Response to case report on myocarditis and pericarditis after COVID‐19 vaccination

Mungmunpuntipantip, Rujittika; Wiwanitkit, Viroj

doi:10.1002/emp2.12559

Cited by 5 publications

(8 citation statements)

References 4 publications

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“…Findings from 12 studies from the original review 15 were carried forward (Q1=5, 25 26 27 28 29 Q2=2, 29 30 Q3 part 2=10 25 26 27 28 31 32 33 34 35 36 ). From the search update, we identified 34 new reports across all questions (Q1=9, 37 38 39 40 41 42 43 44 45 Q2=5, 37 41 45 46 47 Q3 part 1=1, 48 Q4=3, 39 49 50 Q5=21 9 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 ). We excluded five studies that only reported on combined myocarditis and pericarditis (as we located studies reporting these separately), 71 72 73 74 75 eight studies that did not report on confirmed cases, 76 77 78 79 80 81 82 83 and three studies 84 85 <...…”

Section: Resultsmentioning

confidence: 99%

“…We included 21 papers, 9 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 including narrative reviews, opinion pieces, letters to the editor, case reports, case series, a retrospective study, and a protocol for a prospective observational study. Across the included papers, we identified 16 hypotheses that are presented in table 4 .…”

Section: Resultsmentioning

confidence: 99%

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Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

Pillay

Gaudet

Wingert

et al. 2022

BMJ

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ObjectivesTo synthesise evidence on incidence rates and risk factors for myocarditis and pericarditis after use of mRNA vaccination against covid-19, clinical presentation, short term and longer term outcomes of cases, and proposed mechanisms.DesignLiving evidence syntheses and review.Data sourcesMedline, Embase, and the Cochrane Library were searched from 6 October 2020 to 10 January 2022; reference lists and grey literature (to 13 January 2021). One reviewer completed screening and another verified 50% of exclusions, using a machine learning program to prioritise records. A second reviewer verified all exclusions at full text, extracted data, and (for incidence and risk factors) risk of bias assessments using modified Joanna Briggs Institute tools. Team consensus determined certainty of evidence ratings for incidence and risk factors using GRADE (Grading of Recommendations, Assessment, Development and Evaluation).Eligibility criteria for selecting studiesLarge (>10 000 participants) or population based or multisite observational studies and surveillance data (incidence and risk factors) reporting on confirmed myocarditis or pericarditis after covid-19 mRNA vaccination; case series (n≥5, presentation, short term clinical course and longer term outcomes); opinions, letters, reviews, and primary studies focused on describing or supporting hypothesised mechanisms.Results46 studies were included (14 on incidence, seven on risk factors, 11 on characteristics and short term course, three on longer term outcomes, and 21 on mechanisms). Incidence of myocarditis after mRNA vaccines was highest in male adolescents and male young adults (age 12-17 years, range 50-139 cases per million (low certainty); 18-29 years, 28-147 per million (moderate certainty)). For girls and boys aged 5-11 years and women aged 18-29 years, incidence of myocarditis after vaccination with BNT162b2 (Pfizer/BioNTech) could be fewer than 20 cases per million (low certainty). Incidence after a third dose of an mRNA vaccine had very low certainty evidence. For individuals of 18-29 years, incidence of myocarditis is probably higher after vaccination with mRNA-1273 (Moderna) compared with Pfizer (moderate certainty). Among individuals aged 12-17, 18-29, or 18-39 years, incidence of myocarditis or pericarditis after dose two of an mRNA vaccine for covid-19 might be lower when administered ≥31 days compared with ≤30 days after dose one (low certainty). Data specific to men aged 18-29 years indicated that the dosing interval might need to increase to ≥56 days to substantially drop myocarditis or pericarditis incidence. For clinical course and short term outcomes, only one small case series (n=8) was found for 5-11 year olds. In adolescents and adults, most (>90%) myocarditis cases involved men of a median 20-30 years of age and with symptom onset two to four days after a second dose (71-100%). Most people were admitted to hospital (≥84%) for a short duration (two to four days). For pericarditis, data were limited but more variation than myocarditis has been reported in patient age, sex, onset timing, and rate of admission to hospital. Three case series with longer term (3 months; n=38) follow-up suggested persistent echocardiogram abnormalities, as well as ongoing symptoms or a need for drug treatments or restriction from activities in >50% of patients. Sixteen hypothesised mechanisms were described, with little direct supporting or refuting evidence.ConclusionsThese findings indicate that adolescent and young adult men are at the highest risk of myocarditis after mRNA vaccination. Use of a Pfizer vaccine over a Moderna vaccine and waiting for more than 30 days between doses might be preferred for this population. Incidence of myocarditis in children aged 5-11 years is very rare but certainty was low. Data for clinical risk factors were very limited. A clinical course of mRNA related myocarditis appeared to be benign, although longer term follow-up data were limited. Prospective studies with appropriate testing (eg, biopsy and tissue morphology) will enhance understanding of mechanism.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

Pillay

Gaudet

Wingert

et al. 2022

BMJ

View full text Add to dashboard Cite

show abstract

“…25–28 31–36 ). From the search update, we identified 34 new reports across all questions (Q1=9 37–45 , Q2=5 37 41 45–47 , Q3=1 48 , Q4=3 39 49 50 , Q5=21 9 51–70 ); we excluded five studies that only reported on combined myo- and/or pericarditis (as we located other studies with these reported separately), 71–75 eight studies that did not report on confirmed cases, 76–83 and three studies 84–86 that did not contribute additional data to other included studies on the same cases. Tables of study characteristics, with all data on results, and risk of bias ratings for questions 1 and 2 are in Appendix 2.…”

Section: Resultsmentioning

confidence: 99%

“…We included 21 papers, 9 51–70 including narrative reviews, opinion pieces, letters to the editor, case reports, case series, a retrospective study, and a protocol for a prospective observational study. Across the included papers, we identified 16 hypotheses that are presented in Table 7 .…”

Section: Resultsmentioning

confidence: 99%

Myocarditis and Pericarditis following COVID-19 Vaccination: Evidence Syntheses on Incidence, Risk Factors, Natural History, and Hypothesized Mechanisms

Pillay

Gaudet

Wingert

et al. 2022

Preprint

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ObjectivesMyocarditis and pericarditis are adverse events of special interest after vaccination for COVID-19. Evidence syntheses were conducted on incidence rates, risk factors for myocarditis and pericarditis after COVID-19 mRNA vaccination, clinical presentation and short- and longer-term outcomes of cases, and proposed mechanisms and their supporting evidence.DesignSystematic reviews and evidence reviews.Data sourcesMedline, Embase and the Cochrane Library were searched from October 2020 to January 10, 2022; reference lists and grey literature (to January 13, 2021).Review methodsLarge (>10,000) or population-based/multisite observational studies and surveillance data (incidence and risk factors) reporting on confirmed myocarditis or pericarditis after COVID-19 vaccination; case series (n≥5, presentation, short-term clinical course and longer-term outcomes); opinions/letters/reviews/primary studies focused on describing or supporting hypothesized mechanisms. A single reviewer completed screening and another verified 50% of exclusions, using a machine-learning program to prioritize records. A second reviewer verified all exclusions at full text, extracted data, and (for incidence and risk factors) risk of bias assessments using modified Joanna Briggs Institute tools. Team consensus determined certainty of evidence ratings for incidence and risk factors using GRADE.Results46 studies were included (14 on incidence, 7 on risk factors, 11 on characteristics and short-term course, 3 on longer term outcomes, and 21 on mechanisms). Incidence of myocarditis after mRNA vaccines is highest in male adolescents and young adults (12-17y: range 50-139 cases per million [low certainty] and 18-29y: range 28-147 per million [moderate certainty]). For 5-11 year-old males and females and females 18-29 years of age, incidence of myocarditis after vaccination with Pfizer may be fewer than 20 cases per million (low certainty). There was very low certainty evidence for incidence after a third dose of an mRNA vaccine. For 18-29 year-old males and females, incidence of myocarditis is probably higher after vaccination with Moderna compared to Pfizer (moderate certainty). Among 12-17, 18-29 and 18-39 year-olds, incidence of myocarditis/pericarditis after dose 2 of an mRNA vaccine may be lower when administered ≥31 days compared to ≤30 days after dose 1 (low certainty). Data specific to males aged 18-29 indicated that the dosing interval may need to increase to ≥56 days to substantially drop incidence. For clinical course and short-term outcomes only one small series (n=8) was found for 5-11 year olds. In cases of adolescents and adults, the majority (>90%) of myocarditis cases involved 20-30 year-old males with symptom onset 2 to 4 days after second dose (71-100%). Most cases were hospitalized (≥84%) for a short duration (2-4 d). For pericarditis, data is limited but more variation has been reported in patient age, sex, onset timing and rate of hospitalization. Case series with longer-term (3 mo; n=38) follow-up suggest persistent ECG abnormalities, as well as ongoing symptoms and/or a need for medications or restriction from activities in >50% of patients. 16 hypothesized mechanisms are described, with little direct supporting or refuting evidence.ConclusionsAdolescent and young adult males are at the highest risk of myocarditis after mRNA vaccination. Pfizer over Moderna and waiting more than 30 days between doses may be preferred for this population. Incidence of myocarditis in children aged 5-11 may be very rare but certainty was low. Data on clinical risk factors was very limited. Clinical course of mRNA related myocarditis appears to be benign although longer term follow-up data is limited. Prospective studies with appropriate testing (e.g., biopsy, tissue morphology) will enhance understanding of mechanism(s).Funding and Registration noThis project was funded in part by the Canadian Institutes of Health Research (CIHR) through the COVID-19 Evidence Network to support Decision-making (COVID-END) at McMaster University. Not registered.Summary boxWhat is already known about this topic?Case reports and surveillance signals of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the two-layered sac surrounding the heart) after COVID-19 vaccination appeared as early as April 2021.These have prompted ongoing surveillance and research of these complications to investigate their incidence, possible attribution to the vaccines, and clinical course.What this study addsThis review critically appraises and synthesizes the available evidence to-date on the incidence of and risk factors for myocarditis and pericarditis after COVID-19 vaccination in multiple countries. It summarizes the presentation and clinical course of over 8000 reported cases and describes some initial reports of longer term outcomes. Further, many possible mechanisms are outlined and discussed.Though low, the incidence of myocarditis is probably the highest in young males aged 12-29 years and is probably higher with Moderna than Pfizer mRNA vaccines. Longer dosing intervals may be beneficial. Most cases are mild and self-limiting, though data in 5-11 year-olds is very limited. Continued active surveillance with longer term follow-up is warranted.

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“…After a COVID‐19 administration, increased blood viscosity 2 occurs and might lead to myocarditis. 3 The patient with previous COVID‐19 might have more risk to get a problem of COVID‐19 vaccine‐induced hyperviscosity. 2 In an area with high prevalence of disease, a child with previous silent COVID‐19 is possible and the risk has to be monitored.…”

mentioning

confidence: 99%

Multisystem inflammatory syndrome and COVID‐19 vaccine

Sookaromdee¹,

Wiwanitkit

2021

Acta Paediatrica

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Dear Editor, we would like to share ideas on 'Multisystem inflammatory syndrome in a male adolescent after his second Pfizer-BioNTech COVID-19 vaccine 1 '. Chai et al. noted that 'Multisystem inflammatory syndrome (MIS) in children (MIS-C) is a complication of the severe acute respiratory syndrome co….. SARS-CoV-2 vaccines, especially in males aged 12-17 years. 1 ' Adverse effect of COVID-19 vaccine is the present clinical consideration in clinical pediatric. The present case is an example. The exact cause of MIS is not yet clarified. The process might be immunopathological process similar to pathogenesis of MIS following COVID-19. After a COVID-19 administration, increased blood viscosity 2 occurs and might lead to myocarditis. 3 The patient with previous COVID-19 might have more risk to get a problem of COVID-19 vaccine-induced hyperviscosity. 2 In an area with high prevalence of disease, a child with previous silent COVID-19 is possible and the risk has to be monitored.

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Response to case report on myocarditis and pericarditis after COVID‐19 vaccination

Cited by 5 publications

References 4 publications

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

Myocarditis and Pericarditis following COVID-19 Vaccination: Evidence Syntheses on Incidence, Risk Factors, Natural History, and Hypothesized Mechanisms

Multisystem inflammatory syndrome and COVID‐19 vaccine

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