Myocarditis and Pericarditis Are Temporally Associated with BNT162b2 COVID-19 Vaccine in Adolescents: A Systematic Review and Meta-analysis

The incidence of myocarditis and pericarditis has been documented in adolescents after COVID-19 vaccinations. This study aims to assess the risk of myopericarditis in adolescents following COVID-19 vaccination, using a meta-analysis of the published cases. We performed a comprehensive literature search of the following databases on July 5, 2023: MEDLINE, EMBASE, PubMed, and the Cochrane Library. We performed a meta-analysis using a random-effects model to estimate the incidence of myopericarditis per million of administered COVID-19 vaccine doses or COVID-19 infections. A total of 33 studies were included in the meta-analysis. The incidence of myopericarditis per million COVID-19 infections (1583.9 cases, 95% CI 751.8-2713.8) was approximately 42 times higher than that for COVID-19 vaccine administrations (37.6 cases, 95% CI 24.2-53.8). The risk of myopericarditis after COVID-19 vaccination was particularly high among the 16-19 age group (39.5 cases per million, 95% CI 25.8-56.0), males (43.1 cases per million, 95% CI 21.6-71.9), and those who received the second dose (47.7 cases per million, 95% CI 22.2-82.2). There were no significant differences in the incidence of myopericarditis per million COVID-19 vaccine administrations between Europe, the Western Pacific, and the Americas (p = 0.51). Adolescents faced a potential risk of myopericarditis after COVID-19 vaccination, but this risk is less harmful than that of myopericarditis following COVID-19 infection.