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Severe Myocarditis Increase in Children Associated With Parvovirus B19 Infection: MYKKE Registry and German

Franziska Seidel1, Teresa M Nygren2, Bernd Opgen-Rhein3

  • 1Deutsches Herzzentrum der Charité, Department of Congenital Heart Disease-Pediatric Cardiology, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.

JACC. Heart Failure
|January 6, 2026
PubMed
Abstract

Insights

Pediatric myocarditis surged due to parvovirus B19 (B19V) in Germany, particularly affecting young children. Increased severity was linked to younger age, not a more virulent B19V strain.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Virology

Background:

  • A rise in pediatric myocarditis cases in Germany since August 2023 coincided with increased detection of parvovirus B19 (B19V).
  • Concerns were raised regarding the causative agents and effective countermeasures for this surge.

Purpose of the Study:

  • To investigate the association between parvovirus B19 (B19V) and the increase in pediatric myocarditis.
  • To evaluate the severity of B19V-associated myocarditis in children.

Main Methods:

  • Analysis of data from the Myocarditis Registry for Children and Adolescents (MYKKE) across 27 centers.
  • Definition of B19V myocarditis cases using PCR positivity and clinical/histopathologic evidence.
  • Comparison of clinical, histopathologic, and epidemiologic data from 2013-2023 and post-August 2023 cases, including metagenomic and sequencing analyses of current cases.

Main Results:

  • Out of 922 myocarditis patients, 126 (13.6%) had B19V myocarditis; 45.2% of current cases were B19V-associated.
  • Current B19V myocarditis cases predominantly affected children under 2 years old (64.9%) and were more common in females (56.1%).
  • Increased severity, indicated by reduced ejection fraction and higher B19V viral load, was linked to younger age, with no evidence of a more virulent B19V strain (genotype 1A).

Conclusions:

  • The increase in pediatric myocarditis is associated with B19V, primarily due to the disproportionately high number of young children affected.
  • Young children's vulnerability, rather than a more virulent viral strain, explains the observed increase in severity.
  • Enhanced clinical awareness, proactive interdisciplinary management, and targeted prevention strategies are crucial for this vulnerable pediatric cohort.
Keywords:
heart failureincreasemyocarditisparvovirus B19surveillancevirulence

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