![]() ![]() Although the individual with myocarditis displayed increased natural killer cell subsets, elevated cytokines, and several autoantibodies, a specific signature could not be identified. ![]() 10 One group performed extensive immunoanalysis on a case of post–mRNA-1273 (Moderna) vaccine myocarditis and compared the findings with those from vaccinated control subjects. 12 Alternatively, it has been proposed that in certain individuals, vaccination might generate autoantibodies from polyclonal B-cell expansion or immune complex formation and inflammation, 10, 11 or potentially the molecular mimicry between the spike protein and self-antigens may result in cardiac-targeted antibodies. 7– 9 Previous authors have hypothesized that vaccination may trigger a robust overactive or aberrant innate and acquired immune response in genetically predisposed individuals, 10, 11 or given the predilection for male individuals, hormones, specifically testosterone, may alter immune responses, eliciting a more aggressive T helper 1 cell–type immune response. Roughly 1 to 2 cases per 100 000 individuals have developed myocarditis or pericarditis after mRNA vaccination. Understanding the immunophenotype associated with mRNA vaccine–induced myocarditis is an essential first step in preventing negative complications resulting from this novel vaccine technology. The immune response driving postvaccine myocarditis has not yet been elucidated. 5, 6 Rarely, some individuals develop myocarditis after mRNA vaccination. SARS-CoV-2 mRNA vaccines have been shown to dramatically reduce disease severity and mortality of COVID-19 in adults 1, 2 and children, 3, 4 and vaccinated children may be less likely to develop the severe, life-threatening post–COVID-19 complication multisystem inflammatory syndrome in children (MIS-C). Following a tiered approach that prioritized high-risk individuals, infants ≥6 months of age are now eligible for vaccination with SARS-CoV-2 mRNA vaccines in select countries. Within 9 months of coronavirus disease 2019 (COVID-19) reaching pandemic proportions, novel, lifesaving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–targeted mRNA vaccine technologies received emergency regulatory approvals and were distributed to many developed countries. These results do not alter the risk-benefit ratio favoring vaccination against COVID-19 to prevent severe clinical outcomes. ![]()
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