DOI: 10.1016/j.micinf.2024.105318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
Human immune responses to vaccination are variable both within and between populations. Systems vaccinology, which is the application of multi-omics technologies to vaccine studies, seeks to understand such variation and predict responses to optimise vaccine strategies. Here, we outline new approaches to systems vaccinology, focusing on the incorporation of additional cohorts, endpoints and technologies.
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Affiliation(s)
- Jamie A Sugrue
- Translational Immunology Unit, Institut Pasteur, Université de Paris Cité, F75015, Paris, France
| | - Darragh Duffy
- Translational Immunology Unit, Institut Pasteur, Université de Paris Cité, F75015, Paris, France.
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23
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Castelletti S, Gervasi S, Ballardini E, Casasco M, Cavarretta E, Colivicchi F, Contursi M, Cuccaro F, D'Ascenzi F, Gazale G, Mos L, Nistri S, Palmieri V, Patrizi G, Scorcu M, Spampinato A, Tiberi M, Zito GB, Zorzi A, Zeppilli P, Sciarra L. The athlete after COVID-19 infection: what the scientific evidence? What to do? A position statement. Panminerva Med 2024; 66:63-74. [PMID: 36178109 DOI: 10.23736/s0031-0808.22.04723-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The Coronavirus-19 disease (COVID-19) related pandemic have deeply impacted human health, economy, psychology and sociality. Possible serious cardiac involvement in the infection has been described, raising doubts about complete healing after the disease in many clinical settings. Moreover, there is the suspicion that the vaccines, especially those based on mRNA technology, can induce myopericarditis. Myocarditis or pericarditis related scars can represent the substrate for life-threatening arrhythmias, triggered by physical activity. A crucial point is how to evaluate an athlete after a COVID-19 infection ensuring a safe return to play without increasing the number of unnecessary disqualifications from sports competitions. The lack of conclusive scientific data significantly increases the difficulty to propose recommendations and guidelines on this topic. At the same time, the psychological and physical negative consequences of unnecessary sports restriction must be taken into account. The present document aims to provide an updated brief review of the current knowledge about the COVID-19 cardiac involvement and how to recognize it and to offer a roadmap for the management of the athletes after a COVID-19 infections, including subsequent impact on exercise recommendations. Our document exclusively refers to cardiovascular implications of the disease, but pulmonary consequences are also considered.
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Affiliation(s)
| | - Salvatore Gervasi
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Ballardini
- Sports Medicine Centre, Mantova Salus Group, San Pellegrino Hospital, Mantua, Italy
| | | | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | | | - Maurizio Contursi
- Unit of Sports Cardiology, Centro Polidiagnostico Check-up, Salerno, Italy
| | - Francesco Cuccaro
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giovanni Gazale
- Center of Sports Medicine and Sports Cardiology, ASL1, Sassari, Italy
| | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Stefano Nistri
- Cardiology Service-CMSR Veneto Medica, Altavilla Vicentina, Vicenza, Italy
| | - Vincenzo Palmieri
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | - Marco Scorcu
- Department of Sports Medicine and Physical Exercise, ATS Sardegna, Cagliari, Italy
| | | | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV1, Pesaro, Italy
| | | | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Paolo Zeppilli
- Unit of Sports Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Luigi Sciarra
- Department of Cardiology, Casilino Polyclinic, Rome, Italy
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24
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Lai D, Lim D, Lu J, Wang H, Huang T, Zhang YD. Risk of myocarditis after three doses of COVID-19 mRNA vaccines in the United States, 2020-2022: A self-controlled case series study. J Evid Based Med 2024; 17:65-77. [PMID: 38494781 DOI: 10.1111/jebm.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
AIM Myocarditis is a recognized safety concern following COVID-19 mRNA vaccination. However, there is limited research quantifying the risk associated with the third dose or comparing the risk between the three doses. The US Vaccine Adverse Event Reporting System (VAERS) is a passive surveillance system that monitors rare adverse events after US-licensed vaccination. However, studies analyzing VAERS data have often faced criticism for underreporting cases and lacking a control group to assess the increase in baseline risk. METHODS The temporal association between myocarditis onset and COVID-19 vaccination was studied. To overcome limitations, a novel modified self-controlled case series method was employed, explicitly modeling the case reporting process in VAERS data. RESULTS We found an increased risk of myocarditis during the 1- to 3-day period following the second and third doses of both the BNT162b2 vaccine and the mRNA-1273 vaccine. Following the second dose, the relative incidence (RI) was 4.89 (95% confidence interval (CI), 2.39-10.08) for the BNT162b2 vaccine and 2.86 (95% CI: 1.18-7.03) for the mRNA-1273 vaccine. Similarly, following the third dose, the RI was 9.04 (95% CI: 2.79-40.99) for the BNT162b2 vaccine and 4.71 (95% CI: 1.42-19.09) for the mRNA-1273 vaccine. No significant increase in risk was observed during other periods. Notably, our analysis also identified a similar increased risk of myocarditis among individuals aged below 30. CONCLUSIONS These findings raise safety concerns regarding COVID-19 mRNA vaccines, provide insights into the quantification of myocarditis risk at different postvaccination periods, and offer a novel approach to interpreting passive surveillance system data.
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Affiliation(s)
- Daoyuan Lai
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China
| | - Dickson Lim
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China
| | - Junfeng Lu
- First Department of Liver Disease, Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - Han Wang
- College of Science, China Agricultural University, Beijing, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Center for Intelligent Public Health, Academy for Artificial Intelligence, Peking University, Beijing, China
| | - Yan Dora Zhang
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China
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25
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Montone RA, Rinaldi R, Masciocchi C, Lilli L, Damiani A, La Vecchia G, Iannaccone G, Basile M, Salzillo C, Caffè A, Bonanni A, De Pascale G, Grieco DL, Tanzarella ES, Buonsenso D, Murri R, Fantoni M, Liuzzo G, Sanna T, Richeldi L, Sanguinetti M, Massetti M, Trani C, Tshomba Y, Gasbarrini A, Valentini V, Antonelli M, Crea F. Vaccines and Myocardial Injury in Patients Hospitalized for COVID-19 Infection: the CardioCOVID-Gemelli Study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024:qcae016. [PMID: 38414273 DOI: 10.1093/ehjqcco/qcae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Myocardial injury is prevalent among patients hospitalized for COVID-19. However, the role of COVID-19 vaccines in modifying the risk of myocardial injury is unknown. OBJECTIVES To assess the role of vaccines in modifying the risk of myocardial injury in COVID-19. METHODS We enrolled COVID-19 patients admitted from March 2021 to February 2022 with known vaccination status and ≥1 assessment of hs-cTnI within 30 days from the admission. The primary endpoint was the occurrence of myocardial injury (hs-cTnI levels >99th percentile upper reference limit). RESULTS 1019 patients were included (mean age 67.7±14.8 years, 60.8% male, 34.5% vaccinated against COVID-19). Myocardial injury occurred in 145 (14.2%) patients. At multivariate logistic regression analysis, advanced age, chronic kidney disease and hypertension, but not vaccination status, were independent predictors of myocardial injury. In the analysis according to age tertiles distribution, myocardial injury occurred more frequently in the III tertile (≥76 years) compared to other tertiles (I tertile:≤60 years;II tertile:61-75 years) (p<0.001). Moreover, in the III tertile, vaccination was protective against myocardial injury (OR 0.57, CI 95% 0.34-0.94; p=0.03), while a previous history of coronary artery disease was an independent positive predictor. In contrast, in the I tertile, chronic kidney disease (OR 6.94, 95% CI 1.31-36.79, p=0.02) and vaccination (OR 4.44, 95% CI 1.28-15.34, p=0.02) were independent positive predictors of myocardial injury. CONCLUSIONS In patients ≥76 years, COVID-19 vaccines were protective for the occurrence of myocardial injury, while in patients ≤60 years, myocardial injury was associated with previous COVID-19 vaccination. Further studies are warranted to clarify the underlying mechanisms.
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Affiliation(s)
- Rocco Antonio Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Livia Lilli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea Damiani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Mattia Basile
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Salzillo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Caffè
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Alice Bonanni
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro De Pascale
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Rome, Italy
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy
| | - Eloisa Sofia Tanzarella
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy
| | - Danilo Buonsenso
- Department of Women's health, child health and public health sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Richeldi
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maurizio Sanguinetti
- Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Yamume Tshomba
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Radiotherapy, Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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26
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Jeong HS, Chun BC. COVID-19 vaccine safety: Background incidence rates of anaphylaxis, myocarditis, pericarditis, Guillain-Barré Syndrome, and mortality in South Korea using a nationwide population-based cohort study. PLoS One 2024; 19:e0297902. [PMID: 38381729 PMCID: PMC10881009 DOI: 10.1371/journal.pone.0297902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND To properly assess an association between vaccines and specific adverse events requires a comparison between the observed and background rates; however, studies in South Korea are currently limited. Therefore, in this study, we estimated the background incidence of anaphylaxis, myocarditis, pericarditis, Guillain-Barré syndrome (GBS), and mortality in South Korea. METHODS A retrospective cohort study was conducted using the National Sample Cohort (NSC) data. Using NSC, the background incidence rate was estimated by dividing the number of episodes during 2009-2019 by the total population by year and then multiplying by 100,000. Using Statistics Korea data, the background mortality rate was estimated by dividing the number of deaths, during 2009-2019 by the standard population for that year and then multiplying by 100,000. Using background mortality rates, we predicted mortality rates for 2021 using autoregressive integrated moving average models. Further, the expected mortality rates were compared with observed mortality rates. RESULTS The age-adjusted incidence rate (AIR) of anaphylaxis increased from 4.28 to 22.90 cases per 100,000 population (p = 0.003); myocarditis showed no significant increase, changing from 0.56 to 1.26 cases per 100,000 population (p = 0.276); pericarditis increased from 0.94 to 1.88 cases per 100,000 population (p = 0.005); and GBS increased from 0.78 to 1.21 cases per 100,000 population (p = 0.013). The age-adjusted mortality rate decreased from 645.24 to 475.70 deaths per 100,000 population (p <0.001). The 2021 observed/expected mortality rates for overall (ratio: 1.08, 95% confidence interval [CI]: 1.07-1.08), men (ratio: 1.07, 95% CI: 1.07-1.08), and women (ratio: 1.08, 95% CI: 1.07-1.09), were all significantly higher. When stratified by age group, those aged ≥80 (ratio: 1.16, 95% CI: 1.15-1.17), 60-69 (ratio: 1.11, 95% CI: 1.10-1.13), and 20-29 years old (ratio: 1.07, 95% CI: 1.02-1.13) were also significantly higher. CONCLUSION Through the estimation of background rates related to anaphylaxis, myocarditis, pericarditis, GBS, and mortality, we established a reference point for evaluating the potential excess occurrence of adverse events following COVID-19 vaccination. This reference point serves as substantive evidence supporting the safety profile of COVID-19 vaccines.
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Affiliation(s)
- Hye Su Jeong
- Drug Safety Monitoring Center, National Medical Center, Seoul, South Korea
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
| | - Byung Chul Chun
- Department of Public Health, Korea University Graduate School, Seoul, South Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
- Department of Epidemiology and Health Informatics Graduate School of Public Health, Korea University, Seoul, South Korea
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27
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Tham MY, Chan CL, Toh D, Poh J, Lim A, Soh S, Peck LF, Foo B, Ng A, Ng P, Ang PS, Dorajoo S, Teo D, Lim TW, Lim YT, Choo J, Ding ZP, Yeo KK, Yap J, Tan HX. An updated analysis on myocarditis and pericarditis cases reported following mRNA SARS-CoV-2 vaccination in Singapore. Singapore Med J 2024:00077293-990000000-00090. [PMID: 38363732 DOI: 10.4103/singaporemedj.smj-2023-089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/19/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Messenger ribonucleic acid (mRNA) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been associated with myocarditis/pericarditis, especially in young males. We evaluated the risk of myocarditis/pericarditis following mRNA vaccines by brand, age, sex and dose number in Singapore. METHODS Adverse event reports of myocarditis/pericarditis following mRNA vaccines received by the Health Sciences Authority from 30 December 2020 to 25 July 2022 were included, with a data lock on 30 September 2022. Case adjudication was done by an independent panel of cardiologists using the US Centers for Disease Control and Prevention case definition. Reporting rates were compared with expected rates using historical data from 2018 to 2020. RESULTS Of the 152 adjudicated cases, males comprised 75.0%. The median age was 30 years. Most cases occurred after Dose 2 (49.3%). The median time to onset was 2 days. Reporting rates were highest in males aged 12-17 years for both primary series (11.5 [95% confidence interval [CI] 6.7-18.4] per 100,000 doses, post-Dose 2) and following booster doses (7.1 [95% CI 3.0-13.9] per 100,000 doses). In children aged 5-11 years, myocarditis remained very rare (0.2 per 100,000 doses). The reporting rates for Booster 1 were generally similar or lower than those for Dose 2. CONCLUSIONS The risk of myocarditis/pericarditis with mRNA vaccines was highest in adolescent males following Dose 2, and this was higher than historically observed background rates. Most cases were clinically mild. The risk of myocarditis should be weighed against the benefits of receiving an mRNA vaccine, keeping in mind that SARS-CoV-2 infections carry substantial risks of myocarditis/pericarditis, as well as the evolving landscape of the disease.
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Affiliation(s)
- Mun Yee Tham
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Cheng Leng Chan
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Dorothy Toh
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Jalene Poh
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Adena Lim
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Sally Soh
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Li Fung Peck
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Belinda Foo
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Amelia Ng
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Patricia Ng
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Pei San Ang
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Sreemanee Dorajoo
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Desmond Teo
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre, Singapore
| | | | - Jonathan Choo
- Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Hui Xing Tan
- Vigilance and Compliance Branch, Health Sciences Authority, Singapore
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28
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Fan M, Peng K, Zhang Y, Lai FTT, Chui CSL, Wan EYF, Wong CKH, Chan EWY, Li X, Wong ICK. Risk of carditis among adolescents after extending the interdose intervals of BNT162b2. NPJ Vaccines 2024; 9:31. [PMID: 38355656 PMCID: PMC10866879 DOI: 10.1038/s41541-023-00789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/01/2023] [Indexed: 02/16/2024] Open
Abstract
Previous studies indicate an increased carditis risk among adolescents following the two-dose messenger RNA COVID-19 vaccine. Several jurisdictions have extended the interdose interval between the first and second doses to reduce the risk. However, the effectiveness of such an extension policy remains inconclusive. Using the territory-wide vaccine record-linked electronic health records in Hong Kong, we conducted a nested case-control study from February 23, 2021 to August 15, 2022. Adolescents aged between 12 and 17 who received two-dose BNT162b2 were included for comparing risks between standard interdose interval (21-27 days) versus extended interdose interval ( ≥ 56 days). The carditis cumulative incidence within 28 days following the second dose was calculated. The adjusted odds ratio was estimated from multivariable conditional logistic regression. We identified 49 adolescents with newly diagnosed carditis within 28 days following the second dose. The crude cumulative incidence is 37.41 [95% confidence interval (CI): 27.68-49.46] per million vaccinated adolescents. Compared to the standard interdose interval group, adolescents with an extended interval had a significantly lower risk of carditis [adjusted odds ratio (aOR) 0.34 (95% CI: 0.16-0.73)]. Sensitivity analysis of carditis occurring within 14 days following the second dose yielded a similar estimate [aOR 0.30 (95% CI: 0.13-0.73)]. Extending the interdose interval of the BNT162b2 vaccine from 21 to 27 days to 56 days or longer is associated with 66% lower risk of incident carditis among adolescents. Our findings contribute towards an evidence-based vaccination strategy for a vulnerable population and potentially informs product label updates.
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Affiliation(s)
- Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Kuan Peng
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Yin Zhang
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China.
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China.
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pok Fu Lam, Hong Kong, China.
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.
- Aston Pharmacy School, Aston University, Birmingham, UK.
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Markowitz LE, Hopkins RH, Broder KR, Lee GM, Edwards KM, Daley MF, Jackson LA, Nelson JC, Riley LE, McNally VV, Schechter R, Whitley-Williams PN, Cunningham F, Clark M, Ryan M, Farizo KM, Wong HL, Kelman J, Beresnev T, Marshall V, Shay DK, Gee J, Woo J, McNeil MM, Su JR, Shimabukuro TT, Wharton M, Keipp Talbot H. COVID-19 Vaccine Safety Technical (VaST) Work Group: Enhancing vaccine safety monitoring during the pandemic. Vaccine 2024:S0264-410X(23)01505-0. [PMID: 38341293 DOI: 10.1016/j.vaccine.2023.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024]
Abstract
During the COVID-19 pandemic, candidate COVID-19 vaccines were being developed for potential use in the United States on an unprecedented, accelerated schedule. It was anticipated that once available, under U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) or FDA approval, COVID-19 vaccines would be broadly used and potentially administered to millions of individuals in a short period of time. Intensive monitoring in the post-EUA/licensure period would be necessary for timely detection and assessment of potential safety concerns. To address this, the Centers for Disease Control and Prevention (CDC) convened an Advisory Committee on Immunization Practices (ACIP) work group focused solely on COVID-19 vaccine safety, consisting of independent vaccine safety experts and representatives from federal agencies - the ACIP COVID-19 Vaccine Safety Technical Work Group (VaST). This report provides an overview of the organization and activities of VaST, summarizes data reviewed as part of the comprehensive effort to monitor vaccine safety during the COVID-19 pandemic, and highlights selected actions taken by CDC, ACIP, and FDA in response to accumulating post-authorization safety data. VaST convened regular meetings over the course of 29 months, from November 2020 through April 2023; through March 2023 FDA issued EUAs for six COVID-19 vaccines from four different manufacturers and subsequently licensed two of these COVID-19 vaccines. The independent vaccine safety experts collaborated with federal agencies to ensure timely assessment of vaccine safety data during this time. VaST worked closely with the ACIP COVID-19 Vaccines Work Group; that work group used safety data and VaST's assessments for benefit-risk assessments and guidance for COVID-19 vaccination policy. Safety topics reviewed by VaST included those identified in safety monitoring systems and other topics of scientific or public interest. VaST provided guidance to CDC's COVID-19 vaccine safety monitoring efforts, provided a forum for review of data from several U.S. government vaccine safety systems, and assured that a diverse group of scientists and clinicians, external to the federal government, promptly reviewed vaccine safety data. In the event of a future pandemic or other biological public health emergency, the VaST model could be used to strengthen vaccine safety monitoring, enhance public confidence, and increase transparency through incorporation of independent, non-government safety experts into the monitoring process, and through strong collaboration among federal and other partners.
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Affiliation(s)
- Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
| | - Robert H Hopkins
- National Vaccine Advisory Committee, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Karen R Broder
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Grace M Lee
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer C Nelson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | - Robert Schechter
- Association of Immunization Managers, California Department of Public Health, Richmond, CA, USA
| | | | - Francesca Cunningham
- Department of Veterans Affairs, Veterans Affairs Center for Medication Safety - Pharmacy Benefit Management Services, Hines, IL, USA
| | - Matthew Clark
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Anchorage, AK, USA
| | - Margaret Ryan
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, USA
| | - Karen M Farizo
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Hui-Lee Wong
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Jeffery Kelman
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Tatiana Beresnev
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Valerie Marshall
- Office of the Assistant Secretary for Health, Department of Health and Human Services, Washington, DC, USA
| | - David K Shay
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Julianne Gee
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Jared Woo
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Michael M McNeil
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - John R Su
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Tom T Shimabukuro
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Melinda Wharton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, TN, USA
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30
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Minato H, Yoshikawa A, Tsuyama S, Katayanagi K, Hachiya S, Ohta K, Myojo Y. Fatal arrythmia in a young man after COVID-19 vaccination: An autopsy report. Medicine (Baltimore) 2024; 103:e37196. [PMID: 38306524 PMCID: PMC10843519 DOI: 10.1097/md.0000000000037196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
RATIONALE The benefits of COVID-19 mRNA vaccination are claimed to be substantial; however, vaccination-related myocarditis and pericarditis have also been observed globally, particularly among young men. In most cases, the symptoms are mild and resolve on their own; however, fatal cases have rarely been described. PATIENT CONCERNS A healthy 40-year-old Japanese man suddenly experienced tachycardia and lost consciousness 2 days after vaccination. Continued resuscitation recovered the spontaneous heartbeat; however, the patient did not regain consciousness and died 9 days later. Electrocardiography after resuscitation showed marked ST-segment depression and incomplete right bundle branch block. Influenza antigen and polymerase chain reaction tests for SARS-CoV-2 were negative. DIAGNOSES Fatal arrhythmia after a second COVID-19 mRNA vaccination. INTERVENTIONS We performed an autopsy and studied the material morphologically and immunohistochemically. OUTCOMES At autopsy, several small inflammatory foci with cardiomyocytic necrosis were scattered in the right and left ventricles, with a propensity for the right side. Some inflammatory foci were located near the atrioventricular nodes and His bundles. The infiltrating cells predominantly consisted of CD68-positive histiocytes, with a small number of CD8-positive and CD4-positive T cells. In this case, myocarditis was focal and mild, as is mostly observed following COVID-19 mRNA vaccination. However, the inflammatory foci were close to the conduction system and were considered the cause of fatal arrhythmia. LESSONS Although the benefits of COVID-19 vaccination appear to outweigh the side effects, it should be noted that fatal arrhythmias may rarely occur, and caution should be taken if individuals, particularly young men, complain of any symptoms after vaccination.
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Affiliation(s)
- Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Akane Yoshikawa
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Sho Tsuyama
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Satoaki Hachiya
- Department of Emergency and Critical Care, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Keisuke Ohta
- Department of Emergency and Critical Care, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Yasuhiro Myojo
- Department of Emergency and Critical Care, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
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31
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Pastor Pueyo P, Gambó Ruberte E, Gayán Ordás J, Matute Blanco L, Pascual Figal D, Larrañaga Moreira JM, Gómez Barrado JJ, González Calle D, Almenar Bonet L, Alonso Salinas GL, Corbí Pascual MJ, Plaza Martín M, Pons Llinares J, Durante López A, Barreiro Pérez M, Candanedo Ocaña F, Bautista García J, Merchán Ortega G, Domínguez Rodríguez F, Martínez Mateo V, Campreciós Crespo M, Quintás Guzmán M, Jordán Martínez L, Aboal Viñas J, Rodríguez López J, Fernández Santos S, Revilla Martí P, Álvarez Roy L, Gómez Polo JC, García Pinilla JM, Ferré Vallverdú M, García Bueno L, Soriano Colomé T, Worner Diz F. Vaccine-carditis study: Spanish multicenter registry of inflammatory heart disease after COVID-19 vaccination. Clin Res Cardiol 2024; 113:223-234. [PMID: 37368015 DOI: 10.1007/s00392-023-02225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population. METHODS The Vaccine-Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented. RESULTS From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality). CONCLUSIONS In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.
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Affiliation(s)
- Pablo Pastor Pueyo
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain.
| | - Elena Gambó Ruberte
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain
| | - Jara Gayán Ordás
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain
| | - Lucía Matute Blanco
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain
| | - Domingo Pascual Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | | | | | - David González Calle
- Cardiology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | | | - María Plaza Martín
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | | | - Javier Bautista García
- Cardiology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Virgilio Martínez Mateo
- Cardiology Department, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | - Martín Quintás Guzmán
- Cardiology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Jaime Aboal Viñas
- Cardiology Department, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | | | | | - Pablo Revilla Martí
- Cardiology Department, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | - Laura Álvarez Roy
- Cardiology Department, Hospital Universitario Miguel Servet, Saragossa, Spain
| | | | | | - María Ferré Vallverdú
- Cardiology Department, Servicio de Cardiología, Hospital Sant Joan, Reus, Tarragona, Spain
| | | | - Toni Soriano Colomé
- Cardiology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Fernando Worner Diz
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Institut de Reserça Biomèdica (IRB) Lleida, Lleida, Spain
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32
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Wang YH, Lu YW, Chan SW, Kuo L, Chen SA. The application of cardiac magnetic resonance imaging (CMR) in myocarditis after COVID-19 vaccines : Case series from single medical center in Taiwan. J Chin Med Assoc 2024; 87:151-155. [PMID: 38150597 DOI: 10.1097/jcma.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, reports of vaccine-induced myocarditis, particularly messenger ribonucleic acid (mRNA)-based myocarditis, were widely spread. This case series describes various cases of COVID-19 vaccine-induced myocarditis confirmed by cardiac magnetic resonance imaging (MRI), including those who were administered rare protein-based vaccines. Eleven patients comprising eight males and three females with suspected myocarditis underwent cardiac MRI at Taichung Veterans General Hospital between October 2021 and May 2022. The median age of the patients was 33.5 years old (range: 22-57 years). The onset of myocarditis was mainly observed following mRNA vaccine inoculation. One patient received the MVC-COV1901 vaccine, a unique protein-based COVID-19 vaccine in Taiwan, and met the 2018 Lake Louise Criteria for the diagnosis of myocarditis, confirmed by cardiac MRI. Most patients reported chest discomfort after receiving various vaccine types. Among four patients with reduced left ventricular ejection fraction (LVEF), two showed LVEF restoration during the follow-up period, and the other two were lost to follow-up. Cardiac MRI characterizes myocardial features such as edema, inflammation, and fibrosis, and has been proven to diagnose myocarditis accurately with a sensitivity of 87.5% and a specificity of 96.2% according to the 2018 Lake Louise criteria. This diagnosis was achieved without invasive procedures such as endomyocardial biopsy or coronary angiography.
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Affiliation(s)
- Yu-Hsiang Wang
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Ya-Wen Lu
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Si-Wa Chan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Ann Chen
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Shenton P, Schrader S, Smith J, Alafaci A, Cox N, Taylor A, Hare J, Jones B, Crawford NW, Buttery JP, Cheng DR. Long term follow up and outcomes of Covid-19 vaccine associated myocarditis in Victoria, Australia: A clinical surveillance study. Vaccine 2024; 42:522-528. [PMID: 38154991 DOI: 10.1016/j.vaccine.2023.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/08/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Myocarditis and myopericarditis are well described adverse events of special interest (AESI) following COVID-19 vaccinations. Although reports are reassuring regarding initial clinical outcomes, information about longer term outcomes remains limited. We aimed to further this knowledge and report outcomes to 6 months post diagnosis from a single population cohort. METHODS Reports of myocarditis following COVID-19 vaccination were followed up by SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), the state-wide vaccine safety service for Victoria, Australia. Confirmed myocarditis cases (Brighton Collaboration Criteria levels 1-3) were followed up via surveys at 1, 3 and 6 months post symptom onset. Responses received between 22 February 2021 and 30 September 2022 were analysed. RESULTS 87.5 % (N = 182) of eligible participants completed at least 1 survey report. 377 reports were analysed. 76.9 % of completed reports were from male patients. The median age of patients was 21 years [IQR: 16 to 32]. 54.8 % (n = 74) of survey reports at 6 months, reported ongoing symptoms. At all follow-up time points, females were significantly more likely to have ongoing symptoms. At 6 months, 51.9 % of male respondents reported symptom resolution compared to 22.6 % of female patients (p = 0.002). Females were also more likely to continue medication and have ongoing exercise restrictions. However, males were significantly more likely to have higher initial peak troponin results and abnormal initial cardiac imaging investigations. CONCLUSIONS There appears to be a significant proportion of patients who experience ongoing symptoms to 6 months post onset amongst patients that experience these AESI. Male patients were more likely to report earlier and more complete symptom recovery, despite significantly higher average initial peak troponin. This difference in phenotypic presentation in females compared to males warrants further investigation and there is a need for longer term follow up data.
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Affiliation(s)
- Priya Shenton
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Silja Schrader
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Julia Smith
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Annette Alafaci
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Nicholas Cox
- Department of Medicine, Western Health, The University of Melbourne, Australia; Cardiology Unit, Western Health, Australia
| | | | - James Hare
- Department of Cardiology, Alfred Health, Australia
| | - Bryn Jones
- The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Nigel W Crawford
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Jim P Buttery
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia; Centre for Health Analytics, Melbourne Children's Campus, Australia; Health Informatics, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Daryl R Cheng
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia; Centre for Health Analytics, Melbourne Children's Campus, Australia.
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Bardosh K, Krug A, Jamrozik E, Lemmens T, Keshavjee S, Prasad V, Makary MA, Baral S, Høeg TB. COVID-19 vaccine boosters for young adults: a risk benefit assessment and ethical analysis of mandate policies at universities. JOURNAL OF MEDICAL ETHICS 2024; 50:126-138. [PMID: 36600579 PMCID: PMC10850707 DOI: 10.1136/jme-2022-108449] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/23/2022] [Indexed: 06/17/2023]
Abstract
In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207-42 836 young adults aged 18-29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least 18.5 serious adverse events from mRNA vaccines, including 1.5-4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430-4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates.
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Affiliation(s)
- Kevin Bardosh
- School of Public Health, University of Washington, Seattle, Washington, USA
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Allison Krug
- Epidemiology, Artemis Biomedical Communications, Virginia Beach, Virginia, USA
| | - Euzebiusz Jamrozik
- University of Oxford Wellcome Centre for Ethics and Humanities, Oxford, UK
| | - Trudo Lemmens
- Faculty of Law and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Vinay Prasad
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Marty A Makary
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stefan Baral
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tracy Beth Høeg
- Clinical Research, Acumen, LLC, Burlingame, California, USA
- Sierra Nevada Memorial Hospital, Grass Valley, California, USA
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Høeg TB, Krug A, Baral S, Jamrozik E, Keshavjee S, Lemmens T, Prasad V, Makary MA, Bardosh K. University-age vaccine mandates: reply to Lam and Nichols. JOURNAL OF MEDICAL ETHICS 2024; 50:143-145. [PMID: 37225414 DOI: 10.1136/jme-2023-109163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Tracy Beth Høeg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Allison Krug
- Artemis Biomedical Communications LLC, Virginia Beach, Virginia, USA
| | - Stefan Baral
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Euzebiusz Jamrozik
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Trudo Lemmens
- Faculty of Law and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kevin Bardosh
- School of Public Health, University of Washington, Seattle, Washington, USA
- Division of Infection Medicine, University of Edinburgh, Edinburgh, UK
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Bouchlarhem A, Boulouiz S, Bazid Z, Ismaili N, El Ouafi N. Is There a Causal Link Between Acute Myocarditis and COVID-19 Vaccination: An Umbrella Review of Published Systematic Reviews and Meta-Analyses. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2024; 18:11795468231221406. [PMID: 38249317 PMCID: PMC10798131 DOI: 10.1177/11795468231221406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024]
Abstract
Introduction A few months after the beginning of the coronavirus disease of 2019 (COVID-19) vaccination, several reports of myocarditis secondary to the vaccines were published, sometimes with fulminant cases, but until today there is no proven causal link between these 2 events, but with many hypotheses proposed. Methods A systematic review of current evidence regarding myocarditis after COVID-19 vaccination was performed by searching several databases including PubMed/Medline and Web of Science. The quality of Meta-analysis was assessed using the AMSTAR-2 tool as well as other qualitative criteria. Results Our umbrella review appraised 4 Meta-analysis of retrospective studies (range: 5-12), The number of vaccine doses included ranged from 12 to 179 million, with the number of myocarditis cases observed ranging from 343 to 1489. All types of vaccines were evaluated, with no exclusions. The overall incidence ranged from 0.89 to 2.36 cases of myocarditis per 100 000 doses of vaccine received. Heterogeny was assessed in 3 of the Meta-analysis, and was highly significant (>75%) in all included studies, and with a significant P-value (P < .05). Regarding publication bias, 3 of the Meta-analysis conducted the egger and begg regression, with a significant result in only 1. Regarding the assessment of the methodology by the AMSTAR-2 scale indicating that the quality was very critical in 1, low in 2, and moderate in 1 Meta-analysis. Conclusion The quality of current non-randomized evidence on real causality and incidence of myocarditis after COVID-19 vaccine is still low.
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Affiliation(s)
- Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Soumia Boulouiz
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
| | - Noha El Ouafi
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
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Canavati C, Siam A, Labes S, Trabelsi N, Regev E, Parnasa E, Barhoum B, Magadle N, Perzon O, Braun M, Mor-Shaked H, Schueler-Furman O, Tabach Y, Mevorach D. Pathogenic Variants of Scavenger Receptor CD36 Lead to Decreased Efferocytosis and Predispose to Myocarditis Following Vaccination With Pfizer-BioNTech BNT162b2 Against Coronavirus Infection (COVID-19). Circulation 2024; 149:270-273. [PMID: 38227712 DOI: 10.1161/circulationaha.123.064884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Christina Canavati
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada (C.C., S.L., M.B., Y.T.), Jerusalem, Israel
- Hebrew University-Hadassah Faculty of Medicine (C.C., S.L., H.M.-S., Y.T., D.M.), Jerusalem, Israel
| | - Ahmad Siam
- The Wohl Institute for Translational Medicine (A.S., E.R., E.P., B.B., N.M., O.P., D.M.)., Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sapir Labes
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada (C.C., S.L., M.B., Y.T.), Jerusalem, Israel
- Hebrew University-Hadassah Faculty of Medicine (C.C., S.L., H.M.-S., Y.T., D.M.), Jerusalem, Israel
| | - Nirit Trabelsi
- Department of Microbiology and Molecular Genetics, IMRIC (N.T., O.S.F.), Jerusalem, Israel
| | - Eshcar Regev
- The Wohl Institute for Translational Medicine (A.S., E.R., E.P., B.B., N.M., O.P., D.M.)., Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Elchanan Parnasa
- The Wohl Institute for Translational Medicine (A.S., E.R., E.P., B.B., N.M., O.P., D.M.)., Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Barhoum Barhoum
- The Wohl Institute for Translational Medicine (A.S., E.R., E.P., B.B., N.M., O.P., D.M.)., Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nur Magadle
- The Wohl Institute for Translational Medicine (A.S., E.R., E.P., B.B., N.M., O.P., D.M.)., Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer Perzon
- The Wohl Institute for Translational Medicine (A.S., E.R., E.P., B.B., N.M., O.P., D.M.)., Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Maya Braun
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada (C.C., S.L., M.B., Y.T.), Jerusalem, Israel
| | - Hagar Mor-Shaked
- Hebrew University-Hadassah Faculty of Medicine (C.C., S.L., H.M.-S., Y.T., D.M.), Jerusalem, Israel
- Department of Genetics, Hadassah Medical Center, Jerusalem, Israel (H.M.-S.)
| | - Ora Schueler-Furman
- Department of Microbiology and Molecular Genetics, IMRIC (N.T., O.S.F.), Jerusalem, Israel
| | - Yuval Tabach
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada (C.C., S.L., M.B., Y.T.), Jerusalem, Israel
- Hebrew University-Hadassah Faculty of Medicine (C.C., S.L., H.M.-S., Y.T., D.M.), Jerusalem, Israel
| | - Dror Mevorach
- Hebrew University-Hadassah Faculty of Medicine (C.C., S.L., H.M.-S., Y.T., D.M.), Jerusalem, Israel
- The Wohl Institute for Translational Medicine (A.S., E.R., E.P., B.B., N.M., O.P., D.M.)., Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Institute of Rheumatology-Immunology-Allergology and Department of Medicine (D.M.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Hsu WF, Hsu CH, Jeng MJ. Echocardiographic function evaluation in adolescents following BNT162b2 Pfizer-BioNTech mRNA vaccination: A preliminary prospective study. J Chin Med Assoc 2024; 87:88-93. [PMID: 37882061 DOI: 10.1097/jcma.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Vaccination against coronavirus disease 2019 (COVID-19) is crucial for preventing and minimizing illness. Myocarditis and pericarditis after messenger RNA (mRNA) COVID-19 vaccination in adolescents and young adult males have been reported. Most of the studies in this area rely on retrospective symptom reporting, especially for adolescents experiencing myocarditis as a potential side effect. However, prospective postvaccination echocardiographic evaluation is rare. METHODS The study enrolled adolescents aged 12 to 15 years who received the second dose of the BNT162b2 Pfizer-BioNTech mRNA (BNT) vaccine. Serial echocardiographic examinations were conducted at baseline before vaccination, followed by subsequent assessments on days 2, 7, 14, and 28 to identify any notable differences or abnormal changes in cardiac function. Clinical symptom assessments were also recorded during each follow-up. RESULTS The study included 25 adolescents, comprising 14 males and 11 females, who completed the four follow-ups. Their mean age was 14 ± 1 years. The average interval between the first and second BNT vaccine doses was 90 ± 7 days. Ejection fraction values were 73.8% ± 5.2% at baseline, followed by 75.7% ± 5.3%, 75.5% ± 4.6%, 75.7% ± 4.5%, and 77.8% ± 5.8% at day 2, 7, 14, and 28, respectively. The cardiac function remained stable across all time points, with no significant differences observed between male and female participants. Within postvaccination 48 hours, 18 (72%) of the enrolled adolescents experienced temporary discomfort symptoms, which completely resolved by the final follow-up on the 28th day after vaccination. CONCLUSION Although adolescents vaccinated with the second dose of BNT vaccine commonly experienced transient postvaccination discomfort, the serial echocardiographic examinations did not reveal any significant deterioration of cardiac function within 28 days. Further studies are required to investigate the incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA vaccination-associated myocarditis in adolescents and the related mechanisms.
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Affiliation(s)
- Wan-Fu Hsu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Hsiung Hsu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- Health Service and Readiness Section, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, ROC
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Ng MY, Tam CH, Lee YP, Fong HTA, Wong CK, Ng WKC, Yeung MHY, Ling WHI, Tsao S, Wan EYF, Ferreira V, Yan AT, Siu CW, Yiu KH, Hung IFN. Post-COVID-19 vaccination myocarditis: a prospective cohort study pre and post vaccination using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:74. [PMID: 38057820 PMCID: PMC10702006 DOI: 10.1186/s12968-023-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Concerns about COVID-19 vaccination induced myocarditis or subclinical myocarditis persists in some populations. Cardiac magnetic resonance imaging (CMR) has been used to detect signs of COVID-19 vaccination induced myocarditis. This study aims to: (i) characterise myocardial tissue, function, size before and after COVID-19 vaccination, (ii) determine if there is imaging evidence of subclinical myocardial inflammation or injury after vaccination using CMR. METHODS Subjects aged ≥ 12yrs old without prior COVID-19 or COVID-19 vaccination underwent two CMR examinations: first, ≤ 14 days before the first COVID-19 vaccination and a second time ≤ 14 days after the second COVID-19 vaccination. Biventricular indices, ejection fraction (EF), global longitudinal strain (GLS), late gadolinium enhancement (LGE), left ventricular (LV) myocardial native T1, T2, extracellular volume (ECV) quantification, lactate dehydrogenase (LDH), white cell count (WCC), C-reactive protein (CRP), NT-proBNP, troponin-T, electrocardiogram (ECG), and 6-min walk test were assessed in a blinded fashion. RESULTS 67 subjects were included. First and second CMR examinations were performed a median of 4 days before the first vaccination (interquartile range 1-8 days) and 5 days (interquartile range 3-6 days) after the second vaccination respectively. No significant change in global native T1, T2, ECV, LV EF, right ventricular EF, LV GLS, LGE, ECG, LDH, troponin-T and 6-min walk test was demonstrated after COVID-19 vaccination. There was a significant WCC decrease (6.51 ± 1.49 vs 5.98 ± 1.65, p = 0.003) and CRP increase (0.40 ± 0.22 vs 0.50 ± 0.29, p = 0.004). CONCLUSION This study found no imaging, biochemical or ECG evidence of myocardial injury or inflammation post COVID-19 vaccination, thus providing some reassurance that COVID-19 vaccinations do not typically cause subclinical myocarditis.
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Affiliation(s)
- Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China.
- Department of Medical Imaging, HKU-Shenzhen Hospital, Shenzhen, China.
| | - Cheuk Hang Tam
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Yung Pok Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Ho Tung Ambrose Fong
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Wing Kei Carol Ng
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Maegan Hon Yan Yeung
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Wood-Hay Ian Ling
- Grantham Hospital, 125 Wong Chuk Hang Rd, Aberdeen, Hong Kong SAR, China
| | - Sabrina Tsao
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Vanessa Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford BHF Centre of Research Excellence, Oxford Centre for Clinical Magnetic Resonance Research, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew T Yan
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Chung Wah Siu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Ivan Fan-Ngai Hung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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Okuno S, Higo S, Kondo T, Shiba M, Kameda S, Inoue H, Tabata T, Ogawa S, Morishita Y, Sun C, Ishino S, Honda T, Miyagawa S, Sakata Y. SARS-CoV-2 spike receptor-binding domain is internalized and promotes protein ISGylation in human induced pluripotent stem cell-derived cardiomyocytes. Sci Rep 2023; 13:21397. [PMID: 38049441 PMCID: PMC10696029 DOI: 10.1038/s41598-023-48084-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
Although an increased risk of myocarditis has been observed after vaccination with mRNA encoding severe acute respiratory syndrome coronavirus 2 spike protein, its underlying mechanism has not been elucidated. This study investigated the direct effects of spike receptor-binding domain (S-RBD) on human cardiomyocytes differentiated from induced pluripotent stem cells (iPSC-CMs). Immunostaining experiments using ACE2 wild-type (WT) and knockout (KO) iPSC-CMs treated with purified S-RBD demonstrated that S-RBD was bound to ACE2 and internalized into the subcellular space in the iPSC-CMs, depending on ACE2. Immunostaining combined with live cell imaging using a recombinant S-RBD fused to the superfolder GFP (S-RBD-sfGFP) demonstrated that S-RBD was bound to the cell membrane, co-localized with RAB5A, and then delivered from the endosomes to the lysosomes in iPSC-CMs. Quantitative PCR array analysis followed by single cell RNA sequence analysis clarified that S-RBD-sfGFP treatment significantly upregulated the NF-kβ pathway-related gene (CXCL1) in the differentiated non-cardiomyocytes, while upregulated interferon (IFN)-responsive genes (IFI6, ISG15, and IFITM3) in the matured cardiomyocytes. S-RBD-sfGFP treatment promoted protein ISGylation, an ISG15-mediated post-translational modification in ACE2-WT-iPSC-CMs, which was suppressed in ACE2-KO-iPSC-CMs. Our experimental study demonstrates that S-RBD is internalized through the endolysosomal pathway, which upregulates IFN-responsive genes and promotes ISGylation in the iPSC-CMs.
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Affiliation(s)
- Shota Okuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Shuichiro Higo
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
- Department of Medical Therapeutics for Heart Failure, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
| | - Takumi Kondo
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Mikio Shiba
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Satoshi Kameda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Inoue
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Tomoka Tabata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Shou Ogawa
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yu Morishita
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Congcong Sun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Saki Ishino
- CoMIT Omics Center, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Tomoyuki Honda
- Department of Virology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-Ku, Okayama, 700-8558, Japan
- Department of Virology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Kita-Ku, Okayama, 700-8558, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
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Jaiswal V, Mukherjee D, Peng Ang S, Kainth T, Naz S, Babu Shrestha A, Agrawal V, Mitra S, Ee Chia J, Jilma B, Mamas MA, Gebhard C, Postula M, Siller-Matula JM. COVID-19 vaccine-associated myocarditis: Analysis of the suspected cases reported to the EudraVigilance and a systematic review of the published literature. IJC HEART & VASCULATURE 2023; 49:101280. [PMID: 38143781 PMCID: PMC10746454 DOI: 10.1016/j.ijcha.2023.101280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/31/2023] [Accepted: 09/21/2023] [Indexed: 12/26/2023]
Abstract
Background Myocarditis secondary to Coronavirus Disease 2019 (COVID-19) vaccination has been reported in the literature. Objective This study aimed to characterize the reported cases of myocarditis after COVID-19 vaccination based on age, gender, doses, and vaccine type from published literature and the EudraVigilance database. Methods We performed an analysis in the EudraVigilance database (until December 18, 2021) and a systematic review of published literature for reported cases of suspected myocarditis and pericarditis (until 30th June 2022) after the COVID-19 vaccination. Results EudraVigilance database analysis revealed 16,514 reported cases of myocarditis or pericarditis due to the vaccination with COVID-19 vaccines. The cases of myo- or pericarditis were reported predominantly in the age group of 18-64 (n = 12,214), and in males with a male-to-female (M: F) ratio of 1.7:1. The mortality among myocarditis patients was low, with 128 deaths (2 cases per 10.000.000 administered doses) being reported. For the systematic review, 72 studies with 1026 cases of myocarditis due to the vaccination with COVID-19 vaccines were included. The analysis of published cases has revealed that the male gender was primarily affected with myocarditis post-COVID-vaccination. The median (IQR) age of the myocarditis cases was 24.6 [19.5-34.6] years, according to the systematic review of the literature. Myocarditis cases were most frequently published after the vaccination with m-RNA vaccines and after the second vaccination dose. The overall mortality of published cases was low (n = 5). Conclusion Myocarditis is a rare serious adverse event associated with a COVID-19 vaccination. With early recognition and management, the prognosis of COVID-19 vaccine-induced myocarditis is favorable.
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Affiliation(s)
| | | | - Song Peng Ang
- Department of Internal Medicine, Rutgers Health Community Medical Center, Toms River, NJ, USA
| | - Tejasvi Kainth
- Department of Psychiatry, Bronxcare Health System, NY, USA
| | - Sidra Naz
- Department of Internal Medicine, Harvard Medical School/BIDMC, Boston, USA
| | | | | | - Saloni Mitra
- OO Bogomolets National Medical University, Kyiv, Ukraine
| | - Jia Ee Chia
- Department of Internal Medicine, Texas Tech University Health Sciences, El Paso, TX, USA
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Catherine Gebhard
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
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Baritussio A, Giordani AS, Basso C, Vicenzetto C, Lorenzoni G, Gasparin M, Iliceto S, Scarpa B, Gregori D, Marcolongo R, Caforio ALP. Uneventful COVID-19 Infection and Vaccination in a Cohort of Patients with Prior Myocarditis. Vaccines (Basel) 2023; 11:1742. [PMID: 38140147 PMCID: PMC10747303 DOI: 10.3390/vaccines11121742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Myocarditis has in rare cases been associated with COVID-19 infection and has emerged as a possible rare side effect of vaccination with anti-COVID-19 messenger RNA vaccines. However, little is known about possible COVID-19 infection- and/or vaccination-related myocarditis relapse in patients with previous clinically suspected or biopsy-proven myocarditis. Myocarditis may relapse, particularly in females with immune-mediated/autoimmune features and a predisposing immunogenetic background. We aimed to assess the prevalence of myocarditis relapse during the COVID-19 outbreak and following COVID-19 vaccination in a cohort of patients with prior myocarditis. We included in the analysis myocarditis patients on active follow-up, for whom COVID-19 infection and vaccination statuses were known, and collected data on clinical, laboratory and echocardiographic findings, and myocarditis relapse. We enrolled 409 patients, of whom 114 (28%) reported COVID-19 infection and 347 (85%) completed the vaccination scheme. Only one patient, having COVID-19 infection before the vaccination campaign started, was admitted to hospital because of pneumonia; the remaining patients had an uneventful COVID-19 infection course, with only mild symptoms. No myocarditis relapse was recorded following COVID-19 infection or vaccination. Moreover, the frequency of new myocarditis cases following the COVID-19 outbreak was not different compared to the three-year period preceding the COVID-19 era. In conclusion, in our cohort of patients with prior myocarditis, both COVID-19 infection and vaccination were uneventful.
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Affiliation(s)
- Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Andrea Silvio Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Cristina Basso
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy;
| | - Cristina Vicenzetto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (G.L.); (D.G.)
| | - Matteo Gasparin
- Department of Statistical Sciences, University of Padua, 35121 Padua, Italy; (M.G.); (B.S.)
| | - Sabino Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padua, 35121 Padua, Italy; (M.G.); (B.S.)
- Department of Mathematics “Tullio Levi Civita”, University of Padua, 35131 Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy; (G.L.); (D.G.)
| | - Renzo Marcolongo
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
| | - Alida Linda Patrizia Caforio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, University of Padua, 35128 Padua, Italy; (A.B.); (A.S.G.); (C.V.); (S.I.); (R.M.)
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Wigner-Jeziorska P, Janik-Karpińska E, Niwald M, Saluk J, Miller E. Effect of SARS-CoV-2 Infection and BNT162b2 Vaccination on the mRNA Expression of Genes Associated with Angiogenesis. Int J Mol Sci 2023; 24:16094. [PMID: 38003287 PMCID: PMC10671623 DOI: 10.3390/ijms242216094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), discovered in December 2019 in Wuhan, China, caused the coronavirus disease 2019 (COVID-19). Due to the rate of spread of this virus, the World Health Organization, in March 2020, recognised COVID-19 as a worldwide pandemic. The disease is multisystemic with varying degrees of severity. Unfortunately, despite intensive research, the molecular changes caused by SARS-CoV-2 remain unclear. Mechanisms affected by the virus infection include endothelial dysfunction and angiogenesis. Similarly, the vaccines developed so far affect the process of angiogenesis, contributing to the development of undesirable effects on part of the cardiovascular system. The presented research aimed to investigate the impact of the SARS-CoV-2 infection and the Pfizer Comirnaty vaccine (BNT162b2) on the molecular aspect of angiogenesis. We found that convalescents vaccinated with one dose of BNT162b2 were characterised by higher MMP-7 (metalloproteinases 7) expression than non-vaccinated convalescents and healthy volunteers vaccinated with one dose of BNT162b2. Moreover, non-vaccinated convalescents showed increased mRNA expression of ADAMTS1 (ADAM metallopeptidase with thrombospondin type 1 motif 1) compared to healthy volunteers vaccinated with one dose of BNT162b2. In addition, we showed significant sex differences in the expression of MMP-7. In conclusion, the results of our study suggest a significant impact of SARS-CoV-2 infection and vaccination on the course of angiogenesis at the molecular level.
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Affiliation(s)
- Paulina Wigner-Jeziorska
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, 90-136 Lodz, Poland; (P.W.-J.); (J.S.)
| | - Edyta Janik-Karpińska
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, 90-136 Lodz, Poland;
| | - Marta Niwald
- Department of Neurological Rehabilitation, Medical University of Lodz, 90-136 Lodz, Poland;
| | - Joanna Saluk
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, 90-136 Lodz, Poland; (P.W.-J.); (J.S.)
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, 90-136 Lodz, Poland;
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Murished GM, Dandachi I, Aljabr W. Side effects of COVID-19 vaccines in the middle eastern population. Front Immunol 2023; 14:1270187. [PMID: 38022593 PMCID: PMC10654979 DOI: 10.3389/fimmu.2023.1270187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The COVID-19 pandemic has caused severe worldwide health concerns since its first description as the SARS-COV-2 virus in December 2019. The wide dissemination of this virus, together with the lack of treatment, prompted vaccine development within a short period of time to elicit a protective immunity against COVID-19. Due to their rapid development, potential subsequent side effects of COVID-19 vaccines were overlooked, which might lead to many health concerns. This is especially true for patients at a greater risk of harm from COVID-19, such as pregnant women, children, and patients with pre-existing chronic diseases. In this review, we provide a summary of common to rare side effects of administrated COVID-19 vaccines in a Middle Eastern population. We have found that the distinction between side effects from COVID-19 vaccines in terms of frequency and severity is attributed to the differences in study populations, gender, and age. Pain at the injection site, fever, headache, fatigue, and muscle pain were the most common reported side effects. Vaccinated subjects with previous COVID-19 infection exhibited an equivalent neutralizing response after just one dose compared to two doses of vaccine. Consequently, individuals who experienced more side effects had significantly higher antibody levels. This indicates that having better immunity correlates with higher antibody levels, leading to a higher frequency of vaccine side effects. Individuals with underlying comorbidities, particularly having known allergies and with illnesses such as diabetes and cancer, might be more prone to post-vaccination side effects. Studies of a high-risk population in Middle Eastern countries are limited. Future studies should be considered to determine long-term side effects, side effects after booster doses, and side effect differences in cases of heterologous and homologous vaccination for better understanding and proper handling of high-risk populations and patients who experience these side effects.
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Affiliation(s)
| | | | - Waleed Aljabr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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45
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Cotugno N, Amodio D, Buonsenso D, Palma P. Susceptibility of SARS-CoV2 infection in children. Eur J Pediatr 2023; 182:4851-4857. [PMID: 37702769 PMCID: PMC10640404 DOI: 10.1007/s00431-023-05184-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Coronavirus disease 2019 in children presents with distinct phenotype in comparison to adults. Overall, the pediatric infection with a generally milder clinical course of the acute infection compared to adults still faces several unknown aspects. Specifically, the presence of a wide range of inflammatory manifestations, including multisystem inflammatory syndrome in children (MIS-C), myocarditis, and long COVID in the period after infection suggests a particular susceptibility of some children upon severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Albeit peculiar complications such as long covid are less frequent in children compared to adults, research on the relationship between inflammatory syndromes and SARS-CoV-2 is rapidly evolving. Conclusions: new studies and findings continue to emerge, providing further insights into the underlying mechanisms and potential therapeutic strategies. In the present work, we revised current knowledge of the main factors accounting for such variability upon SARS-CoV-2 infection over the pediatric age group. What is Known: • COVID19 in children overall showed a milder course compared to adults during the acute phase of the infection. • Children showed to be susceptible to a wide range of post infectious complications including multisystem inflammatory syndrome in children (MIS-C), myocarditis, neuroinflammation, and long COVID. What is New: • Mechanisms underlying susceptibility to a severe course of the infection were recently shown to pertain to the host. • A specific combination of HLA was recently shown to be associated to higher susceptibility to MIS-C in children.
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Affiliation(s)
- Nicola Cotugno
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Donato Amodio
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Palma
- Clinical Immunology and Vaccinology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy.
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
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Hilu R, Abu Ghosh Z, Leibowitz D, Arow Z, Ovdat T, Or T, Pereg D, Alcalai R. Outcomes of patients with acute coronary syndrome according to COVID-19 vaccination status. Coron Artery Dis 2023; 34:470-474. [PMID: 37799043 DOI: 10.1097/mca.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND COVID-19 vaccination has been associated with reduced risk of acute coronary syndrome (ACS); however, several studies have reported cardiovascular complications following vaccination. We aimed to investigate the effect of COVID-19 vaccination status on the treatment and outcome of ACS patients. METHODS The study was based on the 2021 Acute Coronary Syndrome Israeli Survey. Patients were stratified into two groups according to COVID-19 vaccination status, vaccinated compared to unvaccinated. Patients who had received at least 2 vaccination doses up to 1 week prior to ACS hospitalization were considered vaccinated. The primary endpoint was 1-year all-cause mortality. RESULTS A total of 1261 patients with ACS were included, of whom 990 (78.5%) were vaccinated. Vaccinated patients were older and less frequently smokers. There were no significant differences in coronary reperfusion rates and treatment with guideline-based medical therapy during hospital stay and at discharge. The primary endpoint of 1-year all-cause mortality occurred in 38 (3.8%) and 14 (5.2%) patients in the vaccinated and unvaccinated groups respectively (P = 0.42). 30-day MACE occurred in 94 (9.5%) in the vaccinated patients compared to 31 (11.5%) in the unvaccinated group (P = 0.39). These results remained similar following adjustment for confounders. CONCLUSION There was no association between COVID-19 vaccination status and the outcomes of patients with ACS. Our findings provide support for the cardiovascular safety of COVID-19 mRNA vaccines in patients at high cardiovascular risk.
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Affiliation(s)
- Ranin Hilu
- Cardiology Department, Meir Medical Center, Kfar-Saba and Sackler Faculty of Medicine, Tel-Aviv University
| | | | | | - Ziad Arow
- Cardiology Department, Meir Medical Center, Kfar-Saba and Sackler Faculty of Medicine, Tel-Aviv University
| | - Tal Ovdat
- The Israeli Center for Cardiovascular Research, Sheba Medical Center, Ramat Gan
| | - Tsafrir Or
- Cardiology Department, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - David Pereg
- Cardiology Department, Meir Medical Center, Kfar-Saba and Sackler Faculty of Medicine, Tel-Aviv University
| | - Ronny Alcalai
- Hadassah Hebrew University Medical Center, Jerusalem
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Li M, Fang E, Wang Y, Shi L, Li J, Peng Q, Li X, Zhao D, Liu X, Liu X, Liu J, Xu H, Wang H, Huang Y, Yang R, Yue G, Suo Y, Wu X, Cao S, Li Y. An mRNA vaccine against rabies provides strong and durable protection in mice. Front Immunol 2023; 14:1288879. [PMID: 37954577 PMCID: PMC10639119 DOI: 10.3389/fimmu.2023.1288879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Rabies is a serious public health problem worldwide for which an effective treatment method is lacking but can be prevented by vaccines. Current vaccines are produced in cell or egg cultures, which are both costly and time consuming. Methods Here, a non-replicating mRNA vaccine (RV021) encoding the rabies virus glycoprotein was developed in vitro, and its immunogenicity and protective efficacy against live virus was evaluated in mice. Results A two-dose vaccination with 1 μg of RV021 at 7-day intervals induced a protective level of neutralizing antibody that was maintained for at least 260 days. RV021 induced a robust cellular immune response that was significantly superior to that of an inactivated vaccine. Two doses of 1 μg RV021 provided full protection against challenge with CVS of 30~60-fold lethal dose, 50%. Vaccine potency testing (according to the National Institutes of Health) in vivo revealed that the potency of RV021 at 15 μg/dose was 7.5 IU/dose, which is substantially higher than the standard for lot release of rabies vaccines for current human use. Conclusion The mRNA vaccine RV021 induces a strong protective immune response in mice, providing a new and promising strategy for human rabies prevention and control.
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Affiliation(s)
- Miao Li
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
- Vaccines R&D Department, Changchun Institute of Biological Products, Changchun, China
| | - Enyue Fang
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
- Institute of Health Inspection and Quarantine, Chinese Academy of Inspection and Quarantine, Beijing, China
| | - Yunpeng Wang
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Leitai Shi
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Jia Li
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Qinhua Peng
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Xingxing Li
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Danhua Zhao
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Xiaohui Liu
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
- Vaccines R&D Department, Changchun Institute of Biological Products, Changchun, China
| | - Xinyu Liu
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Jingjing Liu
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Hongshan Xu
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Hongyu Wang
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Yanqiu Huang
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Ren Yang
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Guangzhi Yue
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Yue Suo
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Xiaohong Wu
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Shouchun Cao
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Yuhua Li
- Department of Arbovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
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Lin YC, Chang CH, Su WJ, Yang CH, Wang JT. Risk of Coronavirus Disease 2019 Messenger RNA Vaccination-Associated Myocarditis and Pericarditis - A Systematic Review of Population-Based Data. Risk Manag Healthc Policy 2023; 16:2085-2099. [PMID: 37841076 PMCID: PMC10575036 DOI: 10.2147/rmhp.s422372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose Early studies showed that the risks of mRNA vaccine-associated myocarditis and pericarditis are low but with substantial variation across studies. Study characteristics, ethnicity, vaccine types, dose intervals, and SARS-CoV-2 infection prevalence may influence the rates of myocarditis and pericarditis after mRNA vaccination in population-based studies. Methods We comprehensively searched MEDLINE for relevant articles published before November 30, 2022. We also searched the websites of health authorities in several countries for unpublished surveillance data on myocarditis and pericarditis after mRNA vaccination. The outcome of interest was the incidence of myocarditis and pericarditis developed after mRNA vaccination for COVID-19. Results A total of 17 studies form 10 countries were included for review. We noted that considerable heterogeneity in study characteristics, including surveillance method, case definition, and observation period, may partially be responsible for the widely varied reported rates. Studies from countries that adopted active surveillance reported higher rates than those using passive surveillance. Compared to BNT162b2 vaccine, mRNA-1273 may have a higher risk of myocarditis only in young men after the second dose. Our comparison of sex-, age-, vaccine type-, and dose-specific rates of myocarditis across countries did not support the hypothesis that individuals with recent SARS-CoV-2 infection and young Asian males were at higher risk. We also could not find sufficient evidence to conclude whether extending the between-dose interval could reduce myocarditis incidence following mRNA vaccination. Conclusion Differences in the study characteristics must be fully considered when comparing the risks of mRNA vaccine-related myocarditis and pericarditis in different countries.
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Affiliation(s)
- Yen-Ching Lin
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hsuin Chang
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei-Ju Su
- Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hui Yang
- Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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49
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Amodio D, Pascucci GR, Cotugno N, Rossetti C, Manno EC, Pighi C, Morrocchi E, D'Alessandro A, Perrone MA, Valentini A, Franceschini A, Chinali M, Deodati A, Azzari C, Rossi P, Cianfarani S, Andreani M, Porzio O, Palma P. Similarities and differences between myocarditis following COVID-19 mRNA vaccine and multiple inflammatory syndrome with cardiac involvement in children. Clin Immunol 2023; 255:109751. [PMID: 37660743 DOI: 10.1016/j.clim.2023.109751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
Despite the multiple benefits of vaccination, cardiac adverse Events Following COVID-19 Immunization (c-AEFI) have been reported. These events as well as the severe cardiac involvement reported in Multisystem inflammatory syndrome in children (MIS-C) appear more frequent in young adult males. Herein, we firstly report on the inflammatory profiles of patients experiencing c-AEFI in comparison with age, pubertal age and gender matched MIS-C with cardiac involvement. Proteins related to systemic inflammation were found higher in MIS-C compared to c-AEFI, whereas a higher level in proteins related to myocardial injury was found in c-AEFI. In addition, higher levels of DHEAS, DHEA, and cortisone were found in c-AEFI which persisted at follow-up. No anti-heart muscle and anti-endothelial cell antibodies have been detected. Overall current comparative data showed a distinct inflammatory and androgens profile in c-AEFI patients which results to be well restricted on heart and to persist months after the acute event.
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Affiliation(s)
- Donato Amodio
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Rubens Pascucci
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Cotugno
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Chiara Rossetti
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Emma Concetta Manno
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Chiara Pighi
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Elena Morrocchi
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Annamaria D'Alessandro
- Clinical Biochemistry Laboratory, IRCCS "Bambino Gesù" Children's Hospital, 00165 Rome, Italy
| | - Marco Alfonso Perrone
- Department of Medical and Surgical Cardiology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy; Division of Cardiology and CardioLab, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Alessandra Valentini
- Department of laboratory Medicine, University Hospital "Tor Vergata", Rome, Italy
| | - Alessio Franceschini
- Department of Medical and Surgical Cardiology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Marcello Chinali
- Department of Medical and Surgical Cardiology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Annalisa Deodati
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Diabetology and Growth Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, 00164 Rome, Italy
| | - Chiara Azzari
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
| | - Paolo Rossi
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Stefano Cianfarani
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Diabetology and Growth Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, 00164 Rome, Italy; Department of Women's and Children's Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Marco Andreani
- Transplantation Immunogenetics Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ottavia Porzio
- Clinical Biochemistry Laboratory, IRCCS "Bambino Gesù" Children's Hospital, 00165 Rome, Italy; Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Paolo Palma
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
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50
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Levi N, Hasin T. Myocardial injury related to SARS-CoV-2 mRNA vaccination: The plot thickens. Eur J Heart Fail 2023; 25:1882-1883. [PMID: 37642187 DOI: 10.1002/ejhf.3013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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