Talk:Myocarditis

Epidemiology: Cases vs. Deaths

"myocarditis from SARS-CoV-2 is associated with a spectrum of severities from asymptomatic to fulminant, and is a complication in approximately 2-7% of COVID-19 cases"

The reference is about myocarditis in Covid-19 deaths, not Covid-19 cases:

COVID-19 myocarditis has a rate between 1.4% and 7.2% in an autopsy...Initial review of the data indicate that myocarditis was present in 20 hearts (7.2%); however, closer examination of additional reported information revealed that most cases were likely not functionally significant and the true prevalence of myocarditis is likely much lower (<2%).

The relevant information on the incidence of myocarditis in Covid-19 cases is here:

Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021

I'm not up to fixing this. Someone else please? Thx.CherylJosie (talk) 07:20, 16 February 2022 (UTC)

References

Myocarditis following COVID-19 vaccination

1. ... Yet according to a study of people from 13 years and older vaccinated for COVID-19 in England between 1 December 2020 and 15 December 2021 the number of excess myocarditis events per million people was higher after a second dose of mRNA-1273 than after a positive SARS-CoV-2 test (97 [95% CI, 91–99] versus 16 [95% CI, 12–18]) for men younger than 40 years.
2. According to a study with mice a possible cause for this rare side effect may be accidental intravenous injection and the authors recommend to use (initial) aspiration in intramuscular injection to minimize this risk. Since February 2022, the German Standing Committee on Vaccination recommends aspriation for COVID-19 vaccination as precautionary measure.

Explanation for revert of well-sourced information needed

@Bon courage: I disagree with your revert and cannot understand your explanation: "Unreliable/undue; WP:MEDRS needed" is not understandable since two of the articles were published in well-respected peer-reviewed medical journals and the third article reports about the fact that an aspiration test is required in Germany as a precautionary measure (since mid-February 2022). Please be more specific on what basis you dismiss this.--Myosci (talk) 12:18, 25 September 2022 (UTC)

References

You were adding primary research, which you really shouldn't per WP:MEDRS. The STIKO recommendation is probably okay though. Bon courage (talk) 12:40, 25 September 2022 (UTC)

O.K. then there is some agreement on the 3rd article. But the 1st article has been published in Circulation (journal) and the 2nd in Clinical Infectious Diseases. Both are well-respected journals and the 2nd article was the reason for the STIKO to change its recommendation in regard to aspiration. (Earlier it advised against aspiration and that is still in place for non-COVID-19 vaccination, see 3rd article: "Für alle anderen Impfungen, außer der COVID-19-Impfung, empfiehlt die STIKO prinzipiell keine Aspi­ra­tion bei Impfstoffgabe." [For all other vaccinations, except the COVID-19 vaccination, the STIKO recommends in principle no aspiration during vaccine administration.]) How then are these two articles inferior in standing compared to the other cited articles? --Myosci (talk) 13:36, 25 September 2022 (UTC)

Did you read WP:MEDRS? Failing that see WP:MEDFAQ. (Additionally, that mouse paper has aroused suspicions of research misconduct.[1].) Bon courage (talk) 13:37, 25 September 2022 (UTC)

(1) The article fine-needle aspiration is about a biopsy technique. But the "aspiration" (pulling back on the plunger of a syringe) in this context is not used in order to get material from the body but as a (simple) method to detect if a blood vessel has been hit. So I would recommend another link.

(2) "that mouse paper has aroused suspicions of research misconduct..." Research misconduct is a strong accusation. What is the basis for this? --Myosci (talk) 14:06, 25 September 2022 (UTC)

Read the link for the suspicions. Much primary research is wrong (even if not fraudulent) which is one of the reasons it is generally unsuitable for an encyclopedia. I will fix the wikilink. Bon courage (talk) 14:14, 25 September 2022 (UTC)

(1) If there has been a grave mistake then a repected journal like Clinical Infectious Diseases would retract the article. What I would agree with is to attach the critism. But one cannot say: PubPeer cannot be cited in the article (on the ground of "no reliable source"), but it can be used to invalidate the peer-review of repected journal.

(2) The first objection in [2] is that the dosis is too high. But in the most recent vaccine study from Pfizer-Biontech, they used 1 mcg of mRNA for the mice.[3] Whereas adult humans receive 30 mcg. So the relative dose for a mouse has to be much higher than for humans. --Myosci (talk) 14:55, 25 September 2022 (UTC)

Ha! You're optimistic about the rectitude of journals wrt retraction. Of course PubPeer cannot be cited, this is just background information for discussion here. Anyway, this is primary research and so unreliable for biomedical content. We won't be citing it on Wikipedia. Bon courage (talk) 15:00, 25 September 2022 (UTC)

I'm still curious about the "research misconduct" thing. I searched for the word "misconduct" and there were no matches. I'm not a native speaker so there may be parts that mean this. Can you show me these parts of the discussion? (What I can see it that there were errors in pictures and that these were rectified.(#28) Is that embarrassing for the peer-reviewers? Yes! Is that "research misconduct" or "peer-review misconduct"? I don't think so, do you? )--Myosci (talk) 15:19, 25 September 2022 (UTC)

Errors in pictures yes. If you read Elizabeth Bik you'll see more background on what she does (she was the first commenter). And ah yes, I see the suspicions were allayed with an erratum. But it's still primary research and so not usable. Bon courage (talk) 15:24, 25 September 2022 (UTC)

The background is that she searches for misconduct and errors. Misconduct can sometimes be detected via errors in the article. But there are errors without misconduct and misconduct without (obious) errors. I even think that more often than not, a sophisticated fraud does not have obvious errors. So one cannot infer fraud from this. --Myosci (talk) 15:42, 25 September 2022 (UTC)

No, they were just suspicions - which were fixed by an erratum it seems. The widespread fraud in research articles is just one reason why Wikipedia avoids them. Bon courage (talk) 15:47, 25 September 2022 (UTC)

What I initially didn't understand was why the STIKO changed its advice in February 2022 when the original article has been published in August 2021. So these suspicions were perhaps the reason for the delay. But my approach is to err on the side of caution. Prior to ~2016 the aspiration test was the standard, it was discarded to make vaccinations (a bit) less painful to infants: "Aspiration before injection of vaccines or toxoids (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary because no large blood vessels are present at the recommended injection sites, and a process that includes aspiration might be more painful for infants"[4]

That mRNA Covid-19 vaccines induced myocarditis in humans was/is already established. The article in question is about a possible mechanism and a fix to that mechanism. So if that mechanism is correct the fix (i.e. the aspiration test) will reduce the rate of myocarditis after vaccination. And if the mechanism is incorrect the fix is superfluous but not harmful on the physiological level. According to the peer-reviewers of the journal this research is worth to be published in the journal. And this journal is a valid source for Wikipedia, so it is worth to be published in Wikipedia as well.--Myosci (talk) 16:31, 25 September 2022 (UTC)

So topic #2 is about basic policy and that might be controversial. But that's not the case in topic #1 because it's merely a qualification to the prior sentence: The prior sentence states that myocarditis after mRNA-vaccination in the general population is less often than after a positive Covid-19 test. YET - according to #1 - for men unter the age of 40 it is more frequent after the second vaccination with mRNA-1273 than after a positive test. So if one would argue against #1 one would have to argue against the prior sentence as well. --Myosci (talk) 17:11, 25 September 2022 (UTC)

Just avoid unreliable sources. Bon courage (talk) 17:47, 25 September 2022 (UTC)

But it is a reliable source for the information that mycarditis can be induced by i.v. Covid-19 vaccination in mice. The unanswered question is of course: Can the i.m. injection sometimes get into a blood vessel and be the reason for mycarditis after vaccination in humans? But information about a possibility is already valuable information for making decisions. So what if someone reads this and then comes to the conclusion: "Next time only with an aspiration test!" In case this mechanism is real in humans this has positive implications: a real risk reduction. And in case it's not real? There is no real benefit but also no real drawback either, since the whole rationale for the discontinuation was some pain relief in infants. So even if a doctor disagrees with the new rationale he/she could say to his/her (non-infant) patient: "O.K. it's not necessary and please don't complain when the stitch causes more pain than it must." --Myosci (talk) 20:54, 25 September 2022 (UTC)

"But it is a reliable source for the information that mycarditis can be induced by i.v. Covid-19 vaccination in mice" ← no it's not. See WP:MEDANIMAL. We need WP:MEDRS secondary sources to put such claims in context. Most countries do not require needle aspiration for intramuscular injection of these COVID vaccines; Germany is an outlier. It might be okay to record that (although I notice Zefr has removed it from elsewhere – perhaps they could bring an extra pair of eyes to this discussion?) Bon courage (talk) 00:32, 26 September 2022 (UTC)

As it is a common procedure for healthcare personnel to test-aspirate the syringe before giving an i.m injection, I consider this issue WP:UNDUE for both Covid-19 vaccinations (my edit here) and for myocarditis, as this is a rare event reported only in lab studies (primary research). I removed this sentence and source as WP:OFFTOPIC. Zefr (talk) 01:00, 26 September 2022 (UTC)

CDC: "Aspiration is not recommended before administering a vaccine."[5] It is therefore perhaps a frequent but not a common procedure anymore. --Myosci (talk) 22:44, 26 September 2022 (UTC)

Why do you need a "but" for COVID?

"But" myocarditis following COVID-19 is worse. LMAO. It's so obvious that Wikipedia is pushing a political agenda.

I mean, even if you want to argue that COVID also causes myocarditis (which frankly I don't doubt), why not just have that as a separate bullet point? But no, it's just absolutely necessary for Wikipedia to go on a long tirade trying to rationalie how vaccines are good. 2001:569:57B2:4D00:95B6:294E:CD03:C607 (talk) 02:48, 4 November 2022 (UTC)

Myocarditis risk following vaccination

A source suggests a much higher risk than stated in the article: Estimates of incidence have mostly ranged between about 1 case per 2,500 to 1 case per 10,000 among males aged 12-17 after their second dose. (https://www.vaccinesafety.edu/do-vaccines-cause-myocarditis-and-or-myocardopathy/) Pakbelang (talk) 00:34, 8 January 2023 (UTC)

Would need reliable sourcing i.e. WP:MEDRS. Bon courage (talk) 06:34, 8 January 2023 (UTC)

COVID vaccine cause

Mentioning this seems POV. Especially without mentioning that, you know, COVID itself is a risk. Why not single something else out, like cocaine? Bon courage (talk) 11:12, 22 January 2023 (UTC)

This topic has received significant media coverage, it is actively researched and it is monitored by the CDC.[6] I don't object to presenting this risk in the proper context of the risk posed by COVID-19 itself, but omitting it entirely goes against WP:ASPECT. I like it how this topic was presented for example in Circulation:[7] "Overall, the risk of myocarditis is greater after SARS-CoV-2 infection than after COVID-19 vaccination and remains modest after sequential doses including a booster dose of BNT162b2 mRNA vaccine. However, the risk of myocarditis after vaccination is higher in younger men, particularly after a second dose of the mRNA-1273 vaccine." --TadejM ^{my talk} 11:29, 22 January 2023 (UTC)

So are other things being actively researched for this, like Monkeypox vaccine. COVID vaccines are already mentioned in detail in the list that follows. Why does it need to be pulled out and showcased again? Especially without any context about COVID itself? Bon courage (talk) 11:34, 22 January 2023 (UTC)

This discussion topic is about the COVID-19 vaccine. Thank you for bringing up that the covid-19 vaccine information is mentioned elsewhere in the article. In my opinion the article as it currently stands is fine in this regard. Anyway, feel welcome to add this info about the monkeypox vaccine if it has received prominent coverage in published, reliable sources. Please note that WP:NPOV requires that "mainspace articles and pages fairly represent all significant viewpoints". -TadejM ^{my talk} 11:50, 22 January 2023 (UTC)

Should it be mentioned?

The article mentioned how post COVID myocarditis is rare, but most commonly severe, shouldn’t this mention that German study where nearly 80 percent of COVID patients had recorded abnormal ties after recovering? Patty J H (talk) 18:55, 25 January 2023 (UTC)