Myopericarditis after COVID-19 vaccination

Myopericarditis outcomes were minimal in adolescents and young adults after receiving messenger RNA (mRNA) COVID-19 vaccinations, according to a recent study published in JAMA Pediatrics.

While mRNA COVID-19 vaccines are the standard prevention method against COVID-19, there have been rare reports of myopericarditis incidence after vaccination. Myopericarditis is a serious adverse event and has mainly been reported in adolescents and young adults.

Studies have reported minimal outcomes in adults with myopericarditis following mRNA vaccination, but little clinical data is available on the outcomes of myopericarditis in adolescents and young adults after receiving mRNA vaccines.

To determine how COVID-19 vaccination impacts myopericarditis, investigators conducted a systematic review and meta-analysis. Databases such as PubMed and EMBASE were searched for data on vaccinations and myopericarditis in adolescents and young adults. Afterward, a manual search on secondary sources used as references for the initial studies was performed.

Studies were included if they were observational studies or case series published in a peer-review journal, featured a study population aged 12 to 20 years with myopericarditis after COVID-19 vaccination, and reported myopericarditis outcomes after COVID-19 vaccination.

Data was gathered on the author, year of publication, country of study, sample size, sex, age, race, and ethnicity. Information was also gathered on the type of vaccine, dose of vaccine, and symptoms for both Pfizer-BioNTech’s vaccine and Moderna’s vaccine.

Along with symptoms, data was collected on the outcomes, laboratory values, treatment, electrocardiogram, echocardiogram, and cardiac magnetic resonance in cases of myopericarditis linked to COVID-19 vaccination. Finally, the incidence rate of vaccine-associated myopericarditis was gathered.

Primary outcomes included clinical features and early outcomes related to myopericarditis in adolescents in young adults vaccinated against COVID-19. These outcomes included incidence, hospitalization, in-hospital mortality, intensive care unit (ICU) admission, cardiac findings, and treatments.

There were 23 articles included in the final analysis. Of these, 12 were retrospective or prospective cohort studies and 11 were case series. There were 854 patients in these studies who experienced myopericarditis after being vaccinated against COVID-19.

The mean age of the patients was about 16 years, and about 90% of patients were male. Prior COVID-19 infection was seen in about 4% of patients, and none had a history of myopericarditis or cardiovascular disease. 

Patients more often experienced myopericarditis after the second dose than after the first dose. Most patients experiencing vaccine-associated myopericarditis had been given the BNT162b2 vaccine. Myopericarditis onset was an average 2.6 days after vaccination.

Frequent symptoms included chest pain at 83.7%, fever at 44.5%, headache at 33.3%, and dyspnea or respiratory distress at 25.2%. Nonsteroidal anti-inflammatory drug was the main medication for myopericarditis at 81.8%, then glucocorticoid at 13.8%, intravenous immune globulin at 12%, and colchicine at 7.3%.

While 92.6% of patients were hospitalized and 23.2% required ICU admission, only 1.3% needed inotropic support. There were no deaths, and none of the patients required extracorporeal membrane oxygenation. Hospital stay lengths averaged at 2.8 days.

Most patients with left ventricular (LV) systolic dysfunction had mild cases, and only 1.3% of patients experienced severe LV systolic dysfunction. Late gadolinium enhancement was seen in 87.2% of cases.

Incidence of myocarditis because of mRNA COVID-19 vaccination was only 0.3 to 5 cases per 100,000 vaccinated people. The analysis showed an overall low incidence rate of vaccine-associated myocarditis, with favorable outcomes in patients afflicted.

Reference

Yasuhara J, Masuda K, Aikawa T, Shirasu T, Takagi H, Lee S, et al. Myopericarditis after COVID-19 mRNA vaccination among adolescents and young adults: asystematic review and meta-analysis. JAMA Pediatr. 2022. doi:10.1001/jamapediatrics.2022.4768