A Systematic Review and Meta-analysis of the Association Between SARS-CoV-2 Vaccination and Myocarditis or Pericarditis

Gao, Juan; Feng, Linya; Li, Yaru; Lowe, Scott W.; Guo, Zhichun; Bentley, Rachel; Xie, Chuman; Wu, Birong; Xie, Peng; Xia, Weihang; Ma, Shaodi; Liu, Haixia; Guo, Xianwei; Uy, John Patrick; Zhou, Qin; Wazir, Hina; Sun, Chenyu

doi:10.1016/j.amepre.2022.09.002

Cited by 21 publications

(19 citation statements)

References 49 publications

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“…This study also showed that the excess events of myocarditis after the second dose of the mRNA-1273 vaccine in young males was higher than those observed in COVID-19 infections [ 100 ]. The higher incidence of myocarditis after the Moderna mRNA-1273 is consistent with findings from other large studies; however, the observation that the excess rate of myocarditis after COVID-19 vaccination was higher than after COVID-19 infection is not consistent with other meta-analyses [ 68 , 95 , 101 ]. While COVID-19 infection-associated myocarditis can still occur after vaccination, Patone et al showed that the number of excess cases dropped from 35 per 1,000,000 to 23 per 1,000,000 after vaccination [ 100 ].…”

Section: Vaccination-induced Autoimmunity and Myocarditissupporting

confidence: 83%

“…This is consistent with a second meta-analysis with 58.6 million patients which showed a relative risk for myocarditis of 2.36. This same analysis demonstrated greater risk in males, patients under the age of 40, and those who received two doses of the Moderna mRNA-1273 vaccine [ 95 ]. A higher prevalence in men at 61% was observed, which is consistent with other studies, though in some reports this was shown to be as high as 94% [ 68 , 96 , 97 ].…”

Section: Vaccination-induced Autoimmunity and Myocarditismentioning

confidence: 96%

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Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology

et al. 2023

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The COVID-19 pandemic has led to significant loss of life and severe disability, justifying the expedited testing and approval of messenger RNA (mRNA) vaccines. While found to be safe and effective, there have been increasing reports of myocarditis after COVID-19 mRNA vaccine administration. The acute events have been severe enough to require admission to the intensive care unit in some, but most patients fully recover with only rare deaths reported. The pathways involved in the development of vaccine-associated myocarditis are highly dependent on the specific vaccine. COVID-19 vaccine-associated myocarditis is believed to be primarily caused by uncontrolled cytokine-mediated inflammation with possible genetic components in the interleukin-6 signaling pathway. There is also a potential autoimmune component via molecular mimicry. Many of these pathways are similar to those seen in viral myocarditis, indicating a common pathophysiology. There is concern for residual cardiac fibrosis and increased risk for the development of cardiomyopathies later in life. This is of particular interest for patients with congenital heart defects who are already at increased risk for fibrotic cardiomyopathies. Though the risk for vaccine-associated myocarditis is important to consider, the risk of viral myocarditis and other injury is far greater with COVID-19 infection. Considering these relative risks, it is still recommended that the general public receive vaccination against COVID-19, and it is particularly important for congenital heart defect patients to receive vaccination for COVID-19.

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Section: Vaccination-induced Autoimmunity and Myocarditissupporting

confidence: 83%

Section: Vaccination-induced Autoimmunity and Myocarditismentioning

confidence: 96%

Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology

et al. 2023

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“…128 The overall relative risk of myocarditis or pericarditis calculated for BNT162b2 was 2.2, and for mRNA-1273, primarily given at higher dose levels (100 vs. 30 µg for BNT162b2), it was 4.2. 129 The mechanism behind the myocarditis induced by mRNA COVID-19 vaccination is not fully elucidated, but different hypotheses have been put forward. Firstly, it may be due to cross-reaction between antibodies against SARS-CoV-2 spike protein and human proteins, such as myocardial alpha-myosin.…”

Section: Risk Of Myocarditismentioning

confidence: 99%

mRNA vaccines: The future of prevention of viral infections?

Rzymski

Szuster‐Ciesielska

Dzieciątkowski

et al. 2023

Journal of Medical Virology

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Messenger RNA (mRNA) vaccines against COVID-19 are the first authorized biological preparations developed using this platform. During the pandemic, their administration has been proven to be a life-saving intervention. Here, we review the main advantages of using mRNA vaccines, identify further technological challenges to be met during the development of the mRNA platform, and provide an update on the clinical progress on leading mRNA vaccine candidates against different viruses that include influenza viruses, human immunodeficiency virus 1, respiratory syncytial virus, Nipah virus, Zika virus, human cytomegalovirus, and Epstein-Barr virus. The prospects and challenges of manufacturing mRNA vaccines in low-income countries are also discussed. The ongoing interest and research in mRNA technology are likely to overcome some existing challenges for this technology (e.g., related to storage conditions and immunogenicity of some components of lipid nanoparticles) and enhance the portfolio of vaccines against diseases for which classical formulations are already authorized. It may also open novel pathways of protection against infections and their consequences for which no safe and efficient immunization methods are currently available.

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“…However, some vaccines, particularly mRNA-based vaccines, have been associated with multiple side effects, such as myocarditis/pericarditis. Several systematic reviews and meta-analyses have suggested an increased risk of myocarditis/pericarditis after COVID-19 vaccination [ 36 , 37 , 38 ]. In this Issue, Parra-Lucares et al reviewed the current literature on vaccination-related cardiac involvement and proposed a pathophysiological mechanism for vaccine-induced myocarditis/pericarditis.…”

Section: Introductionmentioning

confidence: 99%