The Centers for Disease Control and Prevention (CDC) is currently investigating the relationship between the Pfizer/BioNTech and Moderna Covid-19 vaccines and an entity known as myocarditis. This disorder is a rapid-onset inflammation of the heart muscle, often presenting with symptoms similar to those of a heart attack. As reported by Dr. Bruce Y. Lee for Forbes, both this week as well as in April 2021, the causal versus coincidental relationship between the vaccine and this condition remain to be determined.
Several hundred cases of myocarditis following Covid-19 vaccination were submitted to the Vaccine Adverse Event Reporting System (VAERS) in late May 2021, followed by a report published in the journal Pediatrics, describing seven adolescent boys who developed myocarditis several days after receiving their second dose of the Covid-19 vaccine. All seven boys fully recovered. As reported in Forbes by Leah Campbell, the relationship between the vaccines and this condition in adolescents remains in question.
On first, second, or even third glance, the data of hundreds or even a handful of those developing acute inflammation of the heart muscle after vaccination seems like a no-brainer of a link between the two. But here’s why it’s not so simple:
- As of late May 2021, nearly 300 million Covid-19 vaccine doses had been administered in the United States alone.
- Countless illnesses and events can occur on any given day, and as the number of vaccinations increases, it becomes more challenging to tease out cause and effect versus association or even coincidence.
- As Dr. Bruce Y. Lee so eloquently stated, “if a watermelon fell on your head after you got vaccinated, it’s unlikely that “attacks by large fruit” should be included as a possible vaccine side effect.” (However, Dr. Lee, if you win the “Vax-a-million” lottery after your vaccine, is winning one million dollars a vaccine side effect?)
- While myocarditis affects thousands of adults and children every year in the U.S., and over 3 million people annually worldwide, it remains quite rare, even in the setting of over one million Covid-19 vaccinations being administered daily in the U.S.
- Many cases of myocarditis are so mild that they go un-diagnosed.
- Severe cardiac issues, including myocarditis, have been encountered during and following acute Covid-19 infections, even in young, healthy athletes.
- While the CDC is investigating a potential link between the vaccine and the disorder, there may, indeed, be none.
Adolescents became eligible for the Pfizer/BioNTech Covid-19 vaccine this spring, which coincides with myocarditis ‘season’, as this disorder tends to be more commonly seen in the late spring and early summer months. On April 19, 2021, all individuals ages 16 years and up in the U.S. became eligible for a Pfizer/BioNTech Covid-19 vaccine (the Moderna and Johnson & Johnson vaccines remain approved only for those ages 18 years and older). On May 12, 2021, both the FDA and CDC approved under Emergency Use Authorization the administration of the Pfizer/BioNTech Covid-19 vaccine for all individuals ages 12 years and up.
Myocarditis, or inflammation of the heart muscle, can be caused by various types of viruses, and is more frequently seen in the spring and summer months, just in time for adolescents to begin receiving Covid-19 vaccines. Myocarditis is most commonly seen in males under age 30. Symptoms of myocarditis may include:
- Shortness of breath
- Chest discomfort
- Fatigue/loss of consciousness
- Swelling of the hands or feet
Many viruses can cause myocarditis, including cold viruses, herpes viruses, Epstein-Barr virus (the cause of infectious mononucleosis, or ‘mono’), and yes, SARS-CoV-2, the virus responsible for Covid-19. Other infectious agents such as bacteria (the bacteria responsible for Lyme disease), fungi (yeast infections) and parasites (those transmitted by insect bites) can lead to inflamed heart muscle, or myocarditis.
While it is critical that the cases of myocarditis following Covid-19 vaccinations, both in adolescents and adults, be fully investigated, as is it critical to continue to monitor for any medical event occurring around the time of vaccinations, it is also critical to keep perspective regarding risk profiles of vaccination versus risks of the acute illness. Severe Covid-19 illness has remained rare in the population under age 30, but as of June 2021, over 2,000 Covid-19 deaths have occurred in the under-30 age group, and over 3,000 under age 18 years have been hospitalized in the U.S. alone.
Pediatricians and pediatric cardiologists continue to recommend Covid-19 vaccination for adolescents, as does the American Heart Association. Acute Covid-19 has been a cause of a wide array of cardiac abnormalities in both adolescents and adults. In severe cases, profound lung failure necessitating long term mechanical ventilation has been seen side by side with heart failure, even requiring high-risk cardiac bypass treatment known as ECMO (Extra-corporeal memebrane oxygenation), which is essentially an external mechanical heart machine.
Dr. Daniel Levi, Professor of Pediatrics and Director of Interventional Cardiology at Mattel Children’s Hospital UCLA, a large tertiary care referral center for high-risk pediatric cardiac patients, notes that “We saw lots of connections of children with possible myocarditis and coronary artery [small blood vessels that supply blood to the heart muscle] abnormalities to Covid-19 disease. We have not seen any from the vaccine to date.”