key: cord-0759694-ljq95rip
authors: Sharff, Katie A.; Dancoes, David M.; Longueil, Jodi L.; Lewis, Paul F.; Johnson, Eric S.
title: Myopericarditis After COVID-19 Booster Dose Vaccination
date: 2022-03-26
journal: Am J Cardiol
DOI: 10.1016/j.amjcard.2022.02.039
sha: 215d8da437e3b9e73fccf808c6d21ecea3b814de
doc_id: 759694
cord_uid: ljq95rip

nan

COVID-19 vaccine boosters were recommended by the Centers for Disease Control (CDC) for all populations ≥18 years to provide better protection against circulating variants. The risk of myopericarditis after sequential COVID-19 vaccination needs to be evaluated. We have demonstrated that the Vaccine Safety Datalink rapid cycle analysis method identified a lower incidence of myopericarditis after COVID-19 mRNA vaccine, in part because their search for hospital discharge claims omitted International Classification of Diseases, Tenth Revision codes, and because insurance claims from community hospitals may be delayed by weeks. 1 We provide a more timely and complete case ascertainment of myopericarditis after COVID-19 booster vaccine in populations aged 18 to 39 years.

We studied a cohort of 65,785 Kaiser Permanente Northwest Health Plan members aged 18 to 39 years who received a COVID-19 vaccine booster at least 5 months after completion of the primary series. We identified cases of myopericarditis by searching the electronic health record for the National Center for Health Statistics text label for "myocarditis" or "pericarditis" diagnosis codes in all inpatient and outpatient encounters through January 18, 2022. The cohort was followed for 21 days after their booster. We excluded anyone with a documented diagnosis of myocarditis or pericarditis before their first COVID-19 vaccination. Two physicians independently reviewed the identified patient records and applied the CDC myocarditis and pericarditis surveillance case definition to classify records as confirmed, probable, or excluded on the basis of the previous published definition. 2 Kaiser Permanente's institutional review board approved the study.

Our method identified 6 patients who met the confirmed or probable CDC case definition for acute myocarditis or pericarditis within 21 days of receiving the COVID-19 booster dose among 65,785 eligible members ( to 19.9) of post-booster myopericarditis per 100,000 booster doses given. In men, we estimated 14.7 cases (exact 95% CI 4.0 to 37.6) per 100,000 booster doses given.

We identified a risk of 9.1 cases per 100,000 booster doses. Our small sample size limits the precision of our estimate. This risk is higher than previous estimates reported by Vaccine Adverse Event Reporting System which identified 54 preliminary reports of vaccinerelated myopericarditis; 12 confirmed and 38 under review, after 26.3 million booster doses administered across all ages, with an unadjusted estimate of 0.21 cases per 100,000 doses (95% CI 0.15 to 0.27). 3 Vaccine Adverse Event Reporting System is passive system relying on patients or providers to report; but limitations include both over-and under-reporting. 4 Active surveillance by the Vaccine Safety Datalink has not yet reported a risk of myopericarditis after booster vaccinations, although we would anticipate underestimation because of limitations in their methods. 1 Israel reported the risk of myopericarditis after booster dose as 4.7 cases per 100,000 in men aged 20 to 24. 5 Myopericarditis occurs after booster doses and may be underreported by current surveillance methods. Completeness or high sensitivity of these case estimates are essential when modeling risk and benefit for wide-scale vaccine 

Risk of myopericarditis following COVID-19 mRNA vaccination in a large integrated health system: a comparison of completeness and timeliness of two methods

Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the Advisory Committee on Immunization Practices -United States

Centers for Disease Control and Prevention. ACIP presentation slides

Surveillance systems and methods for monitoring the post-marketing safety of influenza vaccines at the Centers for Disease Control and Prevention

ARTICLE IN PRESS 2 The American Journal of Cardiology