A new study has found that patients who developed heart inflammation, or myocarditis, after receiving the COVID-19 mRNA vaccine had fewer complications 18 months after hospitalization than patients who had COVID-19 infection or developed the disease from other causes.
The population-based study, conducted in France and published online Monday in JAMA, found that the vaccinated group had significantly lower rates of hospital readmissions, diagnoses of other heart-related diseases and deaths.
The long-term effects of COVID-19 and the COVID-19 vaccine have become a concern for the U.S. military, which saw roughly 500,000 coronavirus cases in the first two years of the pandemic and has mandated vaccinations for all service members.
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The study found that findings were consistent regardless of age, although the authors noted that patients with myocarditis after vaccination were primarily young, healthy men and “may require medical management for up to several months after hospital discharge.”
“Patients who develop myocarditis after receiving COVID-19 mRNA vaccination appear to have a good prognosis near hospital discharge, but their long-term prognosis and management remain unclear,” wrote the researchers, led by Laura Semenzato, a statistician at the EPI-PHARE scientific interest group.
The Defense Department vaccinated more than 2 million service members between December 2020, when the Food and Drug Administration issued emergency use authorizations for the Pfizer and Moderna COVID-19 vaccines, and December 2022, according to the Defense Department.
The vaccine employs novel mRNA technology that uses messenger RNA to instruct cells to make fragments of the virus' spike protein, triggering an immune response, thereby stimulating the body's immune response against the disease.
As early as February 2021, the U.S. military began examining patients who developed myocarditis after receiving the COVID-19 vaccine.
Military.com began tracking cases soon after a civilian member of the Defense Department's press corps and a Military.com reporter serving in the National Guard developed the symptoms, but the Pentagon did not confirm there were additional cases until April.
In a report submitted to Congress last September on troop health following the Defense Department's mandatory COVID-19 vaccination drive that took effect in August 2021, Pentagon officials said 25 service members had developed myocarditis in early 2021, but did not disclose the total number of cases across the force over the past few years.
The rate of myocarditis among military personnel was 57 cases per 100,000 person-years measured over the entire observation period, while the rate among those infected with COVID-19 in 2021 was 98 cases per 100,000 person-years, according to the report.
The Department of Veterans Affairs is conducting 11 long-term coronavirus studies as it may be called upon to pay disability benefits to veterans who were infected while on active duty or who have long-term health problems as a result of being vaccinated.
“VA’s research program is focused on understanding the long-term effects.
“The COVID-19 pandemic prompted VA Undersecretary Sherif Elnahar to write in Federal Practitioner magazine last November, “At the same time, VA remains committed to applying lessons learned during the crisis to address our top priorities in veterans' health care.”
Dr. Harlan Krumholz, a cardiologist at Yale University School of Medicine who was not involved in the French study, said the latest research should reassure patients and doctors about the long-term effects that post-vaccination myocarditis can have on the heart and body.
But he noted that while the study focused on outcomes 18 months after hospitalization — what Krumholz described as “meaningful follow-up” — it didn't provide insight into longer-term outcomes.
“In general, myocarditis in young people can lead to chronic cardiac issues, such as arrhythmias and heart failure, in some patients, but many recover fully. Continued monitoring is important,” Krumholz said in an email to Military.com on Tuesday.
In the study, researchers looked at 4,635 patients aged 12 to 49 years who were hospitalized with myocarditis in France between Dec. 27, 2020, and June 30, 2022.
Of these, 12% developed post-vaccine myocarditis within 7 days of receiving the vaccine, 6% developed post-COVID-19 myocarditis, and 82% developed traditional myocarditis.
Although the number of patients who developed myocarditis after infection was lower than in the vaccinated group, hospitalization, complications and mortality were similar to those in patients who developed regular myocarditis.
However, the study noted that one patient who suffered from post-vaccination myocarditis required extensive medical intervention and died after being discharged from hospital, making it a likely cause of death.
“Outcomes were generally good, but some patients required ongoing medical management for several months after being discharged from the hospital, and 3 percent of patients who developed myocarditis after vaccination were readmitted to the hospital over the next 18 months,” Krumholz noted after reviewing the studies.
Myocarditis can be caused by an exaggerated immune response to a viral infection or disease. It's not clear why some people, particularly young men, develop myocarditis after getting the COVID-19 mRNA vaccine. Krumholz said an “exaggerated immune response,” which occurs in 1 to 10 of every 100,000 people who get the vaccine, is likely to be involved.
The JAMA study had limitations: the researchers only looked at hospitalizations for myocarditis during the study period and were unable to investigate all potential cases. It also did not include details about the severity of cases, and the study was based on medical diagnoses and relied on the accuracy of health care providers.
The researchers noted that guidelines from the American Heart Association and American College of Cardiology advise patients with myocarditis to refrain from competitive sports for three to six months and to have their health evaluated before resuming sports.
He also said that although some studies have reported “reassuring results” regarding the prognosis of myocarditis after vaccination, the likelihood of a poor outcome is low and patients with residual symptoms or cardiac abnormalities have been detected up to a year after onset of symptoms.
The researchers said the study “should be taken into consideration in current and future mRNA vaccine recommendations.”
“Overall, this study provides important data on medium-term outcomes, but continued research on long-term prognosis is still needed,” Krumholz added.
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