What vaccine could have prevented symptoms in a man with new onset chest pain, fatigue, and shortness of breath, with leukocytosis (elevated white blood cell count), mildly elevated troponin I (cardiac biomarker), and an elevated Erythrocyte Sedimentation Rate (ESR)?

From the Guidelines

The COVID-19 vaccine could have prevented the symptoms in a man with new onset chest pain, fatigue, and shortness of breath, with leukocytosis, mildly elevated troponin I, and an elevated ESR, as these symptoms are consistent with myocarditis secondary to COVID-19 infection. According to the 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults 1, COVID-19 vaccination is associated with a very favorable benefit-to-risk ratio for all age and sex groups evaluated thus far. The symptoms described suggest cardiac inflammation that can occur as a complication of COVID-19 infection. COVID-19 virus can directly invade the myocardium or trigger an immune-mediated inflammatory response affecting the heart. The vaccine works by stimulating the immune system to produce antibodies against COVID-19 viruses, preventing infection or reducing its severity if breakthrough occurs.

Some key points to consider:

• Myocarditis following COVID-19 mRNA vaccination is rare, with the highest observed rates in young male individuals after the second vaccine dose 1.
• The incidence of postvaccination myocarditis after at least one dose of a COVID-19 mRNA vaccine was 21 cases per million for the all-comer population and 107 cases per million for male individuals aged 16-29 years 1.
• Accrued observational data suggest that rates of postvaccination myocarditis may differ between the 2 mRNA vaccines (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]), particularly after the second dose 1.
• COVID-19 vaccination remains the most effective preventive strategy against COVID-19 and its potentially serious complications like myocarditis.

While other vaccines like influenza vaccine might also be considered given some overlap in symptoms, the constellation of findings described is particularly consistent with COVID-19-associated cardiac complications, and the COVID-19 vaccine is the most relevant preventive measure in this context 1.

From the FDA Drug Label

Patient Information Sheet Fluzone® Influenza Vaccine Please read this information sheet before getting Fluzone vaccine. This summary is not intended to take the place of talking with your healthcare provider. If you have questions or would like more information, please talk with your healthcare provider. What is Fluzone vaccine? Fluzone is a vaccine that helps protect against influenza illness (flu) Fluzone vaccine is for people who are 6 months of age and older. Vaccination with Fluzone vaccine may not protect all people who receive the vaccine.

The influenza vaccine (IM) could have prevented the symptoms in a man with new onset chest pain, fatigue, and shortness of breath, with leukocytosis, mildly elevated troponin I, and an elevated ESR, as it helps protect against influenza illness (flu) 2.

• Key points:
  • The influenza vaccine is for people who are 6 months of age and older.
  • Vaccination with the influenza vaccine may not protect all people who receive the vaccine.
  • The vaccine helps protect against influenza illness (flu).

From the Research

Vaccine Prevention of Symptoms

The symptoms described, including new onset chest pain, fatigue, and shortness of breath with leukocytosis, mildly elevated troponin I, and an elevated Erythrocyte Sedimentation Rate (ESR), could be indicative of a severe respiratory infection such as COVID-19 or another condition like pneumonia.

• The mRNA-1273 SARS-CoV-2 vaccine has been shown to be highly effective in preventing COVID-19 illness, including severe disease, with a vaccine efficacy of 94.1% 3.
• Influenza vaccination has also been associated with decreased positive COVID-19 testing and improved clinical outcomes, suggesting a potential role in reducing the burden of COVID-19 4.
• Pneumococcal conjugate and quadrivalent inactivated influenza vaccines can be coadministered safely and effectively in adults, providing protection against pneumococcal disease and influenza 5.
• While COVID-19 vaccines may lead to rare cases of new-onset inflammatory arthritis, the benefits of vaccination substantially outweigh the potential risks of such serious adverse effects 6.
• Influenza and pneumococcal vaccines have been shown to be effective in preventing exacerbations of chronic obstructive pulmonary disease (COPD), including reducing the risk of pneumonia and related hospitalization 7.

Potential Vaccines

Based on the available evidence, potential vaccines that could have prevented the symptoms include:

• mRNA-1273 SARS-CoV-2 vaccine 3
• Influenza vaccine 4, 5, 7
• Pneumococcal conjugate vaccine 5, 7