Epidemiology of myocarditis and pericarditis following mRNA vaccination by vaccine product, schedule, and interdose interval among adolescents and adults in Ontario, Canada

Buchan, Sarah A.; Seo, Chi Yon; Johnson, Caitlin; Alley, Sarah; Kwong, Jeffrey C.; Nasreen, Sharifa; Calzavara, Andrew; Lu, Diane; Harris, Tara M.; Yu, Kelly; Wilson, Sarah E.

doi:10.1001/jamanetworkopen.2022.18505

Cited by 157Viral Infections and Immunology ResearchSARS-CoV-2 and COVID-19 ResearchPharmacovigilance and Adverse Drug Reactions

Epidemiology of myocarditis and pericarditis following mRNA vaccination by vaccine product, schedule, and interdose interval among adolescents and adults in Ontario, Canada

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Buchan, Sarah A., Seo, Chi Yon, Johnson, Caitlin, Alley, Sarah, Kwong, Jeffrey C., Nasreen, Sharifa, Calzavara, Andrew, Lu, Diane +3 more·2022·JAMA Network Open

DOI 10.1001/jamanetworkopen.2022.18505PMC PMC9233237

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Abstract

Importance: Increased rates of myocarditis or pericarditis following receipt of COVID-19 mRNA vaccines have been observed. However, few available data are associated with differences in rates of myocarditis or pericarditis specific to vaccine products, which may have important implications for vaccination programs. Objective: To estimate rates of reported myocarditis or pericarditis following receipt of a COVID-19 mRNA vaccine by product, age, sex, dose number, and interdose interval. Design, Setting, and Participants: This population-based cohort study was conducted in Ontario, Canada (population: 14.7 million) from December 2020 to September 2021 and used data from Ontario's COVID-19 vaccine registry and passive vaccine-safety surveillance system. All individuals in Ontario, Canada, who received at least 1 dose of COVID-19 mRNA vaccine between December 14, 2020, and September 4, 2021, and had a reported episode of myocarditis or pericarditis following receipt of the COVID-19 vaccine during this period were included. We obtained information on all vaccine doses administered in the province to calculate reported rates of myocarditis or pericarditis. Exposures: Receipt of a COVID-19 mRNA vaccine (mRNA-1273 [Moderna Spikevax] or BNT162b2 [Pfizer-BioNTech Comirnaty]). Main Outcomes and Measures: All reports of myocarditis or pericarditis meeting levels 1 to 3 of the Brighton Collaboration case definitions were included. Rates and 95% CIs of reported cases of myocarditis or pericarditis per 1 000 000 mRNA vaccine doses administered were calculated by age, sex, dose number, vaccine product, and interdose interval. Results: Among 19 740 741 doses of mRNA vaccines administered, there were 297 reports of myocarditis or pericarditis meeting the inclusion criteria; 228 (76.8%) occurred in male individuals, and the median age of individuals with a reported event was 24 years (range, 12-81 years). Of the reported cases, 207 (69.7%) occurred following the second dose of the COVID-19 mRNA vaccine. When restricted to individuals who received their second dose during the period of enhanced passive surveillance (on or after June 1, 2021), the highest rate of myocarditis or pericarditis was observed in male individuals aged 18 to 24 years following mRNA-1273 as the second dose (299.5 cases per 1 000 000 doses; 95% CI, 171.2-486.4 cases per 1 000 000 doses); the rate following BNT162b2 as the second dose was 59.2 cases per 1 000 000 doses (95% CI, 19.2-138.1 cases per 1 000 000 doses). Overall rates for both vaccine products were significantly higher when the interdose interval was 30 or fewer days (BNT162b2: 52.1 cases per 1 000 000 doses [95% CI, 31.8-80.5 cases per 1 000 000 doses]; mRNA-1273: 83.9 cases per 1 000 000 doses [95% CI, 47.0-138.4 cases per 1 000 000 doses]) compared with 56 or more days (BNT162b2: 9.6 cases per 1 000 000 doses [95% CI, 6.5-13.6 cases per 1 000 000 doses]; mRNA-1273: 16.2 cases per 1 000 000 doses [95% CI, 10.2-24.6 cases per 1 000 000 doses]). Conclusions and Relevance: The findings of this population-based cohort study of Ontario adolescents and adults with myocarditis or pericarditis following mRNA COVID-19 vaccination suggest that vaccine products and interdose intervals, in addition to age and sex, may be associated with the risk of myocarditis or pericarditis after receipt of these vaccines. Vaccination program strategies, such as age-based product considerations and longer interdose intervals, may reduce the risk of myocarditis or pericarditis following receipt of mRNA vaccines.

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Our study confirms findings of previously identified rare cases of myocarditis and pericarditis following first and second doses of mRNA vaccines.
“However, our study confirms findings of previ ously identified rare cases of myocarditis and pericarditis following first and second doses of mRNA vaccines [21 -23,34].”
From COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals (2024) · cites this paper as [34]

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Myocarditis or Pericarditis Events After BNT162b2 Vaccination in Individuals Aged 12 to 17 Years in Ontario, Canada
Buchan, S. A., Alley, S., Seo, C. Y., Johnson, C., Kwong, J. C., Nasreen, S., Thampi, N., Lu, D., Harris, T. M., Calzavara, A. J., et al. (2023) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2022.6166 · Cited by 9 · see citing works
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Authors: Buchan, S. A., Seo, C. Y., Johnson, C., Alley, S., Kwong, J. C., Nasreen, S., Calzavara, A., Lu, D., Harris, T. M., Yu, K., & Wilson, S. E.
Affiliations: University of Toronto (CA)
Public Health Ontario (CA)
University Health Network (CA)
Institute for Clinical Evaluative Sciences (CA)
Corresponding author: Wilson, Sarah E.
ORCID: Buchan, Sarah A.
Kwong, Jeffrey C.
Nasreen, Sharifa
Wilson, Sarah E.
Venue: JAMA Network Open
Publisher: American Medical Association (AMA)
Published: 2022-06-24
Volume: 5
Issue: 6
Pages: e2218505
ISSN: 2574-3805 (ISSN-L)
DOI: 10.1001/jamanetworkopen.2022.18505
PMC: PMC9233237
OpenAlex: W4283367577
Cited by: 157
References: 19
Citations by year: 2026: 10 · 2025: 18 · 2024: 33 · 2023: 62 · 2022: 32 · 2021: 1
FWCI: 25.22
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JAMA Network Open (publishedVersion, cc-by)
medRxiv (acceptedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Federal Open Science Repository of Canada / Le Dépôt fédéral de science ouverte du Canada (submittedVersion, cc-by)
SUNY Digital Repository Support (State University of New York System) (submittedVersion, cc-by-nc-nd)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords: myocarditis, pericarditis, COVID-19 mRNA vaccine, vaccine safety, mRNA-1273, BNT162b2, vaccine adverse events, adolescents and young adults, passive surveillance, vaccine hesitancy
MeSH terms: COVID-19, COVID-19 Vaccines, mRNA Vaccines, BNT162 Vaccine, Adolescent, Adult, Aged, Aged, 80 and over, Child, Humans, Male, Middle Aged, Myocarditis, Ontario, Pericarditis, RNA, Messenger, Vaccination, Vaccines, Vaccines, Synthetic, Cohort Studies, Incidence, Young Adult

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Epidemiology of myocarditis and pericarditis following mRNA vaccination by vaccine product, schedule, and interdose interval among adolescents and adults in Ontario, Canada

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