Fully vaccinated have the lowest risk., iStockphoto.com  | Bihlmayer Fotografie © iStockphoto.com | Bihlmayer Fotografie

Important Patient Information

Vaccination is the Best Protection

Even with CHD, the benefits outweigh the risks

With the omicron subtype BA.2, we have been experiencing another corona wave since the summer of 2022. Due to the increasing infections with the new BA.5 subtype of the omicron mutant, which was initially widespread primarily in Portugal, an elevated incidence of infection is also to be expected for the fall.

The following also applies to children, adolescents, and adults with congenital heart defects: the available mRNA vaccines against COVID-19 offer a high level of protection against developing severe corona infection after complete vaccination plus booster vaccination and renewed booster after three months. However, vaccination rates are not yet sufficient.

  • Current

    How well are we protected in Germany?

    Fully vaccinated have the lowest risk. © iStockphoto.com | Bihlmayer Fotografie
    Fully vaccinated have the lowest risk.

    Basically, the more people who are vaccinated against COVID-19, the greater the protection, including for high risk patients, from serious disease that can even be fatal. However, the vaccination status in Germany is still too low for effective protection of the entire population: Only slightly more than 76 percent of German citizens had basic immunization by the end of July 2022. Around 62 percent have also received a booster vaccination and are thus legally considered to be fully vaccinated.

    Among five- to eleven-year-olds, around 20 percent had been fully vaccinated by the end of July 2022. Around 70 percent of 12- to 17-year-olds have been fully vaccinated to date, and around 31 percent have received their first booster vaccination.

    The Robert Koch Institute (RKI) provides information on the current status of vaccinations.


Children From the Age of 5 Should be Vaccinated

Since May 2022, the Ständige Impfkommission (STIKO) has recommended vaccination of all children from the age of five. Vaccination is especially important for children with pre-existing conditions and for children who have regular contact with people with pre-existing illnesses, such as siblings with clinical relevant congenital heart defects or adults with previous health problems. BioNTech's Comirnaty mRNA vaccine is administered in a dose appropriate for children.

How Safe is Vaccination, Even in Severe CHD?

The pediatric cardiologist from Kiel and chairman of the German Competence Network for Congenital Heart Defects, Professor Anselm Uebing, together with his colleagues, urgently advise following the recommendations of the Ständige Impfkommission (STIKO) and vaccinating children from the age of five with BioNTech's Comirnaty mRNA vaccine: "The health and social risk of infection is simply far too high. This bears no acceptable relation to the vanishingly small risks of vaccination. Vaccination has also been shown to be well tolerated by children and adolescents with severe congenital heart defects, in whom the risk of life-threatening complications from Corona infection is disproportionately higher than in individuals with a healthy heart."

Covid 19 Complications in Children

Among the very rare but serious complications observed in connection with Covid-19 infection in children are the so-called "pediatric inflammatory multisystem syndrome", or PIMS or MIS-C for "multisystem inflammatory syndrome in children", and associated vasculitis, which then also leads to myocarditis.

"Even though statistically only "few" children are affected and the cure rate is high, MIS-C/PIMS is a severe clinical picture with pronounced vascular inflammation throughout the body," pediatric cardiologist Professor Dietmar Schranz already explained in an interview with the German Heart Foundation. For this, it is important to know that in a SARS-Cov-2 infection, the endothelial cell of the inner vessel is the main target of the virus. It is here that the highest density of ACE-2 receptors to which it can dock are to be found. Therefore, vasculitis occurs first and myocarditis only in the second step, according to the pediatric intensive care physician from Frankfurt.

High Vaccination Rate Offers Best Protection with Maximum Freedom

Scientific studies on around 1,000 cases of hepatitis in children suffering from corona in 35 countries point to a possible explanation for this: "It seems to be the case that a certain genetic predisposition and the involvement of so-called "helper viruses" such as a "Dependo" parvovirus coincide in the affected children," says Dietmar Schranz, assessing the results.

Whether such a mechanism is also involved in corona-associated myocarditis remains to be investigated. In any case, however, a high vaccination rate of 90 to 100 percent, which would correspond to mandatory vaccination, would be the best protection for all children and would also offer the highest degree of freedom.

Vaccination Side Effects are the Lower Risk

The expert usually advises vaccination even if chronic, non-acute infection-related myocarditis is already present for other reasons, "but with simultaneous individualized care according to current cardiac data." Coronavirus myocarditis can in no way be equated with the extremely rare vaccine related myocarditis reaction. "Anyone who gets a cardiac inflammatory reaction due to a vaccination should certainly not get a corona infection, as this can be much more life-threatening," emphasizes Professor Dietmar Schranz.

Studies from the USA, Great Britain and Israel underline this statement. According to them, the risk of myocarditis from Covid 19 is at least four times higher than the risk of a vaccine related myocarditis. Experts also point out that for unvaccinated people, corona infection noticeably increases the risk of cardiac arrhythmias, heart attacks, acute kidney damage, and pulmonary embolism.

For more information, see the German Heart Foundation's website, last updated in March 2022.

  • Good to know

    Welche Corona-Varianten gibt es in Deutschland?

    Since December 2021, the omicron variant has become established at an increasing pace. In the meantime, its subvariants increasingly dominate the incidence of infection. In Germany in June 2022, the omicron subvariant BA.2 predominated with over 80 percent. However, the number of infections attributable to the new, more contagious omicron subtype BA.5 is also increasing in this country. Next in order of frequency are: alpha, delta, gamma, and beta. Gamma and beta occur comparatively rare in this country.


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