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Federal health officials have released guidance for clinicians on diagnosing, managing and reporting myocarditis and pericarditis in adolescents and young adults after COVID-19 vaccination.
Since April 2021, there have been reports of myocarditis and/or pericarditis after receipt of an m-RNA COVID-19 vaccine, according to the Centers for Disease Control and Prevention (CDC). The CDC did not provide data on the number of cases but called them rare. It is unclear whether these cases are linked to vaccination.
Most cases have been among male adolescents and young adults ages 16 and older, typically occurring within several days after the second dose of m-RNA COVID-19 vaccine (Pfizer-BioNTech or Moderna vaccines).
Both the AAP and CDC continue to recommend vaccination for people ages 12 and older.
“The known and potential benefits of COVID-19 vaccination outweigh the known and potential risks, including the possible risk of myocarditis or pericarditis,” the CDC said on its website. “Also, most patients with myocarditis and pericarditis who received care responded well to medicine and rest and quickly felt better.”
More than 165 million people in the U.S. have received at least one dose of COVID-19 vaccine, including more than 5 million million adolescents ages 12-17, CDC data show.
The CDC recommends clinicians consider myocarditis and pericarditis in patients who develop acute chest pain, shortness of breath or heart palpitations, within a week after vaccination. Initial evaluation may include an ECG, a troponin level, and tests for inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate.
Clinicians who suspect myocarditis or pericarditis should consider consulting with a pediatric cardiologist. They also may want to consult with an infectious disease specialist or rheumatologist to rule out other possible causes such as a current or previous COVID-19 infection or other viral infections.
Management of heart inflammation will depend on the cause, patient age and clinical presentation Patients with these conditions should wait three months and receive clearance from a doctor before returning to rigorous activity such as competitive sports.
“We look forward to seeing more data about these cases so we can better understand if they are related to the vaccine or if they are coincidental,” said Yvonne A. Maldonado, M.D., FAAP, chair of the AAP Committee on Infectious Diseases. “Meanwhile, it’s important for pediatricians and other clinicians to report any health concerns that arise after vaccination to VAERS (the Vaccine Adverse Event Reporting System) so we can systematically track and analyze them, and determine if they signal a real concern.”