Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", I.R.C.C.S., Università Cattolica Sacro Cuore, Rome, Italy.
Department of Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy.
Acta Paediatr. 2022 Oct;111(10):1846-1852. doi: 10.1111/apa.16462. Epub 2022 Jul 8.
Myopericarditis after COVID-19 vaccination were the most serious adverse events reported in children over 5 years of age. We want to summarise these cases, describing their incidence, clinical features, diagnostic pathways, therapeutic strategies and outcome.
A systematic review of the literature was conducted until 20 March 2022 by bibliographic electronic databases. We included all reports of post-vaccination myopericarditis in children aged between 5 and 18 years.
All reported cases had elevated serum Troponin levels, associated with electrocardiogram changes, but often with normal echocardiogram. Cardiac magnetic resonance images always showed typical alterations. The pathogenetic mechanism is still unknown. Myocarditis following post-COVID vaccination is more frequent in boys with an average age of about 15 years. Treatment involves the usage of non-steroidal anti-inflammatory drugs, and the average hospitalisation is about 3 days. The long-term consequences are not yet known, so these patients should be studied in a cardiological follow-up and abstention from physical activity should be recommended.
The benefits of COVID-19 vaccination in children and adolescents appear to outweigh the risk of developing post-vaccination myopericarditis. We can also speculate a possible approval of vaccination in children under 5 years for the coming winter.
COVID-19 疫苗接种后心肌炎是 5 岁以上儿童报告的最严重的不良事件。我们希望总结这些病例，描述其发病率、临床特征、诊断途径、治疗策略和结局。
我们通过文献电子数据库对截至 2022 年 3 月 20 日的文献进行了系统回顾。我们纳入了所有报告的 5 至 18 岁儿童接种疫苗后心肌炎病例。
所有报告的病例均有血清肌钙蛋白升高，伴有心电图改变，但常伴有正常超声心动图。心脏磁共振图像始终显示出典型的改变。发病机制尚不清楚。COVID-19 疫苗接种后心肌炎在平均年龄约为 15 岁的男孩中更为常见。治疗包括使用非甾体抗炎药，平均住院时间约为 3 天。长期后果尚不清楚，因此这些患者应在心脏随访中进行研究，并应建议避免体力活动。
COVID-19 疫苗在儿童和青少年中的益处似乎超过了接种后发生心肌炎的风险。我们还可以推测，未来冬季可能会批准为 5 岁以下儿童接种疫苗。
