MEDICAL ADVISORY: COVID-19 Vaccination Following Myocarditis or Pericarditis
Issued by: Azim Kasmani, MD FRCPC, Associate Medical Officer of Health
Since June 2021, the National Advisory
Committee on Immunization (NACI) has recommended that people who experienced myocarditis and/or pericarditis after a first dose of an mRNA COVID-19 vaccine should wait to get their second dose until more information was available. On January 14, 2022, after reviewing the latest evidence and consulting with Canadian cardiologists, NACI released new guidance regarding subsequent vaccination for those who experienced myocarditis or pericarditis.
Reports of myocarditis and pericarditis continue to be rare following vaccination with an mRNA vaccine. Most cases:
- Occur in males 12 to 29 years of age
- Occur after the second dose of an mRNA vaccine (more often in Moderna than Pfizer-BioNTech)
- Are mild and resolve quickly
NACI continues to recommend that
- In most circumstances, and as a precautionary measure until more information is available, further doses of mRNA COVID-19 vaccines should be deferred among people who experienced myocarditis (with or without pericarditis) within 6 weeks of receiving a
previous dose of an mRNA COVID-19 vaccine. This includes any person who had an abnormal cardiac investigation including electrocardiogram (ECG), elevated troponins, echocardiogram or cardiac MRI after a dose of an mRNA vaccine.
New NACI Recommendation
- Those with a history compatible with pericarditis and who either had no cardiac workup or had normal cardiac investigations, can receive the next dose once they are symptom free and at least 90 days have passed since their previous dose
- Some people with confirmed myocarditis (with or without pericarditis) after a dose of an mRNA COVID-19 vaccine may choose to receive another dose of vaccine after discussing the risks and benefits with their health care provider
- If another dose of vaccine is offered, regardless of client’s age, they should be offered the Pfizer-BioNTech (Comirnaty) 30 mcg vaccine due to the lower reported rate of myocarditis and/or pericarditis with this vaccine compared to the Moderna (Spikevax) 100 mcg vaccine
- Informed consent should include discussion about
- The unknown risk of recurrence of myocarditis and/or pericarditis after additional doses of Pfizer-BioNTech (Comirnaty) COVID-19 vaccine in individuals with a history of confirmed myocarditis and/or pericarditis (after a previous dose of mRNA COVID-19 vaccine)
- The need to seek immediate medical assessment and care should symptoms develop
More Information
- Health care providers should report cases of myocarditis and/or pericarditis following immunization using the Report of Adverse Event Following Immunization (AEFI) Form and fax it to 905-688-8225
- If you have questions, call the COVID-19 Primary Care Info-Line at 905-688-8248 (press 7, then 1 for physicians). The info-line is open Monday to Friday, 8:30 a.m. to 4:15 p.m.