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A Narrative Review of Myocarditis Following COVID-19 Vaccination

Article Information

Maziar Nasiri1, Marjan Farzad2*, Majid Zare Bidaki3*, Hanieh Hakhamaneshi1, Toba Kazemi4, Alireza Kooshki1

1Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran,

2PhD, Cardiovascular Diseases Research Center, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran,

3Associate Professor of Bacteriology, Infectious Diseases Research Center, School of Allied Medical sciences, Birjand University of Medical Sciences, Birjand, Iran,

4Professor of Cardiology, Cardiovascular Diseases Research Center, Department of Cardiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran

*Corresponding authors: Marjan Farzad, PhD, Cardiovascular Diseases Research Center, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran.

Majid Zare Bidaki, Associate Professor of Bacteriology, Infectious Diseases Research Center, School of Allied Medical sciences, Birjand University of Medical Sciences, Birjand, Iran

Received: 14 March 2022; Accepted: 30 April 2022; Published: 22 April 2022

Citation:

Maziar Nasiri, Marjan Farzad, Majid Zare Bidaki, Hanieh Hakhamaneshi, Toba Kazemi, Alireza Kooshki. A Narrative Review of Myocarditis Following COVID-19 Vaccination. Cardiology and Cardiovascular Medicine 6 (2022): 189-195.

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Abstract

Myocarditis is a rare but serious consequence of COVID-19 vaccination. This study conducted a narrative review of the research on vaccine-induced myocarditis regarding the type, dose of vaccine, time to present from the vaccine, cardiac history, and patient outcomes. All papers of the year 2021 about the study subject were gathered from PubMed using the following MeSH terms: (?Myocarditis" and "COVID-19 vaccine") with no language restriction. Inclusion criteria were case reports and case series. Our search yielded overall 68 studies. After applying inclusion criteria, only 24 studies were included with the total of 46 patients. Forty-one of 46 (89.1%) of the patients were males. The age range was 14-70 years with a mean age of 28.82±14.65 years. The majority of the myocarditis related COVID-19 vaccine cases (73.9%) were associated with the Pfizer-BioNTech following the second dose of the vaccine. The median time to present from the vaccines was 3 days (range, 1-14 days). 93.5% of cases had no previous cardiac history. 91.3% of myocarditis cases were survived and discharged from the hospital.

Keywords

Myocarditis; COVID-19 Vaccine

Myocarditis articles; COVID-19 Vaccine articles

Article Details

1. Introduction

The coronavirus disease-19 (COVID-19) related morbidity and mortality has been declined significantly throughout the world by introducing the variety of COVID-19 vaccines [1]. However, recent scientific reports have raised concerns for myocarditis related to different types of COVID-19 vaccines, both in double-jabbed people [2] and even after the first vaccine shot [3]. Myocarditis subsequent to administration of COVID-19 vaccines, especially the mRNA based one, has been described [4,5]. Similar reports have been defined for Johnson & Johnson's Janssen [6] and AstraZeneca [3] vaccines as well. Although the number of reported myocarditis has been small compared to the large number of people vaccinated, it may become more pronounced as the vaccine is now widely administered. Despite many papers, there are still limited data on vaccine-induced myocarditis. This study conducted a narrative review of the research on vaccine-induced myocarditis regarding the type, dose of vaccine, time to present from the vaccine, cardiac history, and patient outcomes.

We performed a search in the PubMed database. All papers of the year 2021 about the study subject were gathered using the following MeSH terms: (?Myocarditis" and "COVID-19 vaccine") with no language restriction. Inclusion criteria were case reports and case series. The outcomes of interest were vaccine-induced myocarditis regarding the type, dose of vaccine, time to present from the vaccine, cardiac history, and if the patient was died or not.

Our search yielded overall 68 studies. After applying inclusion criteria, only 24 studies were included with the total of 46 patients [2-25]. Forty-one of 46 (89.1%) of the patients were males. The age range was 14-70 years with a mean age of 28.82±14.65 years. The majority of the myocarditis related COVID-19 vaccine cases (73.9%) were associated with the Pfizer-BioNTech 19.6% were associated with the Moderna vaccine, 2.2% were associated with the Johnson & Johnson (Janssen) vaccine, and 4.3% were associated with the AstraZeneca vaccine. Almost all the myocarditis related to the Moderna vaccine (8/9) occurred following the second dose of the vaccine, whereas 27/34 (79.4%) of the myocarditis related to the Pfizer-BioNTech vaccine occurred following the second dose of the vaccine. All the two-myocarditis cases related to the AstraZeneca vaccine occurred following the first dose of the vaccine. The median time to present from the vaccines was 3 days (range, 1-14 days). It was specifically 2.5 days (range, 1-10 days) for Pfizer-BioNTech, 3 days (range, 1-14 days) for Moderna, 2 days (2 days) for Johnson & Johnson, and 2 days (range, 1-3 days) for AstraZeneca vaccine. 93.5% of cases had no previous cardiac history. 91.3% of myocarditis cases were survived and discharged from the hospital (Table 1).

Table 1: Characteristics and outcomes of patients with myocarditis related to COVID-19 vaccine

Patient

Age, Y

Sex

Vaccine

Dose

Time to present from the vaccine, d

Cardiac history

Died/Discharged

1

27

M

Pfizer-BioNTech

2nd

2

N

died

2

34

F

Pfizer-BioNTech

1st

4

N

discharged

3

70

M

AstraZeneca

1st

3

N

discharged

4

39

M

Pfizer-BioNTech

2nd

1

Y

discharged

5

21

M

Pfizer-BioNTech

2nd

2

N

discharged

6

68

F

AstraZeneca

1st

1

Y

discharged

7

25

M

Pfizer-BioNTech

1st

10

N

discharged

8

20

M

Pfizer-BioNTech

2nd

3

N

discharged

9

22

M

Pfizer-BioNTech

1st

5

N

died

10

30

M

Pfizer-BioNTech

2nd

3

N

discharged

11

40

M

Pfizer-BioNTech

1st

6

N

discharged

12

20

M

Pfizer-BioNTech

2nd

2

N

discharged

13

22

M

Moderna

1st

3

N

discharged

14

15

M

Pfizer-BioNTech

2nd

1

N

discharged

15

29

M

Pfizer-BioNTech

2nd

1

N

discharged

16

24

M

Pfizer-BioNTech

2nd

1

N

discharged

17

22

M

Moderna

2nd

3

N

discharged

18

31

M

Moderna

2nd

3

N

discharged

19

40

M

Pfizer-BioNTech

1st

2

N

discharged

20

56

M

Pfizer-BioNTech

2nd

3

N

discharged

21

26

M

Pfizer-BioNTech

2nd

3

N

discharged

22

35

M

Pfizer-BioNTech

2nd

2

N

discharged

23

21

M

Pfizer-BioNTech

2nd

4

N

discharged

24

22

M

Moderna

2nd

2

N

discharged

25

25

M

Moderna

2nd

1

N

discharged

26

21

F

Moderna

2nd

1

N

discharged

27

16

M

Pfizer-BioNTech

2nd

2

N

discharged

28

19

M

Pfizer-BioNTech

2nd

3

N

discharged

29

17

M

Pfizer-BioNTech

2nd

2

N

discharged

30

18

M

Pfizer-BioNTech

2nd

3

N

discharged

31

17

M

Pfizer-BioNTech

2nd

3

N

discharged

32

16

M

Pfizer-BioNTech

2nd

3

N

discharged

33

14

M

Pfizer-BioNTech

2nd

2

N

discharged

34

16

M

Pfizer-BioNTech

2nd

3

N

discharged

35

17

M

Pfizer-BioNTech

2nd

2

N

discharged

36

52

M

Moderna

2nd

3

Y

discharged

37

70

F

Janssen

1st

2

N

died

38

22

M

Pfizer-BioNTech

1st

2

N

discharged

39

19

M

Pfizer-BioNTech

2nd

1

N

discharged

40

25

M

Moderna

2nd

3

N

discharged

41

37

M

Pfizer-BioNTech

2nd

2

N

discharged

42

20

M

Pfizer-BioNTech

2nd

3

N

discharged

43

19

M

Pfizer-BioNTech

2nd

3

N

discharged

44

45

F

Pfizer-BioNTech

1st

10

N

discharged

45

42

M

Moderna

2nd

14

N

died

46

20

M

Pfizer-BioNTech

2nd

2

N

discharged

M: male; F: female; N: no; Y: yes

The analysis of the available data reveals some key findings. First, for the most part, myocarditis related to COVID-19 vaccines occurs in young males following the second dose of the vaccine. It might support the hypothesis proposed by Levin et al. that a severe response of the immune system (i.e., cytokine storm) is more likely to be elicited after the second dose of the vaccine [26]. Second, most myocarditis related to COVID-19 vaccines occurs with mRNA vaccines (Pfizer-BioNTech and Moderna COVID-19 vaccines). Third, myocarditis related to COVID-19 vaccines has a good therapeutic prognosis for the most. Finally, although myocarditis related to COVID-19 vaccines, specially those based on mRNA technology, are common, myocarditis followed by the other types of vaccines should not be overlooked by the clinician.

Disclosures

The authors declare that they have no competing interests.

Funding

None

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