Key result
mRNA-1273 vaccination carries the highest myocarditis risk in young men at ~20 per 100,000 doses.
Why the study?
Most prior meta-analyses of COVID-19 vaccine-associated myocarditis or pericarditis included passive surveillance data prone to reporting errors, leaving a need for accurate risk estimates stratified by age, sex, vaccine dose, and vaccine type.
Does COVID-19 vaccination increase the risk of myocarditis and pericarditis in specific age and sex groups compared to unvaccinated groups or periods?
Meta-Analysis
Does COVID-19 vaccination increase the risk of myocarditis and pericarditis in specific age and sex groups compared to unvaccinated groups or periods?
Effect estimate: Attributable risk 20.02 per 100,000 doses (95% CI 10.47-29.57)
This meta-analysis confirms that the highest attributable risk of myocarditis and pericarditis following mRNA COVID-19 vaccination occurs in young men and boys after the second dose.
Supports preferring BNT162b2 over mRNA-1273 in young men; confirms age- and sex-specific myocarditis risk patterns.
Although COVID-19 vaccines are generally very safe, the risks of myocarditis and pericarditis after receiving an messenger RNA (mRNA) vaccine have been established, with the highest risk in young men. Most systematic reviews and meta-analyses of the risk of myocarditis or pericarditis have included passive surveillance data, which is subject to reporting errors. Accurate measures of age-, sex-, and vaccine dose- and type-specific risks are crucial for assessment of the benefits and risks of the vaccination. A systematic review and meta-analysis of the risks of myocarditis and pericarditis attributable COVID-19 vaccines were conducted, stratified by age groups, sex, vaccine type, and vaccine dose. Five electronic databases and gray literature sources were searched on November 21, 2023. Article about studies that compared a COVID-19-vaccinated group with an unvaccinated group or time period (eg, self-controlled) were included. Passive surveillance data were excluded. Meta-analyses were conducted using random-effects models. A total of 4030 records were identified; ultimately, 17 articles were included in this review. Compared with unvaccinated groups or unvaccinated time periods, the highest attributable risk of myocarditis or pericarditis was observed after the second dose in boys aged 12-17 years (10.18 per 100 000 doses [95% CI, 0.50-19.87]) of the BNT162b2 vaccine and in young men aged 18-24 years (attributable risk, 20.02 per 100 000 doses [95% CI, 10.47-29.57]) for the mRNA-1273 vaccine. The stratified results based on active surveillance data provide the most accurate available estimates of the risks of myocarditis and pericarditis attributable to specific COVID-19 vaccinations for specific populations. Trial registration: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42023443343.
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Kitano et al. (2024) conducted a meta-analysis in Myocarditis and pericarditis. COVID-19 vaccination vs. Unvaccinated groups or unvaccinated time periods was evaluated on Myocarditis or pericarditis (Attributable risk 20.02 per 100,000 doses, 95% CI 10.47-29.57). COVID-19 vaccination with mRNA-1273 carried the highest attributable risk of myocarditis or pericarditis in young men aged 18-24 years (20.02 per 100,000 doses; 95% CI 10.47-29.57).
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