Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2021 Aug 16;36(32):e232. doi: 10.3346/jkms.2021.36.e232.
Korean health authority plans to vaccinate adolescents against coronavirus disease 2019 (COVID-19) starting high school seniors during the summer vacation of 2021. However, the myocarditis/pericarditis following COVID-19 vaccine has been reported recently in adolescents and young adults. This study was performed to answer the urgent questions about the basic epidemiology and clinical course of myocarditis/pericarditis in hospitalized patients prior to the introduction of COVID-19 vaccines in pediatric population.
A retrospective medical record analysis including frequency, clinical characteristics, etiology and outcome of myocarditis/pericarditis was conducted in 17 years and younger patients who were hospitalized in two referral hospitals in Korea between 2010 and 2019.
Total 142 patients with myocarditis (n = 119) and/or pericarditis (n = 23) were identified. Median age was 5.4 years (interquartile range, 0.6-12.9 years; range, 11 days-17.8 years), and male was 61%. In adolescents aged 12-17 years, the male to female ratio was 3.2. Myocarditis/pericarditis occurred 0.70 per 1,000 in-patients during the study period: 0.96 (< 1 year), 0.50 (1-5 years), 0.67 (6-11 years) and 1.22 (12-17 years) per 1,000 in-patients, respectively. There was an increasing tendency for the annual frequency from 0.34 in 2010 to 1.25 per 1,000 in-patients in 2019 ( = 0.021). Among the 56 (40%) proven pathogens at admission, (n = 11, 8%) and enterovirus (n = 10, 7%) were most common. Of the 142 patients, 99 (70%) required pediatric intensive care unit care and 10 (7%) received heart transplantation. In addition, 61 patients (61/131, 47%) without heart medication at admission needed heart medication when they were discharged. Eleven (7.7%) patients died, of which five patients were previously healthy. The median age of deceased patients was lower than the survival group (0.8 vs. 6.3 years, = 0.014).
The frequency of myocarditis/pericarditis was highest among male adolescent in-patients; however, the outcome was favorable in this group without any mortality.
韩国卫生当局计划在 2021 年暑假期间为高中生接种针对 2019 年冠状病毒病（COVID-19）的疫苗。然而，最近在青少年和年轻人中报告了 COVID-19 疫苗接种后的心肌炎/心包炎。本研究旨在回答在儿科人群中引入 COVID-19 疫苗之前，关于住院患者心肌炎/心包炎基本流行病学和临床过程的紧急问题。
对 2010 年至 2019 年间在韩国两家转诊医院住院的 17 岁以下患者进行了回顾性病历分析，包括心肌炎/心包炎的频率、临床特征、病因和结局。
共确定 142 例心肌炎（n = 119）和/或心包炎（n = 23）患者。中位年龄为 5.4 岁（四分位距，0.6-12.9 岁；范围，11 天-17.8 岁），男性占 61%。在 12-17 岁的青少年中，男女比例为 3.2。研究期间，每 1000 名住院患者中发生心肌炎/心包炎的频率为 0.70：0.96（<1 岁）、0.50（1-5 岁）、0.67（6-11 岁）和 1.22（12-17 岁）每 1000 名住院患者，分别。从 2010 年的 0.34 增加到 2019 年的 1.25 每 1000 名住院患者（=0.021）。在 56 例（40%）入院时确诊的病原体中，（n = 11，8%）和肠道病毒（n = 10，7%）最常见。在 142 例患者中，99 例（70%）需要小儿重症监护病房治疗，10 例（7%）需要心脏移植。此外，入院时无心脏药物治疗的 61 例（61/131，47%）患者出院时需要心脏药物治疗。11 例（7.7%）患者死亡，其中 5 例患者之前健康。死亡患者的中位年龄低于存活组（0.8 岁与 6.3 岁，=0.014）。
在男性青少年住院患者中，心肌炎/心包炎的发生率最高；然而，在没有任何死亡的情况下，该组的预后良好。
