Case Series Was About Myocarditis in Military Servicemembers
Command Master Chief Shawn Isbell, assigned to the amphibious assault ship USS Bataan (LHD 5), receives his second injection of the COVID-19 vaccine this spring. U.S. Navy photo by Mass Communication Specialist 3rd Class Alan L. Robertson
FALLS CHURCH, VA — Research on rare adverse effects from COVID-19 vaccines has thrust the military into the center of the rancorous controversy about vaccination safety, causing some Congress members to question whether immunization against novel coronavirus should be required by the nation’s uniformed services.
The question addressed in the clinical study was whether myocarditis should be considered a potential adverse event following immunization with messenger RNA (mRNA) COVID-19 vaccines.
The case series, published as a brief report in late June by JAMA Cardiology, involved 23 male patients, including 22 previously healthy military servicemembers, who were diagnosed with myocarditis within four days of receiving a COVID-19 vaccine. For 20 out of the 22, that occurred after the second dose of mRNA COVID-19 vaccine.1
DHA researchers reported that all of the patients had recovered or were recovering after brief supportive care and pointed out that the episodes were a tiny percentage of the 2.8 million doses of mRNA COVID-19 vaccines administered by the military.
“Vigilance for rare adverse events, including myocarditis, after COVID-19 vaccination is warranted but should not diminish overall confidence in vaccination during the current pandemic,” wrote the authors, who also were from Walter Reed National Military Medical Center and the Uniformed Services University of the Health Sciences, both in Bethesda, MD, and military medical centers in North Carolina, Texas, Washington, Florida and even Japan.
But researchers added a caution: “While the observed number of myocarditis cases was small, the number was higher than expected among male military members after a second vaccine dose.”
“In this case series, myocarditis occurred in previously healthy military patients with similar clinical presentations following receipt of an mRNA COVID-19 vaccine,” the authors concluded. “Further surveillance and evaluation of this adverse event following immunization is warranted. Potential for rare vaccine-related adverse events must be considered in the context of the well-established risk of morbidity, including cardiac injury, following COVID-19 infection.”
After initial reports of myocarditis, but before the study was published, a bill was introduced in Congress to prohibit the military from ever mandating the COVID-19 vaccine for its personnel.
Thomas Massie (R-KY) said he introduced HR 3860 to prohibit any mandatory requirement that a member of the armed forces receive a vaccination against COVID-19. It had about two-dozen sponsors by early July.
About three weeks after being introduced, however, the bill had no text and was being referred to committee for review.
Massie raised some additional controversy himself by tweeting, “I’ve been contacted by members of our voluntary military who say they will quit if the COVID vaccine is mandated.”
He was immediately informed that servicemembers who just quit are considered to have gone AWOL and could end up in prison. The bill is far from becoming law, and President Joe Biden recently ordered that federal employees, including military personnel, should either get vaccinated or undergo frequent testing.
In terms of myocarditis, after a meeting, a national Centers for Disease Control and Prevention advisory committee said it would continue to review the situation but recommended that young people continue to be vaccinated, suggesting the benefits outweighed the risk.
The CDC’s Advisory Committee on Immunization Practices (ACIP) was told the CDC had confirmed 323 cases of myocarditis or pericarditis in young adults 29 years and younger. The vast majority — 295 out of 309—were discharged after hospitalization. At the time, nine were still inpatients, of which two were in intensive care and five had no outcome data.
Young Males
The COVID-19 Vaccine Safety Technical (VaST) Work Group pointed out that the cases occurred predominantly in male adolescents and young adults, usually after the second dose and within a week of vaccination. Usually the symptoms resolved quickly, it added.
In light of the likely link between the condition and vaccination, ACIP recommended that those who recovered from the condition after a first dose could receive a second one in most circumstances.
The decision was in line with the position of the military study authors, who wrote that the “potential for rare vaccine-related adverse events must be considered in the context of the well-established risk of morbidity, including cardiac injury, following COVID-19 infection.”
Interestingly, those researchers advised that inflammatory injury to myocardial tissue more commonly occurs with infectious conditions, such as SARS-CoV-2, although some myocarditis cases are associated with certain drugs and vaccine exposures.
Prominent healthcare associations and federal agencies also chimed in to urge that everyone eligible receive COVID-19 vaccines.
“As physicians, nurses, pharmacists, public health and health care professionals, and, for many of us, parents, we understand the significant interest many Americans have in the safety of the COVID-19 vaccines, especially for younger people,” the groups said in a statement released in late June. “Today, the CDC Advisory Committee on Immunization Practices (ACIP) met to discuss the latest data on reports of mild cases of inflammation of the heart muscle and surrounding tissue called myocarditis and pericarditis following COVID-19 vaccination among younger people.
“The facts are clear: This is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination. Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment. In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19, and the risks to the heart from COVID-19 infection can be more severe.”
“The vaccines are safe and effective, and they prevent COVID-19 illness,” the letter continued. “They will help protect you and your family and keep your community safe. We strongly encourage everyone age 12 and older who are eligible to receive the vaccine under Emergency Use Authorization to get vaccinated, as the benefits of vaccination far outweigh any harm. Especially with the troubling Delta variant increasingly circulating, and more readily impacting younger people, the risks of being unvaccinated are far greater than any rare side effects from the vaccines. If you get COVID-19, you could get severely ill and be hospitalized or even die. Even if your infection is mild, you or your child could face long-term symptoms following COVID-19 infection, such as neurological problems or diminished lung function.”
Signers were from the U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American Heart Association, American Hospital Association (AHA), American Medical Association (AMA), American Nurses Association (ANA), American Pharmacists Association, American Public Health Association (APHA), Association of Public Health Laboratories, Association of State and Territorial Health Officials (ASTHO), Big Cities Health Coalition, Council of State and Territorial Epidemiologists, Infectious Diseases Society of America, and National Association of County and City Health Officials (NACCHO).
“We recommend getting vaccinated right away if you haven’t yet. It is the best way to protect yourself, your loved ones, your community, and to return to a more normal lifestyle safely and quickly,” the healthcare groups wrote.
- Montgomery J, Ryan M, Engler R, et al. Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military. JAMA Cardiol. Published online June 29, 2021. doi:10.1001/jamacardio.2021.2833