Myocarditis COVID Vaccine

What to Know About Myocarditis and COVID-19 Vaccines

Our primary care doctors in Jupiter have been receiving worried calls from parents about the possibility of their children contracting myocarditis and pericarditis from the COVID-19 vaccine.

We’d like to reassure you that the possibility is remote. Here are the facts.

The condition

Myocarditis is inflammation of the muscle of the heart. A related condition, pericarditis, is inflammation of the tissue that forms a sac around the heart. Either one is an indication of the body’s immune system responding to an infection or some other trigger.

This relatively rare condition can occur with many types of infections, especially viruses, including COVID-19. It can also occur with heavy metal poisoning, radiation treatments, some medications, and autoimmune conditions such as rheumatoid arthritis.

It also can occur after certain vaccinations, like smallpox. Now, it has been reported with two of the vaccines for the coronavirus, Pfizer-BioNTech and Moderna. (The effect hasn’t been seen with the Johnson & Johnson vaccine.)

Symptoms of either myocarditis or pericarditis can include chest pain, shortness of breath, or an abnormal heartbeat (racing, pounding, or fluttering).

The incidence

According to the Centers for Disease Control and Prevention (CDC), more than 300 million doses of the mRNA vaccines—Pfizer-BioNTech and Moderna—have been administered in the U.S. Of those, there have been 323 cases of myocarditis, pericarditis, or both, all in individuals under the age of 30.

Nearly 80 percent of those have recovered from the symptoms. Nine patients are still hospitalized, with two remaining in intensive care. No deaths have been reported from the condition.

It usually appears within days following the injection of one of the mRNA vaccines, and occurs more often following the second dose. Reported cases have occurred predominantly in male adolescents and adults 16 years of age and older, according to the CDC.

Jeremy Asnes, chief of pediatric cardiology at Yale Medicine and co-director of the Yale New Haven Children’s Hospital Heart Center, says the incidence is incredibly rare. He adds most patients who report symptoms recover quickly.

“I think that the most important message at this point is that we are still recommending eligible people older than 12 follow the vaccine recommendations from the CDC,” he said.

“While we are taking these reports of myocarditis very seriously, we—along with the CDC—continue to feel that the benefits of being vaccinated against COVID-19 far outweigh the very small risk of getting myocarditis related to the vaccine itself.”

Comparison with COVID-19

A study conducted with U.S. military medical centers released by the Mayo Clinic in late June found that the greater risk for heart damage and death continues to be infection with the SARS-CoV-2 coronavirus versus the vaccines. Up to 60 percent of those who become seriously ill with COVID-19 experience some type of injury to their hearts. And nearly one percent of athletes who were previously deemed fit reveal myocarditis on their MRIs after even mild cases of the virus.

“Hypersensitivity myocarditis following vaccination is rare, with the exception of smallpox vaccine,” said Leslie Cooper, chair of the Department of Cardiology at the Mayo Clinic in Florida. “The risk of myocarditis after receiving mRNA vaccine is far less than the risk of myocarditis following actual COVID-19 infection.” Cooper is the senior author of the study.

To illustrate his point, the CDC calculates that for males between the ages of 18 and 29, 60 cases of myocarditis would occur for every million doses of the vaccine. Those vaccines, however, would also prevent 12,000 infections, 530 hospitalizations, and three deaths.

In comparison with the 323 non-fatal cases of myocarditis following the injection, the CDC reports that adolescents and young adults now constitute 33 percent of all new COVID-19 cases. Since the beginning of the pandemic, 7.7 million people ages 12 to 29 have been infected. And 2,767 of those died.

Other considerations

It’s important to remember the other effects that can occur from infection with the COVID-19 virus:

  • About 25 percent of those who contract it report lingering symptoms. These include chest pain, shortness of breath, muscle pain, and fatigue. Oddly, these so-called long-haul symptoms tend to occur just as much, if not more often, in those who had only mild or no symptoms of COVID-19.
  • The highly contagious and more dangerous delta variant is spreading rapidly in this country, especially among younger people. They tend to be more socially active and are less likely to be vaccinated.

So far, all reported cases of myocarditis, pericarditis, or the extremely rare (fewer than 10) cases of a dangerous blood clotting disorder reported with the Johnson & Johnson vaccine seem to far outweigh the advantages of getting the vaccine.

“People of all ages should choose to get a COVID-19 vaccine because the risks are extremely low compared to the benefits,” said Mayo’s Cooper. “Additionally, the growing body of research shows that vaccine-associated myocarditis resolves quickly in almost all cases.”

after COVID vaccination

What You Can Do After Your COVID-19 Vaccination

Only about 10 percent of the U.S. population has been fully vaccinated for the SARS-CoV-2 coronavirus. But vaccine supplies and distribution have been ramping up. The government expects to have vaccine available for everyone who wants it by the end of May. So our concierge doctors at MD 2.0 in Jupiter want to share the guidelines recently released by the Centers for Disease Control and Prevention (CDC) spelling out what you can do after your COVID-19 vaccination.

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covid variants

Understanding COVID-19 Variants

Our concierge doctors are receiving many questions from our patients about the numerous COVID-19 variants. They want to know what they mean for the vaccine and how worried we should be about them. The U.K. variant, known as B.1.1.7, is spreading more rapidly in Florida at the moment than in any other state. We felt this would be a good time to summarize what we know about all of these questions.

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vaccine effects

What to Expect from the Coronavirus Vaccine

Our concierge doctors are receiving questions as the two approved coronavirus vaccines become more widely available. So we decided to answer many of those questions on the effects of the vaccine here.

The latest

The vaccine rollout has gone more slowly than anticipated. First, there aren’t as many doses available of either vaccine as had been promised originally. There are approximately 200 million Americans in need of the vaccine, which means 400 million total doses for two shots. But there are currently only about 100 million doses available, and approximately three percent of the population has been vaccinated.

Second, there has been confusion and controversy regarding who should be first in line to receive a shot, who should be next, and so on.

Finally, until the end of December, the federal government did not allocate enough money for states to pay for training additional vaccinators, adequately storing and distributing the vaccine, etc. The economic stimulus package passed in December allocated $8 billion for states. But health officials say it will take time to receive the money and implement necessary protocols.

In the coming weeks, however, these problems should begin to be resolved. Experts expect the vaccines to be more available to those who need it: front-line health care and essential workers, seniors in long-term care facilities, and those at high risk of contracting COVID-19. It will likely take longer than that for the general public to begin receiving vaccines.

Effectiveness

Both the Pfizer-BioNTech and Moderna vaccines require two doses for maximum effectiveness. Both vaccines show in early trials to deliver immunity rates around 95 percent. The flu shot generally has an effectiveness rate of between 30-50 percent.

While it is still too early to be certain, it appears the vaccines could take as long as 28 days to create the promised level of immunity. Although, one recent study found immunity can begin within 12 days. (The flu shot takes between 10-14 days for full effectiveness.)

There has also been controversy regarding whether to make sure everyone receives both doses. Some argue one will be enough for now, given the nationwide shortage. Experts still haven’t settled the question. But more are now leaning toward the concept of giving as many people as possible at least some protection– meaning, just a single dose initially until the supply shortage eases. Early research seems to show a single dose may confer between 80-90 percent protection, thereby strengthening that argument.

Health officials say at least 70 percent of the population must be inoculated in order to receive so-called “herd immunity.”

By the way, there is zero chance of contracting the virus from the shot. Unlike traditional vaccines that introduce a weakened or dead virus into the body, both COVID-19 vaccines use messengerRNA (mRNA) to trigger immunity.

And no, the mRNA won’t change your DNA. It never enters the nucleus of the cells where the DNA resides.

Side effects

When we talk about side effects, we mean both the allergic reactions noted in relatively few individuals and the expected aftereffects of a standard vaccination.

Allergic reactions

According to the CDC, nearly two million people received one of the coronavirus vaccines in the first week it was available. It said at least 29 of the had a severe allergic reaction called anaphylaxis. This condition can be life threatening, and must be treated immediately with an emergency injection of epinephrine.

“This is still a rare outcome,” said Dr. Nancy Messonnier, head of the CDC’s National Center for Immunization and Respiratory Diseases, during a media briefing. “Right now, the known and potential benefits of the current COVID-19 vaccines outweigh the known and potential risks of getting COVID-19.”

If you have a history of severe allergic reactions that require you to carry an Epi pen, check with us before being vaccinated.

Normal after-effects

Many of those who have already received the vaccine reported no side effects. Research from the vaccines trials reported most people can expect to experience at least one side effect from the shot. And that’s normal, as the body swings into action to mobilize its immune defenses against the coronavirus. It can also happen with the flu vaccine.

Reported side effects include

  • headache
  • fatigue
  • muscle soreness and aches
  • joint pain
  • pain, redness, or swelling at the injection site

These generally go away in a day or two. We believe such short-term discomfort is a small price to pay to keep from getting COVID-19. Just ask the “long haulers,” whose lives have been disrupted for months with lingering, debilitating effects from the virus.

If you have any questions about the effects of the vaccine, please let us know.

children COVID

All Children in Study Show Blood Vessel Damage from COVID-19

From the onset of the coronavirus pandemic, it became clear the majority of those most affected by COVID-19 infections were adults over the age of 65. The severity of the illness and deaths decreases in younger people. Many began to believe we didn’t have to worry about children when it came to the virus.

Children may be carriers and able to infect others. But many thought if they should become ill, in most cases they’ll exhibit either mild symptoms or none at all.

Dangerous misconception

Our concierge doctors want to warn you that this is a misconception. At least 120 children in the U.S. have died from COVID-19. And a new study last month at the Children’s Hospital of Philadelphia (CHOP) found a disturbing result of coronavirus infection in children. They found elevated levels of a biomarker (C5b9) related to blood vessel damage, even in those with minimal or no symptoms.

They also found a high proportion of children with SARS-CoV-2, the coronavirus that causes COVID-19, were also diagnosed with a condition called thrombotic microangiopathy (TMA). TMA leads to clots in small blood vessel. It has been linked to severe COVID-19 symptoms in adults.

“We do not yet know the clinical implications of this elevated biomarker in children with COVID-19 and no symptoms or minimal symptoms,” co-senior study author David T. Teachey, MD, said in a news release. Teachey is the Director of Clinical Research at the Center for Childhood Cancer Research at CHOP.

“We should continue testing and monitoring children with SARS-CoV-2 so that we can better understand how the virus affects them in both the short and long term,” he added.

The unknowns

There’s still a great deal we don’t yet know about this novel coronavirus, including why it affects both children and adults in varying degrees. At least 30-40 percent of adults, for example, show minimal or no symptoms at all. They still can transmit the infection to others, however.

Despite having a higher viral load, children are even less likely to exhibit symptoms. This means children tend to have a larger amount of the virus in their upper respiratory tracts than adults. Does that mean they can transmit the virus even more readily than adults? 

Again, we don’t know for sure. But a recent Harvard Health paper warns “the presence of high viral loads in infected children does increase the concern that children, even those without symptoms, could readily spread the infection to others.”

One thing we do know is a small number of children can have severe effects. One of these is a new condition. The Centers for Disease Control and Prevention (CDC) calls it “multisystem inflammatory syndrome in children,” or MIS-C. It now seems to have affected approximately 300 children in the U.S, at least five of whom have died.

Long-term implications

Originally, doctors thought there was an unusual outbreak of a rare form of Kawasaki’s disease. The symptoms reported were similar (persistent fever, rash, and inflammation of the blood vessels). It has now, though, been connected specifically with the SARS-CoV-2 virus.

“This [MIS-C] is a new childhood disease that is believed to be associated with [COVID-19], and it can be lethal because it affects multiple organ systems [including] the heart and the lungs, gastrointestinal system or neurologic system,” neonatologist Alvaro Moreira said in a statement. Moreira is an assistant professor of pediatrics at The University of Texas Health Science Center at San Antonio.

His team reviewed 662 cases of MIS-C worldwide between January and July of last year. They found more than half of the children studied suffered heart damage as a result of the condition. These children may require lifelong care and treatment, United Press International (UPI) reported in September.

“Evidence suggests that [these] children . . . have immense inflammation and potential tissue injury to the heart, and we will need to follow [them] closely to understand what implications they may have in the long term,” Moreira concluded.

Further study needed

Researchers in the CHOP study were surprised to find the biomarker C5b9 present. They found it not only in children with severe symptoms of COVID-19 and MIS-C, but also in those with minimal or no symptoms.

“Although most children with COVID-19 do not have severe disease, our study shows that there may be other effects of SARS-Cov-2 that are worthy of investigation,” Teachey said.

“The most important takeaway from this study is we have more to learn about SARS-Cov-2,” he concluded. “We should not make guesses about the short- and long-term impact of infection.”

Neither of the two vaccines approved for adults have been tested in children under age 12. It could be a long wait until kids get protection from the virus.

In the meantime, we urge parents to take the same precautions with their children that they do with themselves. Socially isolate as much as possible, frequently wash your hands, and wear masks when outside the family circle.

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