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Lý lịch

Myocarditis and pericarditis are rare but serious cardiac conditions. Myocarditis involves inflammation of the myocardium (the middle muscular layer of the heart wall). Pericarditis involves inflammation of the pericardium (the sac surrounding the heart). They can occur separately or together (myopericarditis). Complications of these conditions can include irregular heartbeat (arrhythmia), and/or enlargement and weakening of the heart – both of which can impair the ability to pump blood effectively.

Myocarditis and pericarditis can be inherited conditions, or can be caused by infections (such as influenza and COVID

Đ.iagnosis

Myocarditis and pericarditis present with a similar range of symptoms. In cases following vaccination, myocarditis symptoms have typically presented within 2 to 7 days, and pericarditis symptoms can occur within 2 to 3 weeks. Individuals may notice:

• Đau ngực, áp lực, hay khó chịu
• đau khi thở (đau ngực kiểu màng phổi)
• hụt hơi
• đánh trống ngực
• ngất (ngất xỉu)
• các triệu chứng không đặc hiệu khác như mệt mỏi, chóng mặt, đau bụng.

Association and incidence

Myocarditis, from any cause, occurs more commonly in males than females. It is also more likely to affect younger adults, compared with children or older adults.

Pericarditis, from any cause, occurs in similar rates among males and females. It is more likely to affect adults, compared with children.

COVID

19 vaccination

Most cases of COVID

Local and international data shows that pericarditis following COVID

Mpox vaccination

Myocarditis and/or pericarditis have been associated with administration of quần quèe smallpox vaccine ACAM2000, occurring at a rate of approximately 1 in 175 adults who receive the vaccine for the first time. MỘT very small number of cases of myocarditis and/or pericarditis have been reported following receipt of JYNNEOS (MVA-BN), with KHÔNG causal relationship established with this vắc xin.

Sự đối đãi

myocarditis and/or pericarditis (including arrhythmias, decreased cardiac function, congestive cardiac failure) are managed by a cardiologist. Treatment may include in-patient monitoring and pharmacological agents such as ACE-inhibitors and beta-blockers. 

Long

Hàm ý cho liều lượng trong tương lai

All episodes of myocarditis and/or pericarditis occurring following vaccination should be reported to the adverse event reporting service in your jurisdiction. 

tiêm phòng COVID-19

Further vaccination should be withheld until review by a specialist immunisation service if the individual has experienced:

• suspected myocarditis following COVID-19 vaccination (with no clear alternate diagnosis)
• suspected pericarditis following COVID-19 vaccination with abnormal investigations (and no clear alternate diagnosis)
• suspected pericarditis where investigations were unable to be performed/unavailable (in those aged 39 years or younger).

Mpox vaccination

Individuals who have been diagnosed with myocarditis and/or pericarditis following mpox vaccination should be referred to a specialist immunisation service for follow–up and advice on future doses.

Các biện pháp phòng ngừa

If both COVID-19 and mpox vaccination are recommended and the timing is not urgent, an interval of 4 weeks is recommended to minimise the risk for developing myocarditis and/or pericarditis.

However, if mpox primary preventative vaccination (PPV) or post-exposure preventative vaccination (PEPV) is urgent, it should not be delayed or withheld in individuals who recently received a COVID–19 vaccine.

Tài liệu

• Sexson Tejtel SK, Munoz FM, Al-Ammouri I, et al. Myocarditis and pericarditis: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. vắc xin. 2022;40(10):1499-1511. doi:10.1016/j.vaccine.2021.11.074
• ATAGI: COVID-19 vaccination – Guidance on myocarditis and pericarditis after COVID-19 vaccines
• MVEC: Mpox
• MVEC: COVID-19