mRNA Coronavirus Disease 2019 Vaccine-Associated Myopericarditis in Adolescents: A Survey Study

Kohli, Utkarsh; Desai, Lavina; Chowdhury, Devyani; Harahsheh, Ashraf S.; Yonts, Alexandra B; Ansong, Annete; Sabati, Arash; Nguyen, Hoang H.; Hussain, Tarique; Khan, Danyal; Parra, David; Su, Jennifer; Patel, Jyoti K.; Ronai, Christina; Bohun, M. V.; Freij, Bishara J.; O’Connor, Matthew J; Rosanno, J.; Gupta, Aamisha; Salavitabar, Arash; Dorfman, Adam L.; Hansen, J.; Frosch, Olivia; Profita, E.; Maskatia, Shiraz A.; Thacker, Deepika; Shrivastava, Shubhika; Harris, Tyler H.; Feingold, Brian; Berger, Stuart; Campbell, Michael J.; Idriss, Salim F.; Das, Sabyasachi; Renno, Markus S.; Knecht, Ken; Asaki, S. Yukiko; Patel, Sunil; Ashwath, Ravi; Shih, Renata; Phillips, John L.; Das, Bibhuti B.; Ramachandran, P; Sagiv, Eyal; Bhat, Aarti; Johnson, Jonathan N.; Taggart, Nathaniel W.; Imundo, Jason R.; Nakra, Natasha; Behere, Shashank; Patel, Anjlee; Agarwal, Avichal; Aljemmali, Saif; Lang, Sean M.; Batlivala, Sarosh P.; Forsha, Daniel; Conners, Gregory P.; Shaw, Jana; Smith, Frank C.; Pauliks, Linda B.; Vettukattil, Joseph J.; Cheang, Stefanie; Voleti, Sonia; Shenoy, Rajesh; Komarlu, Rukmini; Ryan, Shea J; Snyder, Christopher S.; Bansal, Neha; Sharma, Madhu; Robinson, Jeffrey D.; Arnold, Sandra R.; Salvatore, Christine M.; Kumar, Madan; Fremed, Michael; Glickstein, Julie S.; Perrotta, Melissa; Orr, William B.; Rozema, Tamika; Thirumoorthi, Muthayipalayam C.; Mullett, Charles J.; Ang, Jocelyn Y.

doi:10.1016/j.jpeds.2021.12.025

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…According to a recent US Survey Study in children from 12 to 18 years old, vaccination-related adverse events occurred in 1/1000 recipients, and myocarditis represented 4.3% of the reported events (0.0043% of all adverse events). Notably, most cases were mild or moderate and resolved favorably [ 25 ], as previously reported also in adults [ 26 ].…”

Section: Causessupporting

confidence: 59%

Pediatric Myocarditis: What Have We Learnt So Far?

Pomiato

Perrone

Palmieri

et al. 2022

JCDD

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Myocarditis is an inflammatory disease of the myocardium that is troublesome to diagnose and manage, especially in children. Since the introduction of endomyocardial biopsy (EMB), new diagnostic tools have provided useful data. Especially when enhanced with immunohistochemistry and polymerase chain reaction (PCR) studies, EMB remains the gold standard for the diagnosis. Notably, cardiac magnetic resonance (MRI) is a non-invasive tool that can confirm the diagnosis and has a particular usefulness during the follow-up. The causes of myocarditis are heterogeneous (mostly viral in children). The course and outcome of the illness in the pediatric population represent a complex interaction between etiologic agents and the immune system, which is still not fully understood. The clinical presentation and course of myocarditis vary widely from paucisymptomatic illness to acute heart failure refractory to therapy, arrhythmias, angina-like presentation and sudden cardiac death. In this setting, cardiac biomarkers (i.e., troponins and BNP), although unspecific, can be used to support the diagnosis. Finally, the efficacy of therapeutic strategies is controversial and not confirmed by clinical trials. In this review, we summarized the milestones in diagnosis and provided an overview of the therapeutic options for myocarditis in children.

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Section: Causessupporting

confidence: 59%

Pediatric Myocarditis: What Have We Learnt So Far?

Pomiato

Perrone

Palmieri

et al. 2022

JCDD

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“…The median time from vaccination to NSAID initiation was 2.5 days (range 0-4 days) and from symptom onset to NSAID initiation was 1 day (range 0-4 days). The two patients who presented with echocardiographic LV dysfunction were treated with intravenous immunoglobulin (IVIG) plus a corticosteroid per our institutional pathway for treatment of myocarditis[ 2 ]. One additional patient received IVIG without corticosteroids.…”

Section: Resultsmentioning

confidence: 99%

“…Patients typically exhibit chest pain and an elevated serum troponin level in the days following the COVID-19 mRNA vaccine. They usually are hemodynamically stable, and symptoms and cardiac biomarkers normalize within a few days [ 2 ]. cardiac magnetic resonance studies, when performed early, frequently demonstrate abnormalities such as edema and late gadolinium enhancement (LGE), meeting Lake Louise Criteria for diagnosing myocarditis noninvasively [ 2 , 3 ].…”

mentioning

confidence: 99%

“…They usually are hemodynamically stable, and symptoms and cardiac biomarkers normalize within a few days [ 2 ]. cardiac magnetic resonance studies, when performed early, frequently demonstrate abnormalities such as edema and late gadolinium enhancement (LGE), meeting Lake Louise Criteria for diagnosing myocarditis noninvasively [ 2 , 3 ]. In classical myocarditis LGE can be predictive of a poor outcome [ 5 ].…”

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confidence: 99%

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Persistent Cardiac Magnetic Resonance Imaging Findings in a Cohort of Adolescents with Post-Coronavirus Disease 2019 mRNA Vaccine Myopericarditis

Schauer

Buddhe

Gulhane

et al. 2022

The Journal of Pediatrics

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“…Among the 34 cases in this subgroup, 85% were male and patients tended to present within 5 days of vaccination. Separate analyses of postvaccine myocarditis in a pediatric population aged 12–17 demonstrated similar presenting symptoms as adults [ 44 ], with an incidence of 4.2 cases of myopericarditis per 32.4 million doses [ 45 ], although overall incidence in this subpopulation remains unclear due to the relative delay in vaccination of youth populations.…”

Section: Incidencementioning

confidence: 99%

Myocarditis following COVID-19 vaccination: incidence, mechanisms, and clinical considerations

Power

Keyt

Adler

2022

Expert Review of Cardiovascular Therapy

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Introduction Vaccines have demonstrated protection against the morbidity and mortality of COVID-19, but concerns regarding the rare side effect of acute myocarditis have stymied immunization efforts. This review aims to describe the incidence and theorized mechanisms of COVID vaccine-associated myocarditis and review relevant principles for management of vaccine-associated myocarditis Areas covered Epidemiologic studies of myocarditis after COVID vaccination are reviewed, which show an incidence of approximately 20–30 per million patients. The vast majority of these cases are seen with mRNA vaccines especially in male patients under 30 years of age. Mechanisms are largely theoretical, but molecular mimicry and dysregulated innate immune reactions have been proposed. While studies suggest that this subtype of myocarditis is mild and self-limited, long-term evidence is lacking. Principles of myocarditis treatment and surveillance are outlined as they apply to COVID vaccine-associated myocarditis. Expert Opinion COVID vaccine-associated myocarditis is rare but well described in certain at-risk groups. Better understanding of its pathogenesis is key to mitigating this complication and advancing vaccination efforts. Risk-benefit analyses demonstrate that individual- and population-level benefits of vaccination exceed the risks of this rare and mild form of myocarditis.

show abstract

mRNA Coronavirus Disease 2019 Vaccine-Associated Myopericarditis in Adolescents: A Survey Study

Cited by 9 publications

References 13 publications

Pediatric Myocarditis: What Have We Learnt So Far?

Pediatric Myocarditis: What Have We Learnt So Far?

Persistent Cardiac Magnetic Resonance Imaging Findings in a Cohort of Adolescents with Post-Coronavirus Disease 2019 mRNA Vaccine Myopericarditis

Myocarditis following COVID-19 vaccination: incidence, mechanisms, and clinical considerations

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