The benefit of vaccination against COVID-19 outweighs the potential risk of myocarditis and pericarditis

Abstract

Vaccines against coronavirus 2019 disease (COVID-19) have shown to be greatly effective in preventing viral spread, serious illness and death from this infectious disease and are therefore critical for the management of the COVID-19 pandemic. However, the listing of myocarditis and pericarditis as possible rare side effects of the messenger RNA (mRNA) vaccines against COVID-19 by regulatory agencies has sparked discussion on the vaccines’ safety. The most important published cohort studies to date demonstrat that myocarditis is a very rare side effect after COVID-19 mRNA vaccination, with an incidence of approximately 1–4 cases per 100,000 vaccinated persons. Young males (16–29 years) appear to be at highest risk, predominantly after receiving the second dose. The disease course is self-limiting in a vast majority of cases: 95% of patients show a rapid resolution of symptoms and normalisation of cardiac biomarkers, electro- and echocardiographic findings within days. Importantly, the available data suggest that the incidence rate of myocarditis in the context of COVID-19 is much greater than the risk of this side effect following vaccination. We conclude that the benefit of vaccination against COVID-19 outweighs the potential risk of myocarditis and pericarditis in both adolescents and adults. Prospective follow-up of patients who have developed these complications after vaccination is required to assess long-term outcomes.

Myocarditis and pericarditis associated with SARS-CoV-2 vaccines: A population-based descriptive cohort and a nested self-controlled risk interval study using electronic health care data from four European countries

“…These suggest an elevated risk of myocarditis and potentially pericarditis in the first 7–14 days after vaccination, especially in younger men after the second dose. Most of the cases resolved without problems ( EMA press office, 2021 ; Klamer et al, 2022 ).…”

Do COVID-19 viral infection and its mRNA vaccine carry an equivalent risk of myocarditis? Review of the current evidence, insights, and future directions

“…The incidence of COVID-19 vaccine induced myocarditis is 1–4 cases per 100,000 vaccinated individuals. 54 In 95% of these cases, cardiac markers, echocardiographic and electrocardiographic markers will show a downward trend and eventually subside in few days with complete remission without any sequelae. 54 A systematic review and meta-analysis demonstrated that the risk of myocarditis is 7 times more apparent in COVID-19 patients [RR: 15 (95% CI: 11.09–19.81] as compared to vaccination group RR: 2 (95% CI: 1.44–2.65).…”

SARS-CoV-2 and COVID-19: A Narrative Review

“…A view of the WHO's COVID-19 dashboard (2) shows four cycles of cases, with peaks in January, April, and August 2020 and January 2022 (and possibly in March 2022) (Figure 1), the precise reasons for which are unclear but may reflect the differing infectivity of variants of the original SARS-CoV-2. Similarly, there were peaks in the number of deaths in January (103,228 in the week of 18 January), April (96,071 in the week of 26 April), and August 2021 (71,012 in the week of 23 August), with a fourth in February 2022 (76,118 in the week of 7 February), which may reflect a combination of the infectivity and lethality of the variants.…”

“…Similarly, the pre-pandemic incidence of clinical myocarditis in the general population is around 13/million. The incidence in those hospitalised and unvaccinated with SARS-CoV-2 is 2261/million, but the incidence in those vaccinated = 21/million ( 76 ). The incidence ratio for pulmonary embolism has been reported as being 1.21 (95% CI, 1.07–1.36) after vaccination with BNT162b2, consistent with that seen after ChAdOx1 vaccination.…”

“…Although differences in the format of clinical trials (age, sex, co-morbidities, etc.) bring difficulties in direct comparison between the vaccines, an independent field study reported 28-34-day vaccine effects against hospital admission of 88% (95% CI 75-94) and 91% (75)(76)(77)(78)(79)(80)(81)(82)(83)(84) for the Oxford Astra-Zeneca and Pfizer-BioNtech vaccines, respectively (85). Of 2,572,008 Scottish people with at least one vaccination, 1,196 (0.046%) had severe COVID-19, 883 (0.034%) were admitted, and 541 (0.021%) died.…”