Cases of myocarditis and pericarditis have been reported following the administration of COVID-19 vaccines in the United States. Studies conducted both nationally and globally have provided evidence linking mRNA COVID-19 vaccines like Moderna and Pfizer-BioNTech to these cardiac conditions. While cases are more common among adolescent and young adult males within a week of receiving their second dose, instances have also been observed in females and after other vaccine doses. Data from clinical trials of the Novavax COVID-19 Vaccine indicate an increased risk of myocarditis and pericarditis following administration.
According to the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC), the benefits of COVID-19 vaccination, such as preventing severe outcomes of the disease, outweigh the rare risk of myocarditis and pericarditis in all populations recommended for vaccination. To minimize the risk of vaccine-associated cardiac conditions, it has been suggested that for some individuals, the interval between the first and second doses can be extended to eight weeks. More information on this can be found in the “Considerations for extended intervals for COVID-19 vaccination” section.
It is important to inform individuals, particularly males aged 12-39, about the rare risk of myocarditis and pericarditis following vaccination and the significant benefits of COVID-19 vaccination in reducing the risk of severe COVID-19 outcomes, including the potential for cardiac complications. Counseling should include advising people to seek medical care if symptoms such as chest pain, shortness of breath, or palpitations develop after vaccination, especially within the week following vaccination. For younger children, symptoms of myocarditis might present as non-specific symptoms like irritability, vomiting, poor feeding, rapid breathing, or lethargy.
For individuals with a history of myocarditis associated with Multisystem Inflammatory Syndrome in Children (MIS-C) or Multisystem Inflammatory Syndrome in Adults (MIS-A), it is recommended to refer to the specific guidelines regarding COVID-19 vaccination and MIS-C/MIS-A.
Myocarditis or pericarditis following a COVID-19 vaccine dose
If an individual experiences myocarditis or pericarditis within three weeks after receiving any COVID-19 vaccine dose, it is advised to exercise caution when considering subsequent doses. Experts generally recommend avoiding additional vaccination doses. However, if, after assessing the risks, a decision is made to administer another COVID-19 vaccine dose, it is advisable to wait until the symptoms have resolved, and there is no evidence of ongoing heart inflammation or complications.
Considerations for subsequent COVID-19 vaccination may include evaluating if the myocarditis or pericarditis is unrelated to vaccination (e.g., caused by SARS-CoV-2 or other viruses), assessing the personal risk of severe acute COVID-19 based on age and underlying conditions, and considering the timing of any immunomodulatory therapies. For more information, you can refer to the General Best Practice Guidelines for Immunization provided by ACIP.
History of myocarditis or pericarditis before COVID-19 vaccination or more than three weeks after a COVID-19 vaccine dose
People with a history of myocarditis or pericarditis that occurred before COVID-19 vaccination or more than three weeks after receiving a COVID-19 vaccine dose can receive any currently FDA-approved or FDA-authorized COVID-19 vaccine after their symptoms have completely resolved, and there is no evidence of ongoing heart inflammation or complications. This recommendation applies to individuals who experienced myocarditis or pericarditis due to SARS-CoV-2 or other viruses.
History of other heart disease
Individuals with a history of other heart diseases, including congenital heart disease and Kawasaki disease, can receive any currently FDA-approved or FDA-authorized COVID-19 vaccine.
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By following these guidelines and considering individual circumstances, we can ensure that the benefits of COVID-19 vaccination are maximized while minimizing potential risks. Stay informed and consult with healthcare professionals to make the best decisions regarding COVID-19 vaccination.