Evidence mapPaperPMID 37155666Full record

Observational studyPloS one2023

Myocarditis and pericarditis recovery following smallpox vaccine 2002-2016: A comparative observational cohort study in the military health system.

Renata J M Engler, Jay R Montgomery, Christina E Spooner, Michael R Nelson, Limone C Collins, Margaret A Ryan, Clara S Chu, John E Atwood, Edward A Hulten, Ahlea A Rutt and 11 more

Open access · goldAbstract readObservational Study
In one paragraph

Observational study in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.1field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors at 7 institutions in 1 country.

Renata J M EnglerImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.ORCID 0000-0003-0915-2150
Jay R MontgomeryImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Christina E SpoonerImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Michael R NelsonUniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.ORCID 0000-0003-0839-1010
Limone C CollinsImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Margaret A RyanImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Clara S ChuImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
John E AtwoodUniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
Edward A HultenCardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America.
Ahlea A RuttImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Dacia O ParishImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Bruce M McClenathanImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
David E HrncirImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Laurie DuranImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Catherine SkerrettImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Laurie A HouselImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Janet A BrunaderImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Stephanie L RyderImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Connie L LohslImmunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America.
Brian A HemannWalter Reed National Military Medical Center, Bethesda, Maryland, United States of America.
Leslie T CooperDepartment of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States of America.
Defense Health Agency · USUniformed Services University of the Health Sciences · USWalter Reed National Military Medical Center · USWilford Hall Ambulatory Surgical Center · USWomack Army Medical Center · USJacksonville College · USNaval Medical Center San Diego · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectives(1) Characterize the initial clinical characteristics and long-term outcomes of smallpox vaccine-associated hypersensitivity myocarditis and pericarditis (MP) in United States service members. (2) Describe the process of case identification and adjudication using the 2003 CDC nationally defined myocarditis/pericarditis epidemiologic case definitions to include consideration of case-specific diversity and evolving evidence.

backgroundBetween 2002 and 2016, 2.546 million service members received a smallpox Vaccinia vaccine. Acute MP is associated with vaccinia, but the long-term outcomes have not been studied.

methodsRecords of vaccinia-associated MP reported to the Vaccine Adverse Event Reporting System by vaccination date were adjudicated using the 2003 MP epidemiologic case definitions for inclusion in a retrospective observational cohort study. Descriptive statistics of clinical characteristics, presentation, cardiac complications, and time course of clinical and cardiac recovery were calculated with comparisons by gender, diagnosis and time to recovery.

resultsOut of over 5000 adverse event reports, 348 MP cases who survived the acute illness, including 276 myocarditis (99.6% probable/confirmed) and 72 pericarditis (29.2% probable/confirmed), were adjudicated for inclusion in the long-term follow-up. Demographics included a median age of 24 years (IQR 21,30) and male predominance (96%). Compared to background military population, the myocarditis and pericarditis cohort had a higher percentage of white males by 8.2% (95% CI: 5.6, 10.0) and age <40 years by 4.2% (95% CI: 1.7,5.8). Long-term follow-up documented full recovery in 267/306 (87.3%) with 74.9% recovered in less than a year (median ~3 months). Among patients with myocarditis, the percentage who had a delayed time to recovery at time of last follow-up was 12.8% (95% CI: 2.1,24.7) higher in those with an acute left ventricular ejection fraction (EF) of ≤50% and 13.5% (95% CI: 2.4,25.7) higher in those with hypokinesis. Patient complications included 6 ventricular arrhythmias (2 received implanted defibrillators) and 14 with atrial arrhythmias (2 received radiofrequency ablation). Three of 6 patients (50%) diagnosed with cardiomyopathy had clinical recovery at their last follow-up date.

conclusionsHypersensitivity myocarditis/pericarditis following the smallpox vaccine is associated with full clinical and functional ventricular recovery in over 87% of cases (74.9% <1 year). A minority of MP cases experienced prolonged or incomplete recovery beyond 1 year.

Indexed as

Military Health ServicesMyocarditisPericarditisSmallpoxSmallpox VaccineVacciniaAdultFemaleHumansMaleRetrospective StudiesStroke VolumeUnited StatesVaccinationVaccinia virusVentricular Function, LeftSmallpox Vaccine

Identifiers

PMID37155666
PMCPMC10166549
OpenAlexW4375956102

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.