Incidence and follow-up of inflammatory cardiac complications after smallpox vaccination

Journal of the American College of Cardiology
Robert E EckartDepartment of Defense Smallpox Vaccination Clinical Evaluation Team

Abstract

The purpose of this study was to assess the follow-up of patients with vaccinia-associated myocarditis. With the threat of biological warfare, the U.S. Department of Defense resumed a program for widespread smallpox vaccinations on December 13, 2002. One-year afterwards, there has been a significant increase in the occurrence of myocarditis and pericarditis among those vaccinated. Cases were identified through sentinel reporting to military headquarters, systematic surveillance, and spontaneous reports. A total of 540,824 military personnel were vaccinated with a New York City Board of Health strain of vaccinia from December 2002 through December 2003. Of these, 67 developed myopericarditis at 10.4 +/- 3.6 days after vaccination. The ST-segment elevation was noted in 57%, mean troponin on admission was 11.3+/- 22.7 ng/dl, and peak cardiac enzymes were noted within 8 h of presentation. On follow-up of 64 patients (96%) at a mean of 32 +/- 16 weeks, all patients had objective normalization of echocardiography, electrocardiography, laboratory testing, graded exercise testing, and functional status; 8 (13%) reported atypical, non-limiting persistent chest discomfort. Post-vaccinial myopericarditis should be considered in patients w...Continue Reading

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