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Introduction
OMIC Technologies and Vaccine Development
mRNA Vaccines and The Future of Vaccinology
Discussion
PICU ADMISSION RELATED TO SARS-COV-2 BY VACCINATION STATUS.
Abstract
Backgrounds:
COVID-19 mRNA vaccine immunogenicity and effectiveness is well established in children and adolescents. Summer and autumn 2021 in France were marked by both, waves of COVID-19 cases due to the Delta variant, and by the recommendation of the French Public Health Agency (FPHA) to vaccinate children from the age of 12 years. The aim of this national study was to estimate PICU admission related to SARS-CoV2 by vaccination status - PICURE Study
Methods
From September 1, 2021 to January 5, 2022, all pediatric patients diagnosed with MIS-C according to WHO criteria and/or a positive SARS-CoV2 PCR and admitted to the 41 French Pediatric Intensive Care Units (PICU) were prospectively included in this study. Data regarding age, gender, admission to PICU, vaccination status of patients between 12 and 18 years, hereafter referred to as adolescents, were recorded. To account for the increasing numbers of adolescents vaccinated over time including during the period, hazard ratio (HR) of unvaccinated versus vaccinated adolescents was estimated using Cox proportional hazards model.
Results:
Among the 233 admitted children, 94 (40%) were females. Median age was 77 months (IQR: 7 to 138 months). Admission was related to 71(31%) acute SARS CoV-2 infection, to 109(47%) MIS-C, and 52 (22%) incidental diagnosis of SARS-CoV-2. At least one comorbidity was identified in 73 (31%) cases. Among the 55 included adolescents, 43 were not vaccinated, 5 were vaccinated against COVID-19 and the information was missing for 7 patients. The HR for PICU admission related to SARS-CoV2 was 0.04 (95% CI 0.02 to 0.10, p<.001) after COVID-19 mRNA vaccine compared with unvaccinated adolescents.
Conclusions/Learning Points:
The data suggest that COVID-19 mRNA vaccine in adolescents was associated with a decrease of PICU admission related to SARS-CoV2.
MINIMIZING RISK OF MYOCARDITIS FOLLOWING COVID-19 VACCINATION THROUGH AGE PREFERENTIAL MRNA VACCINE BRAND CHOICE
Abstract
Backgrounds:
Myocarditis has been identified as an adverse event associated with COVID-19 mRNA vaccination, with some countries implementing age-related preferential recommendations using Comirnaty (Pfizer) over Spikevax (Moderna). Australia is one of few countries administering both mRNA vaccines in young adolescents aged 12-17 year-olds, with 87% two-dose coverage of this population achieved by end of 2021.
Methods
Reports of myocarditis following immunisation submitted to Victoria’s vaccine safety surveillance system, SAEFVIC, from 22 February to 31 December 2021 were compared as counts and rates by age-group, dose and mRNA vaccine brand administered. Cases were confirmed using Brighton Collaboration criteria, with those meeting level 1 and level 2 clinical confidence included in analyses. Rates per 100,000 doses administered were estimated according to the Australian Immunisation Registry (AIR), and 90% Poisson confidence intervals calculated.
Results:
185 reports of myocarditis (162 following Comirnaty, 23 post Spikevax) were reported following almost 7 million doses of mRNA vaccines administered (6,572,861 Comirnaty, 376,151 Spikevax), a rate of 2.7 per 100,000 doses. The myocarditis reporting rate following Spikevax was more than double that of Comirnaty (6.1 vs 2.5 per 100,000, p<0.001) and for each dose (Table 1). For both vaccines, the highest reporting rates were observed for 16-17 year-old males following dose 2 (29.0 per 100,000 mRNA second doses), with a reduction in the incidence of cases for the 12-15 and 18-24 age groups.
Conclusions/Learning Points:
Even in adolescents, the risk-benefit equation remains in favour of vaccination, especially given the risk of myocarditis following COVID-19 disease. Australia has the luxury of two available efficacious and safe mRNA vaccines. Mitigating the risk of this rare adverse event via preferential age recommendations in the highest risk adolescent age-group is an option.
SARS-COV-2 INFECTION IN CHILDREN YOUNGER THAN 5 YEARS ACCORDING TO PARENT’S VACCINATION STATUS
Abstract
Backgrounds:
COVID-19 mRNA vaccine immunogenicity and effectiveness are well established in adolescents and children over 5 years of age. To date, COVID-19 mRNA vaccines are not licensed for younger children. The aim of this study was to estimate incidence of SARS-CoV-2 infection in children younger than 5 by parents COVID-19 vaccination status from the start of the general vaccination for all adults.
Methods
In this French national prospective surveillance, 66 pediatric departments enrolled children hospitalized with SARS-CoV-2 infection and/or or Multisystem Inflammatory Syndrome in Children (MIS-C). All children younger than 5 years admitted from 12/05/21 to 21/12/2021 with available data regarding parent’s vaccination status were included. To account for the increasing numbers of vaccinated parents over time including during the period in which cases were measured, hazard ratio (HR) of unvaccinated versus vaccinated parents was estimated using Cox proportional hazards model.
Results:
From 12/05/2021 to 21/12/2021, the number of French adults, 18 to 59 years, fully vaccinated rose from 7% to 90%. Among the 214 enrolled children, 164 (77%) were younger than 5 years, and parent’s vaccination was available for 81 (38%). Overall, 61 children with available parent’s vaccination status were included with 33 (65%) younger than 3 months, 7 (14%) aged from 3 to <12 months, and 11 (22%) aged from 12 to <60 months. Among them, 10 had at least one parent vaccinated, and 51 had none of their parents vaccinated. The HR for COVID-19 infection in children younger than 5 years was 0.03 (95% CI 0.02 to 0.07, p<.001) with vaccinated parents compared with unvaccinated.
Conclusions/Learning Points:
Parent’s COVID-19 vaccination was associated with a dramatic decrease risk of admission related to COVID-19 infection in children younger than 5.