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An updated analysis on myocarditis and pericarditis cases reported following mRNA SARS-CoV-2 vaccination in Singapore

Mun Yee Tham1, Cheng Leng Chan1, Dorothy Toh1

  • 1Vigilance and Compliance Branch, Health Sciences Authority, Singapore.

Singapore Medical Journal
|February 16, 2024
PubMed
Abstract

Insights

The risk of myocarditis/pericarditis following mRNA COVID-19 vaccines is highest in adolescent males after the second dose. While most cases are mild, this risk should be weighed against the benefits of vaccination and the risks of SARS-CoV-2 infection.

Area of Science:

  • Cardiology
  • Vaccinology
  • Public Health

Background:

  • Messenger ribonucleic acid (mRNA) vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been linked to myocarditis/pericarditis, particularly in young males.
  • Understanding the specific risks associated with different vaccine brands, age groups, sexes, and dose numbers is crucial for informed public health strategies.

Purpose of the Study:

  • To evaluate the risk of myocarditis/pericarditis following mRNA SARS-CoV-2 vaccination in Singapore.
  • To analyze these risks by vaccine brand, patient age, sex, and dose number.

Main Methods:

  • Analysis of adverse event reports of myocarditis/pericarditis submitted to the Health Sciences Authority (HSA) between December 2020 and July 2022.
  • Case adjudication by an independent panel of cardiologists using CDC criteria.
  • Comparison of observed reporting rates with historical background rates (2018-2020).

Main Results:

  • Out of 152 adjudicated cases, 75% were male, with a median age of 30 years.
  • The highest reporting rates for myocarditis/pericarditis were observed in males aged 12-17 years, especially after the second primary dose (11.5 per 100,000 doses) and booster doses (7.1 per 100,000 doses).
  • Myocarditis remained very rare in children aged 5-11 years (0.2 per 100,000 doses); reporting rates for the first booster were generally similar to or lower than those for the second primary dose.

Conclusions:

  • The risk of myocarditis/pericarditis following mRNA vaccination was highest in adolescent males after the second dose, exceeding historical background rates.
  • Most identified cases of myocarditis/pericarditis were clinically mild.
  • The decision to vaccinate should balance the observed risks of myocarditis/pericarditis against the significant risks associated with SARS-CoV-2 infection, including myocarditis/pericarditis.

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