Myocarditis can be induced by either viral or bacterial infection, most notably developing in up to two thirds of persons infected with diphtheria. Thus, diphtheria vaccine prevents myocarditis by protecting against natural infection. Smallpox vaccine does very rarely cause myocarditis and myocardopathy/cardiomyopathy, but is not routinely recommended to the general population in the United States. Other vaccines that are currently routinely recommended to the general population in the U.S.* have not been shown to cause myocarditis or myocardopathy.
The 2012 report by the Institute of Medicine (IOM), now called the National Academy of Medicine (NAM), found no relevant studies of quality in the literature assessing myocarditis and diphtheria, tetanus or pertussis vaccines .
One study published since this report of 193,083 adults over 50 years of age found no association between zoster vaccine and myocarditis using both case-centered and self-controlled case series analyses .
U.S. military personnel administered smallpox vaccine had almost 7.5 times higher incidence of myopericarditis in the 30 days post vaccination than non-vaccinated active duty military personnel (16.11 per 100,000 vaccinees versus 2.16 per 100,000 non-vaccinees) .
Myocarditis often results from a prolonged immune response induced by viral infection . In particular, myocardopathy/cardiomyopathy develops in up to two thirds of persons infected with Corynebacterium diphtheria, due to the effects of the exotoxin released by the bacteria. However, the diphtheria vaccine does not contain active toxin. Other mechanisms that could contribute to myocarditis include autoantibodies or T cells .
* These conclusions do not necessarily consider vaccines recommended only for special populations in the United States such as Yellow Fever vaccine (international travelers) or Smallpox vaccine (military personnel).
1. Institute of Medicine. In: Stratton K, Ford A, Rusch E, Clayton EW, eds. Adverse Effects of Vaccines: Evidence and Causality. Washington (DC): National Academies Press (US); 2012.
2. Tseng HF, Liu A, Sy L, et al. Safety of zoster vaccine in adults from a large managed-care cohort: a Vaccine Safety Datalink study. J Intern Med 2012;271:510-20.
3. Poland GA, Grabenstein JD, Neff JM. The US smallpox vaccination program: a review of a large modern era smallpox vaccination implementation program. Vaccine 2005;23:2078-81.
4. Biesbroek PS, Beek AM, Germans T, Niessen HW, van Rossum AC. Diagnosis of myocarditis: Current state and future perspectives. Int J Cardiol 2015;191:211-9.