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November 25, 2021Clinical Infectious Diseases136 citationsOpen Access

Epidemiology of Acute Myocarditis/Pericarditis in Hong Kong Adolescents Following Comirnaty Vaccination

GCGilbert T. ChuaMKMike Yat Wah KwanCCCeline Sze Ling Chui

Key Result

Comirnaty vaccination in adolescents was associated with an overall acute myocarditis/pericarditis incidence of 18.52 per 100,000 persons, representing a significant increase compared to the background rate.

Study Design

Type

Cohort (n=178,163)

Multicenter

Yes

Structured PICO

Does Comirnaty vaccination increase the risk of acute myocarditis/pericarditis in adolescents aged 12-17 years?

P
Population
178,163 adolescents aged 12 to 17 years who received the Comirnaty vaccine, monitored for acute myocarditis/pericarditis within 14 days of vaccination.
E
Exposure
Comirnaty (BNT162b2) mRNA COVID-19 vaccine (first and second doses)
C
Comparator
Background incidence rate of acute myocarditis/pericarditis in adolescents from 2011 to 2020
O
Outcome
Incidence of acute myocarditis/pericarditis within 14 days following Comirnaty vaccinationsafety

Comirnaty vaccination in adolescents is associated with a significantly increased risk of mild acute myocarditis/pericarditis, particularly in males following the second dose.

Main Result

Effect estimate: Incidence rate difference 18.41 per 100,000 person-14 days (95% CI 9.95-26.87)

Absolute Event Rate: 18.52% vs 0.11%

p-value: p=<0.05

Limitations

  • Asymptomatic subjects and subjects with transient and subtle symptoms might not seek medical consultation or have sought medical consultation in the private sector
  • Not all MRI suites in Hong Kong's public hospitals have the capability for T1 and T2 mapping, leading to lower sensitivities
  • Increased awareness of possible acute myocarditis/pericarditis following vaccination might have contributed to the high incidence
  • Different criteria were likely used by clinicians in generating a diagnostic code among the nonvaccinated individuals for the calculation of the background incidence

Abstract

BACKGROUND: Age-specific incidence of acute myocarditis/pericarditis in adolescents following Comirnaty vaccination in Asia is lacking. This study aimed to study the clinical characteristics and incidence of acute myocarditis/pericarditis among Hong Kong adolescents following Comirnaty vaccination. METHODS: This is a population cohort study in Hong Kong that monitored adverse events following immunization through a pharmacovigilance system for coronavirus disease 2019 (COVID-19) vaccines. All adolescents aged between 12 and 17 years following Comirnaty vaccination were monitored under the COVID-19 vaccine adverse event response and evaluation program. The clinical characteristics and overall incidence of acute myocarditis/pericarditis in adolescents following Comirnaty vaccination were analyzed. RESULTS: Between 14 June 2021 and 4 September 2021, 33 Chinese adolescents who developed acute myocarditis/pericarditis following Comirnaty vaccination were identified. In total, 29 (87.88%) were male and 4 (12.12%) were female, with a median age of 15.25 years. And 27 (81.82%) and 6 (18.18%) cases developed acute myocarditis/pericarditis after receiving the second and first dose, respectively. All cases are mild and required only conservative management. The overall incidence of acute myocarditis/pericarditis was 18.52 (95% confidence interval CI, 11.67-29.01) per 100 000 persons vaccinated. The incidence after the first and second doses were 3.37 (95% CI, 1.12-9.51) and 21.22 (95% CI, 13.78-32.28 per 100 000 persons vaccinated, respectively. Among male adolescents, the incidence after the first and second doses were 5.57 (95% CI, 2.38-12.53) and 37.32 (95% CI, 26.98-51.25) per 100 000 persons vaccinated. CONCLUSIONS: There is a significant increase in the risk of acute myocarditis/pericarditis following Comirnaty vaccination among Chinese male adolescents, especially after the second dose.

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Cite This Study

Chua et al. (2021) conducted a cohort in Acute myocarditis/pericarditis (n=178,163). Comirnaty vaccination vs. Background incidence rate in 2020 was evaluated on Incidence of acute myocarditis/pericarditis per 100,000 persons (Incidence rate difference 18.41 per 100,000 person-14 days, 95% CI 9.95-26.87, p=<0.05). Comirnaty vaccination in adolescents was associated with an overall acute myocarditis/pericarditis incidence of 18.52 per 100,000 persons, representing a significant increase compared to the background rate.

synapsesocial.com/papers/6a9cde56a1304504b9599710https://doi.org/10.1093/cid/ciab989
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