Myocarditis: how big is the risk of getting sick after the introduction of the third dose of mRNA vaccine against COVID-19

Administration of the mRNA vaccine against SARS-CoV-2 to a very high degree prevents the risk of symptomatic infection, severe disease, and intubation as complications of COVID-19 infection in children over 5 years of age and adults.

Both the efficacy and safety of vaccines have now been proven in millions of vaccinated people across a wide age range. At the same time, national and international commissions of experts are constantly monitoring adverse reactions in the vaccinated population. National database reports report a specific type of patient diagnosed with myocarditis (inflammation of the myocardium) or pericarditis (inflammation of the lining of the heart). These are mainly young men and adolescents (reaction / myocarditis was recorded within 7 days after receiving the second vaccination). These are the mRNA vaccines BNTb162b (Pfizer vaccine) and mRNA-1273 (Moderna vaccine).

Information obtained from the United States Vaccine Adverse Reactions (VAERS) database, which collects reports from doctors and patients, shows that the incidence of myocarditis was 70.7 cases per million doses of BNTb162b aged 12 to 15 years, 105.9 cases per million at age 17 and 52.4 cases per million between the ages of 18 and 24.

82% of cases were reported in men, while in women the incidence was estimated at 6.4 to 11 cases per million doses of BNTb162b. Most cases of myocarditis/pericarditis are either asymptomatic or have mild symptoms that resolve on their own without treatment. It is reassuring that in most cases, heart function remains normal, while even in those who are ill, the condition improves to normal levels within two weeks.

After mid-2021, and due to an increase in cases, a third booster dose was approved 3 months after completion of vaccination for all adults over 18 years of age. A recently published study in the Journal of the American Medical Association (doi: 10.1001/jama.2022.4425) provided information on the incidence of myocarditis after the third dose.

Professors of the Medical School of the National and Kapodistrian University of Athens Alexandros Briasoulis (Associate Professor of the Department of Cardiology), Charalambos Vlachopoulos (Professor of Cardiology), Kimon Stamatelopoulos (Associate Professor) and Thanos Dimonakas analyzed the study and made their conclusions.

This report compiled information from the Israeli Security Forces’ vaccination database. The experts specifically analyzed the data on the course and the possible occurrence of complications in 126,029 people who were vaccinated with the third dose. At the same time, as noted, 80% of men and 90% of women were aged 18 to 24 years. Among those vaccinated, 7 cases of myocarditis were registered (4 during the first week and 3 within 8-10 days after vaccination).

All cases were characterized by mild symptoms, without arrhythmias and heart failure. Although it is difficult to estimate the incidence of myocarditis within one week after the second dose of the vaccine, since different rates are reported in the reports of the authorities in Israel, Europe and the United States.

The most important finding of the study is that mild uncomplicated myocarditis occurs in a very small percentage of young men.

Given the results of the published data, it is concluded that COVID-19 infection may cause much more frequent and serious complications, especially in hospitalized patients, compared with rare complications from the vaccine. However, its benefits far outweigh the risk of heart disease.

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