Myocarditis after Smallpox Vaccination: A Case Report

Saurina, G.; Shirazi, Syed; Lane, John; Daniel, Brenda; DiEugenia, Laura

doi:10.1086/377178

Cited by 16 publications

(6 citation statements)

References 10 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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“…Recommended doses of ibuprofen vary from 300 to 800 mg every 8 h as needed for symptom relief, and duration of treatment may be as little as a few days or may be for weeks (65). There is one recent case report of myocarditis after smallpox vaccination treated successfully with NSAIDs (66). VIG.…”

Section: Review Of Treatment Optionsmentioning

confidence: 99%

Smallpox vaccination and myopericarditis: a clinical review

Cassimatis

Atwood

Engler

et al. 2004

Journal of the American College of Cardiology

171

131

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Smallpox is a devastating viral illness that was eradicated after an aggressive, widespread vaccination campaign. Routine U.S. childhood vaccinations ended in 1972, and routine military vaccinations ended in 1990. Recently, the threat of bioterrorist use of smallpox has revived the need for vaccination. Over 450,000 U.S. military personnel received the vaccination between December 2002 and June 2003, with rates of non-cardiac complications at or below historical levels. The rate of cardiac complications, however, has been higher than expected, with two confirmed cases and over 50 probable cases of myopericarditis after vaccination reported to the Department of Defense Smallpox Vaccination Program. The practicing physician should use the history and physical, electrocardiogram, and cardiac biomarkers in the initial evaluation of a post-vaccination patient with chest pain. Echocardiogram, cardiac catheterization, magnetic resonance imaging, nuclear imaging, and cardiac biopsy may be of use in further workup. Treatment is with non-steroidal anti-inflammatory agents, four to six weeks of limited exertion, and conventional heart failure treatment as necessary. Immune suppressant therapy with steroids may be uniquely beneficial in myopericarditis related to smallpox vaccination, compared with other types of myopericarditis. If a widespread vaccination program is undertaken in the future, many more cases of post-vaccinial myopericarditis could be seen. Practicing physicians should be aware that smallpox vaccine-associated myopericarditis is a real entity, and symptoms after vaccination should be appropriately evaluated, treated if necessary, and reported to the Vaccine Adverse Events Reporting System.

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“…The currently available VVs, such as strains Lister and Dryvax, are known to be efficacious. However, severe adverse events, such as encephalitis, encephalopathy, progressive and generalized vaccinia, ocular vaccinia virus infections, and cardiac dysfunction, have been reported for recipients and are of great concern (1,2,4,10,16,22,23,25,31,33,38). These observations suggest that LC16m8 is safer than the currently used VVs derived from bovine skin (20,21).…”

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confidence: 99%

LC16m8, a Highly Attenuated Vaccinia Virus Vaccine Lacking Expression of the Membrane Protein B5R, Protects Monkeys from Monkeypox

Saijo¹,

Ami²,

Suzaki³

et al. 2006

J Virol

109

107

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The potential threat of smallpox as a bioweapon has led to the production and stockpiling of smallpox vaccine in some countries. Human monkeypox, a rare but important viral zoonosis endemic to central and western Africa, has recently emerged in the United States. Thus, even though smallpox has been eradicated, a vaccinia virus vaccine that can induce protective immunity against smallpox and monkeypox is still invaluable. The ability of the highly attenuated vaccinia virus vaccine strain LC16m8, with a mutation in the important immunogenic membrane protein B5R, to induce protective immunity against monkeypox in nonhuman primates was evaluated in comparison with the parental Lister strain. Monkeys were immunized with LC16m8 or Lister and then infected intranasally or subcutaneously with monkeypox virus strain Liberia or Zr-599, respectively. Immunized monkeys showed no symptoms of monkeypox in the intranasal-inoculation model, while nonimmunized controls showed typical symptoms. In the subcutaneous-inoculation model, monkeys immunized with LC16m8 showed no symptoms of monkeypox except for a mild ulcer at the site of monkeypox virus inoculation, and those immunized with Lister showed no symptoms of monkeypox, while nonimmunized controls showed lethal and typical symptoms. These results indicate that LC16m8 prevents lethal monkeypox in monkeys, and they suggest that LC16m8 may induce protective immunity against smallpox.

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Myocarditis after Smallpox Vaccination: A Case Report

Abstract: A 20-year-old airman (US Air Force) developed myocarditis 8 days after smallpox vaccination. He was treated with nonsteroidal anti-inflammatory agents, and his symptoms promptly resolved. However, postvaccinial myocarditis can lead to serious complications and even death.

Cited by 16 publications

References 10 publications

Cardiac Adverse Events after Vaccination—A Systematic Review

Cardiac Adverse Events after Vaccination—A Systematic Review

Smallpox vaccination and myopericarditis: a clinical review

LC16m8, a Highly Attenuated Vaccinia Virus Vaccine Lacking Expression of the Membrane Protein B5R, Protects Monkeys from Monkeypox

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