Abstract
Background:
Despite reassuring scientific data, the lay press and social media continue to propagate largely unsubstantiated claims that a significant number of athletes have died from cardiovascular complications related to COVID-19 vaccines. The present study sought to determine the incidence of COVID-19 vaccine cardiovascular complications in Team USA athletes.
Hypothesis:
It was predicted that there would be a low incidence of cardiovascular complications from COVID-19 vaccination in Team USA athletes.
Study Design:
Descriptive epidemiology study.
Level of Evidence:
Level 4.
Methods:
A retrospective review was conducted on the United States Olympic and Paralympic Committee electronic medical record, inclusive of athletes who represented Team USA in the 2020 Tokyo and 2022 Beijing Olympic and Paralympic Games, for COVID-19 vaccine cardiac complications including sudden cardiac arrest/death, myocarditis, pericarditis, and myopericarditis. Vaccination status (ie, fully vaccinated, yes or no), date of vaccination and eligible boosters, and type of vaccination during the study period were abstracted from the electronic medical record.
Results:
A total of 1229 athletes represented Team USA during the 2020 Tokyo (Olympic, 697; Paralympic, 237) and 2022 Beijing Games (Olympic, 229; Paralympic, 66). For the 2020 Tokyo Games, 73.8% of Olympians and 80.6% of Paralympians with available vaccination status had completed a primary vaccine series. For the 2022 Beijing Games, 100% of Olympians and Paralympians with available vaccination status were fully vaccinated. No athletes suffered sudden cardiac arrest/death or were diagnosed with myocarditis, pericarditis, or myopericarditis after COVID-19 vaccination.
Conclusion:
The data demonstrate an overall willingness of elite athletes to receive recommended COVID-19 vaccination coupled with a complete absence of vaccine-related cardiac complications in >1 year of follow-up.
Clinical Relevance:
Supposedly, this is the first study to investigate the incidence of COVID-19 vaccine cardiovascular complications in elite athletes. These data are an important first step to better inform cardiologists and sports medicine physicians who care for elite athletes.
Keywords: athletes, COVID-19 vaccine, myocarditis, pericarditis, sudden cardiac death
Early in the COVID-19 pandemic, comprehensive measures were taken to reintegrate sport participation into society. 4 Large studies in collegiate and professional athletes suggest that 0.6% to 3% of athletes meet clinical criteria for myocarditis after COVID-19 infection.2,3 The introduction of COVID-19 vaccination reduced virus transmission, illness severity, and risk of hospitalization, 5 and facilitated the resumption of sport. Data from the United States (US) Vaccine Adverse Event Reporting System (VAERS) suggest that myocarditis after COVID-19 mRNA vaccination is rare, with 40.6 cases per million after a second dose in males aged 12 to 29 years and 2.4 cases per million in males aged >30 years. 1
Despite reassuring scientific data, the lay press and social media continue to propagate largely unsubstantiated claims that a significant number of athletes have died from cardiovascular complications related to COVID-19 vaccines. Sports medicine and sports cardiology experts have refuted these claims. However, to date, there are no published COVID-19 vaccine cardiovascular safety data in elite athletes. The present study sought to determine the incidence of COVID-19 vaccine cardiovascular complications in Team USA athletes.
Methods
We retrospectively reviewed the United States Olympic and Paralympic Committee (USOPC) electronic medical record (EMR) inclusive of athletes who represented Team USA in the 2020 Tokyo and 2022 Beijing Olympic and Paralympic Games between December 11, 2020 (the first day of the emergency use authorization for the vaccine) and November 1, 2022. We assessed the EMR for COVID-19 vaccine cardiac complications including sudden cardiac arrest/death, myocarditis, pericarditis, and myopericarditis.
Health histories completed by Team USA athletes, vaccination status (ie, fully vaccinated, yes or no), date of vaccination and eligible boosters, and type of vaccination during the study period were abstracted from the EMR. The mean (standard deviation) and median (range) of number of days since an athlete’s last recorded vaccine dose and the date of EMR search (November 1, 2022) were calculated. Fully vaccinated status was defined as 2 doses of the Pfizer-BioNTech, Moderna, and Oxford/AstraZeneca vaccines, or 1 dose of the Johnson & Johnson vaccine. This study was approved by the MedStar Health Institutional Review Board and the USOPC Research Review Group.
Results
A total of 1229 athletes represented Team USA during the 2020 Tokyo (Olympic, 697; Paralympic, 237) and 2022 Beijing Games (Olympic, 229; Paralympic, 66).
For the 2020 Tokyo Games, 73.8% of Olympians and 80.6% of Paralympians with available vaccination status had completed a primary vaccine series (Table 1). For the 2022 Beijing Games, 100% of Olympians and Paralympians with available vaccination status were fully vaccinated. Upon review of the USOPC EMR, no athlete suffered sudden cardiac arrest/death or was diagnosed with myocarditis, pericarditis, or myopericarditis after COVID-19 vaccination. Of the 207 athletes with unknown vaccination status, none sustained a sudden cardiac arrest/death or received a diagnosis of myocarditis, pericarditis, or myopericarditis within the study period. Six months of data after retirement was available for any athlete who retired during the study period.
Table 1.
Demographic information and vaccination status of athletes who represented Team USA in the 2020 Tokyo and 2022 Beijing Games
| 2020 Tokyo Games | 2022 Beijing Games | |||
|---|---|---|---|---|
| Olympic | Paralympic | Olympic | Paralympic | |
| Total number of athletes, n | 697 | 237 | 229 | 66 |
| Age, years (mean (SD)) | 27.6 (5.8) | 30.8 (9.6) | 25.2 (7.7) | 32.1 (10.4) |
| Sex, n (%) | ||||
| Female | 374 (53.7) | 119 (50.2) | 113 (49.3) | 14 (21.2) |
| Male | 323 (46.3) | 118 (49.8) | 116 (50.7) | 52 (78.8) |
| Vaccination status available, n (% of total athletes) a , b | 576 (82.6) | 201 (84.8) | 183 (79.9) | 62 (93.9) |
| Fully vaccinated, n (%) a , b | 425 (73.8) | 162 (80.6) | 183 (100) | 62 (100) |
| Type of vaccine, n (%) a , b | ||||
| Oxford/AstraZeneca | 5 (1.2) | 0 (0) | 0 (0) | 0 (0) |
| Johnson & Johnson | 63 (14.8) | 15 (9.3) | 44 (24.0) | 7 (11.3) |
| Moderna | 110 (25.9) | 50 (30.9) | 61 (33.3) | 23 (37.1) |
| Pfizer-BioNTech | 245 (57.6) | 96 (59.3) | 75 (41.0) | 28 (45.2) |
| Other/not provided | 2 (0.5) | 1 (0.6) | 3 (1.6) | 4 (6.5) |
| COVID-19 booster, n (%) | ||||
| Yes | 10 (1.7) | 6 (3.0) | 83 (45.4) | 16 (25.8) |
| No | 344 (59.7) | 139 (69.2) | 51 (27.9) | 33 (53.2) |
| Not available | 222 (38.5) | 56 (27.9) | 49 (26.8) | 13 (21.0) |
| Days between last vaccine dose and November 1, 2022 | ||||
| Mean (SD) | 542 (61) | 554 (50) | 439 (112) | 461 (110) |
| Median (range) | 551 (128-649) | 561 (247-642) | 398 (164-634) | 511 (270-657) |
Includes all Tokyo delegate athletes, even if they received the vaccine after the Games (Olympic n = 7; Paralympic n = 2), but before our end date for medical record review.
Includes all Beijing delegate athletes, even if they received the vaccine after the Games (Olympic n = 2; Paralympic n = 0), but before our end date for medical record review.
Discussion
To our knowledge, this is the first large-scale study to investigate the cardiovascular safety of COVID-19 vaccination in elite athletes. While rare, cardiac complications after COVID-19 vaccination are a known risk. Among 832 Team USA athletes who were fully vaccinated for COVID-19, no athlete experienced a cardiac complication during a median follow-up of 545 days (range, 128-649 days) for the 2020 Tokyo and 444 days (range, 164-657 days) for the 2022 Beijing delegations. In addition, comparison of the 2020 Tokyo Games and the 2022 Beijing Games demonstrate that increasing availability of vaccines was paralleled by an increasing prevalence of fully vaccinated status among this cohort of elite athletes. While we studied a sizeable cohort of elite athletes, we acknowledge that our sample size has inadequate power to definitively address the issue of cardiovascular complications after vaccination. In addition, our search of the EMR was limited to clinical diagnoses of sudden cardiac arrest/death, or clinically diagnosed myocarditis, pericarditis, and/or myopericarditis. We therefore cannot comment definitively on the prevalence of subclinical vaccine-related cardiac complications. Nonetheless, our data demonstrate an overall willingness of elite athletes to receive recommended COVID-19 vaccination coupled with a complete absence of vaccine-related cardiac complications in >1 year of follow-up.
Acknowledgments
The authors thank Travis Anderson, PhD, for his assistance with review of the USOPC EMR. Dr Anderson is affiliated with the USOPC and did not receive compensation for his role in this paper. This work is the authors own and not that of the United States Olympic and Paralympic Committee, or any of its members or affiliates. This study was funded in part by a grant from the International Olympic Committee.
Footnotes
The following authors declared potential conflicts of interest: A.B.S. has received consulting fees from the USOPC. J.T.F. has received royalties from UpToDate and Demos Publishing. A.L.B. has received grants from the National Institute of Health/National Heart, Lung and Blood Institute, the National Football Players Association, and the American Heart Association, and consulting fees from the USOPC, US Soccer, US Rower, the New England Patriots, the Boston Bruins, the New England Revolution, and Harvard University. W.M.A. has received royalties from Springer Nature, consulting fees from Korey Stringer Institute and Emerja Corp, and has stock or stock options in My Normative and Emerja Corp.
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: grant funding from the International Olympic Committee.
References
- 1. Gargano JW, Wallace M, Hadler SC, et al. Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the Advisory Committee on Immunization Practices - United States, June 2021. MMWR Morb Mortal Wkly Rep. 2021;70(27):977-982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Martinez MW, Tucker AM, Bloom OJ, et al. Prevalence of inflammatory heart disease among professional athletes with prior COVID-19 infection who received systematic return-to-play cardiac screening. JAMA Cardiol. 2021;6(7):745-752. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Moulson N, Petek BJ, Drezner JA, et al. SARS-CoV-2 cardiac involvement in young competitive athletes. Circulation. 2021;144(4):256-266. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Shah AB, Nabhan D, Chapman R, et al. Resumption of sport at the United States Olympic and Paralympic training facilities during the COVID-19 pandemic. Sports Health. 2021;13(4):359-363. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Tregoning JS, Flight KE, Higham SL, Wang Z, Pierce BF. Progress of the COVID-19 vaccine effort: viruses, vaccines and variants versus efficacy, effectiveness and escape. Nat Rev Immunol. 2021;21(10):626-636. [DOI] [PMC free article] [PubMed] [Google Scholar]