17 ms·

Risk of myocarditis following sequential COVID-19 vaccinations by age and sex [pdf]

190 points by busymom0 5y ago

simonsarris 5y ago
This paper essentially argues that the risk of myocarditis in under-40 males getting 2 shots is greater (perhaps much greater) than the risk of getting it from COVID. There have been similar studies before, but none (that I saw) broken down by age and sex like this. It reads: > Despite more myocarditis events occurring in older persons, the risk following COVID-19 vaccination was largely restricted to younger males aged less than 40 years, where the risks of myocarditis following vaccination and infection were similar. However, the notable exception was that in younger males receiving a second dose of mRNA-1273 vaccine, the risk of myocarditis was higher following vaccination than infection, with an additional 101 events estimated following a second dose of mRNA-1273 vaccine compared to 7 events following a positive SARS-CoV-2 test. This guy made a graph of their data, which makes it a little more clear: https://twitter.com/VPrasadMDMPH/status/1475145220618526729 https://twitter.com/VPrasadMDMPH/status/1475145220618526729
- busymom0 5y ago
  That graph in that tweet is included in the study's PDF. It's the very last page of the PDF and has more graphs too. I wish the study's age group was more specific (the authors admit they don't have enough data for the 13-17 age group to make it more specific). Aka, I would like to see 10 year age group intervals. From other studies, the risks is highest in 16-24 if I remember right? There's a study out of Public Health Ontario, ON, Canada which compares the risks depending upon the intervals between first and second dose. https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v1.full.pdf https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...
- jMyles 5y ago
  > This guy made a graph of their data, which makes it a little more clear: As another commenter as has pointed out, the graph in question in included in the PDF version of this preprint (which you can see here: https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v1.full.pdf+html https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...). I want to add: "this guy" is Vinay Prasad, a professor of oncology at UCSF and an incredibly prescient thinker through the COVID-19 pandemic, and someone with whome I've had the joy to correspond and repeatedly be impressed by his straightforward, evidence-based, dry-witty way of thinking, writing, and speaking. He's a significant up-and-come in medical science, without a doubt, and someone to follow if you are interested in science-based policy. We had the pleasure of hosting an AMA with him on /r/lockdownskepticism which you may find enjoyable and educational: https://www.reddit.com/r/LockdownSkepticism/comments/m0ll33/hi_im_vinay_prasad_from_the_university_of/ https://www.reddit.com/r/LockdownSkepticism/comments/m0ll33/...
  - unityByFreedom 5y ago
    Is r/lockdownskepticism also skeptical of vaccination? And do you think covid is worse than or same as the flu?
    - yonaguska 5y ago
      There is a definite overlap in people skeptical of lockdowns and the vaccines, but the sub tries to steer clear of vaccine skepticism due to it being technically off topic, and something that would get the sub nuked. Not that you asked me- I would classify it as "different" than the flu, that it affects different individuals differently, and that the original variant was definitely something more scary than the flu. Especially due to the novelty of the spike protein. Now- I view omicron as about as dangerous as the flu for a much smaller subset of people than the flu is dangerous for. Especially when you account for age and comorbidities. The flu kills children, while covid generally does not.
      - unityByFreedom 5y ago
        yonaguska 5y ago
        > given the rate of deaths are 10-20x worse than the worst flu years. I have a hard time accepting this premise. Mostly because the flu was somehow eradicated at the outset of mass covid testing, many of the covid tests did not distinguish between the flu and covid. Furthermore, I believe that we actually responded to covid in a way that caused excess covid deaths by over counting deaths and actively suppressing unpatentable treatments for covid. I think we hospitalized people that didn't need to be hospitalized, and we told people not to do anything until they needed to be hospitalized. We then started putting too many people on vents, giving them Remdesiver(toxic with highly questionable efficacy), and putting covid patients in nursing homes with the most vulnerable population. Not to mention lockdowns that pushed a huge portion of the world into poverty, nutritional deficiency, and much more susceptible to adverse effects from disease as a result. But those are just my thoughts- I don't think we have good enough data, nor will we ever- to actually make strong conclusions either way.
- ozdave 5y ago
  Thanks for the explanation. > argues that the risk of myocarditis in under-40 males getting 2 shots is greater (perhaps much greater) than the risk of getting it from COVID The way I read this is the risk of myocarditis is greater with vaccination, but this does not tell me about the overall risk of serious illness/death from Covid for vaxed VS unvaxed. So - risk of myocarditis goes up - but is it still overall safer to be vaccinated for the under 40 males, or not? Not pushing any angle or side here - just looking for clarity (as much as possible).
  - mrhands556 5y ago
    IFR for males under 40 is 500/1000000 or .05% if they’re infected. Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
    - sudosysgen 5y ago
      That's a horribly misleading comparison. Compare the risk of illness with severity similar to heart complications, or compare death rates. Don't compare one to the other. The majority of myocarditis cases due to the vaccine don't even require hospitalization.
      - yonaguska 5y ago
        Source? One friend with this exact issue was never hospitalized, was told that it couldn't possibly be due the vaccine, but ended up with several visits to a cardiologist and now had to deal with the long term effects. So no- there was no hospitalization. Technically. And they will never show up in any data set either. Because we aren't even tracking this stuff correctly in the USA.
        sudosysgen 5y ago
        Yes, your friend had no hospitalization. We don't count people who see a doctor a few times and have long term side-effects as hospitalized from COVID, so in an apples-to-apples comparison the example of your friend should not go into that column. Here is the source: https://www.nejm.org/doi/full/10.1056/NEJMoa2110737 https://www.nejm.org/doi/full/10.1056/NEJMoa2110737: > A total of 76% of cases of myocarditis were described as mild and 22% as intermediate; 1 case was associated with cardiogenic shock (Out of 100 cases)
- coolso 5y ago
  > This paper essentially argues that the risk of myocarditis in under-40 males getting 2 shots is greater (perhaps much greater) than the risk of getting it from COVID. There have been similar studies before, but none (that I saw) broken down by age and sex like this. This is especially fascinating to me because for months I noticed that whenever I or anyone else would bring up the fear of myocarditis from the vax (which I ended up not experiencing, by the way, that I know of - and I got two shots of Moderna which I specifically chose because it has more antibodies) a slew of people would show up to admonish, bring up the typical "anti-vaxxer!" arguments, and state that the risk of getting it from COVID was far far greater. I recall every media article on the subject stating the same thing. So where were these people and the media getting their information from, or were they just making it up? And if the latter is the case, it's when people and the media do things like this that people either begin to distrust science more, or use it as another example of why science shouldn't be treated like religion and how the media and people picks and chooses which scientific information to share with the public to fit the narrative they're pushing. It's just sad all around.
  - roenxi 5y ago
    They might still be right; this is only a pre-print, only focused on one specific aspect of COVID and the effect size is small. But if they are wrong, the most likely explanation is they misunderstood something and were just wrong. Ironically, as is well known but bears repeating, the vocal "follow the science" types tend more to be believers in authority figures than people who care what science says. They aren't especially motivated by evidence. Actual scientists will usually be circumspect until the evidence is overwhelming.
    - spurgu 5y ago
      > They might still be right; this is only a pre-print, only focused on one specific aspect of COVID and the effect size is small. There was a study of Canadian data (Ontario) recently as well which interestingly showed large differences depending on the combo (Pfizer/Pfizer, Pfizer/Moderna, Moderna/Moderna, Moderna/Pfizer) of 1st and 2nd shot: https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v1 https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...
- nojokes 5y ago
  This preprint is actually a companion paper to their already published paper in Nature where they do not stratify by age and sex together. In principle this is bad because we know already very well that it affects more young men. I think they made the situation even worse by stratifying only for myocarditis and not for pericarditis and cardiac arrhythmias that according to their paper are much more likely with COVID-19 because it did not register at all for vaccines. This means that people are now getting a very wrong/incomplete picture of the risk benefit relationship. Naturally cardiac issues are not the only possible problems because COVID-19 is systemic disease that can affect many organs and can cause a lot of trouble even without hospitalization.
- scotty79 5y ago
  I've seen similar research about the risk of miocarditis. They compared people after vaccination to themselves before vaccination and calculated the increase. My concern is that after vaccination people changed their behavior exposing themselves more to humans and all the viruses and bacteria capable of infecting humans most of which were never researched for their effect on rusk of miocarditis. This additional risk in this particular age group and gender might be because they (possibly) changed their social behavior the most after they got vaccinated.
Wolfenstein98k 5y ago
Do they know why the shot skyrockets myocarditis risk mostly among young men? Like what's the mechanism?
- TrispusAttucks 5y ago
  The spike protein RNA vaccine saturates the body causing an inflammatory response especial so in certain muscles that use lipids (vaccine contains lipid as a transport mechanism) as a primary source of energy such as the heart muscle. A good interview of this is [1] Joe Rogan Experience episode #1747 - Dr. Peter A. McCullough [1] https://open.spotify.com/episode/0aZte37vtFTkYT7b0b04Qz https://open.spotify.com/episode/0aZte37vtFTkYT7b0b04Qz Edit: [2] The CDCs myocarditis page on this since the Dr. McCullough is upsetting people here. And just so to pre-emptively dismiss any attacks that I am anti-vax I am fully vaxed and boosted. But talking about side effects or risks apparently puts one in said camp. Nuance is dead. [2] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...
  - simondotau 5y ago
    The 30 micrograms of ribonucleic acid in an mRNA vaccine dose get folded into protein and make their way into the lymph nodes in your armpit. They do not “saturate the body”. Joe Rogan interviews are not a reliable source of medical information. Rogan is a COVID conspiracy theorist of the “just asking questions” variety. For anyone unconvinced about this, and values diversity of opinions in their media diet, the recent episode of Decoding the Gurus is worth a listen. https://decoding-the-gurus.captivate.fm/episode/joe-rogan-just-an-average-joe https://decoding-the-gurus.captivate.fm/episode/joe-rogan-ju...
    - TrispusAttucks 5y ago
      Very defensive response. I am not making any claims that are unsupported by the CDC's own data. Just because a response is rare doesn't make it any less true. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...
criticaltinker 5y ago
> In summary, the risk of hospital admission or death from myocarditis is greater following COVID-19 infection than following vaccination and remains modest following sequential doses of mRNA vaccine including a third booster dose of BNT162b in the overall population. > However, the risk of myocarditis following vaccination is consistently higher in younger males, particularly following a second dose of RNA mRNA-1273 vaccine. This is an important reminder for policy makers and the public that vaccination policy cannot be reduced to a simple dichotomy. Vaccines can be beneficial for the overall population AND present excess risk for certain sub-populations. Stratifying by age and sex is essential for discussions on this topic to be accurate and productive. Moreover, it takes a long time and a large sample size for these anomalies to be detected with significant statistical power. Let's do our best to avoid frustrated bickering, we need all the patience and empathy we can muster.
rubyist5eva 5y ago
Yeah but what's my risk of actually catching covid-19 vs. 100% if I just walk into my pharmacy and ask for the shot.
- nradov 5y ago
  Over the long run your risk of catching a SARS-CoV-2 infection approaches 100%. The virus can never be eradicated and we'll all be exposed to it occasionally. Vaccination — and other measures to strengthen your immune system — can reduce the risk of serious COVID-19 symptoms to fairly low levels. https://www.medpagetoday.com/opinion/vinay-prasad/94646 https://www.medpagetoday.com/opinion/vinay-prasad/94646
  - robhunter 5y ago
    The risk of serious COVID-19 symptoms are already at quite low levels in the < 40 male group.
    - sudosysgen 5y ago
      Yes, and WAY higher than the risk of serious symptoms for the virus. For males 18-29 the risk of hospitalization is 0.4% compared to 0.1% for myocarditis, and most myocarditis cases do not require hospitalization. Risk of severe disease is of course much more than risk of hospitalization.
      - thjkgfgrrioppo 5y ago
        I am older than 40 and according to qcovid my risk of hospitalization is about 0,1%, so I doubt your 0,4% number. I am slightly overweight, which increases my risk by about 20%. But I doubt all the 18-29 year olds in your group are so obese that they get to 0,4%.
        sudosysgen 5y ago
        I don't know about qcovid but these two sources disagree : https://pubmed.ncbi.nlm.nih.gov/33729203/ https://pubmed.ncbi.nlm.nih.gov/33729203/ https://riskcalc.org/COVID19Hospitalization/ https://riskcalc.org/COVID19Hospitalization/
nradov 5y ago
An animal study found that aspiration during injection could reduce the risk of vaccine induced myocarditis. It hasn't been reproduced in humans but this seems like something worthy of further research. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab707/6353927 https://academic.oup.com/cid/advance-article/doi/10.1093/cid...
- henearkr 5y ago
  Would make totally sense, as a possible mechanism -- and its remedy -- of how the heart would be affected.
  - Gravyness 5y ago
    Sorry... what? what do you mean?
    - mbar84 5y ago
      The vaccine is intended to be an intramuscular injection. The risk of myocarditis is possibly linked to an accidental intravenous injection. With aspiration, the person performing the injection has a chance to detect that they hit a blood vessel instead of the muscle and try again.
- jagged-chisel 5y ago
  Can you define 'aspiration' in this case? The link is rather dense to the layperson.
  - DoreenMichele 5y ago
    It is apparently a means to double check and make sure you are injecting into a muscle and not into a blood vessel by seeing if you can draw blood at that site before you actually inject anything. https://askinglot.com/what-does-it-mean-to-aspirate-an-injection https://askinglot.com/what-does-it-mean-to-aspirate-an-injec...
  - nradov 5y ago
hnuser847 5y ago
Wow, I just got the Pfizer booster a few days ago and I'm an under-40 male who has previously had pericarditis... I was worried about the risk being greater than the reward for my age group but didn't have the age-stratified data to prove it. Kind of regretting it now, especially since I only got it at the urging of my wife. I just needlessly increased the odds of a giving myself a heart issue for absolutely no reason. Edit: somebody else pointed out that the significantly elevated risk was only observed for Moderna (mRNA-1273). Pfizer (BNT162b2) only has a slightly elevated risk after the 2nd and 3rd doses. Looks like I'll be okay after all :)
- kuhewa 5y ago
  No, not unless Pfizer was a typo and you meant Moderna.
  - TehShrike 5y ago
    After only looking at the charts at the end of the PDF, they seem to indicate that the 3rd dose (booster) of the Pfizer vaccine raises your myocarditis risk about as much as the 2nd dose of Moderna's.
    - sudosysgen 5y ago
      No. 3rd dose Pfizer is not statistically significantly worse than infection for myocarditis.
      - TehShrike 5y ago
        Am I missing something obvious? Am I reading too much from the error bars in the Incidence Rate Ratio charts? Or did I misinterpret the charts some other way?
        sudosysgen 5y ago
        In the chart, the IRR from infection is 2.02, 95% CI 1.13-3.61. The IRR for 3rd dose Pfizer is 7.6, 95% CI 1.92-30.15. Because the confidence interval of the Pfizer 3rd dose contains the datapoint for infection, there is a pretty good chance that the 3rd dose is not anymore likely to lead to myocarditis than COVID, and the result isn't statistically significant at p<=0.05. We can't say for sure.
civilized 5y ago
A bit off-topic but why does PDF export sometimes produce these incredibly, seemingly gratuitously fugly font renderings? The size and spacing of the letters seems to be random. Like, here's a giant d in the middle of a word for no reason.
- chakspak 5y ago
  PDF rendering is the bane of my existence. I've found it stunningly difficult to generate an acceptable output from a source format like Markdown, and the process usually requires massive dependencies and fiddly configuration to get something close to what you want. Don't even try to produce numbered headings or a cover page unless you're willing to write the whole thing in LaTeX from start to finish, but who knows if you'll ever get the table to appear in the right spot on the page. :D
kuhewa 5y ago
The increased risk of myocarditis is confined to ModeRNA 2nd dose, not Pfizer or AZ
- deleted 5y ago
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tlear 5y ago
I wonder when data like this will be available for kids
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cblconfederate 5y ago
I wish these papers were printed in journals that publish the reviewer comments. In fact i think it should be a requirement for all journals. Unfortunately all online commentary ends up becoming a pissing contest where everyone is trying to outwit each other instead of attacking the paper itself from all angles.
- mhh__ 5y ago
  Oh god yes. Considering the leech-like synecdoche journals are for all that stinks in academia at the moment, I really wish they'd try and make a better place for public discussion between experts than Twitter spats. There are probably far too many papers that academics have discovered flaws in but don't have time to do anything about
  - sysOpOpPERAND 5y ago
    i am agreeing with you and parent comment, there is definitely room for growth in how these journals are presented. i think having access to the full discussion would be an amazing step forward for the science community as well as those who are interested in grasping a deeper understanding of how and why the discussion decided to go with their findings
    - cblconfederate 5y ago
      some journals like Elife or Frontiers do publish the commentary. I think for COVID related papers it should be a requirement in all journals
CommanderData 5y ago
Wasn't there a none live attenuation vaccine coming to market that doesnt use MRNA? I read myocarditis is partly caused by the mechanisms of producing the spike protein. Can't we just go back to traditional vaccines?
- fsh 5y ago
  "Traditional vaccines" are by no means free of side effects. The smallpox vaccine is a live vaccine and causes much more severe side effects than mRNA COVID-19 vaccines, including myocarditis [1]. This risk was accepted since smallpox is incredibly dangerous. Inactivated vaccines appear to be quite ineffective against severe COVID and I have read that experts are doubtful about long-term protection against severe cases as well. One alternative might be recombinant protein vaccines like the one from Novavax. This one was just approved in the EU and apparently the phase-3 trial went well. Of course, rare side effects (like myocarditis in mRNA vaccines) can only be measured once at least a few million people have been vaccinated. Also the longevity of the protection is still unknown. [1] https://jamanetwork.com/journals/jama/fullarticle/201967 https://jamanetwork.com/journals/jama/fullarticle/201967
  - josephcsible 5y ago
    > This risk was accepted since smallpox is incredibly dangerous. In particular, it was way more dangerous than COVID is. To figure out an acceptable level of side effects, wouldn't it be better to compare COVID to other diseases of a similar danger level?
ralph84 5y ago
It seemed likely early on that the risks of vaccination exceeded the benefits for healthy young people, but the argument was they should get vaccinated anyway so they wouldn't be able to transmit the virus to someone more vulnerable. Now that it's clear vaccination doesn't prevent transmission, the argument for vaccinating healthy young people is pretty weak.
- fooker 5y ago
  It's incredibly sad that our society can not debate statements like this without being witchunted.
- bigodbiel 5y ago
  When you add the necessity of booster shots, then the equation makes even less sense
- tonyedgecombe 5y ago
  >Now that it's clear vaccination doesn't prevent transmission You seem to be assuming the answer to that is either true or false. Isn't it much more likely that vaccines prevent some transmission and the question is how much.
  - busymom0 5y ago
    The viral load in vaccinated infections has been demonstrated to be the same as unvaccinated infections in multiple studies now. And a perfect example is here in Ontario where 80% of the cases are in vaccinated individuals even though 77% of the population is actually vaccinated. The shots might be helpful as a potential severe symptom mitigator which wanes but it should never have been called a "vaccine" as it neither prevents infection, nor prevents transmission.
    - itsdrewmiller 5y ago
      https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00690-3/fulltext https://www.thelancet.com/journals/laninf/article/PIIS1473-3... positive -> vax infections 1/3 less likely than positive -> unvax - seems like it did prevent (some) infection for Delta at least.
bigodbiel 5y ago
One shortcoming of this and every other study comparing seropositives is that they obviously underestimate such cases 2 to 3 fold. Also further stratifying to “healthy males” would have seen an even more prominent rise. I am sad that only now this has become an open issue. Meanwhile, women are still fighting over menstrual cycle changes post vaccination.
footlose_3815 5y ago
[dead]

190 points by busymom0 5y ago

This paper essentially argues that the risk of myocarditis in under-40 males getting 2 shots is greater (perhaps much greater) than the risk of getting it from COVID. There have been similar studies before, but none (that I saw) broken down by age and sex like this. It reads: > Despite more myocarditis events occurring in older persons, the risk following COVID-19 vaccination was largely restricted to younger males aged less than 40 years, where the risks of myocarditis following vaccination and infection were similar. However, the notable exception was that in younger males receiving a second dose of mRNA-1273 vaccine, the risk of myocarditis was higher following vaccination than infection, with an additional 101 events estimated following a second dose of mRNA-1273 vaccine compared to 7 events following a positive SARS-CoV-2 test. This guy made a graph of their data, which makes it a little more clear: https://twitter.com/VPrasadMDMPH/status/1475145220618526729 https://twitter.com/VPrasadMDMPH/status/1475145220618526729

busymom0 5y ago
That graph in that tweet is included in the study's PDF. It's the very last page of the PDF and has more graphs too. I wish the study's age group was more specific (the authors admit they don't have enough data for the 13-17 age group to make it more specific). Aka, I would like to see 10 year age group intervals. From other studies, the risks is highest in 16-24 if I remember right? There's a study out of Public Health Ontario, ON, Canada which compares the risks depending upon the intervals between first and second dose. https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v1.full.pdf https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...
jMyles 5y ago
> This guy made a graph of their data, which makes it a little more clear: As another commenter as has pointed out, the graph in question in included in the PDF version of this preprint (which you can see here: https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v1.full.pdf+html https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...). I want to add: "this guy" is Vinay Prasad, a professor of oncology at UCSF and an incredibly prescient thinker through the COVID-19 pandemic, and someone with whome I've had the joy to correspond and repeatedly be impressed by his straightforward, evidence-based, dry-witty way of thinking, writing, and speaking. He's a significant up-and-come in medical science, without a doubt, and someone to follow if you are interested in science-based policy. We had the pleasure of hosting an AMA with him on /r/lockdownskepticism which you may find enjoyable and educational: https://www.reddit.com/r/LockdownSkepticism/comments/m0ll33/hi_im_vinay_prasad_from_the_university_of/ https://www.reddit.com/r/LockdownSkepticism/comments/m0ll33/...
- unityByFreedom 5y ago
  Is r/lockdownskepticism also skeptical of vaccination? And do you think covid is worse than or same as the flu?
  - yonaguska 5y ago
    There is a definite overlap in people skeptical of lockdowns and the vaccines, but the sub tries to steer clear of vaccine skepticism due to it being technically off topic, and something that would get the sub nuked. Not that you asked me- I would classify it as "different" than the flu, that it affects different individuals differently, and that the original variant was definitely something more scary than the flu. Especially due to the novelty of the spike protein. Now- I view omicron as about as dangerous as the flu for a much smaller subset of people than the flu is dangerous for. Especially when you account for age and comorbidities. The flu kills children, while covid generally does not.
    - unityByFreedom 5y ago
      - yonaguska 5y ago
        > given the rate of deaths are 10-20x worse than the worst flu years. I have a hard time accepting this premise. Mostly because the flu was somehow eradicated at the outset of mass covid testing, many of the covid tests did not distinguish between the flu and covid. Furthermore, I believe that we actually responded to covid in a way that caused excess covid deaths by over counting deaths and actively suppressing unpatentable treatments for covid. I think we hospitalized people that didn't need to be hospitalized, and we told people not to do anything until they needed to be hospitalized. We then started putting too many people on vents, giving them Remdesiver(toxic with highly questionable efficacy), and putting covid patients in nursing homes with the most vulnerable population. Not to mention lockdowns that pushed a huge portion of the world into poverty, nutritional deficiency, and much more susceptible to adverse effects from disease as a result. But those are just my thoughts- I don't think we have good enough data, nor will we ever- to actually make strong conclusions either way.
ozdave 5y ago
Thanks for the explanation. > argues that the risk of myocarditis in under-40 males getting 2 shots is greater (perhaps much greater) than the risk of getting it from COVID The way I read this is the risk of myocarditis is greater with vaccination, but this does not tell me about the overall risk of serious illness/death from Covid for vaxed VS unvaxed. So - risk of myocarditis goes up - but is it still overall safer to be vaccinated for the under 40 males, or not? Not pushing any angle or side here - just looking for clarity (as much as possible).
- mrhands556 5y ago
  IFR for males under 40 is 500/1000000 or .05% if they’re infected. Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
  - sudosysgen 5y ago
    That's a horribly misleading comparison. Compare the risk of illness with severity similar to heart complications, or compare death rates. Don't compare one to the other. The majority of myocarditis cases due to the vaccine don't even require hospitalization.
    - yonaguska 5y ago
      Source? One friend with this exact issue was never hospitalized, was told that it couldn't possibly be due the vaccine, but ended up with several visits to a cardiologist and now had to deal with the long term effects. So no- there was no hospitalization. Technically. And they will never show up in any data set either. Because we aren't even tracking this stuff correctly in the USA.
      - sudosysgen 5y ago
        Yes, your friend had no hospitalization. We don't count people who see a doctor a few times and have long term side-effects as hospitalized from COVID, so in an apples-to-apples comparison the example of your friend should not go into that column. Here is the source: https://www.nejm.org/doi/full/10.1056/NEJMoa2110737 https://www.nejm.org/doi/full/10.1056/NEJMoa2110737: > A total of 76% of cases of myocarditis were described as mild and 22% as intermediate; 1 case was associated with cardiogenic shock (Out of 100 cases)
coolso 5y ago
> This paper essentially argues that the risk of myocarditis in under-40 males getting 2 shots is greater (perhaps much greater) than the risk of getting it from COVID. There have been similar studies before, but none (that I saw) broken down by age and sex like this. This is especially fascinating to me because for months I noticed that whenever I or anyone else would bring up the fear of myocarditis from the vax (which I ended up not experiencing, by the way, that I know of - and I got two shots of Moderna which I specifically chose because it has more antibodies) a slew of people would show up to admonish, bring up the typical "anti-vaxxer!" arguments, and state that the risk of getting it from COVID was far far greater. I recall every media article on the subject stating the same thing. So where were these people and the media getting their information from, or were they just making it up? And if the latter is the case, it's when people and the media do things like this that people either begin to distrust science more, or use it as another example of why science shouldn't be treated like religion and how the media and people picks and chooses which scientific information to share with the public to fit the narrative they're pushing. It's just sad all around.
- roenxi 5y ago
  They might still be right; this is only a pre-print, only focused on one specific aspect of COVID and the effect size is small. But if they are wrong, the most likely explanation is they misunderstood something and were just wrong. Ironically, as is well known but bears repeating, the vocal "follow the science" types tend more to be believers in authority figures than people who care what science says. They aren't especially motivated by evidence. Actual scientists will usually be circumspect until the evidence is overwhelming.
  - spurgu 5y ago
    > They might still be right; this is only a pre-print, only focused on one specific aspect of COVID and the effect size is small. There was a study of Canadian data (Ontario) recently as well which interestingly showed large differences depending on the combo (Pfizer/Pfizer, Pfizer/Moderna, Moderna/Moderna, Moderna/Pfizer) of 1st and 2nd shot: https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v1 https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v...
nojokes 5y ago
This preprint is actually a companion paper to their already published paper in Nature where they do not stratify by age and sex together. In principle this is bad because we know already very well that it affects more young men. I think they made the situation even worse by stratifying only for myocarditis and not for pericarditis and cardiac arrhythmias that according to their paper are much more likely with COVID-19 because it did not register at all for vaccines. This means that people are now getting a very wrong/incomplete picture of the risk benefit relationship. Naturally cardiac issues are not the only possible problems because COVID-19 is systemic disease that can affect many organs and can cause a lot of trouble even without hospitalization.
scotty79 5y ago
I've seen similar research about the risk of miocarditis. They compared people after vaccination to themselves before vaccination and calculated the increase. My concern is that after vaccination people changed their behavior exposing themselves more to humans and all the viruses and bacteria capable of infecting humans most of which were never researched for their effect on rusk of miocarditis. This additional risk in this particular age group and gender might be because they (possibly) changed their social behavior the most after they got vaccinated.

Wolfenstein98k 5y ago

Do they know why the shot skyrockets myocarditis risk mostly among young men? Like what's the mechanism?

TrispusAttucks 5y ago
The spike protein RNA vaccine saturates the body causing an inflammatory response especial so in certain muscles that use lipids (vaccine contains lipid as a transport mechanism) as a primary source of energy such as the heart muscle. A good interview of this is [1] Joe Rogan Experience episode #1747 - Dr. Peter A. McCullough [1] https://open.spotify.com/episode/0aZte37vtFTkYT7b0b04Qz https://open.spotify.com/episode/0aZte37vtFTkYT7b0b04Qz Edit: [2] The CDCs myocarditis page on this since the Dr. McCullough is upsetting people here. And just so to pre-emptively dismiss any attacks that I am anti-vax I am fully vaxed and boosted. But talking about side effects or risks apparently puts one in said camp. Nuance is dead. [2] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...
- simondotau 5y ago
  The 30 micrograms of ribonucleic acid in an mRNA vaccine dose get folded into protein and make their way into the lymph nodes in your armpit. They do not “saturate the body”. Joe Rogan interviews are not a reliable source of medical information. Rogan is a COVID conspiracy theorist of the “just asking questions” variety. For anyone unconvinced about this, and values diversity of opinions in their media diet, the recent episode of Decoding the Gurus is worth a listen. https://decoding-the-gurus.captivate.fm/episode/joe-rogan-just-an-average-joe https://decoding-the-gurus.captivate.fm/episode/joe-rogan-ju...
  - TrispusAttucks 5y ago
    Very defensive response. I am not making any claims that are unsupported by the CDC's own data. Just because a response is rare doesn't make it any less true. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...

criticaltinker 5y ago

> In summary, the risk of hospital admission or death from myocarditis is greater following COVID-19 infection than following vaccination and remains modest following sequential doses of mRNA vaccine including a third booster dose of BNT162b in the overall population. > However, the risk of myocarditis following vaccination is consistently higher in younger males, particularly following a second dose of RNA mRNA-1273 vaccine. This is an important reminder for policy makers and the public that vaccination policy cannot be reduced to a simple dichotomy. Vaccines can be beneficial for the overall population AND present excess risk for certain sub-populations. Stratifying by age and sex is essential for discussions on this topic to be accurate and productive. Moreover, it takes a long time and a large sample size for these anomalies to be detected with significant statistical power. Let's do our best to avoid frustrated bickering, we need all the patience and empathy we can muster.

rubyist5eva 5y ago

Yeah but what's my risk of actually catching covid-19 vs. 100% if I just walk into my pharmacy and ask for the shot.

nradov 5y ago
Over the long run your risk of catching a SARS-CoV-2 infection approaches 100%. The virus can never be eradicated and we'll all be exposed to it occasionally. Vaccination — and other measures to strengthen your immune system — can reduce the risk of serious COVID-19 symptoms to fairly low levels. https://www.medpagetoday.com/opinion/vinay-prasad/94646 https://www.medpagetoday.com/opinion/vinay-prasad/94646
- robhunter 5y ago
  The risk of serious COVID-19 symptoms are already at quite low levels in the < 40 male group.
  - sudosysgen 5y ago
    Yes, and WAY higher than the risk of serious symptoms for the virus. For males 18-29 the risk of hospitalization is 0.4% compared to 0.1% for myocarditis, and most myocarditis cases do not require hospitalization. Risk of severe disease is of course much more than risk of hospitalization.
    - thjkgfgrrioppo 5y ago
      I am older than 40 and according to qcovid my risk of hospitalization is about 0,1%, so I doubt your 0,4% number. I am slightly overweight, which increases my risk by about 20%. But I doubt all the 18-29 year olds in your group are so obese that they get to 0,4%.
      - sudosysgen 5y ago
        I don't know about qcovid but these two sources disagree : https://pubmed.ncbi.nlm.nih.gov/33729203/ https://pubmed.ncbi.nlm.nih.gov/33729203/ https://riskcalc.org/COVID19Hospitalization/ https://riskcalc.org/COVID19Hospitalization/

nradov 5y ago

An animal study found that aspiration during injection could reduce the risk of vaccine induced myocarditis. It hasn't been reproduced in humans but this seems like something worthy of further research. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab707/6353927 https://academic.oup.com/cid/advance-article/doi/10.1093/cid...

henearkr 5y ago
Would make totally sense, as a possible mechanism -- and its remedy -- of how the heart would be affected.
- Gravyness 5y ago
  Sorry... what? what do you mean?
  - mbar84 5y ago
    The vaccine is intended to be an intramuscular injection. The risk of myocarditis is possibly linked to an accidental intravenous injection. With aspiration, the person performing the injection has a chance to detect that they hit a blood vessel instead of the muscle and try again.
jagged-chisel 5y ago
Can you define 'aspiration' in this case? The link is rather dense to the layperson.
- DoreenMichele 5y ago
  It is apparently a means to double check and make sure you are injecting into a muscle and not into a blood vessel by seeing if you can draw blood at that site before you actually inject anything. https://askinglot.com/what-does-it-mean-to-aspirate-an-injection https://askinglot.com/what-does-it-mean-to-aspirate-an-injec...
- nradov 5y ago

hnuser847 5y ago

Wow, I just got the Pfizer booster a few days ago and I'm an under-40 male who has previously had pericarditis... I was worried about the risk being greater than the reward for my age group but didn't have the age-stratified data to prove it. Kind of regretting it now, especially since I only got it at the urging of my wife. I just needlessly increased the odds of a giving myself a heart issue for absolutely no reason. Edit: somebody else pointed out that the significantly elevated risk was only observed for Moderna (mRNA-1273). Pfizer (BNT162b2) only has a slightly elevated risk after the 2nd and 3rd doses. Looks like I'll be okay after all :)

kuhewa 5y ago
No, not unless Pfizer was a typo and you meant Moderna.
- TehShrike 5y ago
  After only looking at the charts at the end of the PDF, they seem to indicate that the 3rd dose (booster) of the Pfizer vaccine raises your myocarditis risk about as much as the 2nd dose of Moderna's.
  - sudosysgen 5y ago
    No. 3rd dose Pfizer is not statistically significantly worse than infection for myocarditis.
    - TehShrike 5y ago
      Am I missing something obvious? Am I reading too much from the error bars in the Incidence Rate Ratio charts? Or did I misinterpret the charts some other way?
      - sudosysgen 5y ago
        In the chart, the IRR from infection is 2.02, 95% CI 1.13-3.61. The IRR for 3rd dose Pfizer is 7.6, 95% CI 1.92-30.15. Because the confidence interval of the Pfizer 3rd dose contains the datapoint for infection, there is a pretty good chance that the 3rd dose is not anymore likely to lead to myocarditis than COVID, and the result isn't statistically significant at p<=0.05. We can't say for sure.

civilized 5y ago

A bit off-topic but why does PDF export sometimes produce these incredibly, seemingly gratuitously fugly font renderings? The size and spacing of the letters seems to be random. Like, here's a giant d in the middle of a word for no reason.

chakspak 5y ago
PDF rendering is the bane of my existence. I've found it stunningly difficult to generate an acceptable output from a source format like Markdown, and the process usually requires massive dependencies and fiddly configuration to get something close to what you want. Don't even try to produce numbered headings or a cover page unless you're willing to write the whole thing in LaTeX from start to finish, but who knows if you'll ever get the table to appear in the right spot on the page. :D

kuhewa 5y ago

The increased risk of myocarditis is confined to ModeRNA 2nd dose, not Pfizer or AZ

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tlear 5y ago

I wonder when data like this will be available for kids

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cblconfederate 5y ago

I wish these papers were printed in journals that publish the reviewer comments. In fact i think it should be a requirement for all journals. Unfortunately all online commentary ends up becoming a pissing contest where everyone is trying to outwit each other instead of attacking the paper itself from all angles.

mhh__ 5y ago
Oh god yes. Considering the leech-like synecdoche journals are for all that stinks in academia at the moment, I really wish they'd try and make a better place for public discussion between experts than Twitter spats. There are probably far too many papers that academics have discovered flaws in but don't have time to do anything about
- sysOpOpPERAND 5y ago
  i am agreeing with you and parent comment, there is definitely room for growth in how these journals are presented. i think having access to the full discussion would be an amazing step forward for the science community as well as those who are interested in grasping a deeper understanding of how and why the discussion decided to go with their findings
  - cblconfederate 5y ago
    some journals like Elife or Frontiers do publish the commentary. I think for COVID related papers it should be a requirement in all journals

CommanderData 5y ago

Wasn't there a none live attenuation vaccine coming to market that doesnt use MRNA? I read myocarditis is partly caused by the mechanisms of producing the spike protein. Can't we just go back to traditional vaccines?

fsh 5y ago
"Traditional vaccines" are by no means free of side effects. The smallpox vaccine is a live vaccine and causes much more severe side effects than mRNA COVID-19 vaccines, including myocarditis [1]. This risk was accepted since smallpox is incredibly dangerous. Inactivated vaccines appear to be quite ineffective against severe COVID and I have read that experts are doubtful about long-term protection against severe cases as well. One alternative might be recombinant protein vaccines like the one from Novavax. This one was just approved in the EU and apparently the phase-3 trial went well. Of course, rare side effects (like myocarditis in mRNA vaccines) can only be measured once at least a few million people have been vaccinated. Also the longevity of the protection is still unknown. [1] https://jamanetwork.com/journals/jama/fullarticle/201967 https://jamanetwork.com/journals/jama/fullarticle/201967
- josephcsible 5y ago
  > This risk was accepted since smallpox is incredibly dangerous. In particular, it was way more dangerous than COVID is. To figure out an acceptable level of side effects, wouldn't it be better to compare COVID to other diseases of a similar danger level?

ralph84 5y ago

It seemed likely early on that the risks of vaccination exceeded the benefits for healthy young people, but the argument was they should get vaccinated anyway so they wouldn't be able to transmit the virus to someone more vulnerable. Now that it's clear vaccination doesn't prevent transmission, the argument for vaccinating healthy young people is pretty weak.

fooker 5y ago
It's incredibly sad that our society can not debate statements like this without being witchunted.
bigodbiel 5y ago
When you add the necessity of booster shots, then the equation makes even less sense
tonyedgecombe 5y ago
>Now that it's clear vaccination doesn't prevent transmission You seem to be assuming the answer to that is either true or false. Isn't it much more likely that vaccines prevent some transmission and the question is how much.
- busymom0 5y ago
  The viral load in vaccinated infections has been demonstrated to be the same as unvaccinated infections in multiple studies now. And a perfect example is here in Ontario where 80% of the cases are in vaccinated individuals even though 77% of the population is actually vaccinated. The shots might be helpful as a potential severe symptom mitigator which wanes but it should never have been called a "vaccine" as it neither prevents infection, nor prevents transmission.
  - itsdrewmiller 5y ago
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00690-3/fulltext https://www.thelancet.com/journals/laninf/article/PIIS1473-3... positive -> vax infections 1/3 less likely than positive -> unvax - seems like it did prevent (some) infection for Delta at least.

bigodbiel 5y ago

One shortcoming of this and every other study comparing seropositives is that they obviously underestimate such cases 2 to 3 fold. Also further stratifying to “healthy males” would have seen an even more prominent rise. I am sad that only now this has become an open issue. Meanwhile, women are still fighting over menstrual cycle changes post vaccination.

footlose_3815 5y ago

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