The numbers of events per million persons aged 1229 years are the averages of numbers per million persons aged 1217 years, 1824 years, and 2529 years. Receipt of 2 doses of mRNA COVID-19 vaccine, compared with no vaccination. Case numbers have been rounded to the nearest hundred. Ranges calculated as 10% of crude VAERS reporting rates. Cases of myocarditis and pericarditis, although rare, have occurred more often in younger men (adolescents or young adults) and after the second dose, typically within a few days after . References to non-CDC sites on the Internet are That means the vaccines protect heart health. There were likely many cases that went unreported. The ACIP discussion concluded that 1) the benefits of vaccinating all recommended age groups with mRNA COVID-19 vaccine clearly outweigh the risks of vaccination, including the risk of myocarditis after vaccination; 2) continuing to monitor outcomes of myocarditis cases after COVID-19 vaccination is important; and 3) providers and the public should be informed about these myocarditis cases and the use of COVID-19 vaccines. On June 23, 2021, after reviewing available evidence including that for risks of myocarditis, ACIP determined that the benefits of using mRNA COVID-19 vaccines under the FDAs EUA clearly outweigh the risks in all populations, including adolescents and young adults. FLEG: The bottom line is this: The benefits of getting vaccinated markedly outweigh the very small risk of vaccine-related myocarditis. All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. Key Points There have been more than 1,200 reported cases of a myocarditis or pericarditis mostly in people 30 and under who received Pfizer's or Moderna's Covid-19 vaccine, according to CDC. Though both complications were rare, data from Ontario show higher rates of myocarditis and pericarditis with the Moderna COVID-19 vaccine than with the Pfizer-BioNTech vaccine, but the rates were lower for both vaccines if the spacing between receiving two doses was extended, according to a study late last week in JAMA Network Open.. Myocarditis is an inflammation of the heart muscle, and . Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of The Vaccine Safety Datalink: a model for monitoring immunization safety. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Regarding health equity considerations, racial and ethnic minority groups have higher rates of COVID-19 and severe disease*****; potential changes in vaccine policy, or anything that would affect vaccination coverage for adolescents or young adults, might disproportionately affect those groups with the highest rates of poor COVID-19 outcomes. These cookies may also be used for advertising purposes by these third parties. Information about CDCs ongoing study of myocarditis after COVID-19 vaccination can be found here: Investigating Long-Term Effects of Myocarditis | CDC. The work group also reviewed a benefit-risk assessment of myocarditis events after receipt of mRNA COVID-19 vaccines, considering recent epidemiology of COVID-19 and sequelae of COVID-19, including myocarditis and multisystem inflammatory syndrome in children (MIS-C). Myocarditis is rare, but it occurs more often following SARS-CoV-2 infection than after receiving an mRNA COVID-19 vaccine for people of all ages.10, We know that boys and men between the ages of 16 and 29 have a higher risk of COVID-19vaccine-related myocarditis. In a press release, the authors said their findings "support the preferential use of the BNT162b2 (Pfizer-BioNTech . Myocarditis was reported at a higher rate than expected among some people who received the Pfizer or Moderna vaccines, according to a July 2021 study. Gurdasani, D., Bhatt, S., Costello, A., Denaxas, S., Flaxman, S., Greenhalgh, T., Griffin, S., Hyde, Z., Katzourakis, A., McKee, M., Michie, S., Ratmann, O., Reicher, S., Scally, G., Tomlinson, C., Yates, C., Ziauddeen, H., & Pagel, C. (2021). % Even though the studies were among the largest vaccine trials in history, they were not large enough to detect very rare complications like myocarditis that occur only a few times per million vaccinations. You may have seen the recent reports linking rare cases. "In general, the rate of myocarditis or myopericarditis was about threefold to fourfold higher for mRNA-1273 (Moderna) vaccination than that for BNT162b2 (Pfizer-BioNTech) vaccination," the study said. Wong HL, Hu M, Zhou CK, Lloyd PC, Amend KL, Beachler DC, Secora A, McMahill-Walraven CN, Lu Y, Wu Y, Ogilvie RP, Reich C, Djibo DA, Wan Z, Seeger JD, Akhtar S, Jiao Y, Chillarige Y, Do R, Hornberger J, Obidi J, Forshee R, Shoaibi A, Anderson SA. "In general, the rate of myocarditis or myopericarditis was about threefold to fourfold higher for mRNA-1273 (Moderna) vaccination than that for BNT162b2 (Pfizer-BioNTech) vaccination," the. Expected vs. Su, J. R., McNeil, M. M., Welsh, K. J., Marquez, P. L., Ng, C., Yan, M., & Cano, M. V. (2021). At the time of this report, 323 of these 484 cases were determined to meet criteria in CDCs case definitions for myocarditis, pericarditis, or myopericarditis by provider interview or medical record review (Table 1). (2022). These cookies may also be used for advertising purposes by these third parties. When reported, the cases have especially been in adolescents and young adult males within several days after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna). Mary Chamberland, Thomas Clark, Amanda Cohn, Frank DeStefano, Ruth Gallego, Alice Guh, Theresa Harrington, Fiona P. Havers, Lauri Hicks, Amelia Jazwa, Tara Johnson, Brian Kit, Paige Marquez, Sarah Mbaeyi, Elaine Miller, Hannah Rosenblum, Monica Parise, Kadam Patel, Pragati Prasad, David Shay, Jamila Shields, Christopher A. Taylor, Joshua Wong, CDC COVID-19 Response Team; Clinical Immunization Safety Assessment (CISA) Project; Vaccine Safety Datalink; Center for Biologics Evaluation and Research, Food and Drug Administration; Voting members of the Advisory Committee on Immunization Practices: Kevin A. Ault, University of Kansas Medical Center; Lynn Bahta, Minnesota Department of Health; Henry Bernstein, Zucker School of Medicine at Hofstra/Northwell Cohen Childrens Medical Center; Beth Bell, University of Washington, Seattle, Washington; Wilbur Chen, University of Maryland School of Medicine; Sharon E. Frey, Saint Louis University Medical School; Camille Kotton, Harvard Medical School; Sarah Long, Drexel University College of Medicine; Katherine A. Poehling, Wake Forest School of Medicine; Pablo J. Snchez, The Research Institute at Nationwide Childrens Hospital. Results: ". Only about 1 out of 100 cases of heart inflammation linked with COVID-19 vaccines is life-threatening.5 An analysis of 627 cases of vaccine-linked myocarditis worldwide showed that 626 fully recovered and one fatality.7. No other disclosures were reported. COVID-19 Vaccinations in the United States. I doubt we'll ever know. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. In those aged under 18 years, the reported rate for heart inflammation (myocarditis and pericarditis) was 13 per million first doses and 8 per million second doses of the monovalent. We dont know exactly how often this happens, but one study estimated that myocarditis affects about 40 people out of every 1,000,000 people who test positive for COVID-19.3 However, myocarditis is much more common in patients hospitalized for COVID-19 (226 per 100,000). *** Data collection for race/ethnicity of myocarditis cases is ongoing. For more severe cases of myocarditis caused by a virus, such as SARS-CoV-2, people may need to stay in the hospital for a week or two often in the ICU. On July 6, 2021, this report was posted online as an MMWR Early Release. Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US. Researchers added together cases after first and second doses to reach a total rate of 77 cases per million in this male age group triggered by vaccination, a sixth that seen after infection. Pillay J, Gaudet L, Wingert A, Bialy L, Mackie AS, Paterson DI, Hartling L. BMJ. Even in this group, though, heart inflammation is seven or eight times more common after SARS-CoV-2 infection.10 And the data suggest that young adults with myocarditis possibly linked with COVID-19 vaccines recover quickly with supportive care.11. Bethesda, MD 20894, Web Policies 23) cases per 100 000 person-days for the Pfizer-BioNTech The Pfizer and Moderna mRNA vaccines are available in the U.S. Conclusions and relevance: 1 0 obj Impact of COVID-19 on Cardiovascular Disease. CDC and FDA will continue to closely monitor reports of myocarditis after receipt of the mRNA COVID-19 vaccines and will bring any additional data to ACIP for consideration. Vasudeva R, Bhatt P, Lilje C, et al. Abara WE, Gee J, Marquez P, Woo J, Myers TR, DeSantis A, Baumblatt JAG, Woo EJ, Thompson D, Nair N, Su JR, Shimabukuro TT, Shay DK. https://www.sciencedirect.com/science/article/pii/S0735109718388430?via%3Dihubexternal icon** https://academic.oup.com/eurheartj/article/36/42/2921/2293375external icon Typically described as pain made worse by lying down, deep inspiration, or cough, and relieved by sitting up or leaning forward, although other types of chest pain might occur. The researchers noted 9.7 myocarditis cases per 100,000 person-years for unvaccinated males and 4.3 per 100,000 for females. N Engl J Med 2009;360:152638. The benefits (prevention of COVID-19 disease and associated hospitalizations, ICU admissions, and deaths) outweighed the risks (expected myocarditis cases after vaccination) in all populations for which vaccination has been recommended. [Preprint]. When reported, the cases have especially been in adolescents and young adult males within several days after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna). Data sources: Klamer et al., 2022; Cordero et al., 2022; National Weather Service. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). An elevated risk for myocarditis among mRNA COVID-19 vaccinees has been observed, particularly in males aged 1229 years. The analysis assumed 95% vaccine effectiveness of 2 doses of a mRNA COVID-19 vaccine in preventing COVID-19 cases and hospitalization and assessed outcomes for a 120-day period. 1CDC COVID-19 Response Team; 2Franny Strong Foundation, West Bloomfield, Michigan; 3Arkansas Department of Health; 4Vanderbilt University School of Medicine, Nashville, Tennessee; 5Stanford University School of Medicine, Stanford, California; 6Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado. For Moderna's vaccine, rates of myocarditis or pericarditis overall were 23 cases per million first doses and 62.5 cases per million second doses. Reports of Guillain-Barr Syndrome After COVID-19 Vaccination in the United States. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. We take your privacy seriously. Exposures were first and second dose of Pfizer, AstraZeneca, Moderna, and Janssen COVID-19 vaccines. endorsement of these organizations or their programs by CDC or the U.S. FDA has added information to the Pfizer-BioNTech and Moderna COVID-19 vaccine EUA and fact sheets regarding myocarditis cases that have been reported among vaccine recipients. 3 0 obj Among patients in a large Israeli health care system who had received at least one dose of the BNT162b2 mRNA vaccine, the estimated incidence of myocarditis was 2.13 cases per 100,000 persons; the . As younger males get vaccinated, the reported rates have gone up,. Myocarditis after RNA-based vaccines for coronavirus. Pericarditisis inflammation of the outer lining of the heart. doi: 10.1136/bmj-2021-069445. Myocarditis rates from Vaccine Safety Datalink (VSD), based on electronic health records, were also evaluated. official website and that any information you provide is encrypted There were no cases. mRNA Vaccine Technology: A Promising Idea for Fighting HIV, Testing of mRNA HIV vaccines in humans is underway. (2022). Accessibility According to an analysis presented by a C.D.C. Supportive therapy is a mainstay of treatment, with targeted cardiac medications or interventions as needed. You will be subject to the destination website's privacy policy when you follow the link. https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html. They suggest the rates of myocarditis after the Moderna-NIAID vaccine may be two-and-a-half times higher. Severe problems linked with myocarditis include chest pain, arrhythmias, trouble breathing, ankle or leg swelling, and fainting. Online ahead of print. This conversion might result in character translation or format errors in the HTML version. JAMA Netw Open 2021;4:e2116420. SARS-CoV-2 can cause serious heart problems by infecting heart cells and by causing inflammation that injures the heart muscle. Dr Soslow reported receiving personal fees from Esperare. Comparison of MIS-C Related Myocarditis, Classic Viral Myocarditis, and COVID-19 Vaccine related Myocarditis in Children. It affects fewer than 20 people per 1,000,000 COVID-19 vaccinations.3,5,7 Only the mRNA vaccines (Pfizer-BioNTech and Moderna) have been linked with myocarditis. From an analysis done on just 26 medical chart-confirmed cases of myocarditis in people ages 12 to 39, the CDC scientists estimated a rate of 12.6 cases per million second doses. Since June 2020, ACIP has convened 15 public meetings to review data on COVID-19 epidemiology and use of COVID-19 vaccines. Myocarditis linked with COVID-19 illness may also be more severe because these patients are usually older and have other health conditions that increase their risk of complications. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Among 1,194 reports for which patient age was known, 687 were among persons aged <30 years and 507 were among persons aged 30 years; of 1,212 with sex reported, 923 were male, and 289 were female. Among 1,094 patients with number of vaccine doses received reported, 76% occurred after receipt of dose 2 of mRNA vaccine; cases were reported after both Pfizer-BioNTech and Moderna vaccines. Incidence of multisystem inflammatory syndrome in children among US persons infected with SARS-CoV-2. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. *** Department of Health and Human Services. A recent study classifying Long COVID into four types can help health care providers better target treatments for a patients specific symptoms. Healthcare Providers: For additional recommendations and clinical guidance, visit Clinical Considerations: Myocarditis after mRNA COVID-19 Vaccines. COVID-19 is more likely than vaccines to cause myocarditis, and symptoms and outcomes are often worse. The benefit-risk analysis can be updated as needed to reflect changes in the COVID-19 pandemic and additional information on the risk for and outcomes of myocarditis after COVID-19 vaccination. All information these cookies collect is aggregated and therefore anonymous. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Posts making claims regarding the mortality rate of children diagnosed with COVID-19-linked myocarditis are viewable here, here. Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military. If you have any health problems after vaccination, report them to theVaccine Adverse Event Reporting System. ACIP recommendations for all COVID-19 vaccines are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html. To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US. Drs Barnett, Ruberg, and Smith reported receiving grants from Pfizer. Federal government websites often end in .gov or .mil. NHLBI-supported research aims to identify the causes of lasting heart and lung symptoms of COVID-19, find ways to prevent these problems, and improve treatment to promote rapid healing. An analysis of 51 patients with possible or confirmed myocarditis showed that 70% were male, and the average age was 56. Patients can usually return to their normal daily activities after their symptoms improve. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). 2022 Jul 13;378:e069445. The ACIP COVID-19 Vaccines Work Group, comprising experts in infectious diseases, vaccinology, vaccine safety, public health, and ethics, has held weekly meetings since April 2020 to review COVID-19 surveillance data, evidence for vaccine efficacy and safety, and implementation considerations for COVID-19 vaccination programs. Data were used for the most recent week not subject to reporting delays prior to the ACIP meeting. Exposures: Six awards are related to COVID-19related myocarditis. Payne AB, Gilani Z, Godfred-Cato S, et al. 2023 Feb 5;11(2):362. doi: 10.3390/vaccines11020362. All information these cookies collect is aggregated and therefore anonymous. Information on v-safe is available at https://www.cdc.gov/vsafe. Julia W. Gargano, PhD1,*; Megan Wallace, DrPH1,*; Stephen C. Hadler, MD1; Gayle Langley, MD1; John R. Su, MD, PhD1; Matthew E. Oster, MD1; Karen R. Broder, MD1; Julianne Gee, MPH1; Eric Weintraub, MPH1; Tom Shimabukuro, MD1; Heather M. Scobie, PhD1; Danielle Moulia, MPH1; Lauri E. Markowitz, MD1; Melinda Wharton, MD1; Veronica V. McNally, JD2; Jos R. Romero, MD3; H. Keipp Talbot, MD4; Grace M. Lee, MD5; Matthew F. Daley, MD6; Sara E. Oliver, MD1 (View author affiliations). A, For the BNT162b2 vaccine, there were 138 reported cases of myocarditis with known date for symptom onset and dose after 114246837 first vaccination doses and 888 reported cases after 95532396 second vaccination doses. In a Danish study preceding Covid-19 of 753 autopsied sudden death cases, the cause of death was myocarditis in 42 (6%) cases corresponding to an SCD-myocarditis incidence of 0.16 (95%CI: 0.11-0.21) per 100 000 person-years, but males had significantly higher incidence rates of SCD-myocarditis compared to females with an incidence rate ratio of . Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection. The NHLBI supports and conducts research aimed at understanding risk factors for COVID-19, developing prevention and treatment strategies, and finding ways to hasten and enhance recovery. the rates per million doses were roughly 52 with the Pfizer shots and . Moderna said the majority of the infections were mild. Among teenaged boys the group with the highest risk of myocarditis after COVID-19 vaccination the risk is between 2 and 5 times higher after SARS-CoV-2 infection than after vaccination.10, A study of children ages 12 to 17 in England estimated that COVID-19 vaccination prevented 4,500 hospitalizations, 300 ICU hospital stays, and 36 deaths during the summer of 2021 when infection rates were high.11, Children with myocarditis linked with vaccination are less likely to be hospitalized, admitted to the ICU, or need ventilator support, compared with children who had myocarditis after a COVID-19 diagnosis. ACIP emphasized the importance of informing vaccination providers and the public about the benefits and the risks, including the risk for myocarditis after COVID-19 vaccination, particularly for males aged 1229 years. Vaccination prevents most hospitalizations and deaths due to COVID-19. Information on how to submit a report to VAERS is available at https://vaers.hhs.gov/index.htmlexternal icon or 1-800-822-7967. Myopericarditis after vaccination, Vaccine Adverse Event Reporting System (VAERS), 1990-2018. The median age of the 323 patients meeting CDCs case definitions was 19 years (range=1229 years); 291 were male, and 32 were female. Vaccination with mRNA-1273 (Moderna) was associated with a significantly increased rate of myocarditis or myopericarditis, especially among individuals aged 12-39 years (adjusted hazard ratio 5.24 (95% confidence interval 2.47 to 11.12); absolute rate 5.7 (3.3 to 9.3) per 100 000 individuals aged 12-39 years within 28 days of vaccination) 2 0 obj Serious side effects are very uncommon. <>/ExtGState<>/Pattern<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The y-axis range differs between panels A and B. Myocarditis is very uncommon, but it has been on the rise since the pandemic began. If you have concerns about COVID-19 vaccination, talk with your healthcare provider or your childs doctor, nurse, or clinic. Klamer, T. A., Linschoten, M., & Asselbergs, F. W. (2022). We spoke with Fleg about the risk of myocarditis linked with COVID-19 illness and with vaccines. COVID-19 Vaccine Safety Technical Work Group Reports are available at https://www.cdc.gov/vaccines/acip/work-groups-vast/index.html. Centers for Disease Control and Prevention. Data from a government agency's safety monitoring system in that month suggested a rate of 12.6 cases of heart inflammation per million in 12-to 39-year-olds. FLEG: The NHLBI has a strong history of conducting and funding research on myocarditis. Potential cases of postvaccine myocarditis were identified based on reports . Its clear that vaccination can protect you from myocarditis by protecting you from COVID-19 infection. Jerome Fleg, M.D. Canadian public health authorities also found that the rate of myocarditis was higher for both Moderna. While the researchers did observe a higher risk among people that got the Moderna shot, it was still a relatively small risk. Most people recover fully with rest and a few days of supportive treatment while being monitored in a hospital. Myocarditis and pericarditis have rarely been reported. As of now, the FDA Fact Sheet for Moderna's shot says "Myocarditis and pericarditis have occurred . Design, setting, and participants: Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study. According to the CDC, as of June 23, 2021, more than 177 million people had received at least one dose of a COVID-19 vaccine in the U.S. On June 23, 2021, the Advisory Committee on Immunization Practices concluded that the benefits of COVID-19 vaccination to individual persons and at the population level clearly outweighed the risks of myocarditis after vaccination. Evidence suggests that AstraZeneca and Novavax are probably associated with a small increased risk of myocarditis and pericarditis. For children ages 6 months to 2 years, efficacy was 43.7 percent, and in children ages 2 to 6, it was only 37.5 percent. CDC twenty four seven. Myocarditis is an inflammation of the heart muscle; if it is accompanied by pericarditis, an inflammation of the thin tissue surrounding the heart (the pericardium), it is referred to as myopericarditis. These are normal signs that your body is making protective antibodies. Many people have no side effects at all. Myocarditis. This outside group of experts, many of them physicians at academic medical centers, advises the CDC, but doesn't represent the agency itself.The CDC has not said if the number of cases of the . Bookshelf 2023 Feb 13;11(2):432. doi: 10.3390/vaccines11020432. JAMA Netw Open. The cases have been most common in male adolescents and young adults, occurring most often after the second dose, and usually within several days of receiving the vaccine. 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Among all participants aged 16 to 24, myocarditis rates were 18.8 and 4.4 per 100,000 person-years for males and females, respectively. : Myocarditis is an inflammation of the heart muscle. Informed by early reports, CDC prioritized rapid review of myocarditis in persons aged <30 years reported during May 1June 11, 2021; the 484 patient records in this subset were evaluated by physicians at CDC, and several reports were also reviewed with Clinical Immunization Safety Assessment Project investigators, including cardiologists. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Among men ages 18 to 29 who received the Moderna vaccine, the rate was 22.9 per 100,000 doses. During the COVID-19 pandemic, Fleg turned his attention to the effects of SARS-CoV-2 infection on the heart, including myocarditis. Abbreviations: ICU=intensive care unit; VAERS = Vaccine Adverse Event Reporting System. No potential conflicts of interest were disclosed. Expected rates of myocarditis by age and sex were calculated using 2017-2019 claims data. The text reads: "Myocarditis is irreversible. As of June 11, 2021, approximately 296 million doses of mRNA COVID-19 vaccines had been administered in the United States, with 52 million administered to persons aged 1229 years; of these, 30 million were first and 22 million were second doses. If you have any health problems after vaccination, report them toVAERS. Its important to remember that any vaccine can cause side effects. COVID-19 vaccines lower the risk of life-threatening heart problems and other serious health issues. The most common symptoms are chest pain, fever, fatigue, shortness of breath, and a rapid or irregular pulse. The reports to the Vaccine Adverse Event Reporting System met the case definition of myocarditis (reported cases). CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Seek medical care if you or your child have any of the specific or general symptoms of myocarditis or pericarditis especially if its within a week after COVID-19 vaccination. Annie, F. H., Alkhaimy, H., Nanjundappa, A., & Elashery, A. Baggs J, Gee J, Lewis E, et al. %PDF-1.7 Hamedi KR, Loftus G, Traylor L, Goodwin R, Arce S. Vaccines (Basel). The risk of myocarditis linked with COVID-19 illness is several times greater than the risk from vaccination, and it is often more serious.3,5,8 This is because the SARS-CoV-2 virus invades cells of the heart, plus the body generates an overactive immune response to the infection.