There is currently no evidence of a change in the number of cardiac-related deaths or death occurring from any cause after a coronavirus (COVID-19) vaccination in young people aged 12 to 29 years in England.
More deaths were registered in young people aged 15 to 29 years in England in 2021 than the average number registered in 2015 to 2019; however, there was no excess in 2021 for deaths from circulatory diseases.
We do not yet have a complete picture of how the coronavirus pandemic has affected deaths in young people, because it takes a long time to investigate deaths from external causes; we will continue to monitor the safety of vaccines and the changes in excess deaths.
Early indications show deaths in 2020 increased for some causes, particularly suicides in young females and accidental poisonings (mostly drug poisonings) in young males.
On 8 December 2020, the UK began administering vaccines against SARS-CoV-2 according to the priority groups determined by the Joint Committee on Vaccination and Immunisation (JCVI). The vaccines have had high effectiveness against death and hospitalisation and have saved thousands of lives worldwide.
However, the safety of these vaccines is still of concern. An extensive international programme of surveillance and research monitors potential adverse effects. The overall picture is reassuring, but there are some reports of potential side effects, including an alleged association between vaccination and mild myocarditis and myopericarditis in young people.
Deaths in people aged 15 to 29 years are relatively rare. Our Deaths registered in England and Wales dataset shows there were around 3,600 such deaths in England each year in the years preceding the coronavirus (COVID-19) pandemic. More deaths were registered in England in 2021 in people aged 15 to 29 years compared with the average for the five years preceding the coronavirus pandemic. It is important to investigate potential causes of this excess of death registrations, and consider any possible connection with the vaccination programme.Back to table of contents
To assess whether the deaths of young people in 2021 were temporally linked with receiving a COVID-19 vaccination, we compared the number of deaths in two time periods; these were weeks one to six following vaccination (risk period) and weeks 7 to 12 following vaccination (baseline period). Myocarditis tends to appear very soon after vaccination, with evidence suggesting the median time from vaccination to symptom onset is two days. However, we used the first six weeks after vaccination as the risk period to ensure that all deaths resulting from myocarditis would be captured. The number of follow up weeks was restricted to 12 to minimise the impact of registration delay, where deaths that occurred in later calendar weeks were less likely to have been registered. See the Data sources and quality section for more detail.
We analysed deaths of vaccinated people aged 12 to 29 years that occurred up to 2 February 2022 and were registered by 16 February 2022, and vaccinations that were recorded up to 2 February 2022.
In this self-controlled case series study (see Glossary), we estimated the incidence rate ratio of cardiac-related death (ICD-10 code I30-I52 mentioned on the death certificate) and all cause deaths, comparing deaths in the risk period with deaths in the baseline period. We examined these ratios for each of the six individual weeks in the risk period as well the six weeks as a whole.
585 young people aged 12 to 29 years died within 12 weeks of receiving a dose of a COVID-19 vaccine.
Figure 1: There was no change in the risk of cardiac death in the risk period after vaccination among those aged 12 to 29 years
Relative incidence of cardiac and all cause deaths in each of the six weeks in the risk period and in the risk period as a whole compared with the baseline period, England, up to 16 February 2022
- Error bars give 95% confidence intervals (see Glossary).
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There was no evidence of a change in the risk of cardiac-related death in any of the first six weeks in the risk period after vaccination or in the risk period as a whole. The risk of death in the first six weeks after vaccination was 0.99 times (95% confidence interval 0.67 to 1.46) that of the risk in the baseline period. Therefore, there is no statistically significant difference.
There was also no evidence of an elevated risk of all cause death in any of the first six weeks in the risk period after vaccination, and no change in the risk of all cause death in the risk period as a whole (relative incidence 0.94, 95% confidence interval 0.79 to 1.10). A decrease in the risk of death for all causes was observed in the first week after vaccination (0.50, 0.33 to 0.74).
This may reflect the "healthy vaccine effect", where people who are unwell are more likely to delay vaccination until recovered. Therefore, the health of people who have recently received a vaccination is generally better than those who have been vaccinated for a longer time.
There was also no evidence of a change in the risk of cardiac-related death or death from any cause for any of the subgroups analysed (those aged 12 to 17 years, those aged 18 to 24 years, and those aged 25 to 29 years, males, and females) or by dose or vaccine type they received (see dataset).
This analysis therefore does not indicate any increased risk of cardiac-related deaths or deaths owing to any cause following vaccination. To explore this further, we compared excess deaths in young people in 2021 with earlier years.Back to table of contents
Refers to the "coronavirus disease 2019" and is a disease that can affect the lungs and airways. It is caused by a type of coronavirus. Further information is available from the World Health Organization (WHO).
Self-controlled case series
The self-controlled case series (SCCS) is a method developed to study adverse reactions to vaccines. This method compares the incidence of the outcome in a risk period (weeks one to six after vaccination) with a baseline period (weeks 7 to 12 after vaccination) to assess whether there is a change in the risk of death soon after vaccination compared with later after vaccination.
95% confidence intervals
A confidence interval is a measure of the uncertainty around a specific estimate. If a confidence interval is 95%, it is expected that the interval will contain the true value on 95 occasions if repeated 100 times. As intervals around estimates widen, the level of uncertainty about where the true value lies increases. The size of the interval around the estimate is strongly related to the number of deaths, prevalence of health states, and the size of the underlying population. At a national level, the overall level of error will be small compared with the error associated with a local area or a specific age and sex breakdown. More information is available on our Uncertainty and how we measure it for our surveys page.
In this study, the relative incidence is a measure of the relative differences in the number of deaths in different groups. A relative incidence greater than one indicates the incidence of death is higher in a given period, compared with a baseline period. Likewise, a relative incidence less than one indicates the incidence of death is lower in a given period.Back to table of contents
The analysis of death following vaccination in young people is based on linked death registration data from the Office for National Statistics (ONS) to data on COVID-19 vaccination from the National Immunisation Management Service (NIMS) and an extract from NHS point of care data provided by NHS-Digital.
The NIMS data includes most COVID-19 vaccinations administered in England since 8 December 2020. However, in some rare cases, the vaccination records of people who died shortly after vaccination may not be recorded in NIMS. This would happen if the death was recorded on the Personal Demographics Service (PDS) before the vaccination records were sent to NIMS. Therefore, we supplemented the vaccination records from NIMS using a special extract of 2,044 people people who died after vaccination but whose records for the last vaccination received were not sent to NIMS.
Two of these were aged 12 to 29 years and had a linked death record. The linkage was conducted using NHS number, which was available for 99.96% of NIMS records, 99.6% of deaths and 100% of the extract from NHS Digital.
The data covers people residing in England and included deaths that occurred between 8 December 2020 and 2 February 2022 and were registered by 16 February 2022, and vaccinations that were recorded up to 16 February 2022.
We used a self-controlled case study design, which compares the incidence rate of the outcome in a risk period to a baseline period. This helps us assess whether there is a change in the risk of death soon after vaccination compared with later after vaccination.
Follow up started on the day of last vaccination received. Participants were not censured if a death occurred, but were followed for 12 weeks after vaccination or a whole number of weeks until the end of study if sooner. The number of follow up weeks was restricted to 12 to minimise the impact of registration delay, where deaths that occurred in later calendar weeks were less likely to have been registered. We analysed cardiac-related death (ICD-10 code I30-I52 mentioned on the death certificate) and deaths owing to all causes.
The self-controlled case series models were fitted using a conditional logistic regression model on a person-week level, with an individual effect. Incidence rate ratios, the relative rate of cardiac-related or all cause deaths in risk periods relative to baseline periods, and their 95% confidence intervals were estimated using each model. Clustered standard errors accounted for multiple measurements per participant.Back to table of contents
These analyses were conducted in collaboration with analysts from the Office for Health Improvement and Disparities (OHID), in particular Allan Baker, Leigh Fowler-Dowd and Ed Klodawski.Back to table of contents
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