Acute Myocarditis Following COVID-19 mRNA Vaccination in Adults Aged 18 Years or Older

Simone, Anthony; Herald, John; Chen, Aiyu; Gulati, Neil; Shen, Albert Yuh-Jer; Lewin, Bruno; Lee, Ming‐Sum

doi:10.1001/jamainternmed.2021.5511

Cited by 107 publications

(134 citation statements)

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“…17 Compared to the 75 cases (52% men) of myocarditis that occurred during the study period among individuals who were not vaccinated, the risk ratio (RR) for myocarditis was 0.38 (95% confidence interval [CI]: 0.05-1.40) for the first dose and 2.7 (95% CI: 1.4-4.8) for the second dose. 17 Taken together, these results parallel prior studies that showed that vaccine-associated myocarditis primarily occurs in young men who have recently received their second vaccine dose, 17 and also suggest that there is no statistically significant difference in the incidence of myocarditis after the first dose of the mRNA vaccine. However, there is an elevated risk of myocarditis after the second dose of the vaccine when compared to unvaccinated individuals without COVID-19.…”

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confidence: 97%

“…Compared to persons without vaccination, the mRNA vaccines were associated with elevated risk of myocarditis (RR: 3.24; 95% CI: 1.55-12.44; risk difference, 2.7 events per 100,000 persons), a result similar to those reported in the Kaiser Permanente Southern California integrated health care system. 17 Furthermore, a substantial risk of myocarditis was observed among COVID-19 patients without prior vaccination (RR: 18.28; 95% CI, 3.95-25.12; risk difference, 11.0 events per 100,000 persons) compared to persons without COVID-19. 15 Serious adverse events, such as pericarditis, arrhythmia, deep vein thrombosis, pulmonary embolism, myocardial infarction and intracranial hemorrhage were observed among COVID-19 patients compared to milder conditions, such as lymphadenopathy, appendicitis, and herpes zoster infection, that were reported in vaccinated persons.…”

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confidence: 98%

“…17,18 The incidence of vaccine-associated myocarditis was 0.8 cases per 1 million persons after the first dose and 5.8 cases per 1 million persons after the second dose of vaccine. 17 Compared to the 75 cases (52% men) of myocarditis that occurred during the study period among individuals who were not vaccinated, the risk ratio (RR) for myocarditis was 0.38 (95% confidence interval [CI]: 0.05-1.40) for the first dose and 2.7 (95% CI: 1.4-4.8) for the second dose. 17 Taken together, these results parallel prior studies that showed that vaccine-associated myocarditis primarily occurs in young men who have recently received their second vaccine dose, 17 and also suggest that there is no statistically significant difference in the incidence of myocarditis after the first dose of the mRNA vaccine.…”

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confidence: 99%

“…Another study of 2.4 million adults aged 18 years or older who were in the Kaiser Permanente Southern California integrated healthcare system and received at least one dose of the mRNA vaccine between December 14, 2020, and July 20, 2021, reported 15 cases of confirmed myocarditis over a 10-day observation window. 17,18 All 15 cases were men who were ≤ 40 years of age with no prior cardiac history. 17,18 The incidence of vaccine-associated myocarditis was 0.8 cases per 1 million persons after the first dose and 5.8 cases per 1 million persons after the second dose of vaccine.…”

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confidence: 99%

“…17,18 All 15 cases were men who were ≤ 40 years of age with no prior cardiac history. 17,18 The incidence of vaccine-associated myocarditis was 0.8 cases per 1 million persons after the first dose and 5.8 cases per 1 million persons after the second dose of vaccine. 17 Compared to the 75 cases (52% men) of myocarditis that occurred during the study period among individuals who were not vaccinated, the risk ratio (RR) for myocarditis was 0.38 (95% confidence interval [CI]: 0.05-1.40) for the first dose and 2.7 (95% CI: 1.4-4.8) for the second dose.…”

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confidence: 99%

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Coronavirus disease 2019 (COVID-19) messenger RNA vaccination and myocarditis— beauty and the beast

Appiah¹

2021

The Chronicles

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Prior to the 20 th century, several communities and nations were ravished with epidemics and pandemics from infectious diseases that often left in their wake devastation of livelihood and high mortality. 1 With improvements in sanitation and advances in medicine leading to the development of antimicrobials and vaccines, the mortality from infectious diseases waned and was replaced by mortality from chronic diseases. 1 This epidemiologic transition led many to believe that infectious diseases were going to be a thing of the past. But the emergence and re-emergence of new pathogens, such as human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have caused pandemics that reminded the world of the devastation that infectious diseases can cause and of the need for vaccines.

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confidence: 97%

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confidence: 98%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Coronavirus disease 2019 (COVID-19) messenger RNA vaccination and myocarditis— beauty and the beast

Appiah¹

2021

The Chronicles

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COVID-19 Messenger RNA Vaccination and Myocarditis—A Rare and Mostly Mild Adverse Effect

Guduguntla

Katz

2021

JAMA Intern Med

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Several recent case series have described acute myocarditis after COVID-19 messenger RNA (mRNA) vaccination. 1,2 While the cardiac complications of vaccines are important, discussion has been limited by small sample sizes that lack gender and racial and ethnic diversity. In this issue of JAMA Internal Medicine, Simone et al 3 examine the incidence and outcomes of acute myocarditis following COVID-19 mRNA vaccination in a large community health system. During the 6 months of followup, there were 15 cases of myocarditis among the 2 392 924 Kaiser Permanente Southern California members who received at least 1 dose of the Pfizer and Moderna vaccines (1 case per 172 414 fully vaccinated individuals). This represents a relative ratio of 2.7 compared with unvaccinated individuals. The study population was 54.0% women and 31.2% White, 6.7% Black, 37.8% Hispanic, and 14.3% Asian individuals. Interestingly, the affected patients were all men younger than 40 years with no prior cardiac history, and

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Epidemiology of Myocarditis and Pericarditis Following mRNA Vaccination by Vaccine Product, Schedule, and Interdose Interval Among Adolescents and Adults in Ontario, Canada

et al. 2022

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IMPORTANCE Increased rates of myocarditis or pericarditis following receipt of COVID-19 mRNA vaccines have been observed. However, few available data are associated with differences in rates of myocarditis or pericarditis specific to vaccine products, which may have important implications for vaccination programs. OBJECTIVE To estimate rates of reported myocarditis or pericarditis following receipt of a COVID-19 mRNA vaccine by product, age, sex, dose number, and interdose interval. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study was conducted in Ontario, Canada (population: 14.7 million) from December 2020 to September 2021 and used data from Ontario's COVID-19 vaccine registry and passive vaccine-safety surveillance system. All individuals in Ontario, Canada, who received at least 1 dose of COVID-19 mRNA vaccine between December 14, 2020, and September 4, 2021, and had a reported episode of myocarditis or pericarditis following receipt of the COVID-19 vaccine during this period were included. We obtained information on all vaccine doses administered in the province to calculate reported rates of myocarditis or pericarditis. EXPOSURESReceipt of a COVID-19 mRNA vaccine (mRNA-1273 [Moderna Spikevax] or BNT162b2 [Pfizer-BioNTech Comirnaty]). MAIN OUTCOMES AND MEASURESAll reports of myocarditis or pericarditis meeting levels 1 to 3 of the Brighton Collaboration case definitions were included. Rates and 95% CIs of reported cases of myocarditis or pericarditis per 1 000 000 mRNA vaccine doses administered were calculated by age, sex, dose number, vaccine product, and interdose interval. RESULTS Among 19 740 741 doses of mRNA vaccines administered, there were 297 reports of myocarditis or pericarditis meeting the inclusion criteria; 228 (76.8%) occurred in male individuals, and the median age of individuals with a reported event was 24 years (range, 12-81 years). Of the reported cases, 207 (69.7%) occurred following the second dose of the COVID-19 mRNA vaccine.When restricted to individuals who received their second dose during the period of enhanced passive surveillance (on or after June 1, 2021), the highest rate of myocarditis or pericarditis was observed in male individuals aged 18 to 24 years following mRNA-1273 as the second dose (299.5 cases per 1 000 000 doses; 95% CI, 171.2-486.4 cases per 1 000 000 doses); the rate following BNT162b2 as the second dose was 59.2 cases per 1 000 000 doses (95% CI, 19.2-138.1 cases per 1 000 000 doses). Overall rates for both vaccine products were significantly higher when the interdose interval was 30 or fewer days (BNT162b2: 52.1 cases per 1 000 000 doses [95% CI, 31.8-80.5 cases per (continued) Key Points Question Do rates of reported myocarditis or pericarditis following COVID-19 mRNA vaccination vary by vaccine product and interdose interval? Findings This population-based cohort study of 297 individuals in Ontario, Canada, with myocarditis or pericarditis following COVID-19 vaccination found higher rates of myocarditis or pericarditis associated with re...

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Acute Myocarditis Following COVID-19 mRNA Vaccination in Adults Aged 18 Years or Older

Cited by 107 publications

References 6 publications

Coronavirus disease 2019 (COVID-19) messenger RNA vaccination and myocarditis— beauty and the beast

Coronavirus disease 2019 (COVID-19) messenger RNA vaccination and myocarditis— beauty and the beast

COVID-19 Messenger RNA Vaccination and Myocarditis—A Rare and Mostly Mild Adverse Effect

Epidemiology of Myocarditis and Pericarditis Following mRNA Vaccination by Vaccine Product, Schedule, and Interdose Interval Among Adolescents and Adults in Ontario, Canada

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