Editor’s Note

Myocarditis and pericarditis

and the COVID-19 vaccine

In late May 2021, the World Health Organization vaccine safety committee noted that myocarditis and pericarditis following vaccination with COVID-19 mRNA vaccines are events of special interest for continued evaluation.

A small number of case series have emerged from Israel and the United States. The US Centres for Disease Control and Prevention provided recommendations for clinicians and on June 10th presented safety assessments to the Food and Drugs Administration in readiness of review of emergency use authorization of the Moderna mRNA vaccine in adolescents.

Available information indicates that: • Symptom onset was usually within a few days after vaccination • Cases were mainly male adolescents and young adults after the second dose; in the US data the median age of cases following 2nd dose was 24 years • Most cases experienced mild illness, responded well to conservative treatment and rest, and their symptoms improved quickly.

In the US data analyses, the observed cases exceeded the expected number of cases (based on background rates of myocarditis) following the 2nd dose in the age group 16-24 years. The estimated rate of myocarditis was about 16 cases per million 2nd doses (35 per million in 16-17 year olds; 21 per million in 18-24 year olds). While nine per cent of doses were administered in the 12-24 year age group, this group accounted for 53 per cent of myocarditis reports following the 2nd dose.

To date, no regulatory action has been taken in Canada or internationally. Additional discussion including a benefit risk assessment are scheduled for review at the US Advisory Committee on Immunization Practices on June 18th.

SITUATION IN CANADA AND BC

As part of ongoing COVID-19 vaccine safety efforts, BC Centre for Disease Control (BCCDC) along with local medical health officers, the Public Health Agency of Canada (PHAC) and Health Canada are closely monitoring myocarditis/pericarditis in passive and active Canadian safety surveillance systems, including the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS), the Canada Vigilance Program, the Canadian National Vaccine Safety Network (CANVAS) and the Canadian Immunization Monitoring Program ACTive.

In BC and elsewhere in Canada, there have been a small number of reports of pericarditis or myocarditis following vaccination with a COVID-19 mRNA vaccine. In Canada and BC to date, higher rates than would be expected have not yet been observed. The weekly Canadian and BC adverse events following COVID-19 vaccine reports provide updates on the latest numbers.

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UPCOMING DEADLINES

SEPTEMBER 2021 ISSUE

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NEWS Doctors urging health-care workers to do the right thing and get vaccinated

By Dr. Adam Kassam

In a recent Ontario Medical Association survey, we asked Ontario’s doctors to tell us if they had been vaccinated. A full 98 per cent of those who responded said they had.

This is a clear reflection of physicians’ steadfast belief in the effectiveness of vaccines in leading Ontario, Canada and indeed the world out of the COVID-19 pandemic. As doctors, we have reviewed (in some cases, developed) the science behind the vaccines being offered to fight this deadly virus, and vaccines unequivocally have our endorsement.

In rolling up our own sleeves to get the jab, we are taking care of ourselves, our patients and our communities. Now, we are strongly urging not just our patients, but the entire medical community — anyone who works in health care — to follow suit.

While it’s possible that the rate of vaccination among health-care workers is already higher than among the general population, we are nevertheless concerned that even a single person who spends their days or nights caring for the sick and injured, or anyone involved in preventative medicine, or diagnostic testing would hesitate to seek out the vaccines that are so obviously saving lives and reducing serious illness.

We are calling on all health-care workers to have the COVID-19 vaccination and believe strongly that this should be mandatory so that everyone involved in health care may protect their own health as well as the health of the patients they serve and the people around them.

The science shows vaccines are the best way to control the spread of COVID-19 and are an essential component in personal and community health.

In the most recent data available, Ontario’s chief medical officer of health said that nearly 80 per cent of Ontario’s eligible population had received at least one dose of a COVID-19 vaccine.

Dr. Kieran Moore also said modelling suggests that a vaccination rate of 90 per cent among the eligible population of Ontarians aged 12-plus may be required to protect us from the emerging and extremely contagious Delta variant, which has grown dominant in Ontario.

While infection rates remain much lower than at the peak of the pandemic’s third wave, people are still contracting COVID-19. Many are still seeking out a doctor. Some of those patients are requiring hospitalization. Regrettably, some are still dying.

Public Health Ontario has estimated that the risk of contracting COVID-19 in June was 4.7 times higher for unvaccinated people, compared to those fully vaccinated, and 3.4 times higher than for those who have had a single dose. Among those who contract the virus, the risk of being hospitalized is three times higher than for those who have received at least one shot.

NO ONE WANTS THE PANDEMIC TO CONTINUE ANY LONGER THAN NECESSARY

MAXIMIZING VACCINATION RATES WILL ALLOW ONTARIO TO MOVE TOWARD NORMALCY

The virus simply cannot spread widely when most of the population is immune. Children can return to school. Young adults can safely go back to college, or university. Workplaces can re-open. Families can reunite. All without over burdening our intensive care units and health-care system more generally.

Without reaching a higher rate of overall vaccination, unvaccinated people are vulnerable and pose a threat to those who have had their shots, especially to our older community and those who are immune-suppressed, or otherwise vulnerable. Without vaccinated health-care workers, we risk infecting vulnerable children under 12 who need our care.

To say the past 17 months has been challenging is an understatement. Too many people lost their lives. Husbands buried wives, and vice versa. There are sons and daughters without parents and young people without grandparents. Some of those who survived are experiencing long-term effects. Jobs were lost, or put on hold. Children lived in isolation from their friends. Family connections were broken. Mental health issues and addictions are on the rise.

My message to the 2.4 million Ontarians who are eligible to be vaccinated but haven’t yet done so is to talk to your doctor, get informed, and get the shot as soon as possible. To those who have had one dose, and not the second. Make an appointment now.

To health-care workers, I say it’s your duty to protect yourself and protect others. Don’t wait for it to be mandatory to be vaccinated. Whether that happens or not, do the right thing, and get your first and second dose. You owe it to yourselves, your family and to those you care for. ■ H

Dr. Adam Kassam is President of the Ontario Medical Association.