Advisers for the U.S. Centers for Disease Control and Prevention are set to meet Wednesday to consider possible changes to COVID-19 vaccinations of adolescents and young adults as a result of reports of heart inflammation among a small number of younger vaccine recipients.
The Advisory Committee on Immunization Practices, which advises the CDC on vaccine policy, could recommend adjusting the dosing regimen for people in a certain age group, pausing administration of the shots to certain age groups, or adding a warning label. It could also opt not to recommend any changes.
There have been several hundred cases of myocarditis or pericarditis, inflammation of the heart and the lining around it, reported among adults under 30 and adolescents who have received vaccines made by Pfizer and Moderna. Federal health officials have confirmed 323 cases as of June 14, according to the CDC. Most were males, and most developed the inflammation after the second dose.
It’s not clear if there is a connection between the vaccines and myocarditis or pericarditis. Such inflammation is treatable, and no heart-related deaths in young people have been linked to the vaccines.
Many infectious disease experts are waiting to see what new data the CDC committee presents Wednesday before potentially rethinking whether all eligible children and young adults should get both shots right away, which has generally been the recommendation in the U.S. But some are questioning whether at least adolescents should hold off for now on getting their second shot.
An earlier, preliminary analysis by the CDC found that more than half of the reported cases of myocarditis were among people between the ages of 12 and 24, even though that group represents just 9% of doses administered.
The myocarditis cases were reported in people who got mRNA vaccines, made by Pfizer and Moderna. There have been no cases reported among those who received the Johnson & Johnson vaccine.
The number of cases among younger recipients is still a tiny percentage of the young adults and adolescents nationwide who have been fully vaccinated. Among 16- and 17-year-olds, there were 79 myocarditis or pericarditis cases reported through May 31, out of nearly 2.3 million doses administered. Among 18- to 24-year-olds, there were 196 reports out of 9.8 million doses administered. But in both groups, the numbers were higher than the baseline rate expected in that population.
There were not enough cases reported among 12- to 15-year-olds to determine whether that was also true of that age group. The CDC panel on Wednesday is expected to include new cases among 12- to 15-year-olds who only recently became eligible for their second shot.
It’s not known whether myocarditis has been reported in children younger than 12 who are receiving the vaccine in clinical trials. Both Pfizer and Moderna hope to win Food and Drug Administration authorization later this year for their vaccines to be used in this age group.
Myocarditis in general occurs more frequently in adolescent boys, but it’s not clear why. Symptoms include chest pain, shortness of breath and changes in the heart rate. It can be caused by viral or bacterial infection, or linked to medications or autoimmune diseases. In the most severe cases, it can lead to heart failure.
Most of the post-vaccination cases of myocarditis appear mild and the patients have recovered quickly, said Dr. Theodore Ruel, a professor of pediatrics at UCSF who has been tracking the cases since reports began coming in several weeks ago. Doctors have been managing the cases with anti-inflammatory drugs like ibuprofen or, in more serious cases, steroids.
“Speaking to cardiologists, their response at how quickly the kids turn around and do well is different,” Ruel said. “The children seem to do very well and recover quickly in what you see with this myocarditis compared to general myocarditis cases.”
Among the 285 reports of myocarditis in people under age 30, 270 were discharged and 15 were still hospitalized, including three in the intensive care unit, as of May 31, according to the CDC.
Of the 221 who were discharged and for whom recovery status was known, 81% fully recovered and 19% had ongoing symptoms or unknown status.
Dr. Monica Gandhi, an infectious disease physician at UCSF, said these developments have persuaded her to recommend that children 12 to 15 who have gotten their first shot hold off on getting the second until more is known about post-vaccination myocarditis.
If the CDC decides to add a warning label to the Pfizer and Moderna vaccines, Gandhi said she would space out the time between the shots to eight to 12 weeks instead of the current three or four weeks. She cited evidence that countries that give one dose or space out the shots further apart are not reporting myocarditis problems among young people, while countries like the U.S. and Israel that are giving second doses three weeks after the first are seeing these cases.
Israel’s Health Ministry recently found that a small number of myocarditis cases in mostly young men is likely linked to the second dose of the Pfizer vaccine, and is considering shifting to one dose only for children.
Pfizer noted in a statement that “no causal link” had been established between its vaccine and the inflammation cases. “With more than 400 million doses of the Pfizer-BioNTech COVID-19 vaccine administered globally, the benefit risk profile of our vaccine remains positive,” the company said.
Catherine Ho is a San Francisco Chronicle staff writer. Email: cho@sfchronicle.com Twitter: @Cat_Ho
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June 23, 2021 at 06:22AM
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CDC panel to examine heart inflammation cases in young people after COVID vaccinations - San Francisco Chronicle
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