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Short communication| Volume 353, P131-134, April 15, 2022

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Myocarditis after RNA-based vaccines for coronavirus.

Published:January 21, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.01.037

      Highlights

      • Incidence of myocarditis after RNA-based vaccines for coronavirus has gained social and medical interest.
      • We performed a meta-analysis with 17,704,413 subjects that included 627 confirmed myocarditis.
      • The incidence of myocarditis was 0.0035% (95% CI 0.0034–0.0035).
      • Mean incidence rate was 10.69 per 100.000 persons-year.
      • Only 1 case of fatal myocarditis or death was reported.

      Abstract

      Background

      The incidence of myocarditis after RNA-based vaccines for coronavirus has gained social and medical interest.

      Methods

      We performed an intention-to-treat meta-analysis, following the PRISMA statement. After a systematic search, without language restriction, 9 publications were selected. Two were excluded (one was only in subjects with age 12–17 and other might had included subjects from a larger publication). We followed the PRISMA guidelines for abstracting data and assessing data quality and validity. Data was verified by 2 investigators.

      Results

      We analyzed 17,704,413 subjects, from 7 studies, that included 627 cases of confirmed myocarditis). The incidence of myocarditis was 0.0035% (95% CI 0.0034–0.0035). Mean incidence rate was 10.69 per 100.000 persons-year. Cases reported from Israel represented 45.14% from total (283 out of the 627). Only 1 case of fatal myocarditis or death was reported. There was significant heterogeneity between results. The meta-regression analysis excluded mean age, region, number of cases or number of people included as sources of heterogeneity. No small-study effect was observed (p = 0.19).

      Conclusions and relevance

      Myocarditis incidence after RNA vaccines is very rare (0.0035%) and has a very favorable clinical course.

      Graphical abstract

      Keywords

      1. Introduction

      Coronavirus vaccines have demonstrated to reduce very effectively the incidence of severe covid-19 and mortality [
      • Haas E.J.
      • Angulo F.J.
      • McLaughlin J.M.
      • Anis E.
      • Singer S.R.
      • Khan F.
      • et al.
      Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data.
      ]. Nonetheless, the incidence of myocarditis after RNA-based vaccines for coronavirus has gained social and medical interest [
      • Su J.R.
      • McNeil M.M.
      • Welsh K.J.
      • Marquez P.L.
      • Ng C.
      • Yan M.
      • et al.
      Myopericarditis after vaccination, vaccine adverse event reporting system (VAERS), 1990–2018.
      ,
      • Bozkurt B.
      • Kamat I.
      • Hotez P.J.
      Myocarditis with COVID-19 mRNA vaccines.
      ,
      • Abbate A.
      • Gavin J.
      • Madanchi N.
      • Kim C.
      • Shah P.R.
      • Klein K.
      • et al.
      Fulminant myocarditis and systemic hyperinflammation temporally associated with BNT162b2 mRNA COVID-19 vaccination in two patients.
      ]. Several reports have provided very low rates of myocarditis after the second dose of RNA-based vaccines [
      • Mevorach D.
      • Anis E.
      • Cedar N.
      • Bromberg M.
      • Haas E.J.
      • Nadir E.
      • et al.
      Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
      ,
      • Witberg G.
      • Barda N.
      • Hoss S.
      • Richter I.
      • Wiessman M.
      • Aviv Y.
      • et al.
      Myocarditis after Covid-19 vaccination in a large health care organization.
      ]. Moreover, some studies have suggested that the myocarditis incidence has increased since the introduction of this type of vaccines [
      • Diaz G.A.
      • Parsons G.T.
      • Gering S.K.
      • Meier A.R.
      • Hutchinson I.V.
      • Robicsek A.
      Myocarditis and pericarditis after vaccination for COVID-19.
      ,
      • Perez Y.
      • Levy E.R.
      • Joshi A.Y.
      • Virk A.
      • Rodriguez-Porcel M.
      • Johnson M.
      • et al.
      Myocarditis following COVID-19 mRNA vaccine: a case series and incidence rate determination.
      ] meanwhile other reported similar rates than expected based on previous time-periods rates [
      • Montgomery J.
      • Ryan M.
      • Engler R.
      • Hoffman D.
      • McClenathan B.
      • Collins L.
      • et al.
      Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military.
      ].

      2. Methods

      We performed an intention-to-treat meta-analysis in line with recommendations from the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement [
      • Moher D.
      • Cook D.J.
      • Eastwood S.
      • Olkin I.
      • Rennie D.
      • Stroup D.F.
      Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses.
      ]. We performed a systematic search (using PUBMED, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar), without language restriction, for publications using the Medical Subject Headings terms “myocarditis”, “vaccine”, “coronavirus” and “RNA vaccine”. A total of 9 reports were identified [
      • Mevorach D.
      • Anis E.
      • Cedar N.
      • Bromberg M.
      • Haas E.J.
      • Nadir E.
      • et al.
      Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
      ,
      • Witberg G.
      • Barda N.
      • Hoss S.
      • Richter I.
      • Wiessman M.
      • Aviv Y.
      • et al.
      Myocarditis after Covid-19 vaccination in a large health care organization.
      ,
      • Diaz G.A.
      • Parsons G.T.
      • Gering S.K.
      • Meier A.R.
      • Hutchinson I.V.
      • Robicsek A.
      Myocarditis and pericarditis after vaccination for COVID-19.
      ,
      • Perez Y.
      • Levy E.R.
      • Joshi A.Y.
      • Virk A.
      • Rodriguez-Porcel M.
      • Johnson M.
      • et al.
      Myocarditis following COVID-19 mRNA vaccine: a case series and incidence rate determination.
      ,
      • Montgomery J.
      • Ryan M.
      • Engler R.
      • Hoffman D.
      • McClenathan B.
      • Collins L.
      • et al.
      Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military.
      ,
      • Farahmand R.
      • Trottier C.A.
      • Kannam J.P.
      • Ho K.K.L.
      Incidence of myopericarditis and myocardial injury in coronavirus disease 2019 vaccinated subjects.
      ,
      • Simone A.
      • Herald J.
      • Chen A.
      • Gulati N.
      • Shen A.Y.-J.
      • Lewin B.
      • et al.
      Acute myocarditis following COVID-19 mRNA vaccination in adults aged 18 years or older.
      ,
      • Husby A.
      • Hansen J.V.
      • Fosbøl E.
      • Thiesson E.M.
      • Madsen M.
      • Thomsen R.W.
      • et al.
      SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study.
      ,
      • Foltran D.
      • Delmas C.
      • Flumian C.
      • De Paoli P.
      • Salvo F.
      • Gautier S.
      • et al.
      Myocarditis and pericarditis in adolescents after first and second doses of mRNA COVID-19 vaccines.
      ]. The report from Witberg et al. [
      • Witberg G.
      • Barda N.
      • Hoss S.
      • Richter I.
      • Wiessman M.
      • Aviv Y.
      • et al.
      Myocarditis after Covid-19 vaccination in a large health care organization.
      ], evaluated patients who were enrolled in Clalit Health Services, the largest health insurance company in Israel, and the one by Mevorach et al. [
      • Mevorach D.
      • Anis E.
      • Cedar N.
      • Bromberg M.
      • Haas E.J.
      • Nadir E.
      • et al.
      Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
      ] was based on medical records obtained from the Ministry of Health database from Israel; therefore, patients could be have been included in both reports and we excluded data from Witberg et al. [
      • Witberg G.
      • Barda N.
      • Hoss S.
      • Richter I.
      • Wiessman M.
      • Aviv Y.
      • et al.
      Myocarditis after Covid-19 vaccination in a large health care organization.
      ]. The report by Foltran et al. [
      • Foltran D.
      • Delmas C.
      • Flumian C.
      • De Paoli P.
      • Salvo F.
      • Gautier S.
      • et al.
      Myocarditis and pericarditis in adolescents after first and second doses of mRNA COVID-19 vaccines.
      ]only adolescents with age between 12 and 17and, therefore, it was not included. So finally, 7 reports were analyzed [
      • Mevorach D.
      • Anis E.
      • Cedar N.
      • Bromberg M.
      • Haas E.J.
      • Nadir E.
      • et al.
      Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
      ,
      • Diaz G.A.
      • Parsons G.T.
      • Gering S.K.
      • Meier A.R.
      • Hutchinson I.V.
      • Robicsek A.
      Myocarditis and pericarditis after vaccination for COVID-19.
      ,
      • Perez Y.
      • Levy E.R.
      • Joshi A.Y.
      • Virk A.
      • Rodriguez-Porcel M.
      • Johnson M.
      • et al.
      Myocarditis following COVID-19 mRNA vaccine: a case series and incidence rate determination.
      ,
      • Montgomery J.
      • Ryan M.
      • Engler R.
      • Hoffman D.
      • McClenathan B.
      • Collins L.
      • et al.
      Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military.
      ,
      • Farahmand R.
      • Trottier C.A.
      • Kannam J.P.
      • Ho K.K.L.
      Incidence of myopericarditis and myocardial injury in coronavirus disease 2019 vaccinated subjects.
      ,
      • Simone A.
      • Herald J.
      • Chen A.
      • Gulati N.
      • Shen A.Y.-J.
      • Lewin B.
      • et al.
      Acute myocarditis following COVID-19 mRNA vaccination in adults aged 18 years or older.
      ,
      • Husby A.
      • Hansen J.V.
      • Fosbøl E.
      • Thiesson E.M.
      • Madsen M.
      • Thomsen R.W.
      • et al.
      SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study.
      ].
      Numeric rates of confirmed cases of myocarditis were extracted from each report. The percentage of variability across studies attributable to heterogeneity beyond chance was estimated using the I2 statistic. A random effect model was applied because significant heterogeneity was detected. Sensitivity analysis included the identification of potential sources of heterogeneity between trials, tested by meta-regression analyses, and the assessment of the small-study effects, by the Egger test [
      • Moher D.
      • Cook D.J.
      • Eastwood S.
      • Olkin I.
      • Rennie D.
      • Stroup D.F.
      Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses.
      ]. All analyses were performed using STATA 14.3 (StataCorp. 2009. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP).

      3. Results

      We included the results of 7 reports with 17,704,413 subjects (Table 1). The report from the Israel Ministry of Health database represented 28.95% of the subjects, the report from the Denmark 27.86% and the 5 reports from the United States represented the resting 43.19% for the population included in the analyses. A total of 627 cases of confirmed myocarditis were reported what represented an incidence of 0.0035% (95% CI 0.0034–0.0035). Mean incidence rate was 10.69 per 100.000 persons-year. Cases reported from Israel represented 45.14% (283 out of the 627). Only 1 case of fatal myocarditis or death was reported.
      Table 1Characteristics of the reports included in the metanalysis.
      First authorCountryType of studyFully vaccinated peopleConfirmed myocarditisRate/100.000 person-yearsDeathsDiagnostic criteriaPfizerModerna
      Y. PerezUSRochester Epidemiology Project175,472755.350ICD-10 codes
      R. FarahmandUSMassachusetts Immunization Information System268,320100.080ICD-10 codes54%41%
      G. DiazUS40 hospital records2,000,287201.000Hospital diagnosis62.2%32.4%
      A. SimoneUSKaiser Permanente Southern California2,392,924150.580Hospital diagnosis and adjudication by 2 cardiologist50%
      J. MontgoveryUSUS Military Health Service2,810,0002323.000CDC criteria
      A. HusbyDenmarkPopulation based cohort study using the Danish Vaccination Register4,931,7752691.70Hospital-based and ICD-10 codes83.8%12%
      D. MevorachIsraelRetrospective study using the Ministry of Health database5,125,6352831.761ICD-9 and CDC criteria100%
      CDC: Centers for Disease Control and Prevention; ICD: international classification of the diseases.
      As shown in Fig. 1, there was significant heterogeneity between results. The meta-regression analysis excluded mean age, region, number of cases, number of people included or diagnostic criteria as sources of heterogeneity. The Egger test excluded the small-study effect (p = 0.19).
      Fig. 1
      Fig. 1Forest plot for the incidence of myocarditis.

      4. Discusion

      This metanalysis with >17 millions of subjects vaccinated with the 2 doses of RNA vaccines for coronavirus demonstrates the low rate of myocarditis and mortality. Myocarditis are a well described side effect of vaccines [
      • Su J.R.
      • McNeil M.M.
      • Welsh K.J.
      • Marquez P.L.
      • Ng C.
      • Yan M.
      • et al.
      Myopericarditis after vaccination, vaccine adverse event reporting system (VAERS), 1990–2018.
      ] and this metanalysis demonstrates that it also occur after RNA vaccines for coronavirus and have an excellent prognosis.
      The Vaccine Adverse Event Reporting System (VAERS) reported and incidence of myocarditis of 0.1% (708 confirmed cases from 620,195 subjects) between 1990 and 2018 [
      • Su J.R.
      • McNeil M.M.
      • Welsh K.J.
      • Marquez P.L.
      • Ng C.
      • Yan M.
      • et al.
      Myopericarditis after vaccination, vaccine adverse event reporting system (VAERS), 1990–2018.
      ]. The analysis also revealed that despite the introduction of new vaccines over the years, myopericarditis had very low incidence in the United States. RNA coronavirus vaccines have been widely applied since January 2020 and it is estimated that by the end of 2021 more than 3500 millions of people in the world will be vaccinated with 2 doses of any of the vaccines available []. We believe that our results, as well as other reports that exclude cardiovascular complications [
      • Jabagi M.J.
      • Botton J.
      • Bertrand M.
      • Weill A.
      • Farrington P.
      • Zureik M.
      • et al.
      Myocardial infarction, stroke, and pulmonary embolism after BNT162b2 mRNA COVID-19 vaccine in people aged 75 years or older.
      ], should reinforce the wide generalization of coronavirus vaccines that have demonstrated to reduce, dramatically, the incidence of severe covid-19 and mortality [
      • Haas E.J.
      • Angulo F.J.
      • McLaughlin J.M.
      • Anis E.
      • Singer S.R.
      • Khan F.
      • et al.
      Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data.
      ,
      • Arbel R.
      • Hammerman A.
      • Sergienko R.
      • Friger M.
      • Peretz A.
      • Netzer D.
      • et al.
      BNT162b2 vaccine booster and mortality due to Covid-19.
      ].
      Clinical course of myocarditis was benign in all cases but one. The VAERS reported that 69% of the cases diagnosed after vaccines were classified as serious [
      • Su J.R.
      • McNeil M.M.
      • Welsh K.J.
      • Marquez P.L.
      • Ng C.
      • Yan M.
      • et al.
      Myopericarditis after vaccination, vaccine adverse event reporting system (VAERS), 1990–2018.
      ] although some reports have highlighted the rare presentation of fulminant myocarditis leading to multiorgan failure and death [
      • Bozkurt B.
      • Kamat I.
      • Hotez P.J.
      Myocarditis with COVID-19 mRNA vaccines.
      ,
      • Abbate A.
      • Gavin J.
      • Madanchi N.
      • Kim C.
      • Shah P.R.
      • Klein K.
      • et al.
      Fulminant myocarditis and systemic hyperinflammation temporally associated with BNT162b2 mRNA COVID-19 vaccination in two patients.
      ]. These reports reinforce the need of wider studies as our metanalysis. A part from this, the clinical presentation revealed that myocarditis is more incident in men, symptom onset is <2 weeks postvaccination and the highest rates is observed in subjects aged 25 to 44 years is similar to the other forms of vaccine-related myocarditis [
      • Su J.R.
      • McNeil M.M.
      • Welsh K.J.
      • Marquez P.L.
      • Ng C.
      • Yan M.
      • et al.
      Myopericarditis after vaccination, vaccine adverse event reporting system (VAERS), 1990–2018.
      ]. Myocarditis have been also reported in many patients with severe covid-19 [
      • Deng Q.
      • Hu B.
      • Zhang Y.
      • Wang H.
      • Zhou X.
      • Hu W.
      • et al.
      Suspected myocardial injury in patients with COVID-19: evidence from front-line clinical observation in Wuhan, China.
      ] although mortality and myocarditis incidence had a very different pattern in patients with covid-19, since both increased exponentially with age [
      • Bonanad C.
      • García-Blas S.
      • Tarazona-Santabalbina F.
      • Sanchis J.
      • Bertomeu-González V.
      • Fácila L.
      • et al.
      The effect of age on mortality in patients with COVID-19: a Meta-analysis with 611,583 subjects.
      ]. Finally, there is scarce evidence on the optimal therapy for this kind of RNA vaccine-related myocarditis.
      Some analyses concluded that coronavirus vaccination has led to a particular increase in the diagnosis of myopericarditis in men [
      • Diaz G.A.
      • Parsons G.T.
      • Gering S.K.
      • Meier A.R.
      • Hutchinson I.V.
      • Robicsek A.
      Myocarditis and pericarditis after vaccination for COVID-19.
      ,
      • Perez Y.
      • Levy E.R.
      • Joshi A.Y.
      • Virk A.
      • Rodriguez-Porcel M.
      • Johnson M.
      • et al.
      Myocarditis following COVID-19 mRNA vaccine: a case series and incidence rate determination.
      ,
      • Farahmand R.
      • Trottier C.A.
      • Kannam J.P.
      • Ho K.K.L.
      Incidence of myopericarditis and myocardial injury in coronavirus disease 2019 vaccinated subjects.
      ] meanwhile some other concluded that expected and observed rates of myocarditis in their areas or population remained unchanged [
      • Montgomery J.
      • Ryan M.
      • Engler R.
      • Hoffman D.
      • McClenathan B.
      • Collins L.
      • et al.
      Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military.
      ]. Such differences could be attributed to diagnostic criteria, active search or, even, random or uncontrolled effects. We also found different diagnostic criteria that might highlight the clinical challenge of the definite diagnosis of myocarditis. Nonetheless, all evidence concludes that whatever the incidence of myopericarditis might be, it is always much lower than the morbidity seen in patients who got infected or developed covid-19 disease [
      • Mevorach D.
      • Anis E.
      • Cedar N.
      • Bromberg M.
      • Haas E.J.
      • Nadir E.
      • et al.
      Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
      ,
      • Diaz G.A.
      • Parsons G.T.
      • Gering S.K.
      • Meier A.R.
      • Hutchinson I.V.
      • Robicsek A.
      Myocarditis and pericarditis after vaccination for COVID-19.
      ,
      • Perez Y.
      • Levy E.R.
      • Joshi A.Y.
      • Virk A.
      • Rodriguez-Porcel M.
      • Johnson M.
      • et al.
      Myocarditis following COVID-19 mRNA vaccine: a case series and incidence rate determination.
      ,
      • Farahmand R.
      • Trottier C.A.
      • Kannam J.P.
      • Ho K.K.L.
      Incidence of myopericarditis and myocardial injury in coronavirus disease 2019 vaccinated subjects.
      ,
      • Husby A.
      • Hansen J.V.
      • Fosbøl E.
      • Thiesson E.M.
      • Madsen M.
      • Thomsen R.W.
      • et al.
      SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study.
      ].
      Our study might be limited by data source. We included >17 millions of people that represents a low percentage of the population vaccinated world-wide but, in contrast, these data source have been accurately collected. The most solid evidence might be derived from randomized controlled trials although real-life records provide evidence in less homogenous and non-selected population. We only included definite cases of people that received the 2 doses of the vaccines because incidence after the first dose was reported in some studies [
      • Mevorach D.
      • Anis E.
      • Cedar N.
      • Bromberg M.
      • Haas E.J.
      • Nadir E.
      • et al.
      Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
      ,
      • Diaz G.A.
      • Parsons G.T.
      • Gering S.K.
      • Meier A.R.
      • Hutchinson I.V.
      • Robicsek A.
      Myocarditis and pericarditis after vaccination for COVID-19.
      ,
      • Perez Y.
      • Levy E.R.
      • Joshi A.Y.
      • Virk A.
      • Rodriguez-Porcel M.
      • Johnson M.
      • et al.
      Myocarditis following COVID-19 mRNA vaccine: a case series and incidence rate determination.
      ,
      • Farahmand R.
      • Trottier C.A.
      • Kannam J.P.
      • Ho K.K.L.
      Incidence of myopericarditis and myocardial injury in coronavirus disease 2019 vaccinated subjects.
      ] but not in others Perez [
      • Perez Y.
      • Levy E.R.
      • Joshi A.Y.
      • Virk A.
      • Rodriguez-Porcel M.
      • Johnson M.
      • et al.
      Myocarditis following COVID-19 mRNA vaccine: a case series and incidence rate determination.
      ,
      • Montgomery J.
      • Ryan M.
      • Engler R.
      • Hoffman D.
      • McClenathan B.
      • Collins L.
      • et al.
      Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military.
      ,
      • Husby A.
      • Hansen J.V.
      • Fosbøl E.
      • Thiesson E.M.
      • Madsen M.
      • Thomsen R.W.
      • et al.
      SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study.
      ]; however, the study from the Ministry of Health database of Israel reported that the risk difference between the first and second doses was 1.76 per 100,000 persons [
      • Mevorach D.
      • Anis E.
      • Cedar N.
      • Bromberg M.
      • Haas E.J.
      • Nadir E.
      • et al.
      Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
      ]. Finally, some authors have highlighted that establishing a causal link between a RNA-based vaccine and a case of myocarditis could have a limited scientific value, especially without a cardiac biopsy [
      • Cereda A.
      • Conca C.
      • Barbieri L.
      • Ferrante G.
      • Tumminello G.
      • Lucreziotti S.
      • et al.
      Acute myocarditis after the second dose of SARS-CoV-2 vaccine: serendipity or atypical causal relationship?.
      ].
      In conclusion, myocarditis incidence after RNA vaccines is very rare (0.0035%) and has favorable clinical course. National or regional reports on side effects of coronavirus vaccines provide a great tool for the reinforcement of global vaccination.

      Declaration of Competing Interest

      • -
        Alberto Cordero reports a) honoraria for lectures from AstraZeneca, Bristol-Myers Squibb, Ferrer, Boehringer Ingelheim, MSD, and Bristol-Myers Squibb and AMGEN; b) consulting fees from AstraZeneca, Ferrer and AMGEN.
      • -
        María Amparo Quintanilla reports a) honoraria for lectures from Astra Zeneca, Boehringer Ingelheim, Eli Lilly, and Rovi; b) consulting fees from Boehringer Ingelheim, Eli Lilly and AstraZeneca
      • -
        Vicente Bertomeu-González reports a) honoraria for lectures from Daiichi Sankyo, Boehringer Ingelheim, Bayer, Pfizer-BMS, LivaNova, Ferrer, Cardiome, MSD; b) consulting fees none; c) research grants from Medtronic Iberica.

      Acknowledgements

      Investigators received the support of the Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain, the National Network for Biomedical Research in Cardiovascular Disease.

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      Linked Article

      • Myocarditis after RNA-based COVID-19 vaccines: Where do we stand?
        International Journal of CardiologyVol. 356
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          Severe acute respiratory syndrome – Coronavirus 2 (SARS-CoV2) pandemics has been an unprecedented healthcare crisis, and has exacted a toll of millions of deaths worldwide since its inception in 2020. RNA-based vaccine against SARS-CoV2 were rapidly introduced in clinical practice by the end of 2020 and were shown to be effective in dramatically abating the incidence of infection and/or severe disease [1]. With widespread implementation of vaccination campaigns, pharmacovigilance data on RNA-based vaccine related side effects were able to prove overall safety of the drug, with incidence of severe advents being initially reported as being around 1:10,000 [2].
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