Risk of myocarditis and pericarditis after a COVID-19 mRNA vaccine booster and after COVID-19 in those with and without prior SARS-CoV-2 infection: A self-controlled case series analysis in England
PLOS Medicine·
- DOI
- 10.1371/journal.pmed.1004245
- PMID
- 37285378
- PMCID
- PMC10286992
- OpenAlex
- W4379744348
- Study type
- Journal article
- Publisher
- Public Library of Science (PLoS)
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The findings inform COVID-19 vaccination policy by characterizing age- and sex-specific risks of rare cardiac adverse events after booster doses and by demonstrating risk variation by vaccine type and prior infection status. The marked difference in risk between second and third mRNA-1273 doses, which differed in mRNA content, and the lower risk in previously infected individuals provide insights relevant to dosing strategies and immunization schedules.
Structured evidence summary
Research question
The study examined the risk of myocarditis and pericarditis following mRNA COVID-19 vaccine booster doses and after COVID-19 infection, stratifying by prior SARS-CoV-2 infection status.
Study design
Self-controlled case series analysis of hospital admissions in England from February 2021 to February 2022, involving approximately 50 million vaccine-eligible individuals aged 12 to 101 years. The design linked myocarditis and pericarditis admissions from hospital records with vaccination histories and prior infection data, comparing incidence within defined risk windows post-vaccination to baseline periods.
Population and setting
Hospital admissions for myocarditis or pericarditis were analyzed among individuals aged 12 to 101 years in England who were eligible for adenovirus-vectored or mRNA COVID-19 vaccination. The study period covered February 22, 2021 to February 6, 2022.
Main findings
Elevated relative incidence of myocarditis and pericarditis was observed only in 16- to 39-year-olds within six days of vaccination, predominantly in males for myocarditis. Both mRNA vaccines showed elevated risk after first, second, and third doses, with the highest risk following the second dose. The relative incidence after a second mRNA-1273 dose was 5.34, compared to 1.39 after a third dose. Individuals with prior SARS-CoV-2 infection had approximately half the vaccine-associated risk compared to those without prior infection.
Public-health relevance
The findings inform COVID-19 vaccination policy by characterizing age- and sex-specific risks of rare cardiac adverse events after booster doses and by demonstrating risk variation by vaccine type and prior infection status. The marked difference in risk between second and third mRNA-1273 doses, which differed in mRNA content, and the lower risk in previously infected individuals provide insights relevant to dosing strategies and immunization schedules.
Important limitations
This summary relies on the supplied single-article abstract and metadata. Evaluation of important methodological details such as confounding control, case ascertainment completeness, diagnostic validation, and generalizability to other populations requires access to the full published article.
GIDS interpretation
The study addresses myocarditis and pericarditis as rare adverse events following COVID-19 vaccination, which are topics of ongoing pharmacovigilance interest. It links to outbreak investigation, surveillance, and vaccination topics in England and may inform editorial decisions about evidence relevant to vaccine safety monitoring systems. This summary does not assess whether the article responds to an active GIDS surveillance signal.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 12 auditable classifier relationships to diseases, places, topics, and study design.