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COVID-19 Management

More Data on Myocarditis Incidence Following mRNA-Based COVID-19 Vaccination

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BACKGROUND AND PURPOSE:

  • Simone et al. (JAMA Intern Med, 2021) evaluated post-vaccination acute myocarditis incidence and clinical outcomes in adults who received an mRNA-based COVID-19 vaccine

METHODS:

  • Population-based cohort study
    • Kaiser Permanente Southern California (KPSC) 
  • Participants
    • ≥18 years
  • Exposures
    • Receipt of at least 1 dose of the Pfizer or Moderna COVID-19 vaccine between December 2020 and July 2021
    • Unexposed controls
  • Study design
    • Incidence of myocarditis in the vaccinated group was compared to incidence among
      • Cohort of unexposed controls
      • Vaccinated individuals
    • Case identification: Based on reports of hospitalization within 10 days of vaccine administration with a discharge diagnosis of myocarditis
  • Primary outcome
    • Cases of post-vaccine myocarditis
    • Outcomes and characteristics of myocarditis cases

RESULTS:

  • mRNA COVID-19 vaccine recipients: 2,392,924
    • Median (IQR) age: 49 (34 to 64) years | 54.0% women
    • Completed two doses regimen: 93.5%
  • Unexposed cohort: 1,577,741
    • Median (IQR) age: 39 (28 to 53 years) | 49.1% women
  • Myocarditis cases
    • After first dose: 2 cases
      • Incidence: 0.8 cases per 1 million first doses
      • Incidence rate ratio (RR) 0.38 (95% CI, 0.05 to 1.40)
    • After second dose: 13 cases
      • Incidence: 5.8 cases per 1 million second doses
      • Incidence RR 2.7 (95% CI, 1.4 to 4.8)
  • Case demographics
    • Post-vaccination cases
      • All cases were men
      • Median (IQR) age: 25 (20 to 32) years
      • Cases with prior cardiac disease: 0
      • Received Pfizer: 8 | Received Moderna: 7
    • Unexposed cohort cases
      • Men: 52%
      • Median (IQR) age: 52 (32 to 59) years
  • Myocarditis clinical features and outcomes
    • Cases that reported chest pain 1 to 5 days after vaccination: 93%
    • Symptoms resolved with conservative management in all cases
    • No patients required intensive care unit admission or readmission after discharge

CONCLUSION:

  • Acute myocarditis following COVID-19 mRNA vaccination was rare and resolved with conservative management
  • All cases involved young men, which suggests the risk of myocarditis may be higher in this group

Learn More – Primary Sources:

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

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Related ObG Topics:

CDC Reports on the Risk of Myocarditis with COVID-19 Vaccination
CDC Reports: The Latest on COVID-19 and Increased Risk of Myocarditis

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