Eosinophilic Myocarditis Following Coronavirus Disease 2019 (COVID-19) Vaccination

Takeda, Masahiko; Ishio, Naoki; Shoji, T.; Mori, Naoto; Matsumoto, Masako; Shikama, Nobuaki

doi:10.1253/circj.cj-21-0935

Cited by 9 publications

(10 citation statements)

References 1 publication

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“…Findings from 12 studies from the original review 15 were carried forward (Q1=5, 25 26 27 28 29 Q2=2, 29 30 Q3 part 2=10 25 26 27 28 31 32 33 34 35 36 ). From the search update, we identified 34 new reports across all questions (Q1=9, 37 38 39 40 41 42 43 44 45 Q2=5, 37 41 45 46 47 Q3 part 1=1, 48 Q4=3, 39 49 50 Q5=21 9 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 ). We excluded five studies that only reported on combined myocarditis and pericarditis (as we located studies reporting these separately), 71 72 73 74 75 eight studies that did not report on confirmed cases, 76 77 78 79 80 81 82 83 and three studies 84 85 <...…”

Section: Resultsmentioning

confidence: 99%

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

Pillay

Gaudet

Wingert

et al. 2022

BMJ

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ObjectivesTo synthesise evidence on incidence rates and risk factors for myocarditis and pericarditis after use of mRNA vaccination against covid-19, clinical presentation, short term and longer term outcomes of cases, and proposed mechanisms.DesignLiving evidence syntheses and review.Data sourcesMedline, Embase, and the Cochrane Library were searched from 6 October 2020 to 10 January 2022; reference lists and grey literature (to 13 January 2021). One reviewer completed screening and another verified 50% of exclusions, using a machine learning program to prioritise records. A second reviewer verified all exclusions at full text, extracted data, and (for incidence and risk factors) risk of bias assessments using modified Joanna Briggs Institute tools. Team consensus determined certainty of evidence ratings for incidence and risk factors using GRADE (Grading of Recommendations, Assessment, Development and Evaluation).Eligibility criteria for selecting studiesLarge (>10 000 participants) or population based or multisite observational studies and surveillance data (incidence and risk factors) reporting on confirmed myocarditis or pericarditis after covid-19 mRNA vaccination; case series (n≥5, presentation, short term clinical course and longer term outcomes); opinions, letters, reviews, and primary studies focused on describing or supporting hypothesised mechanisms.Results46 studies were included (14 on incidence, seven on risk factors, 11 on characteristics and short term course, three on longer term outcomes, and 21 on mechanisms). Incidence of myocarditis after mRNA vaccines was highest in male adolescents and male young adults (age 12-17 years, range 50-139 cases per million (low certainty); 18-29 years, 28-147 per million (moderate certainty)). For girls and boys aged 5-11 years and women aged 18-29 years, incidence of myocarditis after vaccination with BNT162b2 (Pfizer/BioNTech) could be fewer than 20 cases per million (low certainty). Incidence after a third dose of an mRNA vaccine had very low certainty evidence. For individuals of 18-29 years, incidence of myocarditis is probably higher after vaccination with mRNA-1273 (Moderna) compared with Pfizer (moderate certainty). Among individuals aged 12-17, 18-29, or 18-39 years, incidence of myocarditis or pericarditis after dose two of an mRNA vaccine for covid-19 might be lower when administered ≥31 days compared with ≤30 days after dose one (low certainty). Data specific to men aged 18-29 years indicated that the dosing interval might need to increase to ≥56 days to substantially drop myocarditis or pericarditis incidence. For clinical course and short term outcomes, only one small case series (n=8) was found for 5-11 year olds. In adolescents and adults, most (>90%) myocarditis cases involved men of a median 20-30 years of age and with symptom onset two to four days after a second dose (71-100%). Most people were admitted to hospital (≥84%) for a short duration (two to four days). For pericarditis, data were limited but more variation than myocarditis has been reported in patient age, sex, onset timing, and rate of admission to hospital. Three case series with longer term (3 months; n=38) follow-up suggested persistent echocardiogram abnormalities, as well as ongoing symptoms or a need for drug treatments or restriction from activities in >50% of patients. Sixteen hypothesised mechanisms were described, with little direct supporting or refuting evidence.ConclusionsThese findings indicate that adolescent and young adult men are at the highest risk of myocarditis after mRNA vaccination. Use of a Pfizer vaccine over a Moderna vaccine and waiting for more than 30 days between doses might be preferred for this population. Incidence of myocarditis in children aged 5-11 years is very rare but certainty was low. Data for clinical risk factors were very limited. A clinical course of mRNA related myocarditis appeared to be benign, although longer term follow-up data were limited. Prospective studies with appropriate testing (eg, biopsy and tissue morphology) will enhance understanding of mechanism.

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Section: Resultsmentioning

confidence: 99%

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

Pillay

Gaudet

Wingert

et al. 2022

BMJ

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“…Eosinophilia may also be responsible for post-vaccine adverse reactions. Eosinophilic myocarditis, eosinophilic pneumonia, EGPA (relapse), eosinophilic cellulitis, eosinophilic panniculitis, and non-episodic angioedema with eosinophilia have been reported following COVID-19 vaccination [20][21][22][23][24][25]. SARS-CoV-1 vaccines have also been shown to induce eosinophilia in the lungs of mice [114].…”

Section: Eosinophiliamentioning

confidence: 99%

“…Inflammatory cytokines release [7][8][9][10], autoimmunity involvement [11][12][13][14][15][16][17][18][19], eosinophil association [20][21][22][23][24][25], and angiotensin-converting enzyme 2 (ACE2) downregulation [26,27] Vaccines 2022, 10, 866 2 of 13 have been suggested as contributing etiologies of post-vaccine adverse reactions. Inflammatory cytokines, including interleukin (IL)-6 and IL-1β, are released due to lipid nanoparticles (LNPs) within the mRNA vaccine [9].…”

Section: Introductionmentioning

confidence: 99%

“…Various cardiovascular diseases have been reported to be associated with the COVID-19 vaccine. These include myocarditis and pericarditis [5,20,27,[36][37][38][39][40][41], ACS [5][6][7]36], aortic dissection [5,6,34,35], vasospastic angina [36], Takotsubo cardiomyopathy [42], heart failure [5,7,27], arrhythmia [5,14,27,39,43], and pulmonary embolism [5,44] (Table 1). Stark et al reported the interplay between inflammation cytokines and thrombosis in cardiovascular pathology [45].…”

Section: Introductionmentioning

confidence: 99%

“…NSAIDs, colchicine, and steroid therapy are the standard treat ments for myocarditis/pericarditis [27]. In severe cases, steroids may be effective in pre venting cytokine release, autoimmunity, and eosinophilic myocarditis [20]. Colchicine which has an inhibitory effect on the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome, which is associated with IL-1β (inflammatory cytokine) secre tion [47], may be also effective for vaccine-associated inflammation [48].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

What Should We Do after the COVID-19 Vaccination? Vaccine-Associated Diseases and Precautionary Measures against Adverse Reactions

et al. 2022

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COVID-19 vaccines have been used to counteract the global COVID-19 pandemic. While these are effective, adverse reactions have been reported, such as injection-site pain, muscle ache, fever, palpitation, and chest discomfort. The release of inflammatory cytokines, such as interleukin (IL)-6 and IL-1β, is a potential mechanism for post-vaccine side-effects. Chest discomfort after the vaccination, including myocarditis and acute coronary syndrome, is a particularly serious adverse reaction. It is important to be familiar with the differential diagnoses of chest discomfort and organ-specific diseases associated with COVID-19 vaccines as the preparation for booster shots and vaccinations among children aged 5–11 years begins. High-intensity exercise, alcohol, tobacco smoking, and baths promote inflammatory cytokines, such as IL-6, which may exacerbate the adverse reactions after vaccination. Japanese data show that deaths during baths are the most common for several days after mRNA vaccination. Additionally, alcohol and tobacco smoking were identified as predictive factors of lower antibody titers after vaccination. In this review, we aimed to provide a few recommendations to prevent vaccine-associated disease.

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Eosinophilic fasciitis following SARS-CoV-2 vaccination

Lobo-Antuña¹,

Gimeno²,

Magdaleno-Tapial³

et al. 2023

JAAD Case Reports

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Eosinophilic Myocarditis Following Coronavirus Disease 2019 (COVID-19) Vaccination

Cited by 9 publications

References 1 publication

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

What Should We Do after the COVID-19 Vaccination? Vaccine-Associated Diseases and Precautionary Measures against Adverse Reactions

Eosinophilic fasciitis following SARS-CoV-2 vaccination

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