Expert: “Risk from Covid-19 infection – in every age group – much higher than risk of myocarditis from mRNA vaccination.”

The myocarditis of prominent football players like Alphonso Davies has once again raised the question: How dangerous is Covid-19 for the heart - even in younger people?
And how high is the risk of inflammation of the heart muscle (myocarditis) or inflammation of the pericardium (pericarditis) following vaccination with an mRNA vaccine? “The occurrence of vaccine-related myocarditis or pericarditis is extremely rare,” emphasizes cardiologist Prof. Dr. med. Thomas Meinertz from the Scientific Advisory Board of the German Heart Foundation. At the same time, he points out: “The health risk from a Covid infection is – in every age group – much higher than the risk of myocarditis/pericarditis from vaccination with an mRNA vaccine.” This is the risk of myocarditis from Covid -19 disease is at least four times higher than that of vaccine-related myocarditis, as studies from the USA, Great Britain and Israel show (1, 2, 3).
In addition, the risk of other cardiac risks, such as arrhythmias and heart attack, as well as acute kidney damage and pulmonary embolism, increases significantly for unvaccinated people (3, 5). “We therefore appeal to everyone, especially older people and people at risk of a severe course of Covid-19, to get fully vaccinated or to have their vaccination protection refreshed with a booster,” said the Heart Foundation expert.
How the risk situation for healthy people and those with heart disease can be classified with regard to the risk of myocarditis after a Covid vaccination or a Covid-19 illness according to current study data is explained at www.herzstiftung.de/corona-impfung-myocarditis and in the current podcast at www. herzstiftung.de/herzschaeden-nach-covid-impfung explained. It also explains the symptoms, some of which are non-specific, that myocarditis can manifest itself with.

Current data on vaccine-related myocarditis

The frequency of vaccine-related myocarditis or pericarditis caused by an mRNA vaccine is on average one to ten cases per 100,000 vaccinations.
(1). To assess the risk situation, data from over 300 million Covid-19 vaccinations in different countries worldwide are now available. This also allows a reliable statement to be made about the benefit-risk ratio of a vaccination against Covid-19 with the aim of avoiding severe disease and death due to a SARS-CoV-2 infection. “The risk of severe acute heart damage is apparently noticeably greater when infected with the pathogen SARS-CoV-2 than when vaccinated with an mRNA vaccine to protect against Covid-19,” says Meinertz, referring to a large number of studies, including an evaluation of data from around 1.7 million people with and without vaccination from Israel (3) and a study from Great Britain with data from 38 million vaccinated people, the cases of myocarditis/pericarditis and cardiac arrhythmias as well as SARS-CoV-2 infection data were compared (1). Vaccination data for Germany show that the risk of myocarditis after an mRNA vaccination is present, but very low. As the Paul Ehrlich Institute (PEI) emphasizes in its security report from December 2021 (4), in accordance with other international data (including Israel, USA, Europe), the cases occur predominantly in male adolescents and young adults up to the age of 29 - usually within a few days and more often after the second dose of an mRNA Covid-19 vaccination. According to the PEI, the vast majority of patients with myocarditis/pericarditis after vaccination with mRNA vaccines respond well to treatment and rest and they feel better quickly, even if more serious courses have been observed in individual cases. In general, patients and doctors/medical professionals should pay attention to the signs of heart inflammation after a Covid-19 vaccination, advises the PEI.

What are typical symptoms of myocarditis?

There is no single key symptom of myocarditis/pericarditis. “In the case of Covid-19 disease, the first signs of myocarditis or pericarditis are lost in the general symptoms of infection and are not related to the heart,” explains cardiologist Meinertz. You should pay attention if these symptoms persist or reappear after the infection symptoms have subsided (fever, dizziness, muscle pain, diarrhea):

  • shortness of breath on exertion,
  • heart racing,
  • heart palpitations (arrhythmias),
  • Heart pain (especially with pericarditis)
  • inexplicable tiredness and fatigue,
  • physical weakness.

Although the symptoms are unspecific, diagnosis is difficult, especially in mild forms. To clarify the suspicion, the doctor first uses an ECG, X-ray and echocardiography. In the further course, magnetic resonance imaging of the heart (kMRI) and blood tests for the troponin laboratory value are also important.

If you have myocarditis, be careful

Intensive sporting activities should be avoided for around six months after a suspected case of myocarditis and should only be resumed after a cardiological check-up with normal findings. The long-term prognosis after acute, not significantly complicated viral myocarditis is predominantly positive. Complete healing can be expected in around 70% of patients. For some of those affected, mild symptoms remain due to scarring in the heart muscle, including slight arrhythmias. In patients with already severe heart failure, however, the prognosis is significantly worse.

Suspected cases mainly in young men after Covid-19 vaccination

According to the PEI safety report (4), out of a total of over 107 million doses of Comirnaty/Biontech and Spikevax/Moderna vaccinations that were vaccinated in Germany up to and including November 30, 2021, there were 1,554 suspected cases of myocarditis/pericarditis - regardless of the causal connection with the respective vaccination. been reported.
According to calculations for Comirnaty/Biontech, an overall reporting rate for all age groups and all vaccinations was just under 0.8 suspected cases per 100,000 vaccinations for women and 1.5 suspected cases per 100,000 vaccinations for men. For Spikevax/Moderna there was a reporting rate of 1.28 suspected cases per 100,000 for women and 4.6 for men. For Comirnaty/Biontech, the reporting rate of myocarditis/pericarditis in young men (18-29 years) after the second vaccination is around nine suspected cases per 100,000 vaccination doses (women of the same age 1.5 cases).
For Spikevax/Moderna, the reporting rate was highest among young men (18-29 years) after the second dose with over 25 suspected cases per 100,000 vaccinations (almost six cases for women). As a precautionary measure, the Standing Vaccination Commission (STIKO) only recommends the Comirnaty vaccine for people under 30 years of age. In addition to the suspected cases reported in the PEI report, there are now a number of studies that have evaluated clinical cases: “All data indicate that clinically proven myocarditis after mRNA vaccination is overall very rare. In addition, 95 percent of the cases were described as mild with a mostly short hospital stay,” said cardiologist and pharmacologist Meinertz. www.herzstiftung.de/corona-impfung-myocarditis provides information about the study situation

Conclusion based on practical experience

The following common findings can be gleaned from the study data to date, which scientists have repeatedly confirmed in practice:

  • The risk of myocarditis after mRNA vaccination is present, but very low.
  • The risk is lower with the mRNA vaccine Comirnaty/Biontech than with a vaccination with Spikevax/Moderna.
  • It affects more young men under 30 than women (highest risk between 15 and 29 years).
  • Complaints and symptoms of myocarditis usually appear within a few days after vaccination (usually the second).
  • The course of myocarditis is generally described as mild, with no consequential damage.
  • The health risk from a Covid infection is considered to be much higher - in every age group - than the risk of myocarditis/pericarditis from vaccination with an mRNA vaccine.

Additional information: What is myocarditis/pericarditis?

Myocarditis is an inflammatory disease of the heart muscle (myocardium) in which pathogens (mainly viruses) often attack the heart muscle tissue. They penetrate the cells, which can lead to the destruction of the heart muscle tissue. The process can be regionally limited in the heart, but in the worst case it can also affect the entire heart muscle. The body's own immune system can often counteract this process and achieve healing. The type, extent, duration and remaining final state of this inflammatory process and tissue damage vary greatly from person to person, making the course and prognosis of myocarditis difficult to predict. There are basically three forms of myocarditis:

  • Subclinical myocarditis (often not even noticed, usually heals without serious complications)
  • acute myocarditis (classic form with acute impairment of cardiac function)
  • chronic myocarditis (inflammatory processes in the heart tissue continue to be more or less active)

In the case of pericarditis, similar inflammatory processes occur as in myocarditis and in this case affect the connective tissue sheath (pericardium), which completely surrounds the heart and keeps it in its shape. The pericardium borders directly on the heart muscle tissue. Here too, a distinction is made between an acute and a chronic course.

Sources:

(1) NatMed 2021; https://doi.org/10.1038/s41591-021-01630-0
(2) JAMA, October 4, 2021; doi:10.1001/jamainternmed.2021.5511
(3) NEJM 2021, online August 25, doi: 10.1056/NEJMoa2110475
(4) Paul Ehrlich Institute (PEI) safety report from December 23, 2021
(5) The Lancet, July 29, 2021: DOI: https://doi.org/10.1016/S0140-6736(21)00896-5

http://www.herzstiftung.de/corona-impfung-myocarditis
http://www.herzstiftung.de/herzschaeden-nach-covid-impfung
http://www.herzstiftung.de/infos-zu-herzkrankenen/herzmuskelent...

Article image via Herzstiftung.de / Press / ©Irina Shatilova – stock.adobe.com

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Notes:
1) This content reflects the current state of affairs at the time of publication. The reproduction of individual images, screenshots, embeds or video sequences serves to discuss the topic. 2) Individual contributions were created through the use of machine assistance and were carefully checked by the Mimikama editorial team before publication. ( Reason )