CORRESPONDENCE: LETTERS TO THE EDITOR
Reply
Robert E. Eckart, DO*,
J. Edwin Atwood, MD and
John D. Grabenstein, RPh, PhD
* Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 (Email: robert.eckart{at}us.army.mil).
We appreciate the comments of Dr. Kula and colleagues regarding our publication on vaccinia-associated myocarditis (1). We agree with the need to consider the possible contributions of other vaccinations to myocarditis, and we recognize the potential for confounding. Our group recently published data revealing no statistically significant association of development of vaccinia-associated myocarditis in those with concomitant administration of other vaccines (2). Other vaccines in addition to vaccinia in cases of myocarditis may have included anthrax, typhoid, hepatitis A, hepatitis B, influenza, meningococcal, MMR (measles, mumps, rubella), poliovirus, and yellow fever vaccines. No association was seen between specific lot numbers and development of myocarditis.
We note that all the available references cited by Kula and colleagues were isolated case reports relating to other vaccines (3–6). Although they raise interesting questions, the reported observations are less persuasive than the extended case series we have reported (1,2). Recognizing that our experience is not within the context of a prospective trial, we cannot exclude the possibility of multiple vaccine interactions; however, it appears unlikely at this time.
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References
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1. Eckart RE, Love SS, Atwood JE, et al. Incidence and follow-up of inflammatory cardiac complications after smallpox vaccination J Am Coll Cardiol 2004;44:201-205.[Abstract/Free Full Text]
2. Arness MK, Eckart RE, Love SS, et al. Myopericarditis following smallpox vaccination Am J Epidemiol 2004;160:642-651.[Abstract/Free Full Text]
3. Dilber E, Karagoz T, Aytemir K, et al. Acute myocarditis associated with tetanus vaccination Mayo Clin Proc 2003;78:1431-1433.[Free Full Text]
4. Boccara F, Benhaiem-Sigaux N, Cohen A. Acute myopericarditis after diphtheria, tetanus, and polio vaccination Chest 2001;120:671-672.[Abstract/Free Full Text]
5. Mittermayer CH. Lethal complications of typhoid-cholera-vaccination(case report and review of the literature.) Beitr Pathol 1976;158:212-224.[Web of Science][Medline]
6. Driehorst J, Laubenthal F. Acute myocarditis after cholera vaccination Dtsch Med Wochenschr 1984;109:197-198.[Medline]
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