A Comment on Vaccine Safety and Closing the Diaphragm Blind Spot
Vaccines will become safer once we look at adverse effects on the respiratory diaphragm, a pump just as vital to maintaining life as the heart.
My comment in response to this article by Sara Gorman, PhD, MPH et al. January 28, 2025. Note: Although vaccines may cause medical complications, they are exceedingly rare. Vaccines are, by far, much safer than the infection itself.
Two things I'd like to add.
(1) Being vaccinated is also to protect those around me, like my elderly father whom I live with. That on its own is enough. Perhaps we could use this strategy to convince those who are vaccine hesitant? Something like, "It's not about you. It's to protect your loved ones."
(2) If we looked at diaphragm histology, we would uncover a source of vaccine complications, particularly in those with skeletal muscle weakness and/or sudden unexpected deaths in young ones. I raise this because I've been researching diaphragm myositis/myopathy for two years now (independently), after a fascinating case of spontaneous paroxysmal nocturnal "bearhug pain apneas" thought to be caused by diaphragm cramps. Believe it or not, the evidence supporting this novel pathology (or more like, previously unrecognized-) is highly compelling*. Although he survived it, recurrently throughout his childhood and youth, this could be a potential mechanism of sudden child and infant deaths (SUDC and SIDS, respectively).
In short, viruses are already known to cause pediatric calf muscle influenza-associated myositis [Agyeman 2004]. Given the diaphragm is also a skeletal muscle and that some rare, severe cases of IAM required ICU admissions for MV, it is not a far stretch to consider diaphragm myositis might also occur in some rare cases and could be a cause of apneas. Diaphragmatic myositis and myopathy were reported in fatal COVID-19 infections in ICU adults by Shi et al. (2021 x 2 reports).
Moving on to reports of post-vaccination neuromuscular pathologies:
a) Limb muscle myopathies in 2 cases post-COVID-vaccination (Vutipongsatorn 2022).
b) Diaphragm paralysis by phrenic nerve neuropathy (Kang 2022).
c) Diaphragm myositis/myopathy among other organ inflammation in 14 yo Japanese girl (Nushida 2023)*. [*Note: This is an exceptionally rare case and I must make it clear there is no doubt that vaccines are much safer than the infections they protect us from. I only bring this up now because of ann urgent need to direct scientific attention to this underexplored area].
d) Inflammatory myositis of limbs following COVID-19 vaccinations, some with myonecrosis (case and literature review (Syrmou 2023).
e) Toxic myositis of limbs in 77 yo male after influenza vaccine (Aslam 2024).
f) Polymyositis after injection of first dose COVID-19 mRNA vaccine in a 34-year-old, previously healthy woman who presented progressive proximal muscle weakness, progressive dysphagia, and dyspnea with respiratory failure (Magen 2022). Hypercapnia suggested acute respiratory pump failure but was not discussed. Multiple failed MV weaning attempts further supported sustained diaphragm myopathy.
Viral Myositis/Myopathy
g) COVID-19-induced myopathy in 57 yo female leading to respiratory muscle weakness, pulmonary edema, cardiac arrest and sudden death (not a vaccine case; Schmidt 2023).
Unfortunately, because the diaphragm is not thought of by the medical team, histology on biopsy or autopsy is not being done and there is a consequent paucity of reported data.
Putting it all together, if/when viral and vaccine-induced diaphragm inflammation and injury are confirmed and then prevented, vaccines will become even safer. We could even identify those at highest risk for problems by doing a serum creatine kinase-MM level.
I'm hoping for suggestions please as to how to alert researchers and the medical community in general to this issue. I have a Substack summary of my most recent paper if you're interested to learn more. The problem with research papers, however, is how slow it is disseminating new information.
Thanks for reading! :)
Dov G. MD, MSc.
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References:
Agyeman P, Duppenthaler A, Heininger U, Aebi C. Influenza-associated myositis in children. Infection. 2004 Aug;32(4):199-203. doi: 10.1007/s15010-004-4003-2. PMID: 15293074.
Shi Z, de Vries HJ, Vlaar APJ, et al.; Dutch COVID-19 Diaphragm Investigators. Diaphragm pathology in critically ill patients with COVID-19 and postmortem findings from 3 medical centers. JAMA Intern Med. 2021 Jan 1;181(1):122-124. doi: 10.1001/jamainternmed.2020.6278. PMID: 33196760; PMCID: PMC7670391.
Shi Z, Bogaards SJP, Conijn S, et al.COVID-19 is associated with distinct myopathic features in the diaphragm of critically ill patients. BMJ Open Respir Res. 2021Sep;8(1):e001052. doi: 10.1136/bmjresp-2021-001052. PMID: 34544735; PMCID: PMC8453595. https://bmjopenrespres.bmj.com/content/8/1/e001052 .
Vutipongsatorn K, Isaacs A, Farah Z. Inflammatory myopathy occurring shortly after severe acute respiratory syndrome coronavirus 2 vaccination: two case reports. J Med Case Rep. 2022Jan 30;16(1):57. doi: 10.1186/s13256-022-03266-1. PMID: 35094715; PMCID: PMC8801240.
Kang J, Cho JY. Diaphragmatic dysfunction due to neuralgic amyotrophy after SARS-CoV-2 vaccination: a case report. J Korean Med Sci. 2022 Oct 3;37(38):e283. doi: 10.3346/jkms.2022.37.e283. PMID: 36193639; PMCID: PMC9530308.
Nushida H, Ito A, Kurata H, et al. A case of fatal multi-organ inflammation following COVID-19 vaccination. Leg Med (Tokyo). 2023 Mar 20;63:102244. doi: 10.1016/j.legalmed.2023.102244. Epub ahead of print. PMID: 36990036; PMCID: PMC10027302.
Syrmou, V., Liaskos, C., Ntavari, N. et al. COVID-19 vaccine-associated myositis: a comprehensive review of the literature driven by a case report. Immunol Res 71, 537–546 (2023). https://doi.org/10.1007/s12026-023-09368-2
Aslam S, Khan O, Mehrabi J, Mohammadrezaei F, Wilches RDM, Singh S, Khan MH, Konka S. A Rare Case of Toxic Myositis Associated with Influenza Vaccination. J Community Hosp Intern Med Perspect. 2024 May 7;14(3):98-101. doi: 10.55729/2000-9666.1330. PMID: 39036571; PMCID: PMC11259473.
Magen E, Mukherjee S, Bhattacharya M, et al. Clinical and Molecular Characterization of a Rare Case of BNT162b2 mRNA COVID-19 Vaccine-Associated Myositis. Vaccines (Basel). 2022 Jul 16;10(7):1135. doi: 10.3390/vaccines10071135. PMID: 35891299; PMCID: PMC9324661.
Schmidt P, Okobi T, Atogwe ID, Alonso G, Pena E, Khaja M. COVID-19-Induced Myopathy and Diaphragmatic Weakness: A Case Report. Cureus. 2023 May 3;15(5):e38515. doi: 10.7759/cureus.38515. PMID: 37273343; PMCID: PMC10238763.
*Gebien DJ, Eisenhut M. Uncovering diaphragm cramp in SIDS and other sudden unexpected deaths. Diagnostics (Basel). 2024 Oct 18;14(20):2324. doi: 10.3390/diagnostics14202324. PMID: 39451647; PMCID: PMC11506607. https://www.mdpi.com/2075-4418/14/20/2324 .