1 Of those myopericarditis reports, 79% were in males. In the pre–COVID-19 era, among 620 195 reports filed at the Vaccine Adverse Event Reporting System (VAERS) between 19, 0.1% were attributable to myopericarditis. 1 In the general population, myocarditis is diagnosed in approximately 10 to 20 individuals per 100 000 per year, 2 and occurs more commonly and at younger ages in males compared with females. Historically, postvaccination myocarditis has been reported as a rare adverse event after vaccinations, especially smallpox vaccination, influenza, hepatitis B, or other vaccinations. Despite rare cases of myocarditis, the benefit-risk assessment for COVID-19 vaccination shows a favorable balance for all age and sex groups therefore, COVID-19 vaccination is recommended for everyone ≥12 years of age.Įpidemiology and Clinical Presentation of Myocarditis After COVID-19 Vaccination Almost all patients had resolution of symptoms and signs and improvement in diagnostic markers and imaging with or without treatment. The reasons for male predominance in myocarditis cases are unknown, but possible explanations relate to sex hormone differences in immune response and myocarditis, and also underdiagnosis of cardiac disease in women. Although the mechanisms for development of myocarditis are not clear, molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and self-antigens, trigger of preexisting dysregulated immune pathways in certain individuals, immune response to mRNA, and activation of immunologic pathways, and dysregulated cytokine expression have been proposed. In 1 case, a cardiomyopathy gene panel was negative, but autoantibody levels against certain self-antigens and frequency of natural killer cells were increased. There was no evidence of acute COVID-19 or other viral infections. ECG was abnormal with ST elevations in most, and cardiac MRI was suggestive of myocarditis in all tested patients. In reported cases, patients with myocarditis invariably presented with chest pain, usually 2 to 3 days after a second dose of mRNA vaccination, and had elevated cardiac troponin levels. According to the US Centers for Disease Control and Prevention, myocarditis/pericarditis rates are ≈12.6 cases per million doses of second-dose mRNA vaccine among individuals 12 to 39 years of age. Myocarditis has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccinations, especially in young adult and adolescent males. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.
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