Perez Yalile, Levy Emily R, Joshi Avni Y, Virk Abinash, Rodriguez-Porcel Martin, Johnson Matthew, Roellinger Daniel, Vanichkachorn Greg, Charles Huskins W, Swift Melanie D
Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pediatric and Adolescent Medicine, Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Clin Infect Dis. 2022 Aug 24;75(1):e749-e754. doi: 10.1093/cid/ciab926.
Myocarditis following coronavirus disease 2019 (COVID-19) mRNA vaccines (Pfizer-BioNTech and Moderna) has been increasingly reported. Incidence rates in the general population are lacking, with pericarditis rather than myocarditis diagnostic codes being used to estimate background rates. This comparison is critical for balancing the risk of vaccination with the risk of no vaccination.
A retrospective case series was performed using the Mayo Clinic COVID-19 Vaccine Registry. We measured the incidence rate ratio (IRR) for myocarditis temporally related to COVID-19 mRNA vaccination compared with myocarditis in a comparable population from 2016 through 2020. Clinical characteristics and outcomes of the affected patients were collected. A total of 21 individuals were identified, but ultimately 7 patients met the inclusion criteria for vaccine-associated myocarditis.
The overall IRR of COVID-19-related myocarditis was 4.18 (95% confidence interval [CI], 1.63-8.98), which was entirely attributable to an increased IRR among adult males (IRR, 6.69; 95% CI, 2.35-15.52) compared with females (IRR 1.41; 95% CI, .03-8.45). All cases occurred within 2 weeks of a dose of the COVID-19 mRNA vaccine, with the majority occurring within 3 days (range, 1-13) following the second dose (6 of 7 patients, 86%). Overall, cases were mild, and all patients survived.
Myocarditis is a rare adverse event associated with COVID-19 mRNA vaccines. It occurs in adult males with significantly higher incidence than in the background population. Recurrence of myocarditis after a subsequent mRNA vaccine dose is not known at this time.
2019冠状病毒病（COVID-19）mRNA疫苗（辉瑞-生物科技公司和莫德纳公司）接种后发生心肌炎的报告越来越多。普通人群中的发病率尚无数据，目前使用心包炎而非心肌炎的诊断编码来估计背景发病率。这种比较对于平衡接种疫苗的风险和未接种疫苗的风险至关重要。
利用梅奥诊所COVID-19疫苗登记处进行了一项回顾性病例系列研究。我们测量了与COVID-19 mRNA疫苗接种在时间上相关的心肌炎发病率比（IRR），并与2016年至2020年可比人群中的心肌炎发病率进行比较。收集了受影响患者的临床特征和结局。共识别出21例个体，但最终7例患者符合疫苗相关心肌炎的纳入标准。
COVID-19相关心肌炎的总体IRR为4.18（95%置信区间[CI]，1.63 - 8.98），这完全归因于成年男性的IRR增加（IRR，6.69；95%CI，2.35 - 15.52），而女性的IRR为1.41（95%CI，0.03 - 8.45）。所有病例均在一剂COVID-19 mRNA疫苗接种后2周内发生，大多数病例在第二剂接种后3天内（范围1 - 13天）发生（7例患者中的6例，86%）。总体而言，病例症状较轻，所有患者均存活。
心肌炎是与COVID-19 mRNA疫苗相关的罕见不良事件。它在成年男性中发生的发病率明显高于背景人群。目前尚不清楚后续mRNA疫苗接种剂量后心肌炎是否会复发。
