Myocarditis with COVID-19 mRNA Vaccines
Circulation. 2021 Jul 20. doi: 10.1161/CIRCULATIONAHA.121.056135. Online ahead of print.ABSTRACTMyocarditis has been recognized as a rare complication of coronavirus 2019 (COVID-19) mRNA vaccinations, especially in young adult and adolescent males. According to the U.S. Centers for Disease Control (CDC), myocarditis/pericarditis rates are approximately 12.6 cases per million doses of second dose mRNA vaccine among 12-39-year-olds. In reported cases, patients with myocarditis invariably presented with chest pain, usually 2-3 days after a second dose of mRNA vaccination and had elevated cardiac troponin levels. ECG was abnormal with ST elevations in most, and cardiac MRI was suggestive of myocarditis in all tested patients. There was no evidence of acute COVID-19 or other viral infections. In one case, a cardiomyopathy gene panel was negative, but autoantibody levels against certain self-antigens and frequency of natural killer cells were increased. Although the mechanisms for development of myocarditis are not clear, molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and self-antigens, trigger of preexisting dysregulated immune pathways in certain individuals, immune response to mRNA and activation of immunological pathways, and dysregulated cytokine expression have been proposed. The reasons for male predominance in myocarditis cases are unknown, but possible explanations relate to sex hormone differences in immune resp...
ConclusionsWe established the feasibility of initiating and managing patients in a monthly text-based symptom-monitoring program. The provision of smartphones and patient navigation were unique and vital components of this program.
ConclusionsInformatics solutions can generate timely, tailored office reports including PROs and predictive analytics. Patients successfully complete the pre-visit PRO assessments and clinicians and patients value the report to support shared surgical decisions.
ConclusionMultilevel IS frameworks are necessary for PROM/PREM implementation given the complexity. In cross-study comparisons, barriers to PROM/PREM implementation were consistent across patient populations and care settings, but enablers were context specific, suggesting the need for tailored implementation strategies based on clinic resources. Theoretically guided studies are needed to clarify how, why, and in what circumstances IS principles lead to successful PROM/PREM integration and sustainability.
ConclusionThis study was the preparatory phase for a future trial on a method to stimulate setting specific goals. The future trial would provide a thorough understanding of the quality of person-defined goals.
COVID-19 deaths per day have begun to creep back up again after a decline that started in late September.Associated Press
When I had reviewed the topic of vaccine associated myocarditis for an editorial in the BMH Medical Journal in 2017, most of the cases were associated with small pox vaccination . There were also reports of streptococcal pneumonia vaccine and influenza vaccine associated myocarditis. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) used in the vaccine were also implicated in some cases [2,3]. While the large scale vaccination for small pox in an attempt to prepare for potential bioterrorism was the association in 2003 , COVID-19 mRNA vaccines are currently in the limelight for vaccine induced myocarditis...