The Centers for Disease Control and Prevention (CDC) are investigating a small number of cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining around the heart) among adolescents and young adults who received an mRNA COVID-19 vaccine (Pfizer or Moderna). There is no similar trend among those who received the Johnson & Johnson COVID-19 vaccine. It is not yet known if there is a connection between these rare events and mRNA vaccines. CDC is still investigating whether these rare instances are related to the vaccine.
The cases were reported to the Vaccine Adverse Event Reporting System (VAERS). Most of the cases occurred among male adolescents and young adults 16 years of age and older. Symptom onset was typically within four days after the vaccination and occurred more often after the second dose than the first dose. Severity of symptoms varied. Most of the people who received medical care have responded well to medications and rest.
The CDC continues to recommend COVID-19 vaccination for people 12 years of age and older to prevent serious or fatal complications related to COVID-19.
Clinical Actions
· Maintain a high index of suspicion for myocarditis and pericarditis symptoms in patients who may have recently received an mRNA COVID-19 vaccine, especially in adolescents and young adults 16 years of age and older. Symptoms of these conditions may include:
1. acute chest pain
2. shortness of breath
3. palpitations
Coronary events are less likely to cause these symptoms in male adolescents and young adults 16 years of age and older
· If these symptoms present, ask for:
1. COVID-19 vaccinations history
2. Relevant medical, travel, and social history
· For patients with myocarditis and pericarditis symptoms who received the COVID-19 mRNA vaccine, consider obtaining an ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate as part of the initial evaluation. In the setting of normal ECG, troponin, and inflammatory markers, myocarditis or pericarditis are unlikely.
· For patients with suspected cases of myocarditis and pericarditis who received the COVID-19 mRNA vaccine, consult with a cardiologist for assistance with evaluation and management. Evaluation and management may vary depending on the patient age, clinical presentation, and potential causes of the findings.
· Rule out other causes of myocarditis and pericarditis. Consider consultation with infectious disease specialists and/or rheumatologists to assist in this evaluation. Where available, evaluate for potential etiologies of myocarditis and pericarditis, particularly acute COVID-19 infection (e.g., PCR testing), prior SARS-CoV-2 infection (e.g., detection of SARS-CoV-2 nucleocapsid antibodies), and other viral etiologies (e.g., enterovirus PCR and comprehensive respiratory viral pathogen testing).
· Report adverse events to VAERS, including serious and life-threatening adverse events and deaths in patients following receipt of COVID-19 vaccines, as required under the Emergency Use Authorizations for COVID-19 vaccines.