Monkeypox-Induced Myocarditis: A Systematic Review

Jaiswal, Vikash; Sultana, Qamar; Lahori, Simmi; Mukherjee, Dattatreya; Agrawal, Vibhor; Doshi, Neel; Shrestha, Abhigan Babu; Huang, Helen; Nasir, Yusra Minahil; Naz, Sidra

doi:10.1016/j.cpcardiol.2023.101611

Cited by 10 publications

(3 citation statements)

References 27 publications

(47 reference statements)

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“…8,16,[18][19][20] VAERS reporting rates for myocarditis or pericarditis after JYNNEOS vaccination do not suggest an increased risk above background rates, but the possibility of a small risk cannot be excluded because (1) cases occurring after vaccination might be underreported to VAERS, although serious AEs are more likely to be reported than nonserious AEs, and (2) published population background rates might not accurately represent the expected rate in the JYNNEOS vaccinated cohort because of different distribution of risk factors in the population. Several case reports from the 2022 mpox outbreak have implicated monkeypox virus infection as a possible cause of myocarditis 21 ; therefore, any potential risk of myocarditis after JYNNEOS should be weighed against the potential benefit of JYNNEOS to prevent myocarditis due to monkeypox virus infection.…”

Section: Discussionmentioning

confidence: 99%

JYNNEOS vaccine safety surveillance during the 2022 mpox outbreak using the Vaccine Adverse Event Reporting System (VAERS) and v-safe, United States, 2022—2023

Duffy,

Myers,

Marquez

et al. 2024

Sexual Trans Dis

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Background In response to the 2022 mpox outbreak in the United States, people with higher potential for exposure to mpox were recommended to receive two doses of the JYNNEOS vaccine. Vaccine safety was monitored using two complementary systems. Methods The Vaccine Adverse Event Reporting System (VAERS) is a passive surveillance system that accepts reports of adverse events following vaccination. VAERS is capable of rapidly identifying rare adverse events and unusual reporting patterns. Medical records were requested and reviewed for adverse events of special interest, including myocarditis. Adverse event reporting rates were calculated as the number of verified adverse event cases divided by the number of JYNNEOS doses administered. V-safe for mpox was a voluntary smartphone-based vaccine safety surveillance system that sent enrolled persons text messages linked to health surveys asking about reactions and health impact events occurring after vaccination. Results There were 1,207,056 JYNNEOS doses administered in the United States. VAERS received 1,927 reports for JYNNEOS. The myocarditis reporting rate per million doses was 2.69 after dose 1 and 8.64 after dose 2. V-safe had 213 participants complete at least one health survey. Rates of injection site and systemic reactions were similar in the first week following dose 1 and dose 2. Conclusions JYNNEOS vaccine safety surveillance findings from VAERS and v-safe did not identify any unexpected safety concerns. The VAERS reporting rate for myocarditis was similar to previously published population background rates.

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Section: Discussionmentioning

confidence: 99%

JYNNEOS vaccine safety surveillance during the 2022 mpox outbreak using the Vaccine Adverse Event Reporting System (VAERS) and v-safe, United States, 2022—2023

Duffy,

Myers,

Marquez

et al. 2024

Sexual Trans Dis

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“…Cardiovascular complications typically follow a self-limiting course; however, in rare instances, they can lead to life-threatening arrhythmias, cardiac fibrosis, dilated cardiomyopathy, or cardiogenic shock, significantly impacting both morbidity and mortality [ 27 ]. MPXV-induced myocarditis, pericarditis, or myopericarditis exhibits symptoms akin to those caused by other viral etiologies, with commonly observed presenting symptoms including pleuritic chest pain, exercise intolerance, dyspnea, palpitations, and fever, necessitating a thorough cardiovascular evaluation.…”

Section: Reviewmentioning

confidence: 99%

“…Although gold standard, endomyocardial biopsy is rarely performed due to its invasive nature. The exact pathophysiology is currently the subject of research; however, direct viral damage to the myocardium and lymphocytic infiltration of the myocardium leading to myocardial edema, inflammation, and later necrosis have been proven with other viral etiologies in the past [ 27 ]. The publication of a case report connecting increased creatine phosphokinase levels to a Mpox infection is an interesting finding, and it could have significant implications for understanding the cardiovascular effects of this infection on the human body [ 31 ].…”

Section: Reviewmentioning

confidence: 99%

Current Evidence and Practice Guidelines of Systemic Complications of 2022 Mpox Outbreak: A Scoping Review

Ajmera,

Shah,

Chourasia

et al. 2023

Cureus

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In May of 2022, the World Health Organization declared a worldwide Mpox virus (MPXV) outbreak. Due to the widespread implementation of vaccination protocols and heightened awareness among the general population, there has been a notable decline in the incidence of Mpox (formerly known as Monkeypox) cases since March 2023. Nevertheless, it is crucial to remember that Mpox has the potential to impact multiple physiological systems in humans, encompassing the cardiovascular, gastrointestinal, ear/nose/throat, and ocular systems. The mortality rate of the Mpox disease is comparatively lower than that of smallpox. However, it is essential to note that this disease can still lead to significant systemic consequences. The specific pathophysiological mechanisms by which the virus affects various physiological systems are now being investigated. Direct inoculation through mucosal damage or intranasal exposure, direct viral toxicity, and lymphatic transmission via the seminal fluid are all viable hypotheses. The prompt recognition of such complications is crucial to decrease morbidity and mortality.

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The knowns and unknowns of cardiac autoimmunity in viral myocarditis

Mone,

Reddy

2023

Reviews in Medical Virology

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Myocarditis can result from various infectious and non‐infectious causes that can lead to dilated cardiomyopathy (DCM) and heart failure. Among the infectious causes, viruses are commonly suspected. But the challenge is our inability to demonstrate infectious viral particles during clinical presentations, partly because by that point, the viruses would have damaged the tissues and be cleared by the immune system. Therefore, viral signatures such as viral nucleic acids and virus‐reactive antibodies may be the only readouts pointing to viruses as potential primary triggers of DCM. Thus, it becomes hard to explain persistent inflammatory infiltrates that might occur in individuals affected with chronic myocarditis/DCM manifesting myocardial dysfunctions. In these circumstances, autoimmunity is suspected, and antibodies to various autoantigens have been demonstrated, suggesting that immune therapies to suppress the autoimmune responses may be necessary. From this perspective, we endeavoured to determine whether or not the known viral causes are associated with development of autoimmune responses to cardiac antigens that include both cardiotropic and non‐cardiotropic viruses. If so, what their nature and significance are in developing chronic myocarditis resulting from viruses as primary triggers.

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Monkeypox-Induced Myocarditis: A Systematic Review

Cited by 10 publications

References 27 publications

JYNNEOS vaccine safety surveillance during the 2022 mpox outbreak using the Vaccine Adverse Event Reporting System (VAERS) and v-safe, United States, 2022—2023

JYNNEOS vaccine safety surveillance during the 2022 mpox outbreak using the Vaccine Adverse Event Reporting System (VAERS) and v-safe, United States, 2022—2023

Current Evidence and Practice Guidelines of Systemic Complications of 2022 Mpox Outbreak: A Scoping Review

The knowns and unknowns of cardiac autoimmunity in viral myocarditis

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