Re: SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study
Dear Editor,
This study makes the conclusion that that the Moderna mRNA-1273 vaccination was associated with an increased rate of myocarditis or myopericarditis compared with unvaccinated individuals overall, while the Pfizer BioNtech BNT162b2 vaccination was associated with an increased rate of myocarditis or myopericarditis among female individuals. However, the absolute rate of myocarditis or myopericarditis cases after SARS-CoV-2 mRNA vaccination was low overall, among female participants, and among younger age groups. It also claims, the clinical outcomes after myocarditis or myopericarditis events were predominantly mild, providing evidence to support the overall safety of SARS-CoV-2 mRNA vaccines.
However it gives a proviso that much larger multinational studies and meta-analyses are needed to specify risks within smaller subgroups and the risk of myocarditis or myopericarditis after SARS-CoV-2 infection versus vaccination.
I would postulate that a significant factor increasing the risk of myocarditis or myopericaditis is the current mode and procedure by which these mRNA vaccines are administered to patients. The Green Book, Chapter 14a, page 12 indicates that both these mRNA vaccines should be intramuscular injections in the deltoid muscle. However, the protocol omits a key step, to ensure the vaccine is not injected into a blood vessel, by first aspirating the needle. If aspiration is not carried out first before injection, there is no means to check whether accidental injection into a blood vessel has occurred.
Did the authors of this study examine whether those patients who subsequently developed myocarditis or myopericarditis post vaccinaion, had accidental injection of mRNA vaccine into blood vessels? Or did they check whether the vaccinators were aspirating prior to injection of mRNA vaccines? John Campbell a nurse instructor, suggests that the Green Book protocol in chapter 14a for vaccination needs urgent updating to include aspiration prior to injection of the vaccine. Is the Department of Health, NHS aware of this issue I wonder.
Rapid Response:
Re: SARS-CoV-2 vaccination and myocarditis or myopericarditis: population based cohort study
Dear Editor,
This study makes the conclusion that that the Moderna mRNA-1273 vaccination was associated with an increased rate of myocarditis or myopericarditis compared with unvaccinated individuals overall, while the Pfizer BioNtech BNT162b2 vaccination was associated with an increased rate of myocarditis or myopericarditis among female individuals. However, the absolute rate of myocarditis or myopericarditis cases after SARS-CoV-2 mRNA vaccination was low overall, among female participants, and among younger age groups. It also claims, the clinical outcomes after myocarditis or myopericarditis events were predominantly mild, providing evidence to support the overall safety of SARS-CoV-2 mRNA vaccines.
However it gives a proviso that much larger multinational studies and meta-analyses are needed to specify risks within smaller subgroups and the risk of myocarditis or myopericarditis after SARS-CoV-2 infection versus vaccination.
I would postulate that a significant factor increasing the risk of myocarditis or myopericaditis is the current mode and procedure by which these mRNA vaccines are administered to patients. The Green Book, Chapter 14a, page 12 indicates that both these mRNA vaccines should be intramuscular injections in the deltoid muscle. However, the protocol omits a key step, to ensure the vaccine is not injected into a blood vessel, by first aspirating the needle. If aspiration is not carried out first before injection, there is no means to check whether accidental injection into a blood vessel has occurred.
Did the authors of this study examine whether those patients who subsequently developed myocarditis or myopericarditis post vaccinaion, had accidental injection of mRNA vaccine into blood vessels? Or did they check whether the vaccinators were aspirating prior to injection of mRNA vaccines? John Campbell a nurse instructor, suggests that the Green Book protocol in chapter 14a for vaccination needs urgent updating to include aspiration prior to injection of the vaccine. Is the Department of Health, NHS aware of this issue I wonder.
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Competing interests: No competing interests