Chest Pain, ST Elevation, and Positive Cardiac Enzymes in an Austere Environment: Differentiating Smallpox Vaccination-mediated Myocarditis and Acute Coronary Syndrome in Operation Iraqi Freedom

Taylor, Charles L.; Eckart, Robert E.

doi:10.1016/j.jemermed.2008.08.027

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…Eleven studies described cardiac AEs following influenza vaccination [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], and 18 studies described cardiac AEs after COVID-19 vaccination [ 6 , 7 , 8 , 9 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. There were 20 studies reporting cardiac AEs after smallpox vaccination [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. Among other vaccines, there were two reports of cardiac AEs after pneumococcal vaccination [ 56 , 57 ], three reports of cardiac AEs after tetanus toxoid [ …”

Section: Resultsmentioning

confidence: 99%

Cardiac Adverse Events after Vaccination—A Systematic Review

et al. 2022

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The Vaccine Adverse Event Reporting System database has been used to report adverse events following several vaccines. We studied the patient population predisposed to such reactions and how these reactions differ with respect to the vaccine type. We searched the electronic databases PubMed, EMBASE, and Scopus up to 9 July 2021 for any study describing cardiac adverse events attributed to the vaccination. A total of 56 studies met the criteria comprising 340 patients. There were 20 studies describing cardiac adverse events following smallpox vaccination, 11 studies describing adverse events after influenza vaccination, and 18 studies describing adverse events after COVID-19 vaccination. There was a total of six studies describing cardiac adverse events after the pneumococcal vaccine, tetanus toxoid, cholera vaccine, and rabies vaccine. Adverse events following influenza vaccination occurred more commonly in older females within an average duration of four days from vaccination. Pericardial involvement was the most reported adverse event. Adverse events following COVID-19 vaccination happened at a mean age of 42.7 years, more commonly in males, and mostly after a second dose. Adverse events following smallpox vaccination occurred more commonly in younger males, with an average onset of symptoms from vaccination around 16.6 days. Adverse events were mostly myopericarditis; however, the acute coronary syndrome has been reported with some vaccines.

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Section: Resultsmentioning

confidence: 99%

Cardiac Adverse Events after Vaccination—A Systematic Review

et al. 2022

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“…22 Myocarditis and pericarditis are known possible adverse events associated with ACAM2000, the only SPV product used by the DOD. 3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Due to the potential severity of myopericarditis, the risk of administering SPV should be weighed against the actual risk of exposure to smallpox. The risk of smallpox infection should be informed by available threat intelligence and should be evaluated against the known risks of SPV.…”

Section: Discussionmentioning

confidence: 99%

“…5 Myopericarditis is known to occur by an unknown mechanism from live vaccinia virus, which comprises the SPV. 3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In April 2018, a cluster of 5 illnesses consistent with myopericarditis was reported to the DOD Immunization Healthcare Branch (IHB); all affected persons had received SPV within 2 weeks of their symptom onset with ACAM2000 at Fort Hood, Texas. 10 A joint investigation was launched between an epidemiological consultation team led by the US Army Public Health Center Disease Epidemiology Division and the Centers for Disease Control and Prevention (CDC).…”

Section: Introductionmentioning

confidence: 99%

Myopericarditis Associated With Smallpox Vaccination Among US Army Personnel – Fort Hood, Texas, 2018

Mandra

Superior

Guagliardo

et al. 2021

Disaster med. public health prep.

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Objective: In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation. Methods: The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates. Results: This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7–12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3–8.3). Conclusions: Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox.

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Decision support environment for medical product safety surveillance

Botsis

Jankosky

Arya

et al. 2016

Journal of Biomedical Informatics

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We have developed a Decision Support Environment (DSE) for medical experts at the US Food and Drug Administration (FDA). The DSE contains two integrated systems: The Event-based Text-mining of Health Electronic Records (ETHER) and the Pattern-based and Advanced Network Analyzer for Clinical Evaluation and Assessment (PANACEA). These systems assist medical experts in reviewing reports submitted to the Vaccine Adverse Event Reporting System (VAERS) and the FDA Adverse Event Reporting System (FAERS). In this manuscript, we describe the DSE architecture and key functionalities, and examine its potential contributions to the signal management process by focusing on four use cases: the identification of missing cases from a case series, the identification of duplicate case reports, retrieving cases for a case series analysis, and community detection for signal identification and characterization.

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Chest Pain, ST Elevation, and Positive Cardiac Enzymes in an Austere Environment: Differentiating Smallpox Vaccination-mediated Myocarditis and Acute Coronary Syndrome in Operation Iraqi Freedom

Cited by 7 publications

References 19 publications

Cardiac Adverse Events after Vaccination—A Systematic Review

Cardiac Adverse Events after Vaccination—A Systematic Review

Myopericarditis Associated With Smallpox Vaccination Among US Army Personnel – Fort Hood, Texas, 2018

Decision support environment for medical product safety surveillance

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