- After reviewing data on cases of myocarditis and pericarditis in people vaccinated with an mRNA COVID-19 vaccine, scientists say the benefits still outweigh the risks.
- Myocarditis is inflammation of the heart muscle, while pericarditis is inflammation of the two-layered sac surrounding the heart.
- These conditions can also occur naturally after other viral infections, but cases in people vaccinated with mRNA COVID-19 vaccines were slightly higher in number than average.
U.S. scientists said on June 23 that there is a “likely association” between mRNA COVID-19 vaccines and a higher risk of rare heart inflammation in adolescents and young adults.
Still, the benefits of the vaccines outweigh the risks, said members of the Centers for Disease Control and Prevention’s vaccine advisory committee. They recommend vaccination for all Americans 12 years and older.
The CDC’s Advisory Committee on Immunization Practices (ACIP) reviewed data on over 1,200 cases of myocarditis or pericarditis in Americans following vaccination with the Pfizer-BioNTech or Moderna-NIAID COVID-19 vaccine.
What are the side effects?
Myocarditis is inflammation of the heart muscle, while pericarditis is inflammation of the two-layered sac surrounding the heart.
Reported symptoms included chest pain and difficulty breathing, which typically began within a week after vaccination. Patients also showed abnormal electrocardiogram and blood test results.
Dr. Pranav Patel, chief of cardiology and an interventional cardiologist with UCI Health, says myocarditis and pericarditis can occur naturally due to viral and other infections.
“But the rate seen after [the mRNA] vaccines is slightly higher than would be expected for younger individuals,” he said. “This is what caused the CDC to look more closely into this.”
Most cases reported to the CDC occurred in people under age 30 — particularly men — and after the second dose. Researchers do not know why.
However, this side effect of vaccination is uncommon.
In 12- to 39-year-olds, heart inflammation occurred at a rate of 12.6 cases per million second doses given. The rate after the first dose was 4.4 cases per million doses administered.
Both rates were measured within 21 days after vaccination.
The rates were higher among people who received the Moderna-NIAID vaccine compared to Pfizer-BioNTech.
Health officials in the U.S. Defense Department and Israel have reported similar cases of myocarditis or pericarditis among younger men following vaccination with an mRNA vaccine.
Patel says that because the chance of heart inflammation is extremely low, the CDC is still recommending that all people 12 years old and older receive a COVID-19 vaccine.
However, if a person develops myocarditis or pericarditis after the first dose of an mRNA vaccine, the agency recommends that their second dose be delayed.
Once their heart is fully healed, the CDC says a second dose of an mRNA vaccine could be considered under certain circumstances.
The Food and Drug Administration (FDA) is expected to add a warning to mRNA vaccines authorized in the United States explaining that cases of heart inflammation are rare but a potential side effect of the vaccine, according to Reuters.
Cases more common in younger people and after second dose
So far, 1,226 cases of myocarditis or pericarditis have been reported to the CDC’s vaccine safety monitoring system.
This is out of 318 million vaccine doses administered in the United States as of June 21, according to data presented at the meeting.
Of the reported cases, 484 occurred in people between 12 and 29 years old. Health officials are still investigating to confirm some of these.
Among the verified cases in younger people, 309 were hospitalized. As of June 11, only 9 were still hospitalized, with 2 in intensive care, the agency said.
About 81 percent of those who have been discharged from the hospital had recovered from their symptoms at the time of the report.
No deaths have been associated with these vaccine-related conditions.
Compared to myocarditis not related to a vaccine, the cases that occurred after mRNA vaccination were milder, with a shorter duration and minimal treatment needed, the CDC’s Dr. Matthew Oster told the committee.
Similarly, Dr. Michael Chan, an interventional cardiologist with Providence St. Joseph Hospital in Orange, California, says most cases of myocarditis after the COVID-19 vaccination that he’s seen at his hospital have been mild.
“These children have not been severely involved with the myocarditis,” he said, “like some of the patients that I’ve seen with seasonal viral myocarditis.”
These patients didn’t require medications to support their blood pressure or to treat an abnormal heart rhythm. Instead, they were given a non-steroidal anti-inflammatory medicine such as ibuprofen.
After that, “their chest pain went away after a day or two, the heart muscle tests trended down toward normal, and they were discharged,” said Chan.
Officials at the CDC meeting said warnings about the potential risk of myocarditis and pericarditis should be added to the fact sheets provided to healthcare professionals and vaccine recipients
Heart inflammation side effect is extremely rare
Chan says the benefits of the vaccine clearly outweigh the risks, even with the low risk of myocarditis after vaccination.
While children are less likely than adults to become severely ill from COVID-19, some children are hospitalized or die from the illness.
They can also develop a rare but serious medical condition called multisystem inflammatory syndrome in children (MIS-C).
COVID-19 can also cause heart problems in young people. A study in JAMA Cardiology found that 2.3 percent of collegiate athletes who had recovered from COVID-19 had symptoms of myocarditis.
“COVID-19 infection is much more dangerous than the possibility of getting myocarditis or pericarditis from the vaccination,” said Patel.
Following the CDC meeting, top administration health officials joined with other health groups to endorse the use of mRNA COVID-19 vaccines in adolescents and young adults.
Currently, COVID-19 vaccines are approved in the United States for people 12 years old and older.
“The facts are clear: [heart inflammation] is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination,” CDC Director Rochelle Walensky and others wrote in the statement.
“Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment. In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19, and the risks to the heart from COVID-19 infection can be more severe.”
Chan says that because the coronavirus is unlikely to disappear any time soon, vaccination remains important, especially with the rapid spread of the delta variant.
“I would strongly encourage folks to get vaccinated as soon as possible,” he said. “Vaccination is critical in preventing further mutations of the virus into potentially even deadlier COVID-19 variants in the future.”
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