HCFI Dr KK Aggarwal Research Fund

19^th June, 2021; 11am-12pm

Key points of HCFI Expert Round Table

• Health officials around the globe are investigating the potential link between vaccines and inflammation of the myocardium with the attention focused on the Pfizer-BioNTech and Moderna mRNA vaccines in particular.
• Myocarditis has been found to occur in many young adults, more in men, who have received the Pfizer-BioNTech Covid-19 vaccine. There have been 226 cases of post-vaccine myocarditis or pericarditis in individuals below 30 years of age (CDC).
• Eight cases have been reported in the US and Italy in otherwise healthy men aged 21-56 years. These patients presented with chest pain and were diagnosed with acute myocarditis about 3 days after receiving an mRNA vaccine. Five of these developed fever within 24 hours of the vaccine followed by chest pain after 48-96 hours. The chest pain resolved in all cases and the patients were discharged in stable condition with preserved LVEF.
• Another series of cases has been reported in seven adolescents (males 14-19 years) 4 days after Pfizer-BioNTech vaccine. All of them had high troponin levels and their symptoms resolved rapidly following treatment.
• A series of six cases from Israel has also been reported, where patients presented with chest pain and discomfort. Five patients developed myocarditis after the second dose, while one patient presented after the first dose. The clinical course was mild in all patients. The authors of this case series concluded that myocarditis after Pfizer vaccination may be possibly considered as an adverse reaction following immunization. Although they cautioned that further surveillance is warranted.
• There is a significantly higher risk of cardiac involvement from Covid-19 infection vis-à-vis Covid-19 vaccination. Hence, Covid-19 vaccination should remain the cornerstone for population immunity.
• So far, a causal relationship between vaccine and myocarditis has not been established. But, the medical fraternity should be aware of this side effect and the need for collection of relevant data and monitoring of persons (surveillance) especially after mRNA vaccination.
• The number of reported cases is very small as compared to the number of vaccinations, although cases may be much more as many may go unreported.
• Vaccine should not be taken outside the established vaccine center. Reports of agencies vaccinating individuals with fake and/or expired vaccines are a cause for concern.
• Every death following vaccination should be reported and investigated thoroughly.
• mRNA vaccines may have potential cross reactive antigen issues.
• So far there is no record of post-vaccine myocarditis occurring in India with the vaccines currently in use. Also, mRNA vaccines are not yet approved for use in India. However, most of the post-Covid deaths have a cardiac cause. So there is a definite link between myocarditis and Covid-19.
• High risk patients should get their CRP done. It is probable that patients with high CRP due to a pre-existing inflammatory disease might be developing myocarditis after taking the vaccine.
• These patients need to be examined carefully to find out factors such as any comorbid condition that predisposed them to develop myocarditis after the vaccine.
• While there is a need to keep track of such cases, this should not affect the vaccination drive.
• Prior to Covid vaccine, small pox vaccine was known to cause myocarditis.
• There is an AEFI module on Cowin platform. The user is supposed to report any symptom after vaccination on this platform. Every state has an AEFI committee, which discusses these adverse effects every month. Follow up on these meetings at ground level is extremely important.
• The rural population has a well-defined healthcare structure. For every 1000 population, there is an Asha worker and also an anganwadi worker, who are facilitating immunisation. For every 5000 population, there is a multipurpose worker (MPW). They are in close communication with the community and they capture any adverse event.

Participants

Dr AK Agarwal

Dr Suneela Garg

Dr Ashok Gupta

Dr Prof Mahesh Verma

Dr Anita Chakravarti

Prof Bejon Misra

Dr Jayakrishnan Alapet

Dr DR Rai

Dr KK Kalra

Ms Ira Gupta

Mr Saurabh Aggarwal

Dr S Sharma