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Katoto PDMC, Byamungu LN, Brand AS, Tamuzi JL, Kakubu MAM, Wiysonge CS, Gray G. Systematic review and meta-analysis of myocarditis and pericarditis in adolescents following COVID-19 BNT162b2 vaccination. NPJ Vaccines 2023; 8:89. [PMID: 37296167 DOI: 10.1038/s41541-023-00681-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Myocarditis and pericarditis are frequent complications of COVID-19, but have also been reported following vaccination against COVID-19 in adolescents. To build vaccine confidence and inform policy, we characterized the incidence of myocarditis/pericarditis in adolescents following BNT162b2 vaccination and explored the association with dose and sex. We searched national and international databases for studies reporting the incidence of myocarditis/pericarditis following BNT162b2 vaccination as the primary endpoint. The intra-study risk of bias was appraised, and random-effects meta-analyses were performed to estimate the pooled incidence by dose stratified by sex. The pooled incidence of myocarditis/pericarditis was 4.5 (95%CI: 3.14-6.11) per 100,000 vaccinations across all doses. Compared to dose 1, the risk was significantly higher after dose 2 (RR: 8.62, 95%CI: 5.71-13.03). However, adolescents experienced a low risk after a booster dose than after dose 2 (RR: 0.06; 95%CI: 0.04-0.09). Males were approximately seven times (RR: 6.66, 95%CI: 4.77-4.29) more likely than females to present myocarditis/pericarditis. In conclusion, we found a low frequency of myocarditis/pericarditis after BNT162b2, which occurred predominantly after the second dose in male adolescents. The prognosis appears to be favorable, with full recovery in both males and females. National programs are recommended to adopt the causality framework to reduce overreporting, which undercuts the value of the COVID-19 vaccine on adolescent life, as well as to extend the inter-dose interval policy, which has been linked to a lower frequency of myocarditis/pericarditis.
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Affiliation(s)
- Patrick D M C Katoto
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa.
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Centre for Tropical Diseases and Global Health, Department of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo.
| | - Liliane N Byamungu
- Department of Pediatric, Faculty of Medicine and Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Amanda S Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jacques L Tamuzi
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Glenda Gray
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
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Kakubu MAM, Bikinesi T, Katoto PDMC. Lamivudine induced pure red cell aplasia and HIV-1 drug resistance-associated mutations: a case report. Oxf Med Case Reports 2023; 2023:omad022. [PMID: 36993835 PMCID: PMC10041944 DOI: 10.1093/omcr/omad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
Adverse effects linked to antiretroviral therapy (ART) may contribute to poor adherence on the patient’s side. Consequently, human immunodeficiency virus (HIV) drug resistance mutations could emerge, negatively impacting the body’s immune system. Meanwhile, severe immunosuppression can lead to several conditions, including anemia. The cause of anemia in HIV infection is multifactorial, and can be mainly explained by deleterious direct effects of the virus on the bone marrow, and opportunistic infections such as Parvovirus B19. Other causes include blood loss resulting from neoplasms and gastrointestinal lesions. Moreover, anemia can also be caused by antiretroviral drugs. We report a case of persistent anemia after ART initiation, kidney injury and treatment failure following a lengthy period of non-adherence to ART. The anemia was classified as Pure Red Cell Aplasia (PRCA). With treatment modification, the anemia resolved and the patient attained virologic suppression. Lamivudine (3TC) was pointed out as the cause of PRCA, which resolved after its withdrawal from the ART regimen. This rare side effect should be investigated in patients on 3TC who present with recurrent anemia.
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Affiliation(s)
| | - Tarisai Bikinesi
- Ministry of Health and Social Services of Namibia, Windhoek, Namibia
| | - Patrick D M C Katoto
- Centre for Tropical Disease and Global Health, School of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
- Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, 7501 Cape Town, South Africa
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