ACIP Provides Recommendations for mRNA COVID-19 Vaccines in Adolescents and Young Adults

The United States Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) met on Wednesday to discuss instances of myocarditis or pericarditis in people aged 30 and younger who have received an mRNA COVID-19 vaccine.

Although the cases are very rare, the rate at which they are occurring in the age range of 16 to 24 years is above what is typically expected in the population.

The meeting began with an overview of COVID-19 cases in the United States, the safety of mRNA vaccines, and cases of myocarditis or pericarditis after vaccination.

Health officials from the CDC have confirmed 323 cases of myocarditis or pericarditis in individuals aged 29 years and younger. Of those, 309 were hospitalized, with 295 of them eventually being discharged. Of the remaining, 9 are still in the hospital, of which 2 are in the intensive care unit (ICU), and 5 have no outcome data.

Following the overview, the COVID-19 Vaccine Safety Technical (VaST) Work Group gave an assessment.

According to VaST, the relatively few reports of myocarditis to date have occurred predominantly in adolescents and young adults, more often in males, more often following the second dose and most have typically occurred within 1 week of vaccination.

The majority of the patients’ symptoms lasted only a short time, with most experiencing rapid resolution of laboratory abnormalities and brief stays in the hospital.

The group stated that the data suggests a likely association of myocarditis with mRNA vaccination in adolescents and young adults. Therefore, VaST will continue to review the data on myocarditis and pericarditis from available surveillance systems, as well as ongoing safety evaluations and will update the ACIP on a regular basis.

After the VaST assessment, a benefit-risk discussion took place which determined that the benefits of mRNA vaccinations still clearly outweigh the risks in adolescents and young adults.

Recommendations given were as follows:

• Those with pericarditis prior to vaccination can receive any FDA authorized COVID-19 vaccine.
• Those with pericarditis after the first dose of an mRNA COVID-19 vaccine but prior to a second dose should proceed with a second dose of mRNA COVID-19 vaccine after resolution of symptoms.
• Those with myocarditis prior to a COVID-19 vaccination can receive any FDA-authorized COVID-19 vaccine if their heart has recovered.
• Those with myocarditis after the first dose of an mRNA COVID-19 vaccine but prior to a second dose should defer a second dose of mRNA COVID-19 vaccine until more information is known. However, if their heart has recovered, they should consider proceeding with a second dose under certain circumstances.

The monitoring of cases, clinical course and long-term outcomes of myocarditis following vaccination in this population is of significant importance and will need to continue. As more is learned about the epidemiology, adjustments to the benefit-risk balance will need to take place.

A discussion was then held, which saw many positive comments commending the presenters for their work, as well as praise for the CDC on their continued efforts of transparency and conversations surrounding adverse events of COVID-19 vaccinations.