Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

Israel, 6 October 2021, Mevorach et al, New England Journal of Medicine


We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorized the information using the Brighton Collaboration definition. We analyzed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart).

Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardized incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637.

Timing and Distribution of Myocarditis after Receipt of the BNT162b2 Vaccine.Shown is the timing of the diagnosis of myocarditis among recipients of the first dose of vaccine (Panel A) and the second dose (Panel B), according to sex, and the distribution of cases among recipients according to both age and sex after the first dose (Panel C) and after the second dose (Panel D). Cases of myocarditis were reported within 21 days after the first dose and within 30 days after the second dose.

Risk of Myocarditis within 21 Days after the First or Second Dose of Vaccine, According to Age and Sex.

Standardized Incidence Ratios for 151 Cases of Myocarditis, According to Vaccine Dose, Age, and Sex.
Rate Ratios for a Diagnosis of Myocarditis within 30 Days after the Second Dose of Vaccine, as Compared with Unvaccinated Persons (January 11 to May 31, 2021).

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