Myocarditis after vaccination, firm data

hello and welcome to today's talk now i'm going to give you the essence of this talking about the first four or five minutes and then if you want to watch the whole thing you can now it's based on this question here now this is from sarah john please could you review this article from israel's national news it says the risk of myocarditis following mrna covert vaccine is around 133 times greater than the background risk is this true um and if it is true why is it not all over mainstream media well to deal with that last bit first um i don't know why mainstream media don't seem to report on these things more than they do you would think it would be a legitimate part of informed comment so i don't know the answer to that one you'd have to ask the director general of the various mainstream media outlets and their people in charge but let's just clarify the question here this is it here new study uh and it does say 133 times risk of myocarditis after covered vaccination and to answer this question of course because we have to just go by exactly what the evidence says we have to go to the actual study here where this originated from so this is the study that's actually originated from and it's in the um it's in jama journal of the american medical association you can download the pdf it's all available free which of course is very generous and the whole thing is there now to be fair it's not a very easy read so i'm just going to sort of um i'm just going to give you sort of a quick pre-sale of this a summary of it and you can decide whether you want to listen to the rest or not is there 133 times greater risk it's actually probably much more significant than that but what we know from the data my calculations at least it's 84 times increased risk in the higher risk category of young men and adolescents now why am i saying is actually 84 times the risk based on the data but why am i saying it's probably more than 133 times the risk in other words that this is an underestimated risk well there's fairly strict criteria for diagnosing a case of myocarditis and indeed pericarditis so fairly strict criteria so it's conceivable that some people have an inflamed myocardium then therefore by definition myocarditis might not meet the criteria that that could be true of some cases many cases of course are simply not reported people simply don't report the case how many we have no idea now this is all based on vrs data the the vaccine adverse events reporting system in the united states and i've looked at this and it's it although it says that anyone can fill out a vera's return really you've got to be quite a specialist clinician to do it i mean i i had to think about it and i'll show you why it's complicated before so we can conclude that there's an increased risk of myocarditis and pericarditis after the mrna vaccines we can say that definitely can we say that it's caused by the vaccine technically the paper doesn't claim that it says there's an increased risk after the vaccine so you'll have to decide uh yourself whether it's uh causal link or not the paper doesn't claim doesn't claim it's a causal link it just says there's an increased risk which is is patently the case so if you want to carry on watching do it is it is pretty uh pretty interesting paper now um myocarditis case is reported after this that's the name of the paper there us data uh from the 20th of december to august 2021 so there's a good few months of data there that that's that's good paper published just on the 25th of january now i've just put this list of people in here so you can see where these people are working this is a very uh prestigious source so a lot of people work for the cdc uh school of medicine and more university children's healthcare atlanta etc pretty prestigious uh institutions and a long list of authors so this paper carries quite a lot of credibility uh this is the actual reference that john would like you to cite so i've done so that's their actual reference now this is important because vaccinations against covered 19 provide clear public health benefits according to the paper but vaccination also carries potential risks so i think both fairly obviously true statements there to kick off the risk and outcomes of myocarditis after covered 19 vaccination are unclear according to this paper so they're actually saying that it's still unclear that's why this needs clarified which is of course what they're attempting to carry out on the on with this uh with this paper um whatever i mean there we are to describe reports of myocarditis and the reporting rates after mrna based covered 19 vaccines in the united states so that's what this is about now it's a descriptive study reports from myocarditis um to the vaccine adverse events reporting system vera so it depends on this reporting and it's a passive system so if this complication comes up or any complication comes up from the vaccine people can decide to fill out this viras form or not but as i'll show you it's a really quite complicated form and i know very often when drug complications are come across in in the uk it's actually quite a big job to report it so sometimes it's just simply not done um so so really these veras returns are the minimum amount and the real number could be much higher but of course i can't say that definitively we don't know we don't know how often these forms aren't filled out we don't know how often they are filled out after mrna based vaccine so that's what this is about now let's uh before we look at some interesting graphics let's look at this so it's between those dates 20 december 21st of august in 192 million uh people older than the age of 12. but of course we noticed that if this 192 million which is the the whole number of people probably been vaccinated in this time period many of these are much older than the the age range in which uh myocarditis is likely to occur so that figure you could argue is uh well it is correct but it's also um remember it's the younger demographic that's at risk of this um it's virtually unheard of at my age this is typically people under under 30 that are affected by this so here we have some of the data here so this is a vaccination with the bnt162b2 which of course the physical vaccine so up and down here we've got reported cases of myocarditis after vaccination with pfizer age at onset of myocarditis so the these are years so for example the highest rate here is people that are 16 years of age and that was the number of uh cases with the pfizer vaccine until we get to 40 years of age when 39.40 when there's actually very few cases and they don't even bother putting the uh they don't even bother putting the 50s and 60s and 70s and 80s because it is so uncommon um or virtually unheard of in those older age groups so this is so important because we're dealing with young people here and this is the number this is the number for all all young people are pretty sure yeah i think that's the number four young people there so um and this is the uh this is after the modern vaccine now if we just look at the scales here so that was like 40 60 80. this is 20 40 60 we see many many less cases with the moderna vaccine so more cases with the pfizer vaccine and again aging years across there now this is vaccination with pfizer and this is reported cases of myocarditis after vaccination and this is days after now this shows that you get a few cases on the first day but most cases are recurring on the second day some on the second sorry mo yeah some on the first day after most on the second day after third day after so most of these cases are recurring the vast majority in the first few days but virtually all in the first 10 days so this is shortly after the uh the vaccine does more common of course after the second dose and again with the figures here for um first of all we notice that the numbers here that so that's 200 line there uh with the uh moderna that's the 80 line there so it's less common with with moderna but again similar age uh similar not age group sorry similar time after vaccination most common in the first few days after the vaccine has been given most common with the sec after the second dose now during the analytic period uh visa vaccine 12 years and older mrna vaccines were being given to uh the the uh sorry the the the fisa vaccines were being given to people 12 and older the modern vaccines at this time were only being given to people 18 years and older so during this time period that is what who were being vaccinated so no one was getting the uh nowhere between the ages of 12 and 18 were getting the moderna vaccine during this time period so that's what they were exposed to those vaccines main outcomes and measures expected rates of myocarditis by agent sex were calculated using the 2017 to 2019 data and that that's how we that's how we get that number so the expected number of cases of myocarditis was in that age group was taken before the pandemic 2017-2019 compared to this 2021 time period when this data was actually collected for people younger than 30 years of age medical records reviews of clinicians interviews were conducted to describe clinical presentations diagnosis etc but of course these were not always available the full clinical details were not always about they were in most cases but not always available so the result now remember amongst this 192 million people vaccinated 354 million doses of vaccine but most of these vaccines of course were given to people over the age of 30. so it's a bit it's a bit misleading that so if we look to actually looked at the number of um vaccinated people in that age group it will probably be better because as we say the older people are essentially at no risk of this complication so a bit disappointing they didn't break that number down further really this this would tend to make the cases look rarer than they are because this is these are the cases for the whole population not that particular demographic which was unfortunate that they chose to express it like that uh 1991 reports of myocarditis 1626 met the criteria now how many cases of myocarditis were there that we don't know all we know is that many were reported on the the varas system the actual number of cases we don't know of those with myocarditis uh median age 21 interquartile range in other words 50 fell between the ages of 16 and 31. so to be fair 25 of cases there are over the age of 31. so so um it's not unheard of in in slightly older age groups median time symptom onset as we said was pretty quick two days males 82 percent of cases now it's a pity well you could argue it's a pity that the adenovirus vector vaccines which are associated with a much much lower risk of myocarditis were never rolled out in the states because it could be when you actually add up the the relative risk that it's safer to give the adenovirus vector vaccines like the oxford vaccine to young men because young men are those the ones most at risk eighty-two percent of myocarditis cases meaning that the other eighteen percent of course were in uh in females so the vast majority of cases in young men which of course is uh exactly what we don't want now reporting rates for myocarditis uh within seven days after covered 19 vaccination uh exceeded the expected rates of myocarditis across multiple age and sex strata so um in other words in any age group there's more cases of myocarditis than would be expected and in both sexes there was an an increased incidence if so even in young women there was an increased incidence compared to what had been expected in the was it years 17 2017 and 2018 or whatever the comparative years were the rest of my card eyes were highest after the second dose of vaccine which we've known for a long time adolescent males 12 to 15. 70.7 million doses of the vaccine given and uh so set 70 sorry 70.7 cases of myocarditis per million cases of vaccine given so nearly 71 cases per million vaccine given and i've worked that out as one case in 14 144 but again many of the people that were vaccinated were much older and it's not clear that the paper's actually not clear whether it's just comparing within its demographic or for everyone it's not not really clear on that male's age 16 to 17 105.9 cases per million doses uh that's that's one case for nine thousand four hundred and forty two but if we just look at the demographic i think that'll be a fair bit higher is my understanding as my reading of this paper males 18 to 24 um 52.4 milli per million doses that's one case in 19 000. and 56.3 actually in that particular age group it's a bit confusing there let's go by the graphic that is what it says in the paper but the graphic indicates that that's not correct so i'm not quite sure if that's just a fault in the way the paper's written anyway that works out at one case in seventeen thousand a bit now myocarditis under thirty uh 826 cases who had detailed clinical information available as we said quite a few didn't have detailed clinical information and again we'll see the gaps in the data here become obvious um 792 of enter 809 uh 880 98 had elevated troponins now troponins are associated um in the heart there's contract our fibers that cause the heart to contract so it contracts and then relaxes and troponins are part of these uh contractile fibers and if a heart cell is damaged if a myocyte is damaged these components of the uh the contractile fibers that are supposed to be kept inside the cell get out into the blood and we can it's a sinus it's a sign of cardiac cell damage basically so it means that um most of them had damage to their myocytes their myocardial cells 72 abnormal uh electrocardiogram results and again there are criteria for this so the electrocardiogram is just the way the heart is beating you probably in the uk we call it ecg in the states they call it ekg so you have um you have a p like that then you have a qrs complex like that and then you have a t wave like that and that that they're equal that they represent the electrical activity going on in parts of that so that is the contraction of the top chambers of the heart atrial myocardial contraction this one here the qrs so that's p q r s is the contraction of the the qrs complex is the contraction of the ventricles the main pumping chamber chambers and the t wave is the electrical activity of the main pumping chambers going back to normal so a normal rhythm's got a pqrst roughly in the right order and the rate is uh well in no exactly in the right order and the rate is between 60 and 100 for a sinus rhythm so that is a normal sinus rhythm so there's an abnormality of this um 72 had cardiac magnetic magnetic resonance imaging results so 72 had mris and the good thing about these modern cardiac mri is you can actually see the heart contracting so it gives you kinetic information about the contractility of the heart which of course can be impeded if there's inflammation of the heart muscle um hospital data 96 were hospitalized so most most of these patients were hospitalized of the ones that were recognized of course eighty-seven percent of resolution of symptoms by uh discharge from hospital which i suppose is good but of course that means 13 didn't so um you know it's it's kind of easy to put this in a particular way 13 didn't the most common treatment was non-steroidal anti-inflammatory drugs such as the most simple one that everyone knows about of course is aspirin more common one that's good these days are ibuprofen in the uk in the proxima they've probably got different names in in the states but these are the non-steroidal anti-inflammatory drugs which are very good analgesics um and it doesn't mention this but paracetamol or acetaminophen is also good for pericardial pain surprisingly you i used to treat patients with pericardial pain and they often responded better to uh paracetamol that's acetaminophen or tylenol than they did to morphine strange but but uh but absolutely true um anyway um so the the these are the these are the figures for 16 to 17 year olds now i know you can't see this but that's uh that that's the incidence after the first vaccine which was 7.26 that's the incidence after the second vaccine which was 105. that gives a total of a 113.12 cases and normally you would expect 1.34 in the same time period the expected is 1.34 so 1.34 divided into 113.2 i get 84 times more likely but as we say the real number's probably way higher than that now i don't know how much detail to go into today but this is the supplement that we get so i'm just going to mention this a little bit because there are some causes for concern here so presence of one or more new worsening of the following clinical symptoms chest pain pressure or discomfort shortness of breath difficulty breathing pain with breathing feeling your heart beat inside your chest palpitation syncope is fainting but as well as that you need to have a history of histological confirmation now this would only be detected on postmortem because i really can't imagine that during cardiac biopsies so histiopathology of course is when you look at the heart under the microscope or some of the tissues under the microscope and the idea that you would do that in a healthy in a living person is i've never seen it done um maybe some centers do it so if you're a clinician working in the states and you do do cardiac biopsies on on living patients then do let me know but um i will be surprised so um but if they didn't have that which they probably wouldn't then they would need an mri so it's getting quite difficult to get to be a confirmed case so you have to have the presence of one or more of these fair enough but then you have to have that which would probably never happen or you have to have an mri which can be difficult to obtain so you had to have a cardiac magnetic resonance imaging finding consistent with myocarditis and troponins so they're kind of making it a little difficult and no other identifiable causes to be a probable cause you need those same things as well probable case rather so those same clinical track criteria and um you also need troponin levels above the upper limit fair enough uh an abnormally cg or or rhythm um consistent with myocarditis abnormal cardiac function or wall motion as we said with mri or sometimes ultrasound scan or or mri finding so they're making it quite difficult and to eliminate cases so you could say they're being exacting but that could mean that some people that are this could mean that some people with say mildly inflamed myocardiums aren't being put forward as a probable or confirmed case it could mean that and again quite difficult to uh to die so st segment or two i'm not going to go into these but you can see there's extra criteria there so st segment or t wave abnormalities i mean i'll just i'll just explain the first one the st so um so so as we said the norm the normal rhythm is the uh p uh qrs and the the t wave so remember that's p q r s t so an st abnormality will be an abnormality between there and there so what you might have for example is uh you'd have a p a qrs and then something like st elevation like that before the t wave so that that that would be an abnormality of s so the s that would be the the s there and the t the t there so there will be an abnormality between in those bits so instead of going down like that it might just go like that so that but these are fairly specialized things and i'm not going to go into them i'm not going to go into them in detail um it just me it does mean it's fairly the specific criteria it's not any change in the ecg in other words these specific criteria now reports on the uh the viras system it says this on the vrs website here the vaccine adverse events reporting system is a passive reporting system meaning it relies on individuals to send in reports of their experiences anyone can submit a report to virus including parents and patients so anyone can do it or can they because let me just show you the form that needs to be filled out now here we have part of the form here um part of the form so um you would have to decide whether there's any anaphylaxis coagulopathy covered 19 death gyong barry syndrome kawasaki disease multi-system inflammatory system in adults multisystem inflammatory system in children myocardial infarction uh myopericarditis narcolepsy pregnancy seizure stroke transverse myelitis or other now this is not a quiz but how many members of the public would know what the heck that was talking about i mean you might know what anaphylaxis is there's a very allergic reaction you might not why should you know that that relates to abnormal clotting of the blood you wouldn't have a clue gbs how do we even know it stands for guillain-barre syndrome let alone what it is kawasaki disease inflammatory disease myocardial infarction blocking off of part of the heart muscle myo pericarditis infection of inflammation of the myocardium and pericardia inflammation of the pericardium and myocardium narcolepsy you're always falling asleep seizures fitting stroke is a cerebral vaccine cerebrovascular accident transverse myelitis it is a transverse legion across the spinal cord so that's a spinal cord running up and down there transverse myelitis will be a lesion that goes across that but i mean that's not just not how can a member of the public fill that out i don't they simply wouldn't have the you know it's like me doing a flight check before taking off on an airplane you know whether the flaps are right i don't know a clue also you asked that they'd asked you to identify other infections so the member of the public it would appear is expected to know whether the infection was a dna virus coxsackie coxsackie virus i mean how could you know any of this stuff you know it's it's all specialized stuff another part asks you to say if there's any rheumatoid arthritis scleroderma systemic lupus erythromethosis surge on syndrome or other inflammatory diseases i mean how can a member of the public do that also another part of the question here is st elevation abnormalities two wave abnormalities pr depression atrial supraventricular ventricular thermia's conduction delays or block uh i mean av i mean that stands for atrioventricular block first degree who knows you know unless you're a cardiac nurse or a doctor cardiac cardiologist you're not going to know these things you know try these out on an average gp and see if you can remember them you know you probably won't be able to unless he's done cardiology recently uh or another part decreased left ventricular function per you know pericardial effusion you know what is an effusion well an effusions in the collection of fluid but how how would you know that ejection for actually all these things how would you know them so how on earth a member of the public could fill out one of these forms well they couldn't i don't see how they could i just don't get it so you you are relying on um the patient's doctors to fill it out or specialist nurses who have knowledge of these things but um the idea that you know i actually struggled when i read that it actually it actually said that um anyone can submit a report to virus including patients parents and patients um it would be interesting to know what proportion of these forms were sent in by parents and patients in the individuals because unless they were clinicians themselves or some sort of medical scientist i don't see how they possibly could correct me if i'm wrong but i i don't get that bit so there we go now the last question is has there been any previous um myocarditis pericardites from other vaccines and the answer to that is yes previous vaccination myocarditis only smallpox vaccine is the only one though american military personnel but that wasn't seven to 12 days after vaccination so this pericarditis myocarditis does seem to be unique to the mrna vaccines and of course i'm reminded that we talked to one of the leading scientists in denmark about this professor niels hoyby on a video on this channel and he repo he compared the incidence of myocarditis in denmark to norway and of course in denmark they are aspirating before injecting so they stick the needle in and they draw back to make sure they're not in a vessel and if the blood comes out and they think they're in a vessel they're not going to give it so that's in denmark whereas in norway they don't bother and they found that there was three times more cases of pericarditis in norway where they don't aspirate as opposed to denmark where they do aspirate therefore everyone should be in my view everyone should be aspirating and eliminate that variable but that's not being done okay a bit complicated today so um i hope you followed that so we we can we can we can say that there's more myocarditis uh it's increased after vaccination and uh the 133 figure times 133 figure we don't have data for the times 84 figure we do in that particular age group but for the reasons i've mentioned it's probably more than 133 times so um what i would appeal is for this to be covered more on mainstream media so that people can make informed decisions that's what this is about giving information to make informed decisions and i'm going to leave it there okay thank you for watching

Channel: Dr. John Campbell

Views: 1,966,908

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: Hb1Xm1uaedU

Length: 30min 12sec (1812 seconds)

Published: Fri Feb 11 2022

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