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• Feedback & request for correction
  John J Jones
  Published on: 28 May 2023

• Published on: 28 May 2023

  Feedback & request for correction

  • John J Jones, Physician John J Jones MD

  I read with interest the article titled “Ethics of college vaccine mandates, using reasonable comparisons” by Lam LL and Nichols T1, published on Mar 30, 2023, in the Journal of Medical Ethics.

  I would like to comment on statements that the above authors made that COVID-19 vaccine-caused myocarditis cases are “generally mild” and “over 90% of the hospitalized vaccine-caused myocarditis cases fully recovered within days”, and that “approximately 10% of the hospitalised cases … may have some long-term consequences”.

  Among individuals with COVID-19 vaccine-associated myocarditis, the majority develop cardiac MRI abnormalities including fibrosis, which persist on follow-up, as shown below2-4. The authors’ statements that vaccine-caused myocarditis is ‘mild’ and ‘fully recovered in 90% of cases’ with only ‘10% having long-term consequences’ are misleading, since development of myocardial fibrosis in most patients with vaccine-caused myocarditis refutes these statements. Consequently, any conclusions that the authors make relying on these inaccurate statements are not supported. To promote accuracy, a correction should be issued to the above authors’ statements.

  Schauer J2 et al found that at 3-8 months’ follow-up, repeat cardiac MRI showed persistent late gadolinium enhancement, an indicator of cardiac injury and fibrosis, in 68.8% (11/15) of adolescents aged 12-17 years with COVID-19 vaccine–associated myocarditis.

  Cavalcante JL et al3 found that at...

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  I read with interest the article titled “Ethics of college vaccine mandates, using reasonable comparisons” by Lam LL and Nichols T1, published on Mar 30, 2023, in the Journal of Medical Ethics.

  I would like to comment on statements that the above authors made that COVID-19 vaccine-caused myocarditis cases are “generally mild” and “over 90% of the hospitalized vaccine-caused myocarditis cases fully recovered within days”, and that “approximately 10% of the hospitalised cases … may have some long-term consequences”.

  Among individuals with COVID-19 vaccine-associated myocarditis, the majority develop cardiac MRI abnormalities including fibrosis, which persist on follow-up, as shown below2-4. The authors’ statements that vaccine-caused myocarditis is ‘mild’ and ‘fully recovered in 90% of cases’ with only ‘10% having long-term consequences’ are misleading, since development of myocardial fibrosis in most patients with vaccine-caused myocarditis refutes these statements. Consequently, any conclusions that the authors make relying on these inaccurate statements are not supported. To promote accuracy, a correction should be issued to the above authors’ statements.

  Schauer J2 et al found that at 3-8 months’ follow-up, repeat cardiac MRI showed persistent late gadolinium enhancement, an indicator of cardiac injury and fibrosis, in 68.8% (11/15) of adolescents aged 12-17 years with COVID-19 vaccine–associated myocarditis.

  Cavalcante JL et al3 found that at approximately 3 months of follow-up, late gadolinium enhancement consistent with nonischemic fibrosis was still present in 80% (4/5) of adults aged 18-34 years with COVID-19 vaccine–associated myocarditis.

  Kracalik I et al4 published data on outcomes at least 90 days after onset of COVID-19 vaccine- associated myocarditis in 519 adolescents and young adults aged 12–29 years. 54% of 151 patients with follow-up cardiac MRI’s had one or more abnormalities, including the presence of late gadolinium enhancement (in 47% of patients), inflammation or oedema, or wall motion abnormalities.

  Finally, while the comment by Lam LL and Nichols T is available for free on the website of the Journal of Medical Ethics, the response by the authors of the original article by Bardosh K et al5 is not similarly available for free, which seems unusual.

  Sincerely,

  John J Jones

  References:
  1. Lam LL, Nichols T. Ethics of college vaccine mandates, using reasonable comparisons. J Med Ethics. 2023 Mar 30:jme-2022-108852. Online ahead of print.
  2. Schauer J, Buddhe S, Gulhane A, et al. Persistent Cardiac Magnetic Resonance Imaging Findings in a Cohort of Adolescents with Post-Coronavirus Disease 2019 mRNA Vaccine Myopericarditis. J Pediatr. 2022;245:233-237.
  3. Cavalcante JL, Shaw KE, Gössl M. Cardiac Magnetic Resonance Imaging Midterm Follow Up of COVID-19 Vaccine-Associated Myocarditis. JACC Cardiovasc Imaging. 2022;15:1821-1824.
  4. Kracalik I, Oster M, Broder K, et al. Outcomes at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults in the USA: a follow-up surveillance study. Lancet Child Adolesc Health. 2022;6:788-798.
  5. Bardosh K, Krug A, Jamrozik E, et al. Covid-19 vaccine boosters for young adults: a risk benefit assessment and ethical analysis of mandate policies at universities. J Med Ethics. 2022 Dec 5;jme-2022-108449. Online ahead of print.

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  Conflict of Interest:
  None declared.

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