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Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex.
Circulation. 2022 09 06; 146(10):743-754.Circ

Abstract

BACKGROUND

Myocarditis is more common after severe acute respiratory syndrome coronavirus 2 infection than after COVID-19 vaccination, but the risks in younger people and after sequential vaccine doses are less certain.

METHODS

A self-controlled case series study of people ages 13 years or older vaccinated for COVID-19 in England between December 1, 2020, and December 15, 2021, evaluated the association between vaccination and myocarditis, stratified by age and sex. The incidence rate ratio and excess number of hospital admissions or deaths from myocarditis per million people were estimated for the 1 to 28 days after sequential doses of adenovirus (ChAdOx1) or mRNA-based (BNT162b2, mRNA-1273) vaccines, or after a positive SARS-CoV-2 test.

RESULTS

In 42 842 345 people receiving at least 1 dose of vaccine, 21 242 629 received 3 doses, and 5 934 153 had SARS-CoV-2 infection before or after vaccination. Myocarditis occurred in 2861 (0.007%) people, with 617 events 1 to 28 days after vaccination. Risk of myocarditis was increased in the 1 to 28 days after a first dose of ChAdOx1 (incidence rate ratio, 1.33 [95% CI, 1.09-1.62]) and a first, second, and booster dose of BNT162b2 (1.52 [95% CI, 1.24-1.85]; 1.57 [95% CI, 1.28-1.92], and 1.72 [95% CI, 1.33-2.22], respectively) but was lower than the risks after a positive SARS-CoV-2 test before or after vaccination (11.14 [95% CI, 8.64-14.36] and 5.97 [95% CI, 4.54-7.87], respectively). The risk of myocarditis was higher 1 to 28 days after a second dose of mRNA-1273 (11.76 [95% CI, 7.25-19.08]) and persisted after a booster dose (2.64 [95% CI, 1.25-5.58]). Associations were stronger in men younger than 40 years for all vaccines. In men younger than 40 years old, the number of excess myocarditis events per million people was higher after a second dose of mRNA-1273 than after a positive SARS-CoV-2 test (97 [95% CI, 91-99] versus 16 [95% CI, 12-18]). In women younger than 40 years, the number of excess events per million was similar after a second dose of mRNA-1273 and a positive test (7 [95% CI, 1-9] versus 8 [95% CI, 6-8]).

CONCLUSIONS

Overall, the risk of myocarditis is greater after SARS-CoV-2 infection than after COVID-19 vaccination and remains modest after sequential doses including a booster dose of BNT162b2 mRNA vaccine. However, the risk of myocarditis after vaccination is higher in younger men, particularly after a second dose of the mRNA-1273 vaccine.

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Authors+Show Affiliations

Patone M
Nuffield Department of Primary Health Care Sciences (M.P., X.W.M., S.D., A.H., C.A.C.C., J.H.-C.), University of Oxford.
Mei XW
Nuffield Department of Primary Health Care Sciences (M.P., X.W.M., S.D., A.H., C.A.C.C., J.H.-C.), University of Oxford.
Handunnetthi L
Wellcome Centre for Human Genetics (L.H.), University of Oxford.
Dixon S
Nuffield Department of Primary Health Care Sciences (M.P., X.W.M., S.D., A.H., C.A.C.C., J.H.-C.), University of Oxford.
Zaccardi F
Leicester Real World Evidence Unit, Diabetes Research Centre (F.Z., K.K.), University of Leicester.
Shankar-Hari M
School of Immunology and Microbial Sciences, King's College London, Centre for Inflammation Research (M.S.-H.). Usher Institute (M.S.-H., N.L.M., A.S.), University of Edinburgh.
Watkinson P
National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals National Health Service Trust (P.W.); University of Oxford.
Khunti K
Leicester Real World Evidence Unit, Diabetes Research Centre (F.Z., K.K.), University of Leicester.
Harnden A
Nuffield Department of Primary Health Care Sciences (M.P., X.W.M., S.D., A.H., C.A.C.C., J.H.-C.), University of Oxford.
Coupland CAC
Nuffield Department of Primary Health Care Sciences (M.P., X.W.M., S.D., A.H., C.A.C.C., J.H.-C.), University of Oxford. Centre for Academic Primary Care, School of Medicine, University of Nottingham (C.A.C.C.).
Channon KM
British Heart Foundation Centre of Research Excellence, National Institute for Health Research, Oxford Biomedical Research Centre, Radcliffe Department of Medicine, John Radcliffe Hospital (K.M.C.):, University of Oxford.
Mills NL
Usher Institute (M.S.-H., N.L.M., A.S.), University of Edinburgh. British Heart Foundation University Centre for Cardiovascular Science (N.L.M.), University of Edinburgh.
Sheikh A
Usher Institute (M.S.-H., N.L.M., A.S.), University of Edinburgh.
Hippisley-Cox J
Nuffield Department of Primary Health Care Sciences (M.P., X.W.M., S.D., A.H., C.A.C.C., J.H.-C.), University of Oxford.

MeSH

2019-nCoV Vaccine mRNA-1273AdolescentAdultBNT162 VaccineCOVID-19COVID-19 VaccinesFemaleHumansMaleMyocarditisSARS-CoV-2Vaccines, SyntheticViral VaccinesmRNA Vaccines

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35993236

Citation

Patone, Martina, et al. "Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection By Age and Sex." Circulation, vol. 146, no. 10, 2022, pp. 743-754.
Patone M, Mei XW, Handunnetthi L, et al. Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex. Circulation. 2022;146(10):743-754.
Patone, M., Mei, X. W., Handunnetthi, L., Dixon, S., Zaccardi, F., Shankar-Hari, M., Watkinson, P., Khunti, K., Harnden, A., Coupland, C. A. C., Channon, K. M., Mills, N. L., Sheikh, A., & Hippisley-Cox, J. (2022). Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex. Circulation, 146(10), 743-754. https://doi.org/10.1161/CIRCULATIONAHA.122.059970
Patone M, et al. Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection By Age and Sex. Circulation. 2022 09 6;146(10):743-754. PubMed PMID: 35993236.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex. AU - Patone,Martina, AU - Mei,Xue W, AU - Handunnetthi,Lahiru, AU - Dixon,Sharon, AU - Zaccardi,Francesco, AU - Shankar-Hari,Manu, AU - Watkinson,Peter, AU - Khunti,Kamlesh, AU - Harnden,Anthony, AU - Coupland,Carol A C, AU - Channon,Keith M, AU - Mills,Nicholas L, AU - Sheikh,Aziz, AU - Hippisley-Cox,Julia, Y1 - 2022/08/22/ PY - 2022/8/23/pubmed PY - 2022/9/9/medline PY - 2022/8/22/entrez KW - 2019-nCoV vaccine mRNA-1273 KW - BNT162 vaccine KW - COVID-19 KW - COVID-19 vaccines KW - ChAdOx1 nCoV-19 KW - SARS-CoV-2 KW - myocarditis SP - 743 EP - 754 JF - Circulation JO - Circulation VL - 146 IS - 10 N2 - BACKGROUND: Myocarditis is more common after severe acute respiratory syndrome coronavirus 2 infection than after COVID-19 vaccination, but the risks in younger people and after sequential vaccine doses are less certain. METHODS: A self-controlled case series study of people ages 13 years or older vaccinated for COVID-19 in England between December 1, 2020, and December 15, 2021, evaluated the association between vaccination and myocarditis, stratified by age and sex. The incidence rate ratio and excess number of hospital admissions or deaths from myocarditis per million people were estimated for the 1 to 28 days after sequential doses of adenovirus (ChAdOx1) or mRNA-based (BNT162b2, mRNA-1273) vaccines, or after a positive SARS-CoV-2 test. RESULTS: In 42 842 345 people receiving at least 1 dose of vaccine, 21 242 629 received 3 doses, and 5 934 153 had SARS-CoV-2 infection before or after vaccination. Myocarditis occurred in 2861 (0.007%) people, with 617 events 1 to 28 days after vaccination. Risk of myocarditis was increased in the 1 to 28 days after a first dose of ChAdOx1 (incidence rate ratio, 1.33 [95% CI, 1.09-1.62]) and a first, second, and booster dose of BNT162b2 (1.52 [95% CI, 1.24-1.85]; 1.57 [95% CI, 1.28-1.92], and 1.72 [95% CI, 1.33-2.22], respectively) but was lower than the risks after a positive SARS-CoV-2 test before or after vaccination (11.14 [95% CI, 8.64-14.36] and 5.97 [95% CI, 4.54-7.87], respectively). The risk of myocarditis was higher 1 to 28 days after a second dose of mRNA-1273 (11.76 [95% CI, 7.25-19.08]) and persisted after a booster dose (2.64 [95% CI, 1.25-5.58]). Associations were stronger in men younger than 40 years for all vaccines. In men younger than 40 years old, the number of excess myocarditis events per million people was higher after a second dose of mRNA-1273 than after a positive SARS-CoV-2 test (97 [95% CI, 91-99] versus 16 [95% CI, 12-18]). In women younger than 40 years, the number of excess events per million was similar after a second dose of mRNA-1273 and a positive test (7 [95% CI, 1-9] versus 8 [95% CI, 6-8]). CONCLUSIONS: Overall, the risk of myocarditis is greater after SARS-CoV-2 infection than after COVID-19 vaccination and remains modest after sequential doses including a booster dose of BNT162b2 mRNA vaccine. However, the risk of myocarditis after vaccination is higher in younger men, particularly after a second dose of the mRNA-1273 vaccine. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/35993236/Risk_of_Myocarditis_After_Sequential_Doses_of_COVID_19_Vaccine_and_SARS_CoV_2_Infection_by_Age_and_Sex_ DB - PRIME DP - Unbound Medicine ER -