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Article Abstract
Objective: To compare characteristics of children assessed at Canadian Immunization Monitoring Program Active (IMPACT) centers for myocarditis, myopericarditis, and pericarditis according to COVID-19 vaccination status, and to evaluate the association with vaccination.
Study Design: IMPACT conducted active surveillance for myocarditis, myopericarditis, and pericarditis by monitoring admission lists and diagnostic codes for children ≤16 years of age assessed in emergency departments or hospitalized with these conditions (June 2021 through December 2022). Clinical details and immunization histories were entered in an electronic database. Characteristics of cases meeting Brighton Collaboration case definitions for myocarditis and/or pericarditis were compared between COVID-19 mRNA vaccine-proximate (vaccination 0-21 days prior to presentation), remotely vaccinated (vaccinated >21 days prior), and unvaccinated cases. Relative incidence of myocarditis/myopericarditis/pericarditis 0-21 days after vaccination was estimated via a self-controlled case series analysis adjusted for pre-Omicron vs Omicron periods. Cell sizes <5 were suppressed.
Results: Overall, 168 cases were included: 73 (43%) vaccine-proximate cases, 47 (28%) remotely vaccinated, 39 (23%) unvaccinated, and 9 (5%) with unknown vaccination status. Among vaccine-proximate cases, 88% (64/73) were male, and 95%-99% (69-72/73) were 12-16 years of age. Among unvaccinated cases, 56% (22/39) were male, and 36% (14/39) were 12-16 years of age. Unvaccinated cases appeared more likely to require intensive care unit care (28% vs <7% of vaccine-proximate cases). The adjusted relative incidence of myocarditis/myopericarditis/pericarditis 0-21 days postvaccination was 7.1 (95% CI 4.5-11.1).
Conclusions: Although myocarditis, myopericarditis, and pericarditis were associated with COVID-19 mRNA vaccination, children with postvaccine myocarditis, myopericarditis, and pericarditis appeared to have a less severe initial course than unvaccinated children.
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