What 2 cases of vaccine myocarditis in medical students tells us about vaccine myocarditis rates
Courtesy of the always educational twitter feed of long time NIH researcher and now retired academic Dr. Andrew Bostom comes a study published in Prehospital and Disaster Medicine about 2 medical students diagnosed with vaccine myocarditis during one shift.
Two sixth year medical students with no known prior medical history both complained of palpitations and chest pain during their night shift. They both had their first dose of the Pfizer vaccine 2 and 4 days prior to their symptoms. A “previously healthy” 23-year-old man complained of palpitations that were ongoing for the prior 24 hours. An electrocardiogram showed evidence of myocardial injury corroborated by a blood test that demonstrated myocardial cell death (cardiac Troponin). 12 hours after admission to the hospital, the medical student began having stabbing chest pain.
He was discharged after two days without any further incident. The second medical student who was also working the shift that same evening complained he had been having squeezing chest pain for two days. He had received his first Pfizer vaccine 4 days prior. His electrocardiogram did not show any significant changes, and his cardiac Troponin while elevated were lower than the first case. He was also discharged after 2 days of monitoring in the hospital.
The interesting thing about this case report is not that young healthy men were afflicted with myocarditis after the vaccine. Vaccine associated myocarditis has been reported now since at least April of 2021 to occur most frequently in the young male demographic. The actual rate of vaccine myocarditis that has been found to date has varied a fair amount because of how the data is collected in various databases. The United States, for instance, mostly relies on a passive surveillance system that uses voluntary reporting by patients and doctors. As a result, it is now generally accepted that the US vaccine myocarditis rate is under reported.
Hong Kong is a much smaller country with a robust pharmacovigilance program that recently reported rates of myocarditis in 12–17-year olds of 1/2700 after the second dose of the only messenger RNA vaccine that was available to them (Pfizer). Unfortunately, each shot of the other messenger RNA vaccine, Moderna, delivers three times as much of the active ingredient as Pfizer, and correspondingly, rates of myocarditis have been reported to be about 3-4 times more frequent with the second dose of Moderna vs. the second dose of Pfizer.
This would put the potential rate of vaccine myocarditis associated with a second dose of Moderna in young men at ~1/724 .
The current case report of the two medical students who were working the same evening shift presenting with vaccine myocarditis is troubling because it’s pretty clear one of the medical students was a delayed presentation of myocarditis that was likely reported the same evening because of the first case. How many other young men are brushing off chest pain in the 2–4-day window after vaccination? It is, of course, also possible that the medical system may not be capturing more severe cases of myocarditis that do not make it to the hospital. Regardless, I suspect this means the actual rates of myocarditis related to the vaccines may be much higher than currently reported.
This is buttressed by the smallpox vaccine experience that demonstrated clinical myocarditis that occurred at a rate 200 times higher than background in US service members receiving the smallpox vaccine. A prospective study that measured cardiac markers during the window of risk for myocarditis after vaccine regardless of symptoms found cardiac troponin levels in subjects that were 2 times baseline troponin levels (>99th percentile). Importantly, most of these abnormal blood markers were not associated with any specific cardiac symptoms. So, while the rate of overt clinical myocarditis gleaned from men presenting to the ER with chest pain may be 200 times the background rate of myocarditis in this demographic, the rate of cardiac injury was found to be sixty times higher!
It is entirely possible that these small elevations in a blood test that measures levels of cardiac cell death have no long-term prognostic relevance, but I have a hard time believing that any other therapeutic associated with this particular complication in young, perfectly healthy individuals would get the kind of pass from public policy experts the messenger RNA vaccines appear to be getting. At the very least it would seem to be imperative to run prospective studies that incorporate the use of these widely available blood tests that measure the amount of cardiac cell death to get a more complete picture of the safety profile of the messenger RNA vaccines.
Relying simply on passive reporting from patients/doctors and the health system given what we now know clearly isn’t getting the job done. In the era before politics infected policy and science, this was exactly what was done to ascertain the safety of the smallpox vaccine, and ultimately lead to preferential use of a smallpox vaccine with a lower rate of myocarditis. It may be asking too much of the hopeless COVID bureaucrats that make Inspector Clouseau appear a paragon of competence, but its way past time for them to start making politics bend the knee to common sense and science.
Anish Koka is a Cardiologist. Follow him on twitter @anish_koka
I have to make the obligatory post-script here that I oversaw the administration of hundreds of mrna vaccines starting in March of 2021 in my cardiology clinic. The vaccine efficacy data for the original data was from thousands of patients and I certainly felt given the devastation wreaked on many of my patients in 2020 that the vaccines were the best chance of avoiding morbidity and mortality. The process to get the vaccines from the city department of health was a somewhat arduous 3 month process, and once the vaccines were on hand, there were daily reporting requirements that I dutifully performed for the many months we were administering vaccines. To accommodate the rush of patients, employees, volunteers, and conscripted children worked multiple weekends to administer the vaccines. So I’m especially disgusted by medical colleagues who label any concerns registered about vaccine adverse events as “anti-vaxx”. Registering concern over a vaccine adverse event does not make doctors or patients “anti-vaxx”.
Jenin Younes on Twitter has the screenshot of my tweet. Never had any other infractions. They put a warning on her tweet today I think, so be careful :)
Thank you for that comment. I regret recommending the shot for anyone. Personally I didn’t take it, because too many of my patients were sick after the first shot. Since I had basically asymptomatic Covid in November 2020, I saw no reason to make myself sick with a shot I didn’t need. Since then, I have met several people who are likely injured from the vax. I have not reported any of them, because I cannot prove the vax caused it. I also find it troubling how many previously healthy young people have dropped dead, including one of my husband’s good friends. Stroke at age 49. Crossfitter, firefighter. Labeling a person “anti-vax” for being skeptical of this rushed shot is lazy. It will take decades for our profession to regain credibility…likely longer for public health profession. Thanks for always seeking truth, my friend.