{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T23:30:33Z","timestamp":1781566233824,"version":"3.54.5"},"reference-count":31,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre (BRC)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: The novel SARS-CoV-2 vaccines partially exploit intrinsic DNA or RNA adjuvanticity, with dysregulation in the metabolism of both these nucleic acids independently linked to triggering experimental autoimmune diseases, including lupus and myositis. Methods: Herein, we present 15 new onset autoimmune myositis temporally associated with SARS-CoV-2 RNA or DNA-based vaccines that occurred between February 2021 and April 2022. Musculoskeletal, pulmonary, cutaneous and cardiac manifestations, laboratory and imaging data were collected. Results: In total, 15 cases of new onset myositis (11 polymyositis\/necrotizing\/overlap myositis; 4 dermatomyositis) were identified in the Yorkshire region of approximately 5.6 million people, between February 2021 and April 2022 (10 females\/5 men; mean age was 66.1 years; range 37\u201383). New onset disease occurred after first vaccination (5 cases), second vaccination (7 cases) or after the third dose (3 cases), which was often a different vaccine. Of the cases, 6 had systemic complications including skin (3 cases), lung (3 cases), heart (2 cases) and 10\/15 had myositis associated autoantibodies. All but 1 case had good therapy responses. Adverse event following immunization (AEFI) could not be explained based on the underlying disease\/co-morbidities. Conclusion: Compared with our usual regional Rheumatology clinical experience, a surprisingly large number of new onset myositis cases presented during the period of observation. Given that antigen release inevitably follows muscle injury and given the role of nucleic acid adjuvanticity in autoimmunity and muscle disease, further longitudinal studies are required to explore potential links between novel coronavirus vaccines and myositis in comparison with more traditional vaccine methods.<\/jats:p>","DOI":"10.3390\/vaccines10081184","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T01:41:16Z","timestamp":1659058876000},"page":"1184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["A Large Cluster of New Onset Autoimmune Myositis in the Yorkshire Region Following SARS-CoV-2 Vaccination"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2406-161X","authenticated-orcid":false,"given":"Gabriele","family":"De Marco","sequence":"first","affiliation":[{"name":"NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK"},{"name":"Section of Experimental Rheumatology, The Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Giryes","sequence":"additional","affiliation":[{"name":"Section of Experimental Rheumatology, The Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Williams","sequence":"additional","affiliation":[{"name":"York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Alcorn","sequence":"additional","affiliation":[{"name":"York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Slade","sequence":"additional","affiliation":[{"name":"York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Fitton","sequence":"additional","affiliation":[{"name":"York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmin","family":"Nizam","sequence":"additional","affiliation":[{"name":"Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayle","family":"Smithson","sequence":"additional","affiliation":[{"name":"Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khizer","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui","family":"Tran","sequence":"additional","affiliation":[{"name":"Harrogate and District NHS Foundation Trust, Harrogate HG2 7SX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Pekarska","sequence":"additional","affiliation":[{"name":"Harrogate and District NHS Foundation Trust, Harrogate HG2 7SX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansoor Ul Haq","family":"Keen","sequence":"additional","affiliation":[{"name":"Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Solaiman","sequence":"additional","affiliation":[{"name":"Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Middleton","sequence":"additional","affiliation":[{"name":"Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Wood","sequence":"additional","affiliation":[{"name":"Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rihards","family":"Buss","sequence":"additional","affiliation":[{"name":"Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsty","family":"Devine","sequence":"additional","affiliation":[{"name":"NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Marzo-Ortega","sequence":"additional","affiliation":[{"name":"NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK"},{"name":"Section of Experimental Rheumatology, The Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Green","sequence":"additional","affiliation":[{"name":"Harrogate and District NHS Foundation Trust, Harrogate HG2 7SX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"McGonagle","sequence":"additional","affiliation":[{"name":"Section of Experimental Rheumatology, The Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine","volume":"384","author":"Baden","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0140-6736(20)32661-1","article-title":"Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: An interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK","volume":"397","author":"Voysey","year":"2021","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S1473-3099(20)30942-7","article-title":"Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: A double-blind, randomised, phase 1 trial","volume":"21","author":"Ella","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1016\/S0140-6736(20)32466-1","article-title":"Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): A single-blind, randomised, controlled, phase 2\/3 trial","volume":"396","author":"Ramasamy","year":"2020","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/S1473-3099(20)30843-4","article-title":"Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine in healthy adults aged 18\u201359 years: A randomised, double-blind, placebo-controlled, phase 1\/2 clinical trial","volume":"21","author":"Zhang","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1056\/NEJMoa2109908","article-title":"Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis","volume":"385","author":"Pavord","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1001\/jamacardio.2021.2828","article-title":"Patients with Acute Myocarditis following mRNA COVID-19 Vaccination","volume":"6","author":"Kim","year":"2021","journal-title":"JAMA Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"McGonagle, D., and McDermott, M.F. (2006). A proposed classification of the immunological diseases. PLoS Med., 3.","DOI":"10.1371\/journal.pmed.0030297"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1159\/000494034","article-title":"Extracellular RNA Sensing by Pattern Recognition Receptors","volume":"10","author":"Tatematsu","year":"2018","journal-title":"J. Innate Immun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1038\/s41577-021-00526-x","article-title":"COVID-19 vaccines: Modes of immune activation and future challenges","volume":"21","author":"Teijaro","year":"2021","journal-title":"Nat. Rev. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Krug, A. (2008). Nucleic acid recognition receptors in autoimmunity. Handbook Experimental Pharmacology, Springer.","DOI":"10.1007\/978-3-540-72167-3_7"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2527","DOI":"10.1084\/jem.20161596","article-title":"Type I interferon-mediated monogenic autoinflammation: The type I interferonopathies, a conceptual overview","volume":"213","author":"Rodero","year":"2016","journal-title":"J. Exp. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s12943-021-01339-1","article-title":"Clinical and immunological effects of mRNA vaccines in malignant diseases","volume":"20","author":"Heine","year":"2021","journal-title":"Mol. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1186\/1752-1947-7-223","article-title":"The CARE guidelines: Consensus-based clinical case reporting guideline development","volume":"7","author":"Gagnier","year":"2013","journal-title":"J. Med. Case Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9933","DOI":"10.1073\/pnas.87.24.9933","article-title":"The role of an autoantigen, histidyl-tRNA synthetase, in the induction and maintenance of autoimmunity","volume":"87","author":"Miller","year":"1990","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_17","unstructured":"World Health Organization (2014). Global Manual on Surveillance of Adverse Events Following Immunization."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"170","DOI":"10.12688\/f1000research.22600.1","article-title":"Causality assessment of adverse events following immunization: The problem of multifactorial pathology","volume":"9","author":"Bellavite","year":"2020","journal-title":"F1000Research"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lee, H., Kang, H.Y., Cho, S., Park, S., Kim, A.Y., Jung, S.Y., Seong, B.L., and Lee, Y.M. (2020). Causality Assessment Guidelines for Adverse Events Following Immunization with a Focus on Guillain-Barre Syndrome. Vaccines, 8.","DOI":"10.3390\/vaccines8010101"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Watad, A., De Marco, G., Mahajna, H., Druyan, A., Eltity, M., Hijazi, N., Haddad, A., Elias, M., Zisman, D., and Naffaa, M.E. (2021). Immune-Mediated Disease Flares or New-Onset Disease in 27 Subjects Following mRNA\/DNA SARS-CoV-2 Vaccination. Vaccines, 9.","DOI":"10.3390\/vaccines9050435"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1093\/rheumatology\/keu289","article-title":"Incidence and prevalence of inflammatory myopathies: A systematic review","volume":"54","author":"Meyer","year":"2015","journal-title":"Rheumatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1038\/s41572-021-00321-x","article-title":"Idiopathic inflammatory myopathies","volume":"7","author":"Lundberg","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e747","DOI":"10.1016\/S2665-9913(21)00312-X","article-title":"Inflammatory myositis after ChAdOx1 vaccination","volume":"3","author":"Maramattom","year":"2021","journal-title":"Lancet Rheumatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.3346\/jkms.2022.37.e91","article-title":"Clinicopathological Characteristics of Inflammatory Myositis Induced by COVID-19 Vaccine (Pfizer-BioNTech BNT162b2): A Case Report","volume":"37","author":"Kim","year":"2022","journal-title":"J. Korean Med. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.3346\/jkms.2022.37.e32","article-title":"Dermatomyositis Following BNT162b2 mRNA COVID-19 Vaccination","volume":"37","author":"Gouda","year":"2022","journal-title":"Korean Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/imm.12505","article-title":"CD8 T-cell priming upon mRNA vaccination is restricted to bone-marrow-derived antigen-presenting cells and may involve antigen transfer from myocytes","volume":"146","author":"Lazzaro","year":"2015","journal-title":"Immunology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1038\/d41587-021-00023-5","article-title":"First COVID-19 DNA vaccine approved, others in hot pursuit","volume":"39","author":"Sheridan","year":"2021","journal-title":"Nat. Biotechnol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1016\/S0140-6736(20)31208-3","article-title":"Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: A dose-escalation, open-label, non-randomised, first-in-human trial","volume":"395","author":"Zhu","year":"2020","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3390\/biologics1030020","article-title":"Nucleic Acid Vaccines for COVID-19: A Paradigm Shift in the Vaccine Development Arena","volume":"1","author":"Chavda","year":"2021","journal-title":"Biologics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41541-021-00292-w","article-title":"SARS-CoV-2 vaccines strategies: A comprehensive review of phase 3 candidates","volume":"6","author":"Kyriakidis","year":"2021","journal-title":"npj Vaccines"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s00296-022-05091-7","article-title":"Interferon-gamma release assays outcomes in healthy subjects following BNT162b2 mRNA COVID-19 vaccination","volume":"42","author":"Kurteva","year":"2022","journal-title":"Rheumatol. 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