A Narrative Review of Myocarditis Following COVID-19 Vaccination

Maziar Nasiri¹, Marjan Farzad^2*, Majid Zare Bidaki^3*, Hanieh Hakhamaneshi¹, Toba Kazemi⁴, Alireza Kooshki¹

¹Student Research Committee^, Birjand University of Medical Sciences, Birjand, Iran,

²PhD, Cardiovascular Diseases Research Center, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran,

³Associate Professor of Bacteriology, Infectious Diseases Research Center, School of Allied Medical sciences, Birjand University of Medical Sciences, Birjand, Iran,

⁴Professor of Cardiology, Cardiovascular Diseases Research Center, Department of Cardiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran

*Corresponding authors: Marjan Farzad, PhD, Cardiovascular Diseases Research Center, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran.

Majid Zare Bidaki, Associate Professor of Bacteriology, Infectious Diseases Research Center, School of Allied Medical sciences, Birjand University of Medical Sciences, Birjand, Iran

Received: 14 March 2022; Accepted: 30 April 2022; Published: 22 April 2022

1. Introduction

The coronavirus disease-19 (COVID-19) related morbidity and mortality has been declined significantly throughout the world by introducing the variety of COVID-19 vaccines [1]. However, recent scientific reports have raised concerns for myocarditis related to different types of COVID-19 vaccines, both in double-jabbed people [2] and even after the first vaccine shot [3]. Myocarditis subsequent to administration of COVID-19 vaccines, especially the mRNA based one, has been described [4,5]. Similar reports have been defined for Johnson & Johnson's Janssen [6] and AstraZeneca [3] vaccines as well. Although the number of reported myocarditis has been small compared to the large number of people vaccinated, it may become more pronounced as the vaccine is now widely administered. Despite many papers, there are still limited data on vaccine-induced myocarditis. This study conducted a narrative review of the research on vaccine-induced myocarditis regarding the type, dose of vaccine, time to present from the vaccine, cardiac history, and patient outcomes.

We performed a search in the PubMed database. All papers of the year 2021 about the study subject were gathered using the following MeSH terms: (?Myocarditis" and "COVID-19 vaccine") with no language restriction. Inclusion criteria were case reports and case series. The outcomes of interest were vaccine-induced myocarditis regarding the type, dose of vaccine, time to present from the vaccine, cardiac history, and if the patient was died or not.

Our search yielded overall 68 studies. After applying inclusion criteria, only 24 studies were included with the total of 46 patients [2-25]. Forty-one of 46 (89.1%) of the patients were males. The age range was 14-70 years with a mean age of 28.82±14.65 years. The majority of the myocarditis related COVID-19 vaccine cases (73.9%) were associated with the Pfizer-BioNTech 19.6% were associated with the Moderna vaccine, 2.2% were associated with the Johnson & Johnson (Janssen) vaccine, and 4.3% were associated with the AstraZeneca vaccine. Almost all the myocarditis related to the Moderna vaccine (8/9) occurred following the second dose of the vaccine, whereas 27/34 (79.4%) of the myocarditis related to the Pfizer-BioNTech vaccine occurred following the second dose of the vaccine. All the two-myocarditis cases related to the AstraZeneca vaccine occurred following the first dose of the vaccine. The median time to present from the vaccines was 3 days (range, 1-14 days). It was specifically 2.5 days (range, 1-10 days) for Pfizer-BioNTech, 3 days (range, 1-14 days) for Moderna, 2 days (2 days) for Johnson & Johnson, and 2 days (range, 1-3 days) for AstraZeneca vaccine. 93.5% of cases had no previous cardiac history. 91.3% of myocarditis cases were survived and discharged from the hospital (Table 1).

Table 1: Characteristics and outcomes of patients with myocarditis related to COVID-19 vaccine

M: male; F: female; N: no; Y: yes

The analysis of the available data reveals some key findings. First, for the most part, myocarditis related to COVID-19 vaccines occurs in young males following the second dose of the vaccine. It might support the hypothesis proposed by Levin et al. that a severe response of the immune system (i.e., cytokine storm) is more likely to be elicited after the second dose of the vaccine [26]. Second, most myocarditis related to COVID-19 vaccines occurs with mRNA vaccines (Pfizer-BioNTech and Moderna COVID-19 vaccines). Third, myocarditis related to COVID-19 vaccines has a good therapeutic prognosis for the most. Finally, although myocarditis related to COVID-19 vaccines, specially those based on mRNA technology, are common, myocarditis followed by the other types of vaccines should not be overlooked by the clinician.

Disclosures

The authors declare that they have no competing interests.

Funding

None

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