Category: Covid-19 Vaccine

Key Points

Question Was implementation of the pediatric COVID-19 immunization program of California associated with reductions in the reported pediatric COVID-19 incidence and hospitalizations?

Finding In this case series including 3.9 million children, pediatric vaccination was estimated to avert 146210 cases of COVID-19 among adolescents aged 12 to 15 years during a 141-day postvaccine evaluation period and 230134 cases among children aged 5 to 11 years during a 199-day postvaccine evaluation period. In addition, an estimated 168 hospitalizations were averted among children aged 6 to 59 months during a 225-day evaluation period.

Meaning The findings of this study suggest that vaccination against SARS-CoV-2 was associated with significant reductions in COVID-19 incidence and hospitalizations among children in California.

Importance A SARS-CoV-2 vaccine was approved for adolescents aged 12 to 15 years on May 10, 2021, with approval for younger age groups following thereafter. The population level impact of the pediatric COVID-19 vaccination program has not yet been established.

Objective To identify whether California's pediatric COVID-19 immunization program was associated with changes in pediatric COVID-19 incidence and hospitalizations.

Design, Setting, and Participants A case series on COVID-19 vaccination including children aged 6 months to 15 years was conducted in California. Data were obtained on COVID-19 cases in California between April 1, 2020, and February 27, 2023.

Exposure Postvaccination evaluation periods spanned 141 days (June 10 to October 29, 2021) for adolescents aged 12 to 15 years, 199 days (November 29, 2021, to June 17, 2022) for children aged 5 to 11 years, and 225 days (July 17, 2022, to February 27, 2023) for those aged 6 to 59 months. During these periods, statewide vaccine coverage reached 53.5% among adolescents aged 12 to 15 years, 34.8% among children aged 5 to 11 years, and 7.9% among those aged 6 to 59 months.

Main Outcomes and Measures Age-stepped implementation of COVID-19 vaccination was used to compare observed county-level incidence and hospitalization rates during periods when each age group became vaccine eligible to counterfactual rates predicted from observations among other age groups. COVID-19 case and hospitalization data were obtained from the California reportable disease surveillance system.

Results Between April 1, 2020, and February 27, 2023, a total of 3913063 pediatric COVID-19 cases and 12740 hospitalizations were reported in California. Reductions of 146210 cases (95% prediction interval [PI], 136056-158948) were estimated among adolescents aged 12 to 15 years, corresponding to a 37.1% (35.5%-39.1%) reduction from counterfactual predictions. Reductions of 230134 (200170-265149) cases were estimated among children aged 5 to 11 years, corresponding to a 23.7% (20.6%-27.3%) reduction from counterfactual predictions. No evidence of reductions in COVID-19 cases statewide were found among children aged 6 to 59 months (estimated averted cases, 259; 95% PI, 1938 to 1019), although low transmission during the evaluation period may have limited the ability to do so. An estimated 168 hospitalizations (95% PI, 42-324) were averted among children aged 6 to 59 months, corresponding to a 24.4% (95% PI, 6.1%-47.1%) reduction. In meta-analyses, county-level vaccination coverage was associated with averted cases for all age groups. Despite low vaccination coverage, pediatric COVID-19 immunization in California averted 376 085 (95% PI, 348355-417328) reported cases and 273 (95% PI, 77-605) hospitalizations among children aged 6 months to 15 years over approximately 4 to 7 months following vaccination availability.

Conclusions and Relevance The findings of this case series analysis of 3913063 cases suggest reduced pediatric SARS-CoV-2 transmission following immunization. These results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations.

Vaccination is among the most important interventions to reduce the public health impact of infectious diseases.1 SARS-CoV-2 mRNA vaccines, including mRNA1273 (Moderna) and BNT162b2 (Pfizer BioNTech), were approved for adult use in December 2020.2 On May 10, 2021, the first mRNA COVID-19 vaccine was approved for use in adolescents aged 12 to 15 years. Vaccines were subsequently approved for children aged 5 to 11 years on October 29, 2021, and for children aged 6 to 59 months on June 17, 2022 (Figure 1).2

COVID-19 vaccines are safe for children.3 However, concerns over vaccine-related adverse events, lower vaccine effectiveness against illness in children, and perceptions of a milder disease course in children have resulted in high rates of parental vaccine hesitancy4-6 and resistance to pediatric vaccine mandates.7 While California has among the highest rates of vaccination in the US,8 pediatric vaccination coverage lags that of adults substantially, with only 8.2% of children younger than 5 years and 37.8% of children aged 5 to 11 years fully vaccinated as of May 2023.8 Severe manifestations of COVID-19 are rare among children, but can occur.9 Understanding the population-level impact of COVID-19 vaccinations in SARS-CoV-2 infections and hospitalizations in pediatric populations would aid in public health decision-making on pediatric vaccine and booster policy and provide pediatric-specific information on vaccine outcomes that could be applied to future SARS-CoV-2 variants.

Herein, we analyze data on 3913063 pediatric cases of COVID-19 and 12740 hospitalizations from California. Using the phased introduction of the vaccine to individuals aged 12 to 15 years, 5 to 11 years, and 6 to 59 months, we estimated statewide and county-specific outcomes associated with vaccination on pediatric incidence and hospitalizations in California.

We obtained deidentified information on all pediatric COVID-19 cases reported in California between April 1, 2020, and February 27, 2023, from the California COVID-19 Reporting System, along with the patients county of residence, age, and hospitalization status. Each case was confirmed using a nucleic acid amplification test. Because the research constitutes a public health surveillance activity, the study did not constitute human research and does not require institutional review board review or exemption according to the Common Rule (45 CFR 46). We followed the reporting guideline for case series studies.

Daily cases were aggregated by county and age groups based on dates of vaccination eligibility: 0 to 5 months (vaccine ineligible), 6 to 59 months, 5 to 11 years, 12 to 15 years, and older than 16 years (nonpediatric). To remove variation due to differential health care seeking by day of week, we calculated 7-day moving averages of case counts per county and age group. Due to small counts for pediatric hospitalizations, we aggregated hospitalizations by week and age group within 5 California-designated regions (eFigure 1 in Supplement 1). Descriptions of other covariate data are covered in the eMethods in Supplement 1).

Training and Prediction Periods

For each age group of interest (6-59 months, 5-11 years, and 12-15 years), we split data into age-eligible and age-ineligible periods. The prevaccine eligibility period encompassed data up to the date of vaccine eligibility. The evaluation period for the outcome associated with the vaccine lasted from 1 month following the date of vaccine eligibility (to allow time to complete 2 doses) until the date that the next age group became eligible or until the time of analysis (February 27, 2023) (Figure 1). Ending the evaluation period at the vaccine eligibility date of the next eligible age group permitted that age group to be selected as a control time series in our predictive models.

Candidate Model Generation and Selection

We developed a set of candidate predictive generalized linear models, which are described in greater detail in the eMethods in Supplement 1. Predictors eligible for selection within candidate models included (1) log-incidence series for other age groups (ie, <6 months, 6-59 months, 5-11 years, 12-15 years, and 16 years, omitting the group being modeled) included as either covariates or as an offset term for any 1 age group; (2) an indicator of vaccine age eligibility for other age groups; (3) an indicator for in-person school being in session; (4) interactions between school and vaccine introduction indicators and time series for other age groups, aiming to account for differences in constant proportionality during school periods or when 1 age group became vaccinated; and (5) seasonal controls. Eligible predictors are summarized in eTable 1 in Supplement 1. Quasi-Poisson distributions were fit for the outcome to account for overdispersion. Models were developed separately for each California county.

Candidate models for hospitalizations included similar eligible predictors, with 2 main differences: log weekly case incidence series for other age groups was lagged by 2 weeks in accordance with the expected lag between infection and hospitalization10 and unlagged weekly hospitalizations across other age groups were included as possible predictors. Models were developed separately for each of the 5 regions.

We used a time series with a 1-year gap cross-validation approach (eMethods and eFigure 2 in Supplement 1) to select the best predictive model for each age group and geographic area (county or region) within the prevaccine period.11-13 For each area-age group combination, we selected the model with the lowest out-of-sample mean square error across holdout folds. For this model, we also calculated the coefficient of determination, r2, a goodness-of-fit metric. The selected predictors varied by area and age group. Selected models for each area-age group combination are included in eTable 2 (for cases) and eTable 3 (for hospitalizations) in Supplement 1.

Calculation of Vaccine Outcomes and Association Between Averted Cases and Vaccination Coverage

Selected models were fit to prevaccine eligibility data for their age group and geographic area and then used to predict counterfactual incidence or hospitalization in the postvaccine period or the expected case or hospitalization counts had vaccination not occurred. For inference, we computed 95% prediction intervals (PIs) around the counterfactual predictions, using a sandwich estimator to account for overdispersion when computing SEs (eMethods in Supplement 1).14 Prediction intervals, which are wider than CIs, capture the uncertainty around each future predicted value. Statewide estimates were obtained by summing predictions across geographies (eMethods in Supplement 1).

We estimated the absolute and relative differences between predicted counterfactual values and observed values for each county or region during the postvaccine evaluation period. To understand the association between vaccination coverage and averted cases, we fit regression models relating the reduction in cases within each age and county to county-level vaccination coverage within the same age group, using a fixed-effects meta-analysis with weights equal to the inverse estimated SE of the estimates per county. We used segmented regression models (eMethods in Supplement 1) to examine whether there were coverages below which reductions in cases could not be identified or above which diminishing returns on vaccination were observed.15

To examine whether postvaccine predictions from a different, but well predictive model, yielded similar estimates of vaccination outcomes, we repeated model selection using the mean absolute error instead of the mean square error in our cross-validation algorithm. We conducted jackknife analyses to examine whether postvaccine predictions from any one county were driving observed effects, dropping each county in turn from the overall pool of counties and recalculating the primary analytic end point of cases averted.

All analyses were conducted in R, version 3.6.0 (R Foundation for Statistical Computing).16

Between April 1, 2020, and February 27, 2023, a total of 3913063 COVID-19 cases were reported in California among individuals aged 18 years or younger. Of these, 47174 cases (1.2%) were among children younger than 6 months, 517447 (13.2%) in children aged 6 to 59 months, 1590806 (40.7%) in children aged 5 to 11 years, and 1511690 (38.6%) in adolescents aged 12 to 15 years. A total of 12740 hospitalizations were reported: 1443 (11.3%) were among children younger than 6 months, 3428 (26.9%) in children aged 6 to 59 months, 2536 (19.9%) in children aged 5 to 11 years, and 3921 (30.8%) in adolescents aged 12 to 15 years.

Vaccine-Attributable Averted Cases and Hospitalizations by Pediatric Age Group

As shown in eFigure 3 in Supplement 1, r2 values for models fit to daily case data were 0.92 (IQR, 0.79-0.96) for children aged 6 to 59 months, 0.89 (IQR, 0.78-0.95) for children aged 5 to 11 years, and 0.79 (IQR, 0.62-0.90) for adolescents aged 12 to 15 years. eFigure 4 in Supplement 1 shows the model fit for hospitalizations. More details on model fit are included in the eResults in Supplement 1.

Adolescents Aged 12 to 15 Years

Individuals aged 12 to 15 years were eligible to be vaccinated against SARS-CoV-2 as of May 10, 2021. By October 29, 2021, when the next age group became eligible, 53.5% of this population had completed the 2-dose primary series of the vaccine, corresponding to 1712686 individuals. County-level vaccination rates ranged from 11.5% to 85.7%.8 During the 141 days spanning June 10 to October 29, 2021, 247700 COVID-19 cases were observed among individuals aged 12 to 15 years. We estimated that 394506 (95% PI, 392545-396467) cases of COVID-19 would have occurred absent vaccination, corresponding to 146210 (95% PI, 136056-158948) cases averted statewide or 37.1% (95% PI, 34.5%-40.3%) of expected cases (Table, Figure 2C). Incidence plots from all counties are included as eFigures 9-14 in Supplement 1.

During this same 141-day period, 688 hospitalizations were observed among adolescents. We estimated that 59 (95% PI, 65 to 244) hospitalizations were averted or a reduction of 7.9% (95% PI, 8.7% to 32.7%) from expectation (Table, Figure 3C). Hospitalization plots from all regions are included as eFigures 12-14 in Supplement 1.

Children Aged 5 to 11 Years

Children aged 5 to 11 years were eligible for vaccination on October 29, 2021. By June 17, 2022, 1219432 individuals (34.8% of this population) had completed a primary series of the vaccine, with a range of 10.0% to 74.7% by county.8 During the 199-day period following November 29, 2021, we estimated that 230134 (95% PI, 200170-265149) cases were averted due to the vaccine corresponding to a reduction of 23.7% (95% PI, 20.6%-27.3%) from counterfactual expectations (Table, Figure 2B). During this same period, we estimated that 46 (95% PI, 79 to 221) hospitalizations were averted, corresponding to 5.8% (95% PI, 10.2% to 28.6%) of expected hospitalizations (Table, Figure 3B).

Children Aged 6 to 59 Months

Children aged 6 to 59 months were eligible for vaccination on June 17, 2022. By February 27, 2023, 177087 (7.9%) individuals had received both doses of the primary series, with a range of 0.7% to 38.5% across counties.8 In the 225 days following July 17, 2022, we did not detect any significant changes in cases from counterfactual expectations in the postvaccine period (estimated averted cases: 259; 95% PI, 1938 1019) (Table). The postvaccine evaluation period for this age group did not include a surge in COVID-19 cases as it did for the other age groups (Figure 2A). However, we estimated that 168 (95% PI, 42-324) hospitalizations were averted following vaccination, or a reduction of 24.4% (95% PI, 6.1%-47.1%) from counterfactual expectations (Table and Figure 3A). Summing across all age groups, we estimated that pediatric vaccination was associated with reductions of 376 085 (95% PI, 348 355-417 328) reported cases and 273 (95% PI, 77-605) hospitalizations among children aged 6 months to 15 years during the 4 to 7 months following vaccine availability. This represents a reduction of 26.3% of the number of cases and 12.4% of the hospitalizations that would have been seen in this population absent the vaccine.

As indicated in the eResults and eFigures 5 and 6 in Supplement 1, results for individuals aged 5 to 15 years were not sensitive to the inclusion of any single county, although results for children aged 6 to 59 months were sensitive to the inclusion of Los Angeles (eFigure 7 in Supplement 1). Estimated cases (eTable 4 in Supplement 1) and hospitalizations (eTable 5 in Supplement 1) were consistent when model selection was done using mean absolute error as the loss function for children aged 5 to 15 years. Estimated averted cases in children aged 6 to 59 months were slightly lower using mean absolute error, but hospitalization results were consistent (eResults in Supplement 1). Estimates of cases averted (eTable 6 in Supplement 1) and hospitalizations averted (eTable 7 in Supplement 1) made using the mean absolute error as the loss function for each county or region are available, along with plots of observed and counterfactual case and hospitalization series for all geographic areas (eFigures 9-14 in Supplement 1).

Association Between Averted Cases and Vaccination

County-level vaccination coverage explained 26% of variation of cases averted for children aged 6 to 59 months, 28% for children aged 5 and 11 years, and 12% for adolescents aged 12 to 15 years (Figure 4). On average, every increase of 10 vaccinations per 1000 children corresponded to a reduction of 0.9 (95% CI, 0.3-1.4) cases per 1000 children for individuals aged 6 to 59 months, 3.5 (95% CI, 1.9-5.1) cases per 1000 children for those aged 5 and 11 years, and 2.0 (95% CI, 0.6-3.4) cases per 1000 children for adolescents aged 12 to 15 years. Linear model fits had lower Akaike information criterion and bayesian information criterion values than segmented regression model fits for all age groups. Across all age groups, pediatric vaccination rates in California were generally highest among Bay Area counties (eFigure 8 in Supplement 1), which also ranked highest for averted cases due to vaccination (eResults in Supplement 1).

We provide evidence that Californias pediatric COVID-19 immunization program averted 376 085 (95% PI, 348355-417328) reported cases and 273 (95% PI, 77-605) hospitalizations among children aged 6 months to 15 years during the 4 to 7 months following vaccine availability. This represents a reduction of 26.3% of the number of cases that would have been seen in this population absent the vaccine. Prior work has similarly reported a high impact of widespread administration of mRNA vaccines in adult populations. In California, COVID-19 vaccines were estimated to avert more than 1.5 million cases, 72 000 hospitalizations, and 19 000 deaths statewide during the first 10 months of vaccination (through October 16, 2021).17 In the US, each 10% increase in vaccination coverage among individuals aged 18 years or older at the county level was associated with an 8% reduction in mortality and a 7% reduction in incidence.18 Similarly, a study in Israel estimated that nearly 650 000 cases of COVID-19 were averted in the first 2 months following vaccination introduction,19

Earlier studies have estimated vaccine effectiveness in pediatric populations by comparing incidence rates among vaccinated children with those in unvaccinated children using test-negative designs,20-22 or retrospective23,24 or prospective cohort studies.25 Our counterfactual case series approach, which has been used in other studies to estimate the population-level impact of interventions with a clearly specified rollout time,26,27 enables calculation of vaccine program impact at the population level, without information on individual vaccine status.

The cumulative effect of vaccination at the population level may be meaningful even if individual vaccine effectiveness is low. While influenza vaccine effectiveness was estimated at 29% in 2017-2018,28 it was estimated that widespread vaccination averted more than 3.1 million cases of influenza in the US.29 Nevertheless, overall impact depends on vaccine coverage. We identified positive associations between county-level vaccination coverage and averted cases in each age group, whereby each 10 additional vaccinations per 1000 children corresponded to an average reduction of 0.9 to 3.5 cases per 1000 children. Segmented regression models associating vaccine coverage with averted cases did not identify break points, suggesting that over the range of vaccination coverages examined (0%-85%), we saw neither diminishing returns on increased coverage owing to the acquisition of sufficient population-level immunity nor a threshold below which vaccination has limited public health impact. This is consistent with the persistence of SARS-CoV-2 circulation in populations with high vaccination coverage and resulting value of direct protection.

Results for individuals aged 6 to 59 months differed from those of older age groups in that we found a significant reduction in hospitalizations, but not cases, following vaccination. One explanation for this discrepancy could be that postvaccine evaluation period for children aged 6 to 59 months did not include a surge in COVID-19 cases as it did for the other age groups (Figure 2), potentially making it difficult to detect statistically significant reductions from the counterfactual. However, vaccine effectiveness of early mRNA vaccines was lower against Omicron variants compared with Alpha and Delta variants,30,31 and the Omicron variant dominated during the postvaccine period for children aged 6 months to 11 years (Figure 1). The detection of significant reductions in hospitalization in this age group, but not others, may be due, in part, to the fact that COVID-19 mortality disproportionately affects very young children compared with older children.32 For older age groups, we also estimated reductions in hospitalizations, although the 95% PI spans 0. However, we note that 95% CIs are narrower than PIs and may not have encompassed the null.

This study has limitations. Case data represented individuals who sought testing, which may be differential across unvaccinated and vaccinated groups, geographies, and time. Access to at-home testing likely resulted in further case underascertainment. If individuals were, on average, less likely to seek care for mild illness following vaccination, our analysis could have overestimated the absolute effect of the vaccine on cases averted. Overestimation of the relative effect of the vaccine may have resulted if vaccine recipients were disproportionately represented in the surveillance record both before and after vaccine eligibility compared with never-vaccinated individuals being more connected to care. Data on hospitalizations are less likely to be subjected to biases from differential case ascertainment. We estimated significant reductions in hospitalizations following vaccine introduction compared with counterfactual predictions.

Several considerations could lead to underestimates of the association between vaccination and child long-term health. First, asymptomatic cases are less likely to be reported, yet remain an important outcome, as postCOVID-19 condition symptoms may present after asymptomatic infections.33-35 Second, we were unable to estimate indirect outcomes associated with the vaccine in other age groups or control for social contacts. If children increased social contacts following receipt of the vaccine, as has been shown elsewhere,36 they may be challenged more frequently with SARS-CoV-2. Third, we assessed the outcomes of the vaccine over a short postvaccination period, limiting our ability to examine vaccine responses under waning immunity.

Two important limitations relate to model functional form. First, attributing differences between the observed and the predicted counterfactual cases to the vaccine assumes that the associations between incidence in the age group being modeled and incidence in the age groups selected as model predictors would, absent the vaccine, remain constant over the pre-to-post vaccine periods. This would not occur if one age group developed increased immunity or if different variants had differential age-disease associations. This is especially salient for the 5- to 11-year age group, as the models were primarily trained on data from the period when the Delta variant predominated, yet the Omicron variant, which is less reliant on angiotensin-converting enzyme 2 binding for entry37 and disproportionately influenced children younger than 5 years, prevailed in the evaluation period. Accordingly, the effect of vaccination may have been overestimated for this age group in counties where the incidence in children younger than 5 years was selected as a predictor (eTable 2 in the Supplement).

Second, there is potential for unstable predictions in the evaluation period if the predictive model was faced with values of selected predictors that fell outside the range of data used to fit the model. Our time series with a gap cross-validation approach guards against both of these limitations by prioritizing selection of generalized linear models that do well predicting values in periods that follow the training period, and in periods where the predictors may fall outside the range of what they were during the training period.11-13,38 Moreover, generalized linear models selected using different loss functions resulted in similar model predictions during the postevaluation period, suggesting that results are robust to differences in the nature of the association between incidence in the modeled age group and incidence in the predictor age groups.

In this case series analysis of 3913063 pediatric cases, we provide evidence suggesting that programmatic vaccination against SARS-CoV-2 was associated with significant reductions in COVID-19 incidence among children in California in the 4 to 7 months following vaccine eligibility. At the county level, we found associations of higher vaccine coverage with greater reductions in pediatric cases. Our results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations.

Accepted for Publication: February 23, 2024.

Published: April 23, 2024. doi:10.1001/jamanetworkopen.2024.7822

Open Access: This is an open access article distributed under the terms of the CC-BY License. 2024 Head JR et al. JAMA Network Open.

Corresponding Author: Justin V. Remais, PhD, 2121 Berkeley Way, #5302, Berkeley, CA 94720 (jvr@berkeley.edu).

Author Contributions: Dr Head had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Head, Len, Lewnard, Remais.

Acquisition, analysis, or interpretation of data: Head, Collender, Len, White, Sud, Camponuri, Lee, Remais.

Drafting of the manuscript: Head, Remais.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Head, Collender, Len, Camponuri, Lee.

Obtained funding: Head, Remais.

Administrative, technical, or material support: Collender, Len, White, Sud, Camponuri, Remais.

Supervision: Remais.

Conflict of Interest Disclosures: Dr Len reported having been an employee of the California Department of Public Health (CDPH). No other disclosures were reported.

Funding/Support: This project was supported by a grant from the CDPH through the University of California Health & CDPH COVID Modeling Consortium. Dr Head was supported by the National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health (NIH) award K01AI173529. Dr Remais was supported by NIAID NIH award R01AI148336.

Role of the Funder/Sponsor: The funding organizations did not play a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2.

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COVID-19 Vaccination and Incidence of Pediatric SARS-CoV-2 Infection and Hospitalization - JAMA Network

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JAMA Network Openhas published a new study showing that, from April 1, 2020, to February 27, 2023, in California, an estimated 146,210 COVID-19 cases were averted by vaccination in teens aged 12 to 15 years, representing a 37% reduction.

Researchers also estimated that 230,134 cases were averted in kids aged 5 to 11 years, a 24% reduction.

The study looked at COVID-19 infections in post-vaccination evaluation periods consisting of 141 days (June 10 to October 29, 2021) for adolescents aged 12 to 15 years, 199 days (November 29, 2021 to June 17, 2022) for children aged 5 to 11 years, and 225 days (July 17, 2022, to February 27, 2023) for those aged 6 to 59 months, according to study authors.

From April 2020 to February 2023, California recorded 3,913,063 pediatric COVID-19 cases and 12,740 hospitalizations. During those times, statewide vaccine coverage reached 53.5% among adolescents aged 12 to 15 years, 34.8% among children aged 5 to 11 years, and 7.9% among those aged 6 to 59 months.

The biggest reduction attributed to vaccination occurred with older kids, and there was no evidence of reductions in COVID-19 cases statewide among children aged 6 to 59 months (estimated averted cases, 259; 95% prediction interval, 1,938 to 1,019).

Though there was no evidence in case reduction in the youngest kids, vaccination prevented an estimated 168 hospitalizations among children aged 6 to 59 months during the 225-day evaluation period.

These results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations.

"These results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations," the authors concluded.

Continued here:

Teen vaccination cut COVID-19 cases by 37% in California, new data show - University of Minnesota Twin Cities

Summary

What is already known about this topic?

In September 2023, the Advisory Committee on Immunization Practices (ACIP) recommended updated (20232024 Formula) COVID-19 vaccination for all persons aged 6 months.

What is added by this report?

On February 28, 2024, ACIP recommended that all persons aged 65 years receive 1 additional dose of any updated (20232024 Formula) COVID-19 vaccine (i.e., Moderna, Novavax, or Pfizer-BioNTech).

What are the implications for public health practice?

Adults aged 65 years should receive an additional dose of the updated (20232024 Formula) COVID-19 vaccine to enhance their immunity and decrease the risk for severe COVID-19associated illness.

COVID-19 remains an important public health threat, despite overall decreases in COVID-19related severe disease since the start of the COVID-19 pandemic. COVID-19associated hospitalization rates remain higher among adults aged 65 years relative to rates in younger adults, adolescents, and children; during October 2023January 2024, 67% of all COVID-19associated hospitalizations were among persons aged 65 years. On September 12, 2023, CDCs Advisory Committee on Immunization Practices (ACIP) recommended updated (20232024 Formula) COVID-19 vaccination with a monovalent XBB.1.5-derived vaccine for all persons aged 6 months to protect against severe COVID-19associated illness and death. Because SARS-CoV-2 continues to circulate throughout the year, and because of the increased risk for COVID-19related severe illness in persons aged 65 years, the protection afforded by updated vaccines against JN.1 and other currently circulating variants, and the expected waning of vaccine-conferred protection against disease, on February 28, 2024, ACIP recommended all persons aged 65 years receive 1 additional dose of the updated (20232024 Formula) COVID-19 vaccine. Implementation of these recommendations is expected to enhance immunity that might have waned and decrease the risk for severe COVID-19associated outcomes, including death, among persons aged 65 years.

Since June 2020, CDCs Advisory Committee on Immunization Practices (ACIP) has convened 39 public meetings to review data and consider recommendations related to the use of COVID-19 vaccines (1). On September 12, 2023, ACIP recommended that all persons aged 6 months receive updated (20232024 Formula) monovalent, XBB.1.5 component (updated) COVID-19 vaccination to protect against severe COVID-19associated illness and death (2).

As of February 3, 2024, approximately 6.7 million COVID-19associated hospitalizations and 1.1 million COVID-19associated deaths had occurred in the United States (3). Although the overall risk for COVID-19associated hospitalization and death has decreased, severe illness related to COVID-19 continues to be a public health problem, especially among older adults. COVID-19associated hospitalization rates remain higher among adults aged 65 years relative to rates among younger adults, adolescents, and children. During October 2023January 2024, 67% of all COVID-19associated hospitalizations were among persons aged 65 years (4). Further, COVID-19 death rates during January 1, 2023January 31, 2024, were highest among adults aged 75 years, followed by adults aged 6574 years (5,6). Whereas approximately 98%99% of the U.S. population has measurable antibody titers against SARS-CoV-2 from infection, vaccination, or both (hybrid immunity), adults aged 65 years are less likely to have immunity resulting from infection (including immunity from infection only or hybrid immunity), compared with adults aged 3049 years and 5064 years (7). In addition, immunosenescence, the age-related decline in the functioning of the immune system, results in a less complete immune response to novel antigens and a reduced ability to develop robust immunity after infections or vaccination (8). The pool of naive T-cells diminishes with age, and this insufficient naive T-cell pool affects the ability to generate neutralizing antibody responses and cytotoxic T-cells in response to SARS-CoV-2 (9).

Thus, adults aged 65 years are more likely than are younger adults, adolescents, and children to rely upon vaccination to increase immunity that might have waned and might need more frequent vaccine doses to maintain protection. Coverage with the updated COVID-19 vaccine among adults aged 65 years was 42% as of February 3, 2024 (10,11). Adults in this age group are more concerned about COVID-19 disease and had higher confidence in COVID-19 vaccine safety and vaccine importance than did younger adults (5). A nationally representative survey conducted during November 2023January 2024 indicated that 68.4% of adults aged 65 years who had received an updated COVID-19 vaccine dose definitely would get another updated vaccine if it were recommended, 27.2% probably would or are unsure if they would get another updated vaccine, and 4.4% said they probably or definitely would not. COVID-19 vaccines are currently on the commercial market, but access-related barriers and disparities in vaccine coverage remain (5); in the absence of any recommendations for an additional dose, access to vaccine would be limited among persons unable to pay out of pocket for the vaccine.*

On February 28, 2024, ACIP voted to recommend that all persons aged 65 years receive 1 additional dose of any updated COVID-19 vaccine (i.e., Moderna, Novavax, or Pfizer-BioNTech). This recommendation was based on continuing SARS-CoV-2 circulation throughout the year, increased risk for severe illness attributable to COVID-19 in adults aged 65 years, protection provided by the updated vaccines against JN.1 and other currently circulating variants, the expected waning of SARS-CoV-2 immunity, and additional implementation considerations, including facilitating clear communication and equitable access to vaccine (5).

In 2018, ACIP adopted the Evidence to Recommendations framework to guide the development of vaccine recommendations. Since November 2023, the ACIP COVID-19 work group met seven times to discuss the current policy question, i.e., whether adults aged 65 years should receive an additional dose of updated COVID-19 vaccine. Work group membership included ACIP voting members, representatives of ACIP ex officio and liaison organizations, and scientific consultants with expertise in public health, immunology, medical specialties, and immunization safety and effectiveness. Work group discussion topics included COVID-19 disease surveillance and epidemiology; COVID-19 vaccination coverage; and the safety, effectiveness, feasibility of implementation, and cost effectiveness of COVID-19 vaccines. This report summarizes the ACIP recommendation for an additional dose of the updated COVID-19 vaccine for persons aged 65 years and the rationale, including evidence reviewed by the work group and presented to ACIP (https://www.cdc.gov/vaccines/acip/recs/grade/covid-19-additional-dose-adults-etr.html).

No clinical trial immunogenicity data on an additional dose of the updated COVID-19 vaccines exist; however, the initial dose elicits a robust neutralizing antibody response and provides protection against JN.1 and other circulating variants (12,13). Early vaccine effectiveness (VE) estimates demonstrate that updated COVID-19 vaccination provided increased protection against symptomatic SARS-CoV-2 infection and COVID-19associated emergency department and urgent care visits and hospitalization, compared with receipt of no updated vaccine dose (12,14). Although these early VE estimates show no substantial waning, based on data on effectiveness of original and bivalent COVID-19 vaccines, waning of vaccine-conferred immunity is expected. Effectiveness of an additional dose in older adults has been demonstrated for previously recommended additional original COVID-19 vaccine doses (15). Among adults aged 50 years who were eligible to receive a second original monovalent mRNA COVID-19 vaccine booster dose, VE against COVID-19associated emergency department and urgent care encounters during the SARS-CoV-2 Omicron BA.2/BA.2.12.1 period 120 days after the third dose was 32% but increased to 66% 7 days after the fourth dose. VE against COVID-19associated hospitalization 120 days after the third dose was 55% but increased to 80% 7 days after the fourth dose (15). In addition, in a large cohort of nursing home residents during circulation of SARS-CoV-2 Omicron subvariants, receipt of a second original monovalent mRNA COVID-19 booster dose 60 days earlier was 74% effective against severe COVID-19related outcomes (including hospitalization or death) and 90% effective against death, compared with receipt of a single booster dose (16).

COVID-19 vaccines have a favorable safety profile as demonstrated by robust safety surveillance during 3 years of COVID-19 vaccine use (17). Anaphylactic reactions have rarely been reported after receipt of COVID-19 vaccines (18). A rare risk for myocarditis and pericarditis exists, predominately in males aged 1239 years (19). No new safety concerns have been identified for the updated COVID-19 vaccine (5). Among adults aged 65 years, overall reactogenicity after COVID-19 vaccination is less frequent and less severe than among adolescents and younger adults (20). A statistical signal for ischemic stroke after Pfizer-BioNTech bivalent mRNA COVID-19 vaccine was detected in the CDC Vaccine Safety Datalink among persons aged 65 years, and information about this detection has been presented at previous ACIP meetings. Ongoing efforts to evaluate the signal have not identified any clear and consistent evidence of a safety concern for ischemic stroke with bivalent mRNA COVID-19 vaccines either when given alone or when given simultaneously with influenza vaccines (21). A recent VE study indicated that the bivalent COVID-19 vaccine was 47% effective in preventing COVID-19 related thromboembolic events (ischemic stroke, myocardial infarction, and deep vein thrombosis) among persons aged 65 years (22).

ACIP considered whether an additional dose of updated COVID-19 vaccine in persons aged 65 years is a reasonable and efficient allocation of resources. The societal incremental cost-effectiveness ratio (ICER) for an additional dose of COVID-19 vaccine in persons aged 65 years was $255,122 per quality-adjusted life year saved for the base case estimate. ICER values were sensitive to probability of hospitalizations, costs, and seasonality assumptions. Estimates of ICER values that approximate cost effectiveness for those with higher risk for COVID-19associated hospitalization, such as persons with underlying conditions or those aged 75 years, were more favorable (23).

On February 28, 2024, ACIP recommended that all persons aged 65 years receive 1 additional dose of any updated COVID-19 vaccine (i.e., Moderna, Novavax, or Pfizer-BioNTech). This additional dose should be administered 4 months after the previous dose of updated COVID-19 vaccine. For initial vaccination with Novavax COVID-19 vaccine, the 2-dose series should be completed before administration of the additional dose. Because Novavax COVID-19 vaccine is currently authorized under Emergency Use Authorization, the recommendation for the updated Novavax COVID-19 vaccine is an interim recommendation.

Persons aged 65 years who are moderately or severely immunocompromised, have completed an initial series, and have received 1 updated COVID-19 vaccine dose should receive 1 additional updated COVID-19 vaccine dose 2 months after the last dose of updated vaccine. Further additional doses may be administered, guided by the clinical judgment of a health care provider and personal preference and circumstances. Any further additional doses should be administered 2 months after the last COVID-19 vaccine dose. Additional clinical considerations, including detailed schedules and tables by age for all age groups and vaccination history for those who are or are not moderately or severely immunocompromised, are available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.

Adverse events after vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS). For licensed COVID-19 vaccines administered to persons aged 12 years, reporting is encouraged for any clinically significant adverse event even when whether the vaccine caused the event is uncertain, as well as for vaccination errors. For COVID-19 vaccines given under Emergency Use Authorization, vaccination providers are required to report certain adverse events to VAERS. Additional information is available at https://vaers.hhs.gov or by telephone at 1-800-822-7967.

Karen Broder, Mary Chamberland, Demetre Daskalakis, Susan Goldstein, Aron Hall, Elisha Hall, Fiona Havers, Andrew Leidner, Pedro Moro, Sara Oliver, Ismael Ortega-Sanchez, Kadam Patel, Manisha Patel, Amanda Payne, Huong Pham, Jamison Pike, Lauren Roper, Sierra Scarbrough, Tom Shimabukuro, Benjamin Silk, John Su, Evelyn Twentyman, Eric Weintraub, David Wentworth, Melinda Wharton, Michael Whitaker, JoEllen Wolicki, Fangjun Zhou, CDC. Voting members of the Advisory Committee on Immunization Practices (in addition to listed authors): Wilbur Chen, University of Maryland School of Medicine; Sybil Cineas, Warren Alpert Medical School of Brown University; Camille Kotton, Harvard Medical School; James Loehr, Cayuga Family Medicine; Sarah Long, Drexel University College of Medicine. Members of the Advisory Committee on Immunization Practices COVID-19 Vaccines Work Group: Beth P. Bell, University of Washington; Edward Belongia, Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute; Henry Bernstein, Zucker School of Medicine at Hofstra/Northwell Cohen Childrens Medical Center; Uzo Chukwuma, Indian Health Service; Paul Cieslak, Christine Hahn, Council of State and Territorial Epidemiologists; Richard Dang, American Pharmacists Association; Jeffrey Duchin, Infectious Diseases Society of America; Kathy Edwards, Vanderbilt University Medical Center; Sandra Fryhofer, American Medical Association; Jason M. Goldman, American College of Physicians; Robert Hopkins, University of Arkansas for Medical Sciences; Michael Ison, Chris Roberts, National Institutes of Health; Lisa A. Jackson, Jennifer C. Nelson, Kaiser Permanente Washington Health Research Institute; Denise Jamieson, American College of Obstetricians and Gynecologists; Jeffery Kelman, Centers for Medicare & Medicaid Services; Kathy Kinlaw, Center for Ethics, Emory University; Alan Lam, U.S. Department of Defense; Grace M. Lee, Stanford University School of Medicine; Lucia Lee, Anuga Rastogi, Adam Spanier, Rachel Zhang, Food and Drug Administration; Valerie Marshall, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services; Dayna Bowen Matthew, George Washington University Law School; Preeti Mehrotra, Society for Healthcare Epidemiology of America; Kathleen Neuzil, Center for Vaccine Development and Global Health, University of Maryland School of Medicine; Sean OLeary, American Academy of Pediatrics; Christine Oshansky, Biomedical Advanced Research and Development Authority; Stanley Perlman, Department of Microbiology and Immunology, University of Iowa; Marcus Plescia, Association of State and Territorial Health Officials; Rob Schechter, National Foundation for Infectious Diseases; Kenneth Schmader, American Geriatrics Society; Peter Szilagyi, University of California, Los Angeles; H. Keipp Talbot, Vanderbilt University School of Medicine; Jonathan Temte, American Academy of Family Physicians; Matthew Tunis, National Advisory Committee on Immunization Secretariat, Public Health Agency of Canada; Matt Zahn, National Association of County and City Health Officials; Nicola P. Klein, Kaiser Permanente Northern California; Cara B. Janusz, Lisa Prosser, Angela Rose, University of Michigan.

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The Metropolitan Transportation Authority has fired one Metro-North Railroad employee and suspended 11 Long Island Rail Road workers for submittingfake COVID-19 vaccination cards, which were provided by an Amityville nurse practitioner convicted ofa $1.5 million scheme to sell fraudulent cards, MTA officials said Wednesday.

The dozen employees, whom the agency did not identify, were disciplined afteran investigation by the MTA inspector general, who reviewed statements by the employees as well as financial information, MTA time and payroll records, and COVID-19 testing records, according to an agency news release.

"The COVID-19 vaccination requirement was implemented to protect MTA workers and the riding public at a time of great uncertainty, but these employees decided the rules don't apply to them," said MTA Inspector General Daniel Cort in the release. "MTA employees who submit fraudulent documents will be caught and face consequences."

The MTA implemented the COVID-19 Vaccine and Test program on Oct. 4, 2021, requiring the vaccination and weekly testing of workers. The investigation began in 2022 after the arrest of Julie DeVuono, a nurse practitioner and owner of Wild Child Pediatric Healthcare in Amityville. She pleaded guilty in September to charges of forging vaccine cards, money laundering and offering a false instrument for filing.

Her sentencing is set for June 11, according to the Suffolk County district attorney's office.

Investigators had obtained a list from the state Health Department of MTA employees who submitted COVID-19 cards claiming they were vaccinated by DeVuono, officials said. The 11 LIRR employees signed agreements admitting to various administrative charges, including submitting false documents and not complying with MTA COVID-19 policies, according to the release.

The MTA ended the vaccine and testing program June 7, 2022.

The Metro-North employee was terminated and the 11 LIRR workers were removed from service in January, with those employees agreeingto serve unpaid suspensions that ranged from 60 to 120 days.

Four of the LIRR workers had admitted not getting vaccinated and paying DeVuono for fake vaccination cards, MTA officials said. Six of the LIRR employees and the terminated Metro-North employee claimed they got vaccinated and paid DeVuono for a homeopathic "detox treatment." The inspector general's office found their accounts "illogical and not credible." The other LIRR worker claimed he got vaccinated at DeVuono's office and did not pay anything. That account, which was contradicted by financial records, was found not to be credible, officials said.

DeVuono admitted that between June 15, 2021, and Jan. 27, 2022, she chargedadult customers $220 for a false vaccination entry on their COVID-19 cards and another $220 to enter the false information into the New York State Immunization Information System, a statewide vaccination database.

DeVuono agreed to forfeit criminal proceeds totaling $1.2 million, officials said. She surrendered her professional license as a nurse practitionerand registered professional nurse, and agreed to shut down her pediatric office, officials said.

Craig Schneider is a Long Island native and Stony Brook University alumnus. He joined Newsday as a general assignment reporter in January 2018 after 20 years at the Atlanta Journal-Constitution.

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People with a history of uveitis were more likely to experience recurrences of the potentially dangerous eye inflammation after vaccination against COVID-19, a retrospective population-based cohort study from South Korea found.

Of 473,934 vaccinated individuals with a prior case of uveitis, 16.8% developed it again within a year of vaccination, with an overall 21% elevated risk compared with the pre-vaccination period, Seong Joon Ahn, MD, PhD, of Hanyang University Seoul Hospital in South Korea, and colleagues reported in JAMA Ophthalmology.

The risk was especially high in the initial 30 days after the first shot as compared with the pre-vaccination period (HR 1.64, 95% CI 1.55-1.73) and in patients who received the Johnson & Johnson Ad.26.COV2.S vaccine, which is no longer available in the U.S. (HR 2.07, 95% CI 1.40-3.07).

"These findings suggest that there was an elevated risk of uveitis following COVID-19 vaccination, with the vaccine type and period mediating this risk," the authors wrote. "For individuals with a history of uveitis, clinicians should consider the potential risk of uveitis recurrence in vaccination strategies and clinical monitoring."

Although rare, uveitis remains a leading cause of legal blindness in the U.S.

Prior findings on a link between uveitis and COVID-19 vaccines have been mixed. A 2023 analysis of the CDC's Vaccine Adverse Event Reporting System concluded it's a "low safety concern," with estimated incident rates per million persons of 0.57 with Pfizer's BNT162b2 mRNA vaccine (Comirnaty) vaccine, 0.44 with Moderna's mRNA-1273 (Spikevax), and 0.35 with the Johnson & Johnson vaccine. However, a similar 2024 study from British regulators found no links between the vaccines and uveitis in the general population.

The new study aimed to determine if uveitis risk is higher in those with a history of the condition and whether the risk levels differ by type of vaccine or timing of doses.

Within the 3 months after vaccination, 8.6% of patients had anterior uveitis, and 1.6% nonanterior uveitis. The total rates grew to 12.5% at 6 months and 16.8% at 12 months. The ratio of anterior to nonanterior forms remained about the same at 4.4 and 4.8, respectively.

Overall, the post-vaccination rate was higher than pre-vaccination (HR 1.21, 95% CI 1.19-1.24), although it decreased after the initial 30 days after the first vaccine dose. The researchers speculated that an "increased immune response following the initial dose might activate inflammatory pathways, resulting in conditions like uveitis, particularly in individuals prone to autoimmune reactions or with a uveitis history." Later, they wrote, the declining risk "may stem from the immune system adapting to the vaccine antigen, resulting in a more controlled immune response that mitigates inflammatory side effects."

In a commentary accompanying the paper, Anika Kumar, BA, and Nisha Acharya, MD, MS, of the University of California San Francisco, noted that it's important to consider the study findings in light of the risk of not getting vaccinated against COVID-19. On the ocular front alone, conjunctivitis is a well-known symptom in COVID-19, which is also linked to a long list of other ocular conditions.

For their study, the researchers tracked all 473,934 patients in South Korea who were vaccinated, had a history of uveitis, and did not develop COVID-19 during the study period using national healthcare databases. Among these patients, 51.3% were female, the mean age was 59 years, 74.3% had rheumatic diseases, and 45.7% had hypertension. Nearly 40% had four vaccine doses.

By type of vaccine, 36.3% of the individuals received the AstraZeneca ChAdOx1 shot, and 9.3% of those developed uveitis in the 30 days after the first dose. Those numbers were 51.2% and 9.9%, respectively, for Pfizer's vaccine; 10.3% and 10.4% for Moderna's shot; and 2% and 11.7% for the single-dose Johnson & Johnson vaccine.

The uveitis hazard ratios for the 30 days after the first dose versus the pre-vaccination period were:

The authors noted limitations such as a reliance on diagnostic codes and lack of information about uveitis severity or use of anti-inflammatory drugs that could decrease the risk of uveitis. The commentary authors also noted that the approach used "did not account for the healthy vaccinee bias, which refers to how individuals in better health are more likely to receive vaccinations."

Randy Dotinga is a freelance medical and science journalist based in San Diego.

Disclosures

The National Research Foundation of Korea, Ministry of Science and Information and Communication Technology, and Hanyang University funded the study.

The study authors reported no disclosures.

Acharya disclosed receiving advisory fees from Roche and nonfinancial support from AbbVie.

Primary Source

JAMA Ophthalmology

Source Reference: Kim J, et al "COVID-19 vaccineassociated uveitis in patients with a history of uveitis" JAMA Ophthalmol 2024; DOI: 10.1001/jamaophthalmol.2024.0973.

Secondary Source

JAMA Ophthalmology

Source Reference: Kumar A, Acharya NR "Real-world vaccine research and clinical practice" JAMA Ophthalmol 2024; DOI: 10.1001/jamaophthalmol.2024.1049.

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Uveitis History Linked to Recurrence After COVID Vaccination - Medpage Today

A 7 year-old child holds a sticker she received after getting the Pfizer-BioNTech Covid-19 vaccine ... [+] at the Child Health Associates office in Novi, Michigan on November 3, 2021. - An expert panel unanimously recommended Pfizer-BioNTech's Covid vaccine for five- to 11-year-olds on November 2, the penultimate step in the process that will allow injections in young children to begin this week in the United States. The Centers for Disease Control and Prevention (CDC), the top US public health agency, was expected to endorse that recommendation later in the day. (Photo by JEFF KOWALSKY / AFP) (Photo by JEFF KOWALSKY/AFP via Getty Images)

A new California-based study including the data of 3.9 million pediatric Covid-19 cases found that thanks to the states Covid-19 immunization program, there was a reduction of 26.3% in the number of cases among children aged 6 months to 15 years.

More specifically, the researchers estimated that there was a 37.1% reduction in Covid-19 cases among adolescents aged 12 to 15 years and a 23.7% reduction among children aged 5 to 11 years. Whereas Covid-19 vaccinations were associated with 24.4% fewer hospitalizations among children aged 6 months to 4.9 years.

Despite low vaccination coverage, pediatric COVID-19 immunization in California averted 376,085 reported cases and 273 hospitalizations among children aged 6 months to 15 years over approximately 4 to 7 months following vaccination availability, the researchers wrote in their study that was published in JAMA Network Open on April 23, 2024.

COVID-19 vaccines are safe for children. However, concerns over vaccine-related adverse events, lower vaccine effectiveness against illness in children, and perceptions of a milder disease course in children have resulted in high rates of parental vaccine hesitancy and resistance to pediatric vaccine mandates, the authors added. While California has among the highest rates of vaccination in the US, pediatric vaccination coverage lags that of adults substantially, with only 8.2% of children younger than 5 years and 37.8% of children aged 5 to 11 years fully vaccinated as of May 2023. Severe manifestations of COVID-19 are rare among children, but can occur.

Lead author Justin V. Remais of the University of California, Berkeley, and colleagues, analyzed data on 3,913,063 pediatric Covid-19 cases and 12,740 hospitalizations in California. They then studied how pediatric Covid-19 vaccinations were introduced to children belonging to different age groups and calculated statewide outcomes that could be associated with vaccinations preventing or reducing new pediatric cases and Covid-19-related hospitalizations between April 2020 and February 2023. The team obtained data from the California COVID-19 Reporting System.

Of the 3.9 million pediatric Covid-19 cases reported in California among children younger than 18 years, 1.2% cases were among infants younger than 6 months, 13.2% in children aged 6 to 4.9 years, and 38.6% in children aged 12 to 15 years. The highest percentage of cases (40.7%) was in children aged 5 to 11 years. Among pediatric Covid-19 hospitalized cases, adolescents aged 12 to 15 were the most hospitalized group (30.8%).

"On average, every increase of 10 vaccinations per 1000 children corresponded to a reduction of 0.9 cases per 1000 children for individuals aged 6 to 59 months, 3.5 cases per 1000 children for those aged 5 and 11 years, and 2 cases per 1000 children for adolescents aged 12 to 15 years," the researchers explained.

"Prior work has similarly reported a high impact of widespread administration of mRNA vaccines in adult populations. In California, COVID-19 vaccines were estimated to avert more than 1.5 million cases, 72,000 hospitalizations, and 19,000 deaths statewide during the first 10 months of vaccination (through October 16, 2021). In the US, each 10% increase in vaccination coverage among individuals aged 18 years or older at the county level was associated with an 8% reduction in mortality and a 7% reduction in incidence," the researchers added.

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A major bivalent COVID-19 vaccine induces production of neutralizing antibodies against the coronavirus that circulated at the start of the pandemic as well as subvariants of omicron, albeit less abundantly, according to a Brazilian study reported in the Journal of Medical Virology.

The study confirmed the vaccine's effectiveness and its importance to control of the disease, while also showing that more than three years after the first application of a COVID-19 vaccine in Brazil, the vaccination model should be similar to that adopted for influenza, with frequent adjustments to the formulation to prioritize more recent variants.

This was the first research project conducted to evaluate the immunity induced by the Pfizer-BioNTech bivalent vaccine (COMIRNATY Original/omicron BA.4-5) in a group of Brazilian subjects. The scientists investigated the antibody neutralization response against different variants of SARS-CoV-2 using serum samples from 93 healthy volunteers (31 males and 62 females) aged between 16 and 84 years and living in Barreiras, Bahia state.

Some of the volunteers had previously been given three or four doses of monovalent vaccines based only on the original strain of the virus first identified in Wuhan, China, such as Coronavac (Butantan Institute/Sinovac), Covishield (Oxford/AstraZeneca), or those of Janssen and Pfizer. Others were also given as an extra booster the bivalent vaccine containing components of the original strain as well as omicron subvariants BA.4 and BA.5.

Serum samples collected from the volunteers were submitted to antibody neutralization assays using different strains of SARS-CoV-2: the original strain from the start of the pandemic; omicron (BA.1), predominant in 2021; and omicron subvariants FE.1.2 and BQ.1.1, predominant in Brazil more recently.

The study showed that the bivalent vaccine administered as a booster reinforced the immune response and was more effective in neutralizing omicron and its subvariants than in volunteers given only four shots of a monovalent vaccine. However, its main focus was still the original strain that predominated at the start of the pandemic, and the resulting competition limited medium- to long-term immunity against more recent variants, which are now more important epidemiologically.

"This was expected because immune memory is based on cells capable of recognizing fractions of the virus and is reinforced by the number of contacts with the contaminant. The immune system will naturally react more against what it already knows, and the participants given the bivalent vaccine had already taken three or four doses of a monovalent vaccine," said Jaime Henrique Amorim, last author of the article. Amorim is a professor at the Federal University of Western Bahia (UFOB) and a visiting researcher at the University of So Paulo's Biomedical Sciences Institute (ICB-USP).

"Controlling a virus with the high transmission capacity of SARS-CoV-2 requires equally high vaccine coverage," said Lus Carlos de Souza Ferreira, head of ICB-USP's Vaccine Development Laboratory and a co-author of the article. "The results of the study show that bivalent vaccines are effective to achieve immunity against subvariants of omicron and that their administration has been fundamental to control novel variants."

According to the researchers, another conclusion to be drawn from the findings is that future planning of vaccination policy should take into account the fact that the immune response induced by existing vaccines is mainly to the original strain, which has ceased circulating since 2020, and vaccines should have their formulation adjusted so that they no longer include these components.

"Forthcoming doses should be designed to combat the variants that are circulating now, instead of those that have disappeared, so that immunity is updated and reinforced in accordance with the current epidemiological situation, as it already is in the case of influenza vaccines," Amorim said.

The joint first authors of the article are Milena Silva Souza and Jssica Pires Farias, researchers at UFOB. The other co-authors are affiliated with institutions in Brazil and the United States.

More information: Milena Silva Souza et al, Neutralizing antibody response after immunization with a COVID19 bivalent vaccine: Insights to the future, Journal of Medical Virology (2024). DOI: 10.1002/jmv.29416

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Study confirms effectiveness of bivalent COVID-19 vaccine - Medical Xpress

Oklahoma State Department of Health officials received all information necessary to safely administer the Pfizer COVID-19 vaccine to those ages 12 to 15.

Thursday, May 13th 2021, 5:13 pm

Oklahoma State Department of Health officials received all information necessary to safely administer the Pfizer COVID-19 vaccine to those ages 12 to 15.

We want our kids to get back to some normalcy as well, said Keith Reed, the state deputy commissioner of health.

The Centers of Disease Control and Prevention approved the Pfizer vaccine for children ages 12 and up.

Reed said that normalcy comes through vaccination, and vaccinating the young population is very similar to vaccinating adults.

The dosing is the same and that is what was studied and it remains the same recommendation, said Reed. Really, the only difference we are looking at in rolling it out to 12- to 15-year-olds is parental consent.

Which OSDH officials are working to make easier with an authorization form that will on the states vaccine portal that a parent can fill out if they cant make the childs appointment.

The child would need to be brought to the clinic with an adult that can attest to that consent and we can then take care of them, said Reed.

Parents also dont need to worry about separating routine vaccines from the COVID-19 vaccine after a new CDC recommendation.

So that means when you go to your doctor and you have that conversation with your doctor, you can get all your vaccines when you get there so you no longer have to wait that two weeks, which will expedite that process to get you back to a new normal moving forward," said Jolianne Stone, a state epidemiologist.

State health officials said they will not mandate kids to get vaccinated to go back to school.

We have no intent in requiring these vaccines, said Reed.

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Concerns about the common side effects of COVID-19 vaccines and their effectiveness are key to determining whether adults in Germany and the UK choose to get vaccinated against the virus, according to new research being presented at this year's ESCMID Global Congress (formerly ECCMID) in Barcelona, Spain (27-30 April).

In contrast, timing of COVID-19 and influenza vaccines and their type have little influence on people's willingness to get vaccinated in both countries.

The survey and discrete choice experiment involved 1,000 adults (500 from Germany and 500 from the UK, with 250 who were fully vaccinated and 250 who were willing to receive a COVID-19 vaccine but were not up to date on their vaccine in each country. These "vaccine-hesitant" people included 230/250 participants from the UK who were partially vaccinated, and 20 who were unvaccinated, respectively; and 226/250 from Germany who were partially vaccinated, and 24 who were unvaccinated, respectively. Fully vaccinated was defined as participants who believed they were fully vaccinated, having received the initial primary series and additional COVID-19 booster doses. Un/partially vaccinated consisted of those who did not receive all primary series or booster doses available to them.

The study by Professor Jeffrey Lazarus from the Barcelona Institute for Global Health in Spain and international colleagues offers important insights into the drivers of behavior that might boost COVID-19 vaccine uptake, especially in those who are vaccine-hesitant.

"With vaccination fatigue growing alongside vaccine disinformation and hesitancy, our research suggests that educating the public about the benefits of vaccines, with messaging focusing largely on vaccine safety and efficacy, will get more people to roll up their sleeves," says Professor Lazarus. "What's more, a better understanding of the importance of the perceptions of possible vaccine side effects will be essential to developing more appropriate messaging to reduce vaccine hesitancy."

Despite medical evidence of the importance and safety of COVID-19 vaccines, some of the public is hesitant and/or opposed to COVID-19 vaccination. Understanding the public's preferences for different COVID-19 vaccines and drivers of vaccine hesitancy is critical for implementing effective strategies to increase vaccine uptake.

To identify the most important factors when choosing to be vaccinated against COVID-19, the researchers first conducted an online survey of 1,000 adults in Germany (average age 47 years; 50% women) and the UK (average age 50 years; 49% women) between July and August 2023, to find out their preferences and experiences with SARS-CoV-2 infections and COVID-19 vaccines.

Participants were recruited using a specialist patient recruitment agency called Global Perspectives (GP). GP identified eligible participants through their panel databases, as well as through support groups, word of mouth, internet advertising, email blasts, and social media. Recruitment messages were used to support this process. The sample was stratified by country, vaccination status, and disease risk status.

Then the study went a step further to examine which of six attributes of a COVID-19 vaccine were the most important in making a decision to be vaccinated or notvaccine type (mRNA or protein), level of protection against COVID infection, level of protection against severe COVID-19 disease, chance of experiencing common side effects (i.e., reactogenicity events), risk of serious side effects (i.e., myocarditis/pericarditis), or joint and separate administration of influenza and COVID-19 vaccines.

This was done by giving each participant an illustrative choice task in which they viewed 11 unique vaccine profiles with a different combination of the six vaccine attributes. Participants were asked to choose between two different vaccine profiles at a time, and to pick which vaccine they would choose if there were only those two vaccine options, or they could select that they would prefer neither of the two options. Using this approach, researchers were able to understand the relative importance of each attribute to each participant.

In the baseline survey that asked participants how they felt about different attributes individually, 59% of German and 46% of UK respondents reported being moderately to extremely worried about COVID-19. More than three-quarters of those surveyed in both countries considered that being able to choose a COVID-19 vaccine to be moderately to extremely important. Additionally, around two-thirds of German and around half (45%) of UK participants reported that they were moderately to extremely worried about serious vaccine side effects.

The survey results differed substantially between the vaccinated and unvaccinated/partially vaccinated groups (based on ranking moderately to severely combined)while concerns about COVID-19 were higher in the vaccinated group, having a choice of vaccine, vaccine type and concerns of side effects were all rated higher in the unvaccinated/partially vaccinated groups, with the trend followed in both countries.

However, when these attributes were put together in a combined profile in the discrete choice experiment (i.e., when considered together with efficacy, side effects, timing, etc.), the results showed that the most important considerations when deciding whether to be vaccinated in respondents from both countries were vaccine effectiveness against COVID-19 infection and severe disease, followed by common side effects.

Interestingly, the relative importance of common side effects was nearly 10% higher among Germany participants than their UK counterparts, while the importance of serious side effects was less than half as important as common side effects in both countries.

The researchers' next steps involve examining the rate at which participants experience common side effects and the impact on individuals' activities.

The authors note several limitations, including that the study used self-reported/stated preferences that might not always match preferences/decision-making in real-world situations.

More information: Poster abstract P0344 at the ESCMID Global Congress (formerly ECCMID).

Provided by European Society of Clinical Microbiology and Infectious Diseases

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COVID-19 vaccine effectiveness and fewer common side effects most important factors in whether adults choose vaccination - Medical Xpress