Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study
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Abstract
Background
Both COVID-19 infection and COVID-19 vaccines have been associated with the development of myopericarditis. The objective of this study is to (1) analyse the rates of myopericarditis after COVID-19 infection and COVID-19 vaccination in Hong Kong, (2) compared to the background rates, and (3) compare the rates of myopericarditis after COVID-19 vaccination to those reported in other countries.
Methods
This was a population-based cohort study from Hong Kong, China. Patients with positive RT-PCR test for COVID-19 between 1st January 2020 and 30th June 2021 or individuals who received COVID-19 vaccination until 31st August were included. The main exposures were COVID-19 positivity or COVID-19 vaccination. The primary outcome was myopericarditis.
Results
This study included 11,441 COVID-19 patients from Hong Kong, four of whom suffered from myopericarditis (rate per million: 326; 95% confidence interval [CI] 127–838). The rate was higher than the pre-COVID-19 background rate in 2019 (rate per million: 5.5, 95% CI 4.1–7.4) with a rate ratio of 55.0 (95% CI 21.4–141). Compared to the background rate, the rate of myopericarditis among vaccinated subjects in Hong Kong was similar (rate per million: 5.5; 95% CI 4.1–7.4) with a rate ratio of 0.93 (95% CI 0.69–1.26). The rates of myocarditis after vaccination in Hong Kong were comparable to those vaccinated in the United States, Israel, and the United Kingdom.
Conclusions
COVID-19 infection was associated with significantly higher rate of myopericarditis compared to the vaccine-associated myopericarditis.
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SciScore for 10.1101/2021.12.13.21267730: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: This population-based retrospective cohort study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 20-250).
Consent: The need for informed consent was waived by the Ethics Committee owing to its observational retrospective nature.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The vaccination data of other countries were extracted using keywords labelled “Myocarditis” and “Pericarditis” upon searching PubMed and the official reports of Hong Kong and the United Kingdom. PubMedsuggested: …SciScore for 10.1101/2021.12.13.21267730: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: This population-based retrospective cohort study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 20-250).
Consent: The need for informed consent was waived by the Ethics Committee owing to its observational retrospective nature.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The vaccination data of other countries were extracted using keywords labelled “Myocarditis” and “Pericarditis” upon searching PubMed and the official reports of Hong Kong and the United Kingdom. PubMedsuggested: (PubMed, RRID:SCR_004846)The analysis was conducted using PRISM (Version: 9.0.0). PRISMsuggested: (PRISM, RRID:SCR_005375)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: This study has several strengths. Firstly, COVID-19 cases were identified by RT-PCR testing across the public sector. Therefore, missing cases are likely to be few. Secondly, possible cases of vaccine-related myopericarditis were reviewed by an expert panel, that examined the medical records independently. This adjudication has permitted the accurate classification of cases according to established international guidelines. Nevertheless, had we included possible cases rather than cases definitely linked to vaccinations, the rate ratios of myopericarditis cases in infected patients to cases occurring after COVID-19 vaccination would be even lower, and therefore does not alter our conclusion. However, several limitations should be noted. Firstly, the cohort included patients recruited from a single region and as such, is unable to account for any geographical heterogeneity that may exist. Secondly, the vaccination data reported in the local Department of Health did not provide the number of myopericarditis after the first and the second dose of vaccination and therefore the results are not stratified. Thirdly, we might have missed COVID-19 myopericarditis in patients who might have died from acute heart failure complications due to myopericarditis, but recorded as heart failure deaths. This however, would have increased the difference between COVID-19 and vaccine related myopericarditis, further strengthening the usefulness of vaccination.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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