The Michigan Department of Health and Human Services (MDHHS) has received additional guidance from the Centers for Disease Control and Prevention (CDC) regarding myocarditis and pericarditis to share with providers. Since April 2021, increased cases of myocarditis and pericarditis have been reported in the United States after mRNA COVID-19 vaccination (Pfizer-BioNTech and Moderna). CDC is aware of these reports, which are rare given the number of vaccine doses administered. CDC and its partners are actively monitoring these reports, by reviewing data and medical records, to learn more about what happened and to see if there is any relationship to COVID-19 vaccination. Cases reported to VAERS have occurred mostly in male adolescents and young adults aged 16 years or older. These cases have been seen more often after getting the second dose than the first dose, and typically within several days after COVID-19 vaccination.
Recommendation Key Point:
It is important to note that CDC has assured that vaccine recommendations remain in place:
Clinical Consideration, Provider Guidance and Talking Points:
CDC has developed and published Clinical Considerations for myocarditis and pericarditis following COVID-19 vaccination which provides a background and recommendations for providers.
Recommendations for providers during patient encounters:
- CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older given the greater risk of other serious complications related to COVID-19, such as hospitalization, multisystem inflammatory syndrome in children (MIS-C), or death.
- Consider myocarditis and pericarditis in adolescents or young adults with acute chest pain, shortness of breath, or palpitations. Other symptoms are tiredness; rapid or abnormal heart rhythms (arrhythmias); fluid retention; and swelling of legs, ankles, and feet.
- Ask about prior COVID-19 vaccination if you identify these symptoms, as well as relevant other medical, travel, and social history.
- For initial evaluation, consider an ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. In the setting of normal ECG, troponin, and inflammatory markers, myocarditis or pericarditis are unlikely.
- For suspected cases, consider consultation with cardiology for assistance with cardiac evaluation and management. Evaluation and management may vary depending on the patient age, clinical presentation, potential causes, or practice preference of the provider.
- Report all cases of myocarditis and pericarditis post COVID-19 vaccination to VAERS.
- For follow-up of patients with myocarditis, consult the recommendations from the American Heart Association and the American College of Cardiology.
- It is important to rule out other potential causes of myocarditis and pericarditis. Consider consultation with infectious disease and/or rheumatology to assist in this evaluation.
Talking points for providers regarding myocarditis and pericarditis:
- About 285 million doses of COVID-19 vaccines have been given in the U.S. and only several cases of myocarditis were reported.
- These reports are rare, given the number of vaccine doses administered, and have been reported after mRNA COVID-19 vaccination (Pfizer-BioNTech and Moderna), particularly in adolescents and young adults.
- In a typical year, about 10 to 20 people out of every 100,000 people in the U.S. are diagnosed with myocarditis.
- Due to the rarity of people developing myocarditis after vaccination, it is hard to know if the vaccine is the cause or if these are cases that would have happened even without the vaccine.
- CDC and its partners are actively monitoring these reports, by reviewing data and medical records, to learn more about what happened and to see if there is any relationship to COVID-19 vaccination.
- Patients can usually return to their normal daily activities after their symptoms improve, and they should speak with their doctor about return to exercise or sports.
It is important to remember that possible safety signals like this are made public so that providers can know that certain symptoms might be myocarditis and need appropriate treatment. Without a public alert, a doctor might dismiss fatigue as something other than myocarditis, but the publicity helps them know to think of myocarditis as a possible cause. Note that it is more likely a person would develop this condition after COVID-19 infection itself.
As MDHHS receives additional updates we will share information. CDC has developed resources for the public Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination that can be shared with patients.
If you have any questions regarding COVID-19 vaccination, you may always reach out to us at CHECCimms@michigan.gov.