| アブストラクト | BACKGROUND: Data on medium-term outcomes in indivduals with myocarditis after mRNA COVID-19 vaccination are scarce. We aimed to assess clinical outcomes and quality of life at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults. METHODS: In this follow-up surveillance study, we conducted surveys in US individuals aged 12-29 years with myocarditis after mRNA COVID-19 vaccination, for whom a report had been filed to the Vaccine Adverse Event Reporting System between Jan 12 and Nov 5, 2021. A two-component survey was administered, one component to patients (or parents or guardians) and one component to health-care providers, to assess patient outcomes at least 90 days since myocarditis onset. Data collected were recovery status, cardiac testing, and functional status, and EuroQol health-related quality-of-life measures (dichotomised as no problems or any problems), and a weighted quality-of-life measure, ranging from 0 to 1 (full health). The EuroQol results were compared with published results in US populations (aged 18-24 years) from before and early on in the COVID-19 pandemic. FINDINGS: Between Aug 24, 2021, and Jan 12, 2022, we collected data for 519 (62%) of 836 eligible patients who were at least 90 days post-myocarditis onset: 126 patients via patient survey only, 162 patients via health-care provider survey only, and 231 patients via both surveys. Median patient age was 17 years (IQR 15-22); 457 (88%) patients were male and 61 (12%) were female. 320 (81%) of 393 patients with a health-care provider assessment were considered recovered from myocarditis by their health-care provider, although at the last health-care provider follow-up, 104 (26%) of 393 patients were prescribed daily medication related to myocarditis. Of 249 individuals who completed the quality-of-life portion of the patient survey, four (2%) reported problems with self-care, 13 (5%) with mobility, 49 (20%) with performing usual activities, 74 (30%) with pain, and 114 (46%) with depression. Mean weighted quality-of-life measure (0.91 [SD 0.13]) was similar to a pre-pandemic US population value (0.92 [0.13]) and significantly higher than an early pandemic US population value (0.75 [0.28]; p<0.0001). Most patients had improvements in cardiac diagnostic marker and testing data at follow-up, including normal or back-to-baseline troponin concentrations (181 [91%] of 200 patients with available data), echocardiograms (262 [94%] of 279 patients), electrocardiograms (240 [77%] of 311 patients), exercise stress testing (94 [90%] of 104 patients), and ambulatory rhythm monitoring (86 [90%] of 96 patients). An abnormality was noted among 81 (54%) of 151 patients with follow-up cardiac MRI; however, evidence of myocarditis suggested by the presence of both late gadolinium enhancement and oedema on cardiac MRI was uncommon (20 [13%] of 151 patients). At follow-up, most patients were cleared for all physical activity (268 [68%] of 393 patients). INTERPRETATION: After at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination, most individuals in our cohort were considered recovered by health-care providers, and quality of life measures were comparable to those in pre-pandemic and early pandemic populations of a similar age. These findings might not be generalisable given the small sample size and further follow-up is needed for the subset of patients with atypical test results or not considered recovered. FUNDING: US Centers for Disease Control and Prevention. |
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| ジャーナル名 | The Lancet. Child & adolescent health |
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| Pubmed追加日 | 2022/9/25 |
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| 投稿者 | Kracalik, Ian; Oster, Matthew E; Broder, Karen R; Cortese, Margaret M; Glover, Maleeka; Shields, Karen; Creech, C Buddy; Romanson, Brittney; Novosad, Shannon; Soslow, Jonathan; Walter, Emmanuel B; Marquez, Paige; Dendy, Jeffrey M; Woo, Jared; Valderrama, Amy L; Ramirez-Cardenas, Alejandra; Assefa, Agape; Campbell, M Jay; Su, John R; Magill, Shelley S; Shay, David K; Shimabukuro, Tom T; Basavaraju, Sridhar V |
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| 組織名 | CDC COVID-19 Response Team, US Centers for Disease Control and Prevention,;Atlanta, GA, USA. Electronic address: nrm7@cdc.gov.;Atlanta, GA, USA; Children's Healthcare of Atlanta, Emory University School of;Medicine, Atlanta, GA, USA.;Atlanta, GA, USA.;Vanderbilt University Medical Center, Nashville, TN, USA.;Duke Human Vaccine Institute, Durham, NC, USA; Duke University School of;Medicine, Durham, NC, USA.;Duke University School of Medicine, Durham, NC, USA. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/36152650/ |
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