ABSTRACT
Background: Several studies described occurrence of myocarditis after SARS-CoV-2 vaccination in pediatric patients. Weaimed to characterize the clinical course of myocarditis following SARS-CoV2 vaccination including follow-up data within the prospective German registry for suspected myocarditis in children and adolescents "MYKKE." Method: Patients younger than 18 years with suspected myocarditis and onset of symptoms within 21 days followingSARS-CoV2 vaccination were enrolled within the MYKKE registry. The suspect of myocarditis is valid in patients with clinical symptoms and diagnostic findings typically seen in myocarditis. Clinical data are monitored at initial admission and duringshort-term and long-term follow-up. Result(s): Between July 2021 and August 2022, a total of 48 patients with a median age of 16.2 years (IQR: 15.2-16.8)were enrolled by 13 centers, 88% male. Onset of symptoms occurred at a median of 3 days (IQR: 2-7) after vaccine administration, most frequently after the second dose (52%). Most common symptoms at initial admission were anginapectoris (81%), fatigue (56%), dyspnea (24%) and documented arrhythmias (17%). Initial ECG abnormalities included ST-elevation (48%) and T-wave inversion (23%). Elevated Tropon in was observed in 32 patients (67%) and in 19 cases (40%)NT-proBNP was above the normal range with a median level of 171 pg/mL (IQR: 32-501). 11 (23%) patients presentedwith mildly reduced systolic function at initial echocardiography or cardiac MRI. In 40 patients cardiac MRI and/orendomyocardial biopsy was performed (83%) and diagnosis of myocarditis could be verified in 27 cases (68%). Thirty-nine patients underwent short-term follow-up with a median of 2.8 months (IQR: 1.9-3.9) after discharge. 19 patients (49%)presented with either clinical symptoms (n = 9) and/or diagnostic abnormalities (n = 16) at follow-up. 12 patients (38%)still had medical treatment. Except for one patient with malign arrhythmias (ventricular tachycardia), no major cardiac adverse events were observed during initial admission and follow-up. Conclusion(s): Our data confirm that SARS-CoV-2 vaccine-related myocarditis is characterized by a mild disease course. However, after short-term follow-up a considerable number of patients still presented with symptoms and/or diagnostic abnormalities. Data on long-term follow-up are awaited.
ABSTRACT
Background: While SARS-CoV-2 infections in children are usually mild to asymptomatic, severe disease manifestation has been described in patients with comorbidities. We aimed to assess the risk for severe disease courses in children and adolescents with underlying cardiovascular disease (CVD). Method: Analysis of the national prospective registry for children and adolescents hospitalized with a SARS-CoV-2 infection from March 2020 to April 2021. Regression analyses were used to estimate the risk for severe disease course defined as admission to a pediatric intensive care unit (PICU) or death. Results: Overall 1,501 hospitalized children were included in the registry with confirmed SARS-CoV-2 infection. Of these, 73 had underlying CVD (median age = 12 [IQR: 3-15];49 [67%] male). Also, 33/73 (45%) had relevant associated comorbidities including syndromic disease in 20/73 (27%), including 7 patients with trisomy 21. Congenital heart disease (CHD) was present in 32 (44%) and pulmonary hypertension (PH) in 9 (12%) patients. Eleven of 32 underwent cardiac surgery for their CHD. Analysis of the PH subgroup showed that the need for intensive care therapy (56 vs. 16%;p = 0.006) and ventilatory support (56 vs. 11%, p < 0.001) was higher in the PH group. Two children (3%) died in the non-PH cohort (both on a palliative care track). In addition, one child (11%) with PH died 4 weeks after confirmed SARS-CoV-2 infection from vasculitis with brainstem involvement. Overall, CVD was associated with an increased risk for PICU admission (RR = 3.0;95% CI: 1.84-4.93). In the CVD subgroup analysis, male gender (OR = 9.2;95% CI: 1.1-74.8;p = 0.04), syndromic disease (OR = 4.4;1.3-14.5;p = 0.02), trisomy 21 (OR = 14;2.4-82.4;p = 0.004), respiratory disease (OR = 7.7;2.2-26.7;p = 0.001), or PH (OR = 6.8;1.5-29.6;p = 0.01) were significantly associated with disease severity requiring PICU support. In addition, a trend toward increased risk for CHD was found (OR = 3.3;0.99-10.8;p = 0.052). Patients after cardiac surgery showed a significantly increased risk (OR = 4.3;1.1-17.0;p = 0.04). Conclusion: Children and adolescents with CVD are at higher risk of severe SARS-CoV-2 course. During SARS-CoV2- infection, children with associated disease, syndromes, or PH had a significantly higher risk for intensive care support compared with patients with other associated CVD. Although overall mortality and morbidity of hospitalized SARS-CoV-2 children is low, these vulnerable cohorts may require specific attention and prevention measures.