The Skeptical Cardiologist

Covid-19 Vaccines and Myocarditis: Balancing Benefits and Risks in Adolescents and Young Adults

Two days ago the FDA indicated it will add a warning about rare cases of myocarditis in adolescents and young adults to information sheets for the Pfizer/BioNTech, and Moderna COVID-19 vaccines.

This followed a decision made by CDC advisor that myocarditis in adolescents and young adults is likely linked to the vaccines, but that the benefits of the vaccine ouweight the risks.

I think this is a reasonable approach to the problem: make doctors and patients aware of the issue, provide them with the best possible statistics and let them make the decision together.

The slides that the CDC advisory groups viewed are available online and they present an excellent and easily readable summary of the topic.

First we have a presentation on myocarditis in general and as it relates tothe mRNA COVID vaccines:

The incidence of myocarditis in 15 to 18 year olds in 2015-2016 was 1.8 cases per 100,000 individuals and 2/3 were male.

There are lots of different causes of myocarditis. For most patients a specific cause is not determined.

Benefit Versus Risk of Vaccination In the Young

Another presentation focused on the risk to benefit ratio of the mRNA vaccines and there is a wonderful slide deck available online and presented below

The slides show in detail by age group both the benefits of the vaccines (cases/hospitalization/ICU admissions/deaths prevented) and the presumed risk of myocarditis after first and second doses of the vaccine.

It is clear that individuals over the age of 29 years stand to benefit tremendously from vaccination with minimal risk.

Everyone in this age group should get vaccinated as soon as possible because COVID-19 is resurging and the vaccines protect against the delta variant which is leading the resurgence. My state, Missouri, I am sad to say, lead by southwest Missouri is leading the country in COVID resurgence as of this writing.

The benefit to risk ratio is lowest for second doses in males aged 12-17.

Young adults, aged 18-24 years show increased benefit compared to adolescents with decreased risk of myocarditis

There are additional considerations beyond myocarditis regarding benefits for individuals

And there are significant population-level benefits to consider:

The presentation concludes that benefits outweigh risk for COVID -19 vaccination in these younger age groups

Misinformation and the Vaccine Hesitant

I ask every patient I see in my office if they have received a COVID-19 vaccination. If they haven’t we have a discussion and I attempt to counter whatever misinformation is leading to their vaccine hesitancy.

Clearly, a lot of misinformation and propaganda is being circulated.

One patient told me that vaccines had caused 4000 deaths. This widespread fallacy is clearly false.

Another told me that the vaccines weren’t approved by the FDA. They are approved under an emergency use authorization and it is a foregone conclusion that they will receive full approval because large well-done randomized controlled clinical trials have demonstrated dramatic efficacy and safety.

Provaccinely Yours,

-ACP

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