Severe Myocarditis Increase in Children Associated With Parvovirus B19 Infection: MYKKE Registry and German Surveillance Data

Seidel F, Nygren TM, Opgen-Rhein B, Hecht T, Boehne M, Weickmann J, Anderheiden F, Reineker K, Böcker D, Rentzsch A, Wiegand G, Fischer M, Kiski D, Frede W, Ruf B, Tarusinov G, Papakostas K, Logeswaran T, Schiebel A, Voges I, Kaestner M, Kramp J, Kerst G, Khedim M, Gatzweiler E, Wannenmacher B, Knirsch W, Meyer-Dobkowitz L, Donner B, Klingner J, Rau C, Haller S, Brinkmann A, Nitsche A, Noldt M, Schmoock G, Herzmann C, Degenhardt U, Bühler S, Enders M, Hermes J, Rolfs N, Manuylova T, Schwarzkopf E, Beudt J, Siffczyk C, Schubert S, Sandfort M, Klingel K (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 14

Pages Range: 102854-

Journal Issue: 5

DOI: 10.1016/j.jchf.2025.102854

Abstract

BACKGROUND: Following a surge in myocarditis in Germany since August 2023, many with parvovirus B19 (B19V) detection, concerns arose about causes and countermeasures. OBJECTIVES: The authors aimed to verify the association among B19V, myocarditis increase, and severity. METHODS: Data from the pediatric multicenter registry (MYKKE) from 27 centers were analyzed. B19V myocarditis cases were defined by polymerase chain reaction (PCR) positivity in blood or myocardium with clinical or histopathologic myocarditis evidence. Comprehensive clinical, histopathologic, and epidemiologic analyses were conducted. Past patients were hospitalized from 2013 to July 2023, current from August 2023 to November 2024. Registry data were compared with surveillance and consultant laboratory data. Specimens of current cases underwent metagenomic analysis and B19V sequencing. RESULTS: Since 2013, 922 myocarditis patients including 126 (13.6%) with B19V myocarditis were enrolled. With 57 of 126 (45.2%) current cases, B19V myocarditis increased, compared with other myocarditis causes. Most current cases were patients who were <2 years of age (64.9%), 56.1% were female. The ratio of B19V myocarditis to incidence did not increase compared with the earlier period. Current cases presented with more reduced ejection fraction (29.0% vs 34.5%; P = 0.007), linked to severe cardiac T-cell infiltration and high numbers of B19V copies. Increased severity was associated with younger age. Phylogenetic analysis identified B19V genotype 1A, without sequence variants indicating increased virulence. CONCLUSIONS: The increase in pediatric myocarditis since August 2023 was associated with B19V, more likely explained by disproportionately young current cases and young children's vulnerability than a virulent strain. Raising clinicians' awareness and proactive, interdisciplinary approaches are essential for improving prevention of B19V infection, management of myocarditis, and treatment strategies in this vulnerable cohort. (Myocarditis Registry for Children and Adolescents [MYKKE]; NCT02590341).

Authors with CRIS profile

Involved external institutions

Deutsches Herzzentrum Berlin Germany (DE) Robert Koch-Institut (RKI) Germany (DE) Herz- und Diabeteszentrum Nordrhein-Westfalen Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universitätsklinikum Leipzig Germany (DE) Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Universitätsklinikum Tübingen Germany (DE) Klinikum der Universität München (LMU Klinikum) Germany (DE) Universitätsklinikum Münster Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Technische Universität München (TUM) Germany (DE) Herzzentrum Duisburg Germany (DE) Universitätsklinikum Göttingen Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universitätsklinikum Ulm Germany (DE) Universitätsklinikum Köln Germany (DE) Klinikum Stuttgart Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) Universitätsklinikum Bonn Germany (DE) Universitätsklinikum Halle (Saale) Germany (DE) Universitäts-Kinderspital Zürich Switzerland (CH) Klinikum Westbrandenburg GmbH Germany (DE) Universitäts-Kinderspital beider Basel (UKBB) Switzerland (CH) Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen (LUA) Germany (DE) Bezirksamt Hamburg Germany (DE) Der Kreis Stormarn Germany (DE) hamburg.de GmbH Germany (DE) Hamburger Landesinstitut für Lebensmittelsicherheit, Gesundheitsschutz und Umweltuntersuchungen Germany (DE) Klinikverbund Bremen (Gesundheit Nord) Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) Germany (DE)

How to cite

APA:

Seidel, F., Nygren, T.M., Opgen-Rhein, B., Hecht, T., Boehne, M., Weickmann, J.,... Klingel, K. (2026). Severe Myocarditis Increase in Children Associated With Parvovirus B19 Infection: MYKKE Registry and German Surveillance Data. JACC Heart Failure, 14(5), 102854-. https://doi.org/10.1016/j.jchf.2025.102854

MLA:

Seidel, Franziska, et al. "Severe Myocarditis Increase in Children Associated With Parvovirus B19 Infection: MYKKE Registry and German Surveillance Data." JACC Heart Failure 14.5 (2026): 102854-.

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