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Myocarditis and pericarditis after Covid vaccine in young people, how to limit the risks

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Myocarditis and pericarditis after Covid vaccine in young people, how to limit the risks

Risk. And benefit. We play on these two words, on the relationship between advantages and disadvantages, the choice of vaccination for Sars-CoV-2 with Rna-messenger vaccines in young people and children. A relationship that is in favor of vaccine prophylaxis.

Now, to add an important piece to the knowledge on such a complex and constantly updated issue as the possible onset of myocarditis and pericarditis in this age group, following Covid-19 infection and after vaccination, comes a Canadian research that brings really important numbers (and considerations).

The study examines over 8000 cases reported in 46 different reports by Canadian scholars and, in addition to confirming the substantial rarity of cases of myocardial and pericardial inflammation after vaccination, reports a series of indications that can help to further limit the risks. which are however lower than those related to natural infection.

Myocarditis and pericarditis, you risk much more with Covid than with the vaccine

The survey is published on the British Medical Journal and was coordinated by Lisa Hartlingof the University of Alberta in Edmonton.

Who risks the most and when

Data analysis involves two main observations. Cases of myocarditis and pericarditis are highest among young males soon after a second dose of mRna vaccine. Furthermore, in the face of substantially mild cardiac pictures in the vast majority of cases, it is emphasized that the risk of myocarditis or pericarditis could decrease by extending the interval between the first and second dose to at least one month.

In particular, the results show that myocarditis rates after mRNA vaccines were higher in adolescent males and young adult males (50-139 cases per million between 12-17 years of age and 28-147 cases per million among 18 years of age). -29 years old).

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For girls and boys between the ages of 5 and 11 and girls between the ages of 18 and 29, rates of myocarditis after vaccination with Pfizer vaccine in particular could be less than 20 cases per million. Again: for people aged 18 to 29, myocarditis is likely higher after vaccination with Moderna than with Pfizer, and for people aged 12 to 39, rates of myocarditis or pericarditis may be lower when the second dose is given more than 30 days after the first dose.

Specific data for males aged 18-29 indicate that the interval between dosing may need to increase to even more than 56 days to substantially reduce rates of these conditions. In short: to limit the risks, it is better to space out vaccine administrations.

“This information can be very useful, with a view to postponing the second dose: we are constantly updated on the basis of scientific evidence to update the vaccination schedules in this age group – he comments. Giancarlo Icardi, director of the Hygiene Department of the University of Genoa. However, it must be said that these indications will be useful above all for any boosters that may be proposed in the future, given that by now there are very few subjects between 18 and 29 years who must receive the second dose. And we must not forget that already today for antibody kinetics, boosters are proposed 120 days after the previous recall or a natural infection “.

The situation must be followed

In their work, Canadian scholars do not fail to propose some questions to which a definitive answer still needs to be provided, pointing out once more the complexity of a topic that still presents uncertainties. For example, in the face of post-vaccination myocarditis in children who are substantially light and tend to reduce on their own, it is essential to continue observation over time to define a long-term prognosis of the cardiac picture. In fact, the authors point out the importance of “a continuous surveillance of myocarditis after mRna vaccines, especially at a younger age, after the third dose (and any subsequent doses) and in previous cases to support the continuous decision-making process for possible boosters. vaccines for Covid-19 “.

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In short, in cases where cardiac inflammation has been observed, the picture must be checked, even with long-term follow-up. The goal must be to unravel the still unknown mechanisms behind the potential risk of post-vaccination myocarditis and pericarditis.

“In this sense, vaccination” vigilance “already exists in Italy, even beyond the Sars-CoV-2 vaccine – says Icardi. However, it is a process that requires the person to report. For myocarditis and pericarditis it is important that the doctor enters the control process, as is indicated by the forms that are delivered and that warn about any symptoms to be monitored and reported to the doctor in the period following the administration of the vaccine, to then establish a monitoring path for those who have reactions such as myocarditis or pericarditis “.

Heart door

Vaccine for Covid and myocarditis risk, the indications of cardiologists

by Federico Mereta

The identikit of pericarditis and myocarditis

Inflammation of the membrane that protects the heart, the pericarditis, it can lead to the heart not working properly because it is as if it is being squeezed in a vise that allows the muscle to expand. Thus, pain can appear, changes in heart rhythm with increased beats, a feeling of malaise.

Few tests are then sufficient to clarify the picture, which in its exudative form typical of viral infection is almost always treated successfully with symptomatic treatments. The constrictive form, on the other hand, appears rarer and can be linked to specific conditions, such as a tuberculous infection or be among the consequences of an operation on the heart.

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The cardiologist specialist, on a case-by-case basis, can study the most suitable treatment which in any case depends on the causes that caused the picture: if a viral infection is involved, it is above all necessary to counteract the symptoms by reducing inflammation and pain.

The myocarditis it is instead linked to the acute inflammation of the myocardial cells, which is precisely the heart muscle tissue. It manifests itself with symptoms ranging from palpitations with increased heart rate to chest tightness, but in some cases there are fever and unexplained cough. It must be said that also for this picture the viral cause is often important, so much so that, in the period prior to Covid-19, myocarditis was often the consequence of a flu infection.

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