Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military
Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military
复制标题
DOI：
10.1001/jamacardio.2021.2833
复制
发表时间：
2021-06-29
期刊：
影响因子：
24
通讯作者：
Cooper, Leslie T., Jr.
中科院分区：
文献类型：
--
作者：
Montgomery, Jay;Ryan, Margaret;Cooper, Leslie T., Jr.
已报道COVID-19合并心肌炎，但尚未明确认为这是接种COVID-19疫苗后可能出现的不良事件。目的了解军队卫生系统新型冠状病毒疫苗接种后出现的心肌炎。设计、环境和参与者本回顾性病例系列研究了2021年1月至4月期间美国军事卫生系统中接种COVID-19疫苗后出现心肌炎的患者。纳入了在COVID-19疫苗接种后因胸痛就诊并随后被诊断为临床心肌炎的患者。2021年1月1日至4月30日期间接受信使RNA (mRNA) COVID-19疫苗。在没有其他明确病因的情况下，COVID-19疫苗接种后心肌炎的临床诊断。结果共有23例男性患者（22例现役军人，1例退休人员，年龄中位数为25岁[20-51]岁）在接种mRNA COVID-19疫苗后4天内出现明显的急性胸痛发作。所有军人以前都很健康，身体素质很高。7只接种了BNT162b2-mRNA疫苗，16只接种了mRNA-1273疫苗。共有20名患者在适当间隔的2剂量系列的第二次剂量后出现症状发作。所有患者心肌肌钙蛋白水平均显著升高。8例急性期行心脏磁共振成像的患者，均符合心肌炎的临床诊断。其他检测未发现心肌炎的其他病因，包括急性COVID-19和其他感染、缺血性损伤或潜在的自身免疫性疾病。所有患者均接受了简短的支持性治疗，并在本报告发布时已康复或正在康复中。在此期间，军方接种了280多万剂mRNA COVID-19疫苗。虽然观察到的心肌炎病例数量很少，但在第二次接种疫苗后，男性军人的心肌炎病例数量高于预期。结论和相关性在本病例系列中，接受mRNA - COVID-19疫苗后临床表现相似的既往健康军人患者发生心肌炎。有必要在免疫接种后进一步监测和评估这一不良事件。必须在COVID-19感染后确定的发病率风险（包括心脏损伤）的背景下考虑罕见疫苗相关不良事件的可能性。
IMPORTANCE Myocarditis has been reported with COVID-19 but is not clearly recognized as a possible adverse event following COVID-19 vaccination.OBJECTIVE To describe myocarditis presenting after COVID-19 vaccination within the Military Health System.DESIGN, SETTING, AND PARTICIPANTS This retrospective case series studied patients within the US Military Health System who experienced myocarditis after COVID-19 vaccination between January and April 2021. Patients who sought care for chest pain following COVID-19 vaccination and were subsequently diagnosed with clinical myocarditis were included.EXPOSURE Receipt of a messenger RNA (mRNA) COVID-19 vaccine between January 1 and April 30, 2021.MAIN OUTCOMES AND MEASURES Clinical diagnosis of myocarditis after COVID-19 vaccination in the absence of other identified causes.RESULTS A total of 23 male patients (22 currently serving in the military and 1 retiree; median [range] age, 25 [20-51] years) presented with acute onset of marked chest pain within 4 days after receipt of an mRNA COVID-19 vaccine. All military members were previously healthy with a high level of fitness. Seven received the BNT162b2-mRNA vaccine and 16 received the mRNA-1273 vaccine. A total of 20 patients had symptom onset following the second dose of an appropriately spaced 2-dose series. All patients had significantly elevated cardiac troponin levels. Among 8 patients who underwent cardiac magnetic resonance imaging within the acute phase of illness, all had findings consistent with the clinical diagnosis of myocarditis. Additional testing did not identify other etiologies for myocarditis, including acute COVID-19 and other infections, ischemic injury, or underlying autoimmune conditions. All patients received brief supportive care and were recovered or recovering at the time of this report. The military administered more than 2.8 million doses of mRNA COVID-19 vaccine in this period. While the observed number of myocarditis cases was small, the number was higher than expected among male military members after a second vaccine dose.CONCLUSIONS AND RELEVANCE In this case series, myocarditis occurred in previously healthy military patients with similar clinical presentations following receipt of an mRNA COVID-19 vaccine. Further surveillance and evaluation of this adverse event following immunization is warranted. Potential for rare vaccine-related adverse events must be considered in the context of the well-established risk of morbidity, including cardiac injury, following COVID-19 infection.