Trends in Acute Myocarditis Related Pediatric Hospitalizations in the United States, 2007–2016

Vasudeva, Rhythm; Bhatt, Parth; Lilje, Christian; Desai, Pooja; Amponsah, Jason K.; Umscheid, Jacob; Parmar, Narendrasinh; Bhatt, Neel S.; Adupa, Reshmi; Pagad, Sukrut; Agrawal, Prerna; Donda, Keyur; Dapaah‐Siakwan, Fredrick; Yagnik, Priyank

doi:10.1016/j.amjcard.2021.03.019

Cited by 28 publications

(40 citation statements)

References 21 publications

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“…The frequency of myocarditis showed a bimodal trend in infants and adolescents in this study, which was comparable to previous studies on pediatric myocarditis. 25 26 In addition, age younger than one year was the risk factor for poor outcome in this present study with higher mortality than other age groups. A multicenter study in the U.S. reported that the death/transplant group had a lower median age than the survived group (7.75 years vs. 14 years).…”

Section: Discussionsupporting

confidence: 44%

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Epidemiology and Clinical Features of Myocarditis/Pericarditis before the Introduction of mRNA COVID-19 Vaccine in Korean Children: a Multicenter Study

et al. 2021

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Background 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. Methods 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. Results 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 ( P = 0.021). Among the 56 (40%) proven pathogens at admission, Mycoplasma pneumoniae (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, P = 0.014). Conclusion The frequency of myocarditis/pericarditis was highest among male adolescent in-patients; however, the outcome was favorable in this group without any mortality.

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Section: Discussionsupporting

confidence: 44%

“…However, other studies suggest that the increase in incidence is due to changes in physician's perception of the myocarditis 23 and the development of diagnostic techniques such as cardiac magnetic resonance imaging (MRI). 25 …”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Clinical Features of Myocarditis/Pericarditis before the Introduction of mRNA COVID-19 Vaccine in Korean Children: a Multicenter Study

et al. 2021

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“…Among these 323 patients, the median age was 19 years, 291 (90%) were males, and the median interval from vaccination to symptom onset was 2 days [ 18 ]. From previous literature, it also appears that myocarditis typically occurs more commonly in males, and the incidence is highest amongst adolescent and young adults [ 19 , 20 ]. The underlying pathophysiologic mechanism(s) of higher prevalence of acute myocarditis in males is poorly understood, but limited data suggest that elevated testosterone can contribute to acute myocarditis is by increasing viral binding to myocytes [ 21 ], inhibiting anti-inflammatory cell population [ 22 ], and upregulating cardiac fibrotic remodeling genes [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular magnetic resonance findings in young adult patients with acute myocarditis following mRNA COVID-19 vaccination: a case series

Patel

Louis

Atalay

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Messenger RNA (mRNA) coronavirus disease of 2019 (COVID-19) vaccine are known to cause minor side effects at the injection site and mild global systemic symptoms in first 24–48 h. Recently published case series have reported a possible association between acute myocarditis and COVID-19 vaccination, predominantly in young males. Methods We report a case series of 5 young male patients with cardiovascular magnetic resonance (CMR)-confirmed acute myocarditis within 72 h after receiving a dose of an mRNA-based COVID-19 vaccine. Results Our case series suggests that myocarditis in this setting is characterized by myocardial edema and late gadolinium enhancement in the lateral wall of the left ventricular (LV) myocardium, reduced global LV longitudinal strain, and preserved LV ejection fraction. All patients in our series remained clinically stable during a relatively short inpatient hospital stay. Conclusions In conjunction with other recently published case series and national vaccine safety surveillance data, this case series suggests a possible association between acute myocarditis and COVID-19 vaccination in young males and highlights a potential pattern in accompanying CMR abnormalities.

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“…Myocarditis typically occurs more commonly in males than in females, and incidence is highest among infants, adolescents, and young adults ( 1 , 2 ). The clinical presentation and severity of myocarditis vary among patients.…”

mentioning

confidence: 99%

Use of mRNA COVID-19 Vaccine After Reports of Myocarditis Among Vaccine Recipients: Update from the Advisory Committee on Immunization Practices — United States, June 2021

Gargano¹,

Wallace²,

Hadler³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

489

477

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Trends in Acute Myocarditis Related Pediatric Hospitalizations in the United States, 2007–2016

Cited by 28 publications

References 21 publications

Epidemiology and Clinical Features of Myocarditis/Pericarditis before the Introduction of mRNA COVID-19 Vaccine in Korean Children: a Multicenter Study

Epidemiology and Clinical Features of Myocarditis/Pericarditis before the Introduction of mRNA COVID-19 Vaccine in Korean Children: a Multicenter Study

Cardiovascular magnetic resonance findings in young adult patients with acute myocarditis following mRNA COVID-19 vaccination: a case series

Use of mRNA COVID-19 Vaccine After Reports of Myocarditis Among Vaccine Recipients: Update from the Advisory Committee on Immunization Practices — United States, June 2021

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