Sweden and Norway pause the use of Moderna vaccine due to the risk of myocarditis
By NewsDesk @infectiousdiseasenews
Earlier this week we reported on Finland restricts the use of Modernas Spikevax mRNA COVID-19 vaccine due to risk of myocarditis in certain populations.
Finland’s Nordic neighbors – Sweden and Norway – have taken a similar course on the vaccine.
Sweden
The Swedish Public Health Agency has, for precautionary reasons, decided to discontinue the use of the Mother’s vaccine Spikevax, for everyone born in 1991 and later. The cause is signals of an increased risk of side effects such as inflammation of the heart muscle or heart sac. However, the risk of being affected is very small.
Myocarditis (pericarditis) and pericarditis usually go away on their own, but the symptoms must be assessed by a doctor. The conditions are most common among young men, in connection with, for example, viral infections such as covid-19. In 2019, approximately 300 people under the age of 30 were treated in hospital with myocarditis.
Data indicate an increased incidence also in connection with vaccination against covid-19, mainly in adolescents and young adults and mainly in boys and men. For the individual, the risk of being affected is very small, it is a very rare side effect.
New preliminary analyzes from Swedish and Nordic data sources indicate that the connection is particularly clear with regard to Moderna’s vaccine Spikevax, especially after the second dose. The increase in risk is seen within four weeks after vaccination, mainly within the first two weeks.
The Swedish Public Health Agency has decided to recommend a break for all use of Spikevax for people born in 1991 and later. The decision is valid until 1 December 2021. The Swedish Public Health Agency will return with a notice of recommendation after this date.
-We follow the situation closely and act quickly to ensure that vaccinations against covid-19 are always as safe as possible and at the same time provide effective protection against covid-19, says Anders Tegnell, head of department and state epidemiologist at the Swedish Public Health Agency.
People born in 1991 and later who have received a dose of Moderna’s vaccine will not be offered a second dose of covid-19 vaccine at present, discussions are ongoing about the best solution for that group. In total, there are about 81,000 people.
For people born in 1991 who have not been vaccinated before, the Pfizer / Biontech Comirnaty vaccine is recommended as the first and second dose.
– Those who have been vaccinated recently, with their first or second dose of Moderna’s vaccine, do not have to worry that the risk is very small, but it is good to know what symptoms you need to be vigilant about, says Anders Tegnell.
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Both myocarditis and pericarditis often disappear on their own without causing any lasting problems, but suspicious symptoms should be assessed by a doctor at, for example, a health center or emergency department. Medical treatment and hospital monitoring may be needed in established cases.
Symptoms of myocarditis and / or pericarditis include:
- Fatigue and shortness of breath
- Irregular heartbeat and palpitations
- Fever and pain in the body
- A feeling of pressure or weight over the chest
- It hurts to breathe deeply
- Pain in the left or middle of the chest
Norway
Norway’s FHI reiterates the recommendation that young people under the age of 18 who are to be vaccinated are offered Comirnaty regardless of which mRNA vaccine they received as the first dose. Men under the age of 30 should also consider choosing Comirnaty when they are to be vaccinated, says Geir Bukholm, director of infection control at the Norwegian Institute of Public Health.
Surveillance analyzes of reported adverse reactions from the United States have suggested that myocarditis may be more common when using Moderna’s vaccine as a different dose than the BioNTech / Pfizer vaccine, but the numbers have been small and therefore uncertain. New monitoring data from Ontario, Canada, confirm that this observation is correct and preliminary monitoring data from Norway, Sweden and other countries may indicate the same.
The most common cause of myocarditis is viral infections and you see a seasonal variation where it occurs more often in late summer and autumn than at other times of the year. Myocarditis is most common in young men and boys. An increased incidence of myocarditis has been seen after the use of mRNA vaccines, and here too it is more common in young men and boys. Most people who suffer from the rare side effect of myocarditis after vaccination have had relatively mild symptoms and people have recovered quickly with regular treatment of the disease.
Background for advice
Norway is cooperating with the other Nordic countries on health register analyzes to detect and investigate rare side effects. An overall basis of figures from all the Nordic countries gives the analyzes strength. The Nordic register study look at the prevalence of myocarditis and pericarditis has not been completed and has therefore not yet been published and final conclusions can not yet be drawn from this study. Norwegian monitoring data included in the Nordic registry study indicate an increased incidence after Moderna as the second dose. The Norwegian Institute of Public Health therefore now issues a clarification to the Council not to give Spikevax to those under 18 years of age, and that men under 30 years of age should consider choosing Comirnaty, as a precautionary principle. The same has been done in Sweden.
However, the side effect is rare and the absolute risk is still low . Both of the two mRNA vaccines used in the Norwegian coronary vaccination program are good and very effective and provide a high degree of protection against severe covid-19 infection. . Nail wax from Moderna seems to provide slightly better protection than Comirnaty from BioNTech / Pfizer against diseases caused by the delta variant (updated 7 October, removed “mild and severe” before disease).
– Those who are to be vaccinated in the future can at least choose the type of vaccine they want, both as a first and second dose, Bukholm continues. It is important to emphasize that Spikevax from Moderna is as effective a vaccine against covid-19 as Comirnaty, and both types of vaccine are still recommended for people over 30 years of age.
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The recommendation that Comirnaty should be used for everyone under the age of 18 has already been given . Children and young people under the age of 18 have previously recommended to Comirnaty as there is greater experience with the use of this vaccine in the age group, in accordance with the precautionary principle. The knowledge that myocarditis may occur more often after using Spikevax than Comirnaty, even in slightly older age groups, strengthens the previous assessment.
FHI therefore emphasizes the recommendation that children and young people between the ages of 12 and 17 should still be offered Comirnaty and not Spikevax. Those under the age of 18 who have received the first dose of Spikevax should also receive the second dose of Comirnaty. This applies to approximately 3,500 young people born in 2004 and 2005 who have received Spikevax (4% of those vaccinated), the rest have received Comirnaty.
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