Post-vaccine myocarditis is not ‘mild’, warn doctors

Conservative Woman – by Kathy Gyngell

DR Jonathan Engler and Dr Clare Craig, the co-chairs of HART (Health Advisory & Recovery Team), www.hartgroup.org with some 70 doctors and scientists from HART, have written to Dr Jenny Harries, the Chief Executive, UKHSA, urging her to take the cumulative and disturbing evidence of post-Covid vaccine myocarditis with the seriousness it warrants. Below we publish the letter, which details how myocarditis adverse events have been dangerously downplayed by the UK’s medical authorities, gives up-to-date evidence of its severity and cumulative effects, and outlines the actions immediately required from government. 

Dr Jenny Harries.

Chief Executive, UKHSA

Copies: Dr Andrew Goddard: RCP, Dame Clare Gerada: RCGP, Professor Kevin Fenton: FPH,

Dr Jim McManus: ADPH, Dr Camilla Kingdon: RCPCH, Dr Tim Cooksley: Society for Acute Medicine, Dr John Greenwood: British Cardiovascular Soc, Dame Helen Stokes-Lampard: AoMRC

14th August 2022

Dear Dr Harries,

re: Covid-19-vaccine-associated Myocarditis – a Cumulative Risk

We, the undersigned, are writing to express our deep concern at the guidance regarding further mRNA vaccination after any episode of myocarditis, as detailed in the UKHSA guidance for healthcare professionals.

Myocarditis severity has been downplayed:

The majority of patients with vaccine-associated myocarditis present with chest pain. This may be misinterpreted, by either the patient or doctor, as musculoskeletal pain, which is a recognised non-serious side effect of these products, and cardiac pathology could be missed.  Any patient presenting with chest pain should be assessed immediately in hospital as this may be life-threatening.

During the Covid pandemic, anyone admitted to hospital with a positive test result was considered to have severe Covid-19. With myocarditis, every patient presenting with cardiac symptoms needs hospital assessment including ECGs, blood troponin levels and echocardiograms. This would therefore not fit the definition of a mild illness. A recent BMJ review quotes ‘Most people were admitted to hospital (≥84 per cent) for a short duration (two to four days).’ The review further quotes, ‘persistent echocardiogram abnormalities, as well as ongoing symptoms or a need for drug treatments or restriction from activities in >50 per cent of patients’. Where cardiac MRI scans have been performed, 89 per cent of patients have shown Late Gadolinium Enhancement (LGE), which is known to be a predictor of a bad prognosis.  Inflammation of the heart can lead to fibrosis and other complications such as arrhythmias and death. Left undiagnosed and therefore untreated, there is also a real risk of silent left ventricular dysfunction. Myocarditis should be considered far from being a mild illness.

The long-term prognosis for post-vaccination myocarditis is also uncertain, but early follow-up studies in children have shown two-thirds had persistent changes on cardiac MRI scans 3-8 months later, despite clinical improvement. A detailed US FDA advisory committee report from late 2021 showed that 40 per cent of affected adolescents were still symptomatic at 3 month follow-up and 50 per cent were still restricting their physical activity. Viral myocarditis can have serious late consequences with an approximately 20 per cent six-year mortality. In the absence of appropriate long-term follow-up, it is reckless to assume that vaccine-associated myocarditis has a milder outcome.

It is therefore concerning that the UKHSA guidance contains advice such as:

·       ‘Where appropriate the patient should be seen face to face and this assessment should include their vital signs.’We would consider a face-to-face assessment essential and feel the phrase ‘where appropriate’ to be misplaced. ‘If patients have mild symptoms, they do not require a referral to secondary care at this point.’Again, every patient with chest pain or palpitations should have an urgent ECG and blood sent for cardiac troponins. The term mild myocarditis refers to symptoms which resolve and therefore can only be considered a retrospective diagnosis.

·       It is impossible to substantiate the statement that ‘the majority of cases appear to be mild and self-limiting’, whilst acknowledging that ‘no long-term follow-up data is available yet on hospitalised patients’.

Myocarditis incidence has been underplayed: Quoted risk of vaccine-associated myocarditis varies widely, with younger age and male sex being the two biggest risk factors and the vast majority of studies have shown a greater risk after a second dose. In Hong Kong, where specific information about myocarditis is given to all vaccinees, one in 2,680 adolescent boys developed myocarditis after their second dose of Pfizer.  A change in policy to a single dosage for this age-group was estimated to have saved several cases. For boys aged 12-17, post-vaccine-myocarditis exceeds rates of hospitalisation for Covid-19 itself. It is also concerning that there has been no serious attempt to prospectively study the incidence of myocarditis. A study from the US military found that myocarditis post smallpox vaccination was 200-fold higher than background rates when using diary cards, compared with 7.5 x expected when using routine self-reporting. Blood testing post-vaccination elucidated asymptomatic cases at a further 6-fold higher rate. A small prospective study of secondary school-children in Thailand, using diary cards and blood troponins on day 3 and day 7, showed 29 per cent with a potential cardiac symptom and 18 per cent with abnormal ECGs. This is only a preprint but needs replicating before sweeping assertions of safety can be made.

Cumulative risk:

In most series, myocarditis has occurred after the second dose, yet government guidance suggests patients who have suffered with myocarditis following initial vaccination, may still undergo further vaccinations:

‘If there is no evidence of ongoing myocarditis, they can be offered vaccination with the Pfizer (Cominarty) vaccine from 12 weeks after their last dose if further doses are due. If there is evidence of ongoing effects of acute or subacute myocarditis, then an individual risk benefit assessment should be undertaken.’

None of the vaccine trials included patients with a past history of myocarditis and we are aware of no data to support this advice. Giving a Covid-19 vaccine to someone with a past history of myocarditis of any cause would require a thorough assessment and individual discussion of benefit and risk. Any episode of post-vaccination myocarditis should be seen as an absolute contraindication to receiving any further doses, as the risk of this serious cardiac condition is known to increase after the second dose. The UKHSA has acknowledged the total absence of long-term follow up following vaccine-associated myocarditis. Continuing with the policy outlined above is therefore reckless.

Actions required:

·         We ask that you urgently update the advice to ensure that all patients with relevant symptoms are seen face to face and receive at minimum an ECG and cardiac troponins, proceeding to echocardiogram and cardiac MRI if initial investigations support a diagnosis of myocarditis.

·         We also urge you to recognise myocarditis is a potentially serious cardiac condition and not refer to it as a mild illness. This is misleading as we do not have long-term safety data to support the use of the word ‘mild’. Myocarditis has undoubtedly proved fatal for some.

·         The guidance should also be corrected to advise that a diagnosis of vaccine-associated myocarditis should be an absolute contraindication to further doses.

·         These changes should be notified to all GPs, vaccination centres and emergency medicine departments.

We await a timely reply.

This letter will be published openly, and we hope it is shared widely along with any response.

Yours sincerely

Dr Jonathan Engler, MBChB, LlB (Hons), DipPharmMed and Dr Clare Craig, BMBCh, FRCPath

Co-chairs of HART (Health Advisory & Recovery Team, www.hartgroup.org)

Signatories from HART:

Dr Mark A Bell, MBChB, MRCP (UK), FRCEM, Consultant in Emergency Medicine

Dr Michael D Bell, MBChB, MRCGP, retired General Practitioner

Dr Alan Black, MBBS, MSc, DipPharmMed, retired Pharmaceutical Physician

Dr Emma Brierly, MBBS, MRCGP, General Practitioner

Dr Elizabeth Burton, MB ChB, retired General Practitioner

Dr David Cartland, MBChB, BMedSci, General practitioner

Dr Peter Chan, BM, MRCS, MRCGP, NLP, General Practitioner, Functional medicine

Michael Cockayne, MSc, PGDip, SCPHNOH, BA, RN, Occupational Health Practitioner

James Cook, NHS Registered Nurse, Bachelor of Nursing (Hons), Master of Public Health

Dr David Critchley, BSc (Hons), PhD, Clinical Pharmacologist

Dr Elizabeth Evans, MA (Cantab), MBBS, DRCOG, retired Doctor, Director UKMFA

Dr Ali Haggett, Mental health community work, 3rd sector, former lecturer in the history of medicine

Mr Anthony Hinton, MBChB, FRCS, Consultant ENT surgeon, London

Dr Keith Johnson, BA, DPhil (Oxon), IP Consultant for Diagnostic Testing

Dr Rosamond Jones, MBBS, MD, FRCPCH, retired consultant paediatrician, convener CCVAC

Dr Tanya Klymenko, PhD, FHEA, FIBMS, Senior Lecturer in Biomedical Sciences

Dr Branko Latinkic, BSc, PhD, Molecular Biologist

Dr John Flack, BPharm, PhD, retired Director of Safety Evaluation at Beecham Pharmaceuticals, retired Senior Vice-president for Drug Discovery SmithKline Beecham

Dr Ayiesha Malik, MBChB, General Practitioner

Mr Ian McDermott, MBBS, MS, FRCS(Tr&Orth), FFSEM(UK), Consultant Orthopaedic Surgeon

Dr Franziska Meuschel, MD, ND, PhD, LFHom, BSEM, Nutritional, Environmental and Integrated Medicine

Dr Alan Mordue, MBChB, FFPH. Retired Consultant in Public Health Medicine & Epidemiology

Dr Rachel Nicholl, PhD, Medical researcher

Rev Dr William J U Philip MB ChB, MRCP, BD, Senior Minister The Tron Church, Glasgow, formerly physician specialising in cardiology

Dr Jon Rogers, MB ChB (Bristol), Retired General Practitioner

Mr James Royle, MBChB, FRCS, MMedEd, Colorectal surgeon

Dr Roland Salmon, MB BS, MRCGP, FFPH, Former Director, Communicable Disease Surveillance Centre Wales

Natalie Stephenson, BSc (Hons) Paediatric Audiologist

Dr Zenobia Storah,MA (Oxon), Dip Psych, DClinPsy, Senior Clinical Psychologist (Child and Adolescent)

Dr Helen Westwood MBChB MRCGP DCH DRCOG, General Practitioner

Mr Lasantha Wijesinghe, FRCS, Consultant Vascular Surgeon

Further signatories

Julie Annakin, RN, Immunisation Specialist Nurse

Dr Michael Bazlinton, MBCHB, MRCGP, DCH, General Practitioner

Dr David Bell, MBBS, PhD, FRCP (UK), Public Health Physician

Dr Michael D Bell, MBChB, MRCGP, retired General Practitioner

Dr Alan Black, MBBS, MSc, DipPharmMed, retired Pharmaceutical Physician

Dr Emma Brierly, MBBS, MRCGP, General Practitioner

Mr John Bunni, MBChB (Hons), Dip Lap Surg, FRCS [ASGBI Medal] – Consultant Colorectal and General Surgeon

Professor Angus Dalgleish, MD, FRCP, FRACP, FRCPath, FMed Sci, Principal, Institute for Cancer Vaccines & Immunotherapy (ICVI)

Dr Christopher Exley, PhD FRSB, retired professor in Bioinorganic Chemistry

Professor John Fairclough, FRCS FFSEM, retired Honorary Consultant Surgeon

Dr Jenny Goodman, MA, MBChB, Ecological Medicine

Dr Catherine Hatton, MBChB, General Practitioner

Dr Renée Hoenderkampf, General Practitioner

Dr Charles Lane, MA, DPhil, Molecular Biologist

Dr Felicity Lillingstone, IMD DHS PhD ANP, Doctor, Urgent Care, Research Fellow

Professor David Livermore, BSc, PhD, retired Professor of Medical Microbiology

Katherine MacGilchrist, BSc (Hons), MSc, CEO/Systematic Review Director, Epidemica Ltd

Dr Geoffrey Maidment, MBBS, MD, FRCP, Consultant physician, retired

Dr Kulvinder Singh Manik, MBBS, General Practitioner

Dr Fiona Martindale, MBChB, MRCGP, General Practitioner

Dr S McBride, BSc (Hons) Medical Microbiology & Immunobiology, MBBCh BAO, MSc in Clinical Gerontology, MRCP (UK), FRCEM, FRCP (Edinburgh). NHS Emergency Medicine & geriatrics

Professor Dennis McGonagle, PhD, FRCPI, Professor of Investigative Rheumatology, University of Leeds

Dr Scott Mitchell, MBChB, MRCS, Emergency Medicine Physician

Dr David Morris, MBChB, MRCP (UK), General Practitioner

Dr Greta Mushet, MBChB, MRCPsych, retired Consultant Psychiatrist in Psychotherapy

Dr Sarah Myhill, MBBS, retired GP and Naturopathic Physician

Dr Christina Peers, MBBS, DRCOG, DFSRH, FFSRH, Menopause specialist

Anna Phillips, RSCN, BSc Hons, Clinical Lead Trainer Clinical Systems (Paediatric Intensive Care)

Dr Angharad Powell, MBChB, BSc (hons), DFRSH, DCP (Ireland), DRCOG, DipOccMed, MRCGP, General Practitioner

Dr Salmaan Saleem, MBBS, BmedSci, MRCGP, General Practitioner

Dr Rohaan Seth, Bsc, MBChB, MRCGP, Retired General Practitioner

Dr Noel Thomas, MA, MBChB, DCH, DObsRCOG, DTM&H, MFHom, retired doctor

Dr Stephen Ting, MB CHB, MRCP, PhD, Consultant Physician

Dr Livia Tossici-Bolt, PhD, Clinical Scientist

Dr Carmen Wheatley, DPhil, Orthomolecular Oncology

Dr Ruth Wilde, MB BCh, MRCEM, AFMCP, Integrative & Functional Medicine Doctor

Dr Lucie Wilk, MD, Consultant Rheumatologist

Dr Stefanie Williams, MD, Dermatologist

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