Covid-19: vaccines and myocarditis 0:42
All the teens seemed to be having a heart attack.
They complained of chest pain and malaise, and the tests looked at first as if they were having an acute myocardial infarction, or a heart attack.
But it was not so.
In contrast, the seven young people between the ages of 14 and 19 suffered from a very rare type of heart inflammation.
This is a type that public health experts are beginning to link to COVID-19 vaccines.
"Fortunately, none of our patients were in critical condition and all of them responded very quickly to treatment," Dr. Judith Guzmán-Cottrill of Oregon Health and Science University said Thursday at a meeting of the National Advisory Committee of the Vaccines (NVAC).
Although all the young patients were hospitalized to monitor their cardiac symptoms, they recovered quickly.
Guzmán-Cottrill said he believes the inflammation of the heart, called myocarditis, could be the result of a very rare reaction to the COVID-19 vaccine.
All seven patients had recently been vaccinated, and none had evidence of a recent coronavirus infection.
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Children and adolescents appear to have stronger immediate reactions to the vaccine than adults, he noted.
These reactions, which have been widely reported, include fever, malaise, and headache.
Inflammation of the heart may be a more extreme manifestation of this response, Guzmán-Cottrill said.
"I wonder if myocarditis is actually a rare additional adverse event related to reactogenicity and / or systemic immunogenicity and these younger patients tend to have more reactogenicity compared to older populations, and more severe reactogenicity." he said at the NVAC meeting.
The NVAC advises the US Department of Health and Human Services and asked Guzmán-Cottrill to describe the findings he published June 1 in the journal Pediatrics.
All seven young men had chest pain, fever and other symptoms, and the test results resembled those seen in people with acute myocardial infarctions, the technical term for a heart attack.
But none of the teens were having a heart attack.
All patients improved within a few days.
Different treatments were tried, such as aspirin, ibuprofen, and steroids.
"We still don't know to date what the optimal therapy is," Guzmán-Cottrill said.
Doctors in Virginia and Texas reported Wednesday that they found similar results in a case series of seven men ages 19 to 39, who also had alarming symptoms, such as chest pain.
They were diagnosed with myocarditis, and were treated and released, the doctors reported in the journal Circulation.
Another group of vaccine advisers, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) was scheduled to meet this Friday. to discuss whether myocarditis could clearly be related to vaccines. That meeting has been rescheduled for next week due to the federal holiday of June 19.
The US Food and Drug Administration (FDA) is considering the possible risk of myocarditis while deciding what to advise companies seeking authorization to use vaccines in children under 12 years of age.
The FDA has indicated that additional safety data will be wanted for minors, especially since the virus is less likely to cause serious illness and death in children than in adults.
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Guzmán-Cottrill says it's important for pediatricians and parents to be aware of symptoms, but said CDC data indicates that of the millions of young people who have been vaccinated, very few cases of myocarditis have occurred.
"That reassures me a lot," he said.
CDC Director Dr. Rochelle Walensky said her agency is keeping an eye on the cases but is finding they are unusual.
"These cases are rare, and the vast majority have been fully resolved with rest and supportive care," he told the White House covid-19 briefing on Thursday.
The agency is preparing a report for the ACIP meeting next week.
"CDC will present details on more than 300 confirmed cases of myocarditis and pericarditis reported to CDC and FDA among the more than 20 million vaccinated adolescents and young adults in the United States," he said.
The big question is whether the risk of myocarditis may be related to vaccines and, if so, whether the risk to children and young people is greater than that of contracting the virus.
The CDC has urged doctors to consider the risk of myocarditis and a similar condition called pericarditis if children or teens present with heart symptoms.
“Consider myocarditis and pericarditis in adolescents or young adults with acute chest pain, shortness of breath, or palpitations.
In this younger population, coronary events are less likely to be a source of these symptoms, ”he advises.
And doctors should ask if they have been vaccinated recently.
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But Walensky noted that he has not hesitated to vaccinate his own children.
"My children received the Covid-19 vaccine because vaccination is the best way to protect our adolescents, youth and young adults from Covid-19 and its complications," Walensky said at the briefing.
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Covid-19 has caused more than 320 deaths in children under the age of 18 in the United States during this pandemic.
And hospitalization rates among teens who became ill with COVID-19 were two and a half to three times higher than during a typical flu season, "he added.
'In addition to preventing hospitalizations, the vaccine also reduces the risk of Covid-19 and therefore reduces the risk of MIS-C, a serious condition of multi-system inflammation in children, which has affected more than 4,000 children in United States during the pandemic, including 36 children whose deaths were the result of MIS-C.
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Although authorities are concerned about the complication, organizations representing doctors have supported the vaccination of minors.
"The American Heart Association continues to urge all adults and children 12 and older in the United States to receive the COVID-19 vaccine as soon as possible, as recommended by the CDC," said that group.
The association stated that 81% of the first 270 patients under the age of 30 who were discharged after suspecting that it was myocarditis related to the Covid-19 vaccine have fully recovered.
Members of the FDA's Advisory Committee on Vaccines and Related Biologics also noted the dangers of COVID-19 for children.
"I think we need these vaccines as soon as possible in children," said Dr. Mark Sawyer, a professor of pediatrics at the University of California, San Diego School of Medicine, during a group meeting last week.