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Risk of Coronavirus Disease 2019 Messenger RNA Vaccination-Associated Myocarditis and Pericarditis - A Systematic

Yen-Ching Lin1, Chia-Hsuin Chang1,2,3, Wei-Ju Su4,5

  • 1Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

Risk Management and Healthcare Policy
|October 16, 2023
PubMed
Abstract

Insights

mRNA vaccines have low risks of myocarditis and pericarditis, but rates vary. Study methods and characteristics significantly impact reported incidence, necessitating careful consideration when comparing data across different populations and surveillance systems.

Area of Science:

  • Cardiology
  • Vaccinology
  • Epidemiology

Background:

  • Myocarditis and pericarditis are rare adverse events associated with mRNA COVID-19 vaccines.
  • Previous studies indicated low but variable risks, prompting investigation into influencing factors.
  • Understanding these variations is crucial for accurate risk assessment and public health communication.

Purpose of the Study:

  • To systematically review and analyze the incidence of myocarditis and pericarditis following mRNA COVID-19 vaccination.
  • To identify factors contributing to the heterogeneity in reported rates across population-based studies.
  • To compare risks associated with different vaccine types and dosing strategies.

Main Methods:

  • Comprehensive literature search of MEDLINE and health authority websites for relevant studies up to November 30, 2022.
  • Inclusion of 17 studies from 10 countries focusing on mRNA vaccine-associated myocarditis and pericarditis incidence.
  • Analysis of study characteristics, surveillance methods, vaccine types, and demographic factors.

Main Results:

  • Heterogeneity in study characteristics (surveillance method, case definition, observation period) contributed to varied reported rates.
  • Active surveillance studies reported higher rates than passive surveillance.
  • mRNA-1273 may be associated with a higher risk of myocarditis in young men after the second dose compared to BNT162b2; however, hypotheses regarding increased risk in individuals with recent SARS-CoV-2 infection or young Asian males were not supported.
  • Evidence regarding the effect of extended between-dose intervals on myocarditis incidence was insufficient.

Conclusions:

  • Differences in study methodologies and characteristics must be accounted for when comparing mRNA vaccine-associated myocarditis and pericarditis risks globally.
  • Further research is needed to elucidate specific risk factors and optimize vaccination strategies to minimize adverse events.
Keywords:
COVID-19mRNA vaccinemyocarditispopulation-based studysurveillance data

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