Systematic review and meta-analysis of myocarditis and pericarditis in adolescents following COVID-19 BNT162b2 vaccination

Abstract

Myocarditis and pericarditis are frequent complications of COVID-19, but have also been reported following vaccination against COVID-19 in adolescents. To build vaccine confidence and inform policy, we characterized the incidence of myocarditis/pericarditis in adolescents following BNT162b2 vaccination and explored the association with dose and sex. We searched national and international databases for studies reporting the incidence of myocarditis/pericarditis following BNT162b2 vaccination as the primary endpoint. The intra-study risk of bias was appraised, and random-effects meta-analyses were performed to estimate the pooled incidence by dose stratified by sex. The pooled incidence of myocarditis/pericarditis was 4.5 (95%CI: 3.14–6.11) per 100,000 vaccinations across all doses. Compared to dose 1, the risk was significantly higher after dose 2 (RR: 8.62, 95%CI: 5.71–13.03). However, adolescents experienced a low risk after a booster dose than after dose 2 (RR: 0.06; 95%CI: 0.04–0.09). Males were approximately seven times (RR: 6.66, 95%CI: 4.77–4.29) more likely than females to present myocarditis/pericarditis. In conclusion, we found a low frequency of myocarditis/pericarditis after BNT162b2, which occurred predominantly after the second dose in male adolescents. The prognosis appears to be favorable, with full recovery in both males and females. National programs are recommended to adopt the causality framework to reduce overreporting, which undercuts the value of the COVID-19 vaccine on adolescent life, as well as to extend the inter-dose interval policy, which has been linked to a lower frequency of myocarditis/pericarditis.

Suspected Myocarditis after mRNA COVID-19 Vaccination among South Korean Adolescents

“…However, our findings are consistent with other studies, including one in other provinces of South Korea, reporting the similar or milder clinical course of VAM in the East Asian population, 12 14 19 As such, our study can serve as a meaningful preliminary study for further nationwide or multicountry studies of East Asian countries. We found lower incidence of VAM in South Korea compared with that of other ethnicities (3.9–16.3 cases per 100,000), 19 34 35 36 37 38 and we also found that VAM cases were less severe. The incidence of VAM in South Korea is only 3.9 cases per 100,000 (135/3,481,287, as announced by the central disease control headquarters of Korea on May 20, 2022), while more than 80% of the adolescents aged 12 to 17 years were vaccinated with the second dose.…”

Circulating Synthetic SARS-CoV-2 Spike Proteins Possibly Contribute to a Transient ACE2 Dysfunction Leading to Rare Cases of Myocarditis after COVID-19 mRNA Vaccination

“…With the rapid rollout of COVID-19 vaccinations, numerous associated and suspected adverse events have been reported nationally and worldwide and their occurrence remains unpredictable. Literature reporting confirmed cases of pericarditis and myocarditis following SARS-CoV-2 mRNA vaccinations [21,[23][24][25][26][27][28][29][30][31]. For example, from the 27.3 million Pfizer-BioNTech (BNT162b2) doses administered in Australia to 2 January 2022, there have been 415 reports of likely myocarditis and 735 reports of likely pericarditis and that from the 1.8 million Moderna (mRNA-1273) doses administered in Australia to 2 January 2022, there have been 40 reports of likely myocarditis and 52 reports of likely pericarditis (COVID-19 vaccine weekly safety report -06-01-2022 | Therapeutic Goods Administration (TGA); accessed on 07.01.2022).…”

“…The focal/diffuse degrees of myocardial inflammation determine the severity of symptoms in patients with myocarditis and the fulminant myocarditis cases predominantly progress with elevated serum cardiac troponins [8][9][10][11][12]. Cardiovascular complications have been described in many COVID-19 patients and myocarditis (from subclinical myocardial injury to fulminant lethal myocarditis) has been proposed to account for a small fraction of cardiac injury among patients infected with SARS-CoV-2 [13][14][15][16][17][18][19][20][21]. (Figure 1).…”

Fulminant Myocarditis with SARS-CoV-2 Infection: A Narrative Review from the Case Studies

“…Regarding vaccination, myocarditis following vaccination has been reported, with an incidence of myocarditis/pericarditis of 4.5 per 100,000 vaccinations across all doses [ 110 ]. Our review revealed that most cases of fulminant myocarditis caused by COVID-19 did not receive vaccination; however, vaccination's number was limited, with the accumulation of more findings being expected in the future.…”