Skip to main navigation menu Skip to main content Skip to site footer

Review article: Medical guidelines

Vol. 151 No. 4142 (2021)

The very low risk of myocarditis and pericarditis after mRNA COVID-19 vaccination should not discourage vaccination: Position Paper of the Swiss Society of Cardiology (SSC), Working Group of Echocardiography and Cardiac Imaging of the SSC and the Swiss Society of Paediatric Cardiology

  • Philip Haaf
  • Gabriela M. Kuster
  • Christian Mueller
  • Christoph T. Berger
  • Pierre Monney
  • Peter Burger
  • Simon F. Stämpfli
  • Christine Helena Attenhofer Jost
  • Michael J. Zellweger
  • Stefan Osswald
  • Birgit C. Donner
  • Simon C. Koestner
  • Felix C. Tanner
DOI
https://doi.org/10.4414/SMW.2021.w30087
Cite this as:
Swiss Med Wkly. 2021;151:w30087
Published
19.10.2021

Summary

 

The benefits of vaccination – regarding COVID-19 infection and transmission, as well as COVID-associated complications – clearly outweigh the potential risk of vaccine-associated inflammation of the heart and other adverse events. Given the current state of knowledge, the outcome of myocarditis and pericarditis following vaccination is generally good. This review aims to guide physicians in the early diagnosis and management of suspected myocarditis following mRNA COVID vaccination. The initial work-up should include detailed history, a 12-lead electrocardiogram and serological biomarkers (high-sensitivity cardiac troponin T/I, natriuretic peptides and markers of inflammation) in accordance with the assessments recommended in current clinical practice guidelines for patients presenting with acute chest pain. In patients with suspected myocarditis, further assessment with transthoracic echocardiography and cardiovascular magnetic resonance imaging should be undertaken to confirm peri-/myocarditis and to distinguish the findings from other diseases with similar presentation. Patients with mRNA vaccine-associated myocarditis should be followed-up at least once to exclude chronic myocardial inflammation and deterioration of left ventricular ejection fraction. Consultation with an expert such as an immunologist with experience in vaccination regarding further mRNA vaccinations is advised in all patients with mRNA vaccine-associated perimyocarditis. Reporting of mRNA vaccine-associated myocarditis to Swissmedic is mandatory. Cohort studies prospectively follow-up on young adult and paediatric populations following immunisation with an mRNA COVID vaccine to monitor cardiac and immune parameters would generate valuable knowledge to better understand pathogenesis and risk factors for vaccine-associated perimyocarditis.

References

  1. Barda N, Dagan N, Ben-Shlomo Y, Kepten E, Waxman J, Ohana R, et al. Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting. N Engl J Med. 2021 Sep;385(12):1078–90. https://doi.org/10.1056/NEJMoa2110475
  2. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 4. February 2021;384(5):403–16.
  3. Eidgenössische Kommission für Impffragen EKIF. Covid-19-Impfstrategie (Status 22 June2021) (https://www.bag.admin.ch/dam/bag/de/dokumente/mt/k-und-i/aktuelle-ausbrueche-pandemien/2019-nCoV/impfstrategie-bag-ekif.pdf.download.pdf/Covid-19-Impfstrategie%20BAG%20EKIF.pdf)
  4. Myocarditis and pericarditis following mRNA COVID-19 vaccination. Centers for Disease Control and Prevention, June 2021 (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html)
  5. Direct Healthcare Professional Communications – mRNA-Impfstoffe gegen COVID-19 (COVID-19 Vaccine Moderna und Comirnaty) (https://www.swissmedic.ch/swissmedic/en/home/humanarzneimittel/market-surveillance/health-professional-communication--hpc-/dhpc-mrna-impfstoffe-gegen-covid-19.html)
  6. Liu PP, Blet A, Smyth D, Li H. The Science Underlying COVID-19: Implications for the Cardiovascular System. Circulation. 7. Juli 2020;142(1):68–78.
  7. Bozkurt B, Kamat I, Hotez PJ. Myocarditis With COVID-19 mRNA Vaccines. Circulation. 10. August 2021;144(6):471–84.
  8. Stone CA Jr, Rukasin CR, Beachkofsky TM, Phillips EJ. Immune-mediated adverse reactions to vaccines. Br J Clin Pharmacol. 2019 Dec;85(12):2694–706. https://doi.org/10.1111/bcp.14112
  9. Shay DK, Shimabukuro TT, DeStefano F. Myocarditis Occurring After Immunization With mRNA-Based COVID-19 Vaccines. JAMA Cardiol. 2021 Oct;6(10):1115–7. https://doi.org/10.1001/jamacardio.2021.2821
  10. Covid-19 vaccine-associated myocarditis/pericarditis. A report of the chief science advisor of Canada. 16 July 2021. (https://science.gc.ca/eic/site/063.nsf/vwapj/report-myocarditis-pericarditis-en.pdf/$file/report-myocarditis-pericarditis-en.pdf)
  11. Montgomery J, Ryan M, Engler R, Hoffman D, McClenathan B, Collins L, et al. Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military. JAMA Cardiol. 2021 Oct;6(10):1202–6. https://doi.org/10.1001/jamacardio.2021.2833
  12. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 7. April 2021;42(14):1289–367.
  13. Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol. 18. December 2018;72(24):3158–76.
  14. Ismail TF, Hua A, Giorgetti A, Haaf P. Imaging of Inflammation and Infection in Cardiovascular Diseases. Chapter 7: Myocarditis. Springer 1st edition 2021.
  15. Ammirati E, Frigerio M, Adler ED, Basso C, Birnie DH, Brambatti M, et al. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ Heart Fail. 2020 Nov;13(11):e007405. https://doi.org/10.1161/CIRCHEARTFAILURE.120.007405
  16. Guidance on Myocarditis and Pericarditis after mRNA COVID-19 Vaccines by the Australian Technical Advisory Group on Immunisation (ATAGI) and the Cardiac Society of Australia and New Zealand (CSANZ). Version 1.1 - 6 August 2021 (https://www.health.gov.au/sites/default/files/documents/2021/08/covid-19-vaccination-guidance-on-myocarditis-and-pericarditis-after-mrna-covid-19-vaccines_1.pdf)
  17. Verma AK, Lavine KJ, Lin CY. Myocarditis after Covid-19 mRNA Vaccination. N Engl J Med. 2021 Sep;385(14):1332–4. https://doi.org/10.1056/NEJMc2109975
  18. https://www.swissmedic.ch/swissmedic/de/home/news/coronavirus-covid-19/covid-19-vaccines-safety-update-6.html

Most read articles by the same author(s)

1 2 3 4 5 > >>