Author + information
- 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
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.
- American College of Cardiology Foundation