COVID Vaccine | Myocarditis Risk

Hello, Welcome to my channel Medicine with Dr.  Moran. If you've not been here before I'm Dr.   Keith Moran. Today I want to talk about two  specific side effects of the Covid-19 vaccine   Myocarditis and Pericarditis. I want to report on  a study that was done in the province of Ontario   in Canada. This province includes the cities  of Toronto and Canada's capital city Ottawa.   This looked at the incidence of Myocarditis which  is inflammation of the heart muscle as well as   Pericarditis. Pericarditis is inflammation of the  sac that surrounds the heart. Now there's a long   list of causes for Myocarditis. The main causes  include viruses, fungi, bacteria, parasites,   as well as toxins, medications, radiation  chemotherapy, trauma, and autoimmune diseases.   The list for possibilities of causes for  pericarditis is actually very very similar.   The study in question looked at the frequency  of these two conditions between December 13,   2020 to August 7, 2021. This was done because  there were significant signals from the United   States as well as Israel about Myocarditis  and Pericarditis secondary to the vaccine.   I recently mentioned this side effect was more  frequent in the vaccinated versus control and   vaccinated group on a recent video. This video  looked at short-term side effects to the Pfizer   vaccine over a six-week period. There's a  link to that video below in the description.   Now on to the Ontario study. Since the start  of the immunization program they found 204   cases in Ontario of either Myocarditis or  Pericarditis which met the Brighton collaboration   case definition for those two diagnoses.  So we know that there are definite cases.   Now of these 204 cases 79.9% occurred in  males and 69.6% occurred following the   second dose. The average time from vaccine  administration to symptom onset was two days   and 79% of cases occurred within seven days of  vaccine administration. There were 72 cases of   Myocarditis, 58 cases of Pericarditis, and 74  cases of a mixture which we call Myopericarditis.   99% of the cases attended the emergency department  with 72% of the cases getting admitted to the   hospital and 1.5% of the cases ended up in the  intensive care unit. Now fortunately there were   no deaths. I was very disappointed to not see any  data on the patients that were admitted in terms   of their length of stay, whether there was cardiac  dysfunction, the levels of their cardiac injury,   blood test markers, and whether there were things  like heart failure, or rhythm abnormalities.   As you can see on this graph the majority  of the cases occurred after the end of May   when vaccination programs started to involve  younger adults. Many second doses were also   around that time being administered. There was  also an increased vaccine supply particularly   of Moderna as well as release of an enhanced  surveillance directive to follow Myocarditis   and Pericarditis. So at this point doctors as  well as people who were vaccinated were more in   tune to look for symptoms that might indicate  Myocarditis or Pericarditis. These symptoms   of this would be chest discomfort, palpitations,  shortness of breath which typically would occur as   I've mentioned one to seven days post-vaccination.  This is the reporting rate of Myocarditis and   Pericarditis per million doses administered  by age by Pfizer in green and Moderna in blue.   You can see that the majority of cases are  occurring in people under the age of 40 with   a much higher incidence in the younger age  group. As Pfizer in Ontario has been given to   people below the age of 18 there's an increased  rate in the green line of Pfizer at those ages.   Moderna has not been approved in Ontario and so  its statistics only go down to the age of 18.   When you look at the Moderna statistics which  is the blue line the risk of Myocarditis or   Pericarditis is much higher in the 18 to 24  age group. On this slide the overall reporting   rate in all age groups of Myocarditis or  Pericarditis following the Pfizer vaccine   was 8.7 per million following the second dose  compared to 6.4 per million following the first   dose. For the Moderna vaccine it was higher it  was 28.2 per million following the second dose   and 6.6 per million following the first dose.  What they found though was that the frequency   was highest for individuals between 18 and 24  and it was much higher following the second dose.   So here Moderna was 263.2 versus 37.4 per million  doses for the Pfizer vaccine in this age group.   Now this difference in the reporting  rates persisted when the analysis was   just restricted to the June 1st to August 7th  period which was the surveillance directive time.   To put it in better perspective Moderna at  263 per million is a risk of 1 in 3,800.   For the Pfizer second dose their risk was 1 in  26,000. These numbers are in line with what has   been seen in previous observational reports  from the USA as well as Israel. These are a   definite increase from the baseline incidence of  cases that we would expect to see in the general   unvaccinated population. Meaning the vaccine is  definitely causal here meaning it's causing what   we're seeing. It's possible but not proven that  the higher frequency with Moderna over Pfizer may   be simply due to the dose of the Moderna vaccine.  The Moderna dose is a hundred micrograms in each   vaccination whereas the Pfizer MRNA vaccine  is only 30 micrograms. So there's a threefold   difference there. I would also point out that the  dose given to people in the 12 to 17 age group are   exactly the same as the adult dose which may not  be optimal. Many 12 year olds are not fully grown.   I would point out that there have been numerous  case reports in children between 12 and 18 in a   number of medical journals and Myocarditis reports  early in the pandemic from Covid-19 infections   they mostly stemmed from an abnormal MRI scan  without symptoms without ECG abnormalities and   without significant troponin elevations.  Troponin is a marker for cardiac injury.   There were a handful of flawed medical studies  which nearly stopped the U.S. college sports   scene last year due to this. Now the pediatric  cases that I'm talking about post-vaccination   are in contrast to Myocarditis from the  virus because they had significant troponin   elevations which is a marker of injury.  They had abnormal MRI scans, abnormal ECGs,   and significantly elevated inflammatory  markers. Heart ultrasounds also demonstrated   reduced cardiac function in some people with this  diagnosis. So when it comes to the vaccine these   cases of Myocarditis are definite cases with not  just a mild abnormality on an MRI but many other   abnormalities seen on their tests. Over the years  I've managed numerous people with Myocarditis   and Pericarditis in my practice and I point out  that we would recommend avoiding high intensity   exercise for six months after the diagnosis has  been made. So it isn't always a benign diagnosis.   It appears rare in the literature thus far  that vaccine-induced Myocarditis causes   any long-term cardiac dysfunction but there's  always a small chance of that from the vaccine.   Myocarditis itself can be a serious condition but  it's been downplayed in the media. So there are   some things to consider moving forward should  we give a lower dose vaccine in this age group   or simply a single dose. These are important  considerations. People can feel risk differently.   Some patients fear the illness more than the risk  of the prevention or treatment. Understanding   concerns of the patient is important to try to put  the risks and the benefits in context for them.   Parents or the individual may feel  more risk from the virus than from   the vaccine or even vice versa  despite whatever data you provide.   There are many factors that come into play such  as whether the young adult has comorbidities   or whether their parents or grandparents  that might live with them are at risk also   and if so in this situation it would make sense  to consider vaccination. This kind of discussion   with your physician is important and of course it  should be up to the kids and parents to decide.   This is a nuanced decision. This is why in the  UK they've not been vaccinating people under   the 18 as of September 2021. They're looking for  more evidence-based data. The data of course can   change with new variants and we do need to be  ready to change our course if the data changes.   I appreciate you watching till the end today.  Thanks for joining me on Medicine with Dr. Moran.   I'm Dr. Keith Moran. Get healthy and stay healthy.

Channel: Medicine with Dr. Moran

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Id: aJETb9EKaI8

Length: 9min 57sec (597 seconds)

Published: Fri Sep 17 2021