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COVID Vaccines In Teens And Heart Inflammation: What You Need To Know : Shots - Health News Health officials have been investigating an extremely rare side-effect of vaccination with the mRNA vaccines in young people: heart inflammation that's mostly mild and temporary.
COVID Vaccines In Teens And Myocarditis: What You Need To Know
Updated June 23, 20214:24 PM ET Originally published June 17, 202111:17 AM ET
A teen gets a dose of Pfizer's COVID-19 vaccine last month at Holtz Children's Hospital in Miami. Nearly 7 million U.S. teens and preteens (ages 12 through 17) have received at least one dose of a COVID-19 vaccine so far, the CDC says. Eva Marie Uzcategui/Bloomberg via Getty Images hide caption
It's been a little more than a month since adolescents as young as 12 became eligible in the United States to receive the Pfizer vaccine against COVID-19, and nearly all reports have been positive: The vaccine is very effective in this age group, and the vast majority of kids experience mild side effects, if any — the same sore arm or mild flulike symptoms seen among adults who get the shot.
The Centers for Disease Control and Prevention has recommended that everyone 12 and older get vaccinated against COVID-19, and the rollout is well underway: According to the CDC last week, around 7 million U.S. teens and preteens (ages 12 through 17) had received at least one dose of a COVID-19 vaccine so far.
Still, soon after the Food and Drug Administration authorized the use of Pfizer's vaccine in young people, federal agencies began receiving reports of mild chest pain or other signs of possible heart inflammation (known as myocarditis) in a small percentage of teens and young adults soon after vaccination.
According to the CDC, after a meeting of expert advisors discussed the data Wednesday, more than 300 cases of heart inflammation have been documented after the Pfizer or Moderna COVID-19 vaccines. The cases have been seen mostly in teens and young adults between 12 and 39 years old, the agency says. Symptoms can include chest pain or pressure and a temporarily abnormal ECG and blood test results.
Naturally occurring heart inflammation is rare, but it does occur from time to time in teens and young adults. The rate seen after these vaccines is slightly higher than the "background" rate.
The CDC says the findings do not change the basic recommendation that all people 12 and older should be vaccinated against COVID-19. However, if a person develops myocarditis after the first dose of one of the mRNA vaccines, a second dose should be delayed until the condition has fully resolved and the heart has returned to a normal state.
So, should parents of teens hesitate to have their kids vaccinated against COVID-19?
Vaccine experts and the American Academy of Pediatrics say no, don't hesitate. It's good for doctors and patients to be aware that there might be a connection between the mRNA vaccines and heart inflammation, and to report to their pediatrician anything they see in that first week after vaccination. But it is also important, the CDC notes, to recognize that even if this does turn out to be an extremely rare side effect of the vaccine, "most patients who received care responded well to medicine and rest and quickly felt better." And the serious risks of COVID-19 — even for young healthy people — outweigh the risks of any possible side effects from the vaccine. Here are some questions you may have, and what's known:
Myocarditis is an inflammation of the heart muscle, and pericarditis, also being investigated, is an inflammation of the sac around the heart.
Long before the pandemic, thousands of cases of myocarditis were diagnosed in the U.S. and around the world each year, often triggered by the body's immune response to infections. SARS-CoV-2, the virus that causes COVID-19, can trigger it, and so can cold viruses, and staph and strep and HIV. Other causes include toxins and allergies.
Symptoms include chest pain and shortness of breath. It's often mild enough to go unnoticed, but a full-blown case in adults can cause arrhythmias and heart failure that require careful treatment with multiple medications, and several months of strict rest. In a case study of seven teenagers who got myocarditis following vaccination published last week in the journal Pediatrics, all seven got better after routine treatment with anti-inflammatory drugs.
Pediatric cardiologist Stuart Berger of the Northwestern University Feinberg School of Medicine, a spokesperson for the American Academy of Pediatrics, says vaccine-related myocarditis in teens is not all that worrisome. "Although they appear with some symptoms of chest pain, and maybe some findings on EKGs, all of the cases we've seen have been on the mild end of the spectrum," he says.
Several hundred reports about the inflammation have been filed with the federal government's Vaccine Adverse Event Reporting System, or VAERS; that's a repository of reports sent in by health professionals and patients about any health events they spot in the hours or days after vaccinations. Many of the events reported turn out to be coincidental — not caused by a vaccine. The database is just meant as a starting point for further investigation and not proof of cause and effect. But as NPR's Geoff Brumfiel has reported, "when millions of people are vaccinated within a short period, the total number of these reported events can look big."
That said, anecdotes reported by doctors in medical journals and reports to VAERS suggest that both of the mRNA vaccines authorized for use in the U.S. — the Pfizer and Moderna vaccines — might slightly increase the incidence of myocarditis in young people. In 2003, a report in The New England Journal of Medicine estimated the background incidence of myocarditis to be 1.13 cases in 100,000 children per year.
Paul Offit, professor of pediatrics at the Children's Hospital of Philadelphia and a member of an FDA vaccine advisory committee, says there likely is a causal link between the heart inflammation some doctors are seeing in these teens and the second dose of vaccine. "I think it's real," he says, but he hastens to add that the effect is exceedingly small — based on the data collected so far, maybe one in 50,000 vaccinees between the ages of 16 and 39. "And the good news is at least so far it looks to be transient and self-resolving."
According to the CDC, there have been some cases of heart inflammation reported to the Vaccine Adverse Events Reporting System after the Johnson & Johnson vaccine, though not as many as have been seen after the Moderna and Pfizer vaccines.
The federal health agency confirmed Wednesday that most people who have experienced this side effect have recovered from symptoms and are doing well. Nine remained in the hospital as of last week and more than 300 others have been discharged. No deaths have been associated with this side effect.
Uhm, no, according to several vaccine experts contacted by NPR. And this is where a little math comes in handy.
"Take a stadium full of 100,000 people between the ages of 16 and 39, which is the subset that appears to be at greater risk," Offit says. "Vaccinate all of them, and two might get myocarditis." But if you don't vaccinate any of the 100,000, he estimates that about 1,300 would eventually get COVID-19. And those numbers are likely to increase this winter.
About 1 in 1,000 children who get COVID-19 have gone on to develop a condition called MIS-C (multisystem inflammatory syndrome in children), says Offit, and most of those kids have had some level of myocarditis. In addition, the coronavirus has directly caused myocarditis in some children and adults. Which of the two stadiums in Offit's metaphor would have more cases of myocarditis — the vaccinated children or unvaccinated kids — is not known precisely. But Offit says he suspects it would be the unvaccinated group. And there's no doubt that 1,000 unvaccinated children would suffer more illnesses related to COVID-19. "A choice not to get a vaccine is not a choice to avoid myocarditis," he says. "It's a choice to take a different risk — and I would argue a more serious one" — of developing a bad case of COVID-19 or long COVID-19 or myocarditis as a result of COVID-19.
Yes. "I understand people having concerns," Dr. Judith Guzman-Cottrill says. She's a parent and professor of pediatric infectious diseases at the Oregon Health and Science University as well as the senior author on a small study that came out this month in the journal Pediatrics. In the report, Guzman-Cottrill and her colleagues analyzed the cases of seven boys around the country who developed myocarditis within four days of receiving the Pfizer-BioNTech vaccine.
She and her family recently faced the vaccination decision for her 13-year-old daughter — and said a wholehearted yes to the shot.
Guzman-Cottrill suspects there may turn out to be a slightly increased risk of heart inflammation from vaccination in young people, but she and her co-authors note in the Pediatrics report that a direct cause-and-effect connection — even in these seven cases they studied — has yet to be established. And she's impressed that despite the millions of doses that have so far been delivered to teens, no clear and serious post-vaccination problems have shown up. "The emergency departments and urgent care clinics are not filled with teenagers complaining of chest pain," she says.
She's treated unvaccinated teens who developed severe myocarditis from an infection with the COVID-19 virus, and others who developed COVID-19 pneumonia and respiratory failure. Seeing those teens struggle — lacking the powerful immune protection the vaccine provides — was enough for her to suggest vaccination to her daughter, who got her second vaccination this week.
"She saw it as a pathway back to a normal, post-pandemic life," Guzman-Cottrill says.
And that's where public health comes in. "We really need a highly vaccinated student body when kids return to the classroom this fall," Guzman-Cottrill says, "so we don't see surges in COVID-19 cases."
Joanne Silberner, a former health policy correspondent for NPR, is a freelance journalist in Seattle.

Your source for the latest research news
Middle school youth are engaging in sexual intercourse as early as age 12, according to a study by researchers at The University of Texas School of Public Health.
Results from this study are published in the April issue of Journal of School Health.
Christine Markham, Ph.D., assistant professor of behavioral science at the UT School of Public Health, and colleagues examined sexual risk behaviors among middle school students in a large southeastern U.S. urban public school district.
“This is one of the few school-based studies conducted with this age group to look at specific sexual practices in order to develop more effective prevention programs,” Markham said. “This study shows that although most seventh graders are not engaging in sexual risk behaviors, a small percentage are putting themselves at risk.”
In the study, Markham and colleagues defined sexual intercourse as vaginal, oral or anal sex. According to their research, by age 12, 12 percent of students had already engaged in vaginal sex, 7.9 percent in oral sex, 6.5 percent in anal sex and 4 percent in all three types of intercourse.
Markham said, “These findings are alarming because youth who start having sex before age 14 are much more likely to have multiple lifetime sexual partners, use alcohol or drugs before sex and have unprotected sex, all of which puts them at greater risk for getting a sexually transmitted disease (STD) or becoming pregnant.”
The study found one-third of sexually active students reported engaging in vaginal or anal sex without a condom within the past three months, and one-fourth had four or more partners. The more experienced students in all three types of intercourse were more likely to be male and African-American.
“We need to develop prevention programs that address the needs of students who are not yet sexually active in order to promote skills and attitudes to help them wait until they are older to have sex,” Markham said. “And we need to provide skills and knowledge related to condoms and contraception for youth who are already sexually active.”
The study recommends that sexually active students also need to receive accurate and factual information and services related to STDs and pregnancy testing, as well as skills for future abstention and risk reduction for those who intend to remain sexually active.
More than one-third of youth in the study reported engaging in precoital touching behaviors. Among the students who engaged in precoital behavior, 43 percent reported having engaged in sexual intercourse.
According to the Centers for Disease Control and Prevention (CDC), 80 percent of the 435,427 births to mothers ages 15 to 19 were the result of unintended pregnancies. According to the National Vital Statistics Report, birth rates among Hispanic and black teens remain higher than other racial/ethnic groups, including rates among those ages 10 to 14.
In 2000, youth between the ages of 15 and 24 accounted for 9.1 million or 48 percent of all new STD cases, according to a report by the CDC. Minority youth also are disproportionately affected. The CDC’s 2006 STD Surveillance Report stated that minority racial and ethnic populations had higher rates of STDs when compared to whites and, although black teens represent only 17 percent of U.S. teenagers, they account for 70 percent of HIV/AIDS cases reported among teens. “We need more research to develop effective interventions, in particular for youth of color living in underserved areas,” Markham said.
“A common misperception among adolescents is that oral or anal intercourse is not as risky for STD transmission,” said Markham. “But transmission of non-viral and viral STDs can occur through all three types of intercourse when condoms are not used.”
These findings clearly indicate the need for open discussion about sexual health at the middle school level, Markham said. “It is critical that health education teachers and school nurses feel comfortable addressing these issues with their students and that their efforts are supported by parents and the school administration,” she added.
Materials provided by University of Texas Health Science Center at Houston. Note: Content may be edited for style and length.
University of Texas Health Science Center at Houston. "Middle School Youth As Young As 12 Engaging In Risky Sexual Activity." ScienceDaily. ScienceDaily, 10 April 2009. .
University of Texas Health Science Center at Houston. (2009, April 10). Middle School Youth As Young As 12 Engaging In Risky Sexual Activity. ScienceDaily. Retrieved July 7, 2021 from www.sciencedaily.com/releases/2009/04/090408145354.htm
University of Texas Health Science Center at Houston. "Middle School Youth As Young As 12 Engaging In Risky Sexual Activity." ScienceDaily. www.sciencedaily.com/releases/2009/04/090408145354.htm (accessed July 7, 2021).
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Middle School Youth As Young As 12 Engaging In Risky Sexual Activity
https://www.sciencedaily.com/releases/2009/04/090408145354.htm
Middle school youth are engaging in sexual intercourse as early as age 12, according to a new study. Researchers examined sexual risk behaviors among middle school students in a large southeastern US urban public school district.

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