J Korean Med Sci.  2021 Aug;36(32):e232. 10.3346/jkms.2021.36.e232.

Epidemiology and Clinical Features of Myocarditis/Pericarditis before the Introduction of mRNA COVID-19 Vaccine in Korean Children: a Multicenter Study

• Park H
• Yun KW
• Kim KR
• Song SH
• Ahn B
• Kim DR
• Kim GB
• Huh J
• Choi EH
• Kim YJ

• KMID: 2519228
• DOI: http://doi.org/10.3346/jkms.2021.36.e232

Abstract

Background
Korean health authority plans to vaccinate adolescents against coronavirus disease 2019 (COVID-19) starting high school seniors during the summer vacation of 2021. However, the myocarditis/pericarditis following COVID-19 vaccine has been reported recently in adolescents and young adults. This study was performed to answer the urgent questions about the basic epidemiology and clinical course of myocarditis/pericarditis in hospitalized patients prior to the introduction of COVID-19 vaccines in pediatric population.
Methods
A retrospective medical record analysis including frequency, clinical characteristics, etiology and outcome of myocarditis/pericarditis was conducted in 17 years and younger patients who were hospitalized in two referral hospitals in Korea between 2010 and 2019.
Results
Total 142 patients with myocarditis (n = 119) and/or pericarditis (n = 23) were identified. Median age was 5.4 years (interquartile range, 0.6–12.9 years; range, 11 days–17.8 years), and male was 61%. In adolescents aged 12–17 years, the male to female ratio was 3.2. Myocarditis/pericarditis occurred 0.70 per 1,000 in-patients during the study period: 0.96 (< 1 year), 0.50 (1–5 years), 0.67 (6–11 years) and 1.22 (12–17 years) per 1,000 in-patients, respectively. There was an increasing tendency for the annual frequency from 0.34 in 2010 to 1.25 per 1,000 in-patients in 2019 (P = 0.021). Among the 56 (40%) proven pathogens at admission, Mycoplasma pneumoniae (n = 11, 8%) and enterovirus (n = 10, 7%) were most common. Of the 142 patients, 99 (70%) required pediatric intensive care unit care and 10 (7%) received heart transplantation. In addition, 61 patients (61/131, 47%) without heart medication at admission needed heart medication when they were discharged. Eleven (7.7%) patients died, of which five patients were previously healthy. The median age of deceased patients was lower than the survival group (0.8 vs. 6.3 years, P = 0.014).
Conclusion
The frequency of myocarditis/pericarditis was highest among male adolescent in-patients; however, the outcome was favorable in this group without any mortality.

Keyword

Myocarditis; Pericarditis; Epidemiology; COVID-19 Vaccines

Figure

• 

  Fig. 1 The number of myocarditis/pericarditis patients per 1,000 in-patients from 2010 to 2019.The stippled bar shows the number of myocarditis/pericarditis patients per 1,000 in-patients in 0–17 years. Each line with red, blue, orange, and brown colors shows the number of patients per 1,000 in-patients in <1, 1–5, 6–11, 12–17 years, respectively. The most frequent age group is 12–17 years in almost years followed by group of under one year-old. The trend of total number of myocarditis/pericarditis increases over the years.

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  Fig. 2 The proportion of the survived patients with heart medication at discharge.Heart medications included digoxin, captopril, enalapril, carvedilol, furosemide, and spironolactone.

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