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Laura D. Zambrano, PhD1; Margaret M. Newhams, MPH2; Regina M. Simeone, PhD1; Amanda B. Payne, PhD1; Michael Wu, MSc1; Amber O. Orzel-Lockwood, MPH2; Natasha B. Halasa, MD3; Jemima M. Calixte, MS2; Pia S. Pannaraj, MD4,5; Kanokporn Mongkolrattanothai, MD6; Julie A. Boom, MD7; Leila C. Sahni, PhD7; Satoshi Kamidani, MD, PhD8,9; Kathleen Chiotos, MD10; Melissa A. Cameron, MD11; Aline B. Maddux, MD12,13; Katherine Irby, MD14; Jennifer E. Schuster, MD15; Elizabeth H. Mack, MD16; Austin Biggs, MD16; Bria M. Coates, MD17,18; Kelly N. Michelson, MD17,18; Katherine E. Bline, MD19; Ryan A. Nofziger, MD20; Hillary Crandall, MD, PhD21,22; Charlotte V. Hobbs, MD23; Shira J. Gertz, MD24; Sabrina M. Heidemann, MD25; Tamara T. Bradford, MD26,27; Tracie C. Walker, MD28; Stephanie P. Schwartz, MD28; Mary Allen Staat, MD29; Samina S. Bhumbra, MD30; Janet R. Hume, MD31; Michele Kong, MD32; Melissa S. Stockwell, MD33,34,35; Thomas J. Connors, MD35,36; Melissa L. Cullimore, MD37; Heidi R. Flori, MD38; Emily R. Levy, MD39; Natalie Z. Cvijanovich, MD40; Matt S. Zinter, MD41; Mia Maamari, MD42; Cindy Bowens, MD42; Danielle M. Zerr, MD43; Judith A. Guzman-Cottrill, DO44; Ivan Gonzalez, MD45; Angela P. Campbell, MD1,*; Adrienne G. Randolph, MD2,46,47,*; Overcoming COVID-19 Investigators (View author affiliations)
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Summary
What is already known about this topic?
COVID-19 vaccination was shown to be effective against pediatric COVID-19 hospitalization before the emergence of the Omicron variant.
What is added by this report?
During December 19, 2021–October 29, 2023, receipt of ≥2 doses of an original monovalent mRNA COVID-19 vaccine was 52% effective against pediatric COVID-19 hospitalization and 57% effective against critical illness related to COVID-19, when the last dose was received within the 4 months preceding hospitalization, but protection decreased over time.
What are the implications for public health practice?
These findings support existing recommendations that children and adolescents aged 5–18 years remain up to date with COVID-19 vaccination given low vaccination coverage and waning effectiveness over time against COVID-19–related hospitalizations.
Abstract
Pediatric COVID-19 vaccination is effective in preventing COVID-19–related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021–October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19–related hospitalization and critical illness among U.S. children and adolescents aged 5–18 years, using a case-control design. Too few children and adolescents received bivalent or updated monovalent vaccines to separately evaluate their effectiveness. Most case-patients (persons with a positive SARS-CoV-2 test result) were unvaccinated, despite the high frequency of reported underlying conditions associated with severe COVID-19. VE of the original monovalent vaccine against COVID-19–related hospitalizations was 52% (95% CI = 33%–66%) when the most recent dose was administered <120 days before hospitalization and 19% (95% CI = 2%–32%) if the interval was 120–364 days. VE of the original monovalent vaccine against COVID-19–related hospitalization was 31% (95% CI = 18%–43%) if the last dose was received any time within the previous year. VE against critical COVID-19–related illness, defined as receipt of noninvasive or invasive mechanical ventilation, vasoactive infusions, extracorporeal membrane oxygenation, and illness resulting in death, was 57% (95% CI = 21%–76%) when the most recent dose was received <120 days before hospitalization, 25% (95% CI = –9% to 49%) if it was received 120–364 days before hospitalization, and 38% (95% CI = 15%–55%) if the last dose was received any time within the previous year. VE was similar after excluding children and adolescents with documented immunocompromising conditions. Because of the low frequency of children who received updated COVID-19 vaccines and waning effectiveness of original monovalent doses, these data support CDC recommendations that all children and adolescents receive updated COVID-19 vaccines to protect against severe COVID-19.
Introduction
mRNA COVID-19 vaccines have been recommended for U.S. children and adolescents aged ≥5 years since November 2021† (1). Two doses of Pfizer-BioNTech (BNT162b2) vaccine protected against COVID-19–related hospitalizations before and after emergence of the SARS-CoV-2 Delta variant (2,3). Throughout Omicron variant predominance (beginning in December 2021), estimated pediatric COVID-19 vaccine effectiveness (VE) of the original monovalent vaccine was lower (2,4). This analysis evaluated durability of effectiveness of original monovalent vaccines, which were only available before September 2022, against COVID-19–related hospitalization among children and adolescents aged 5–18 years during December 19, 2021–October 29, 2023, when the SARS-CoV-2 Omicron variant predominated.
Methods
Study Participants
VE of ≥2 original monovalent COVID-19 vaccine doses§ against COVID-19–related hospitalizations (December 19, 2021–October 29, 2023¶) across 34 Overcoming COVID-19 Network sites** was evaluated using a case-control design according to previously described methods (2,3). Case-patients were children and adolescents aged 5–18 years who were hospitalized for acute COVID-19 and received a positive SARS-CoV-2 test result.†† Control patients hospitalized for COVID-19–like illness were matched to case-patients by site, age group, and admission date, but received a negative SARS-CoV-2 test result.§§ Critical COVID-19–related illness was defined as receipt of noninvasive or invasive mechanical ventilation, vasoactive infusions, extracorporeal membrane oxygenation, and illness resulting in death. Children and adolescents were a priori excluded from the analysis if they 1) received their most recent dose ≥365 days before hospitalization, 2) had an incomplete COVID-19 mRNA primary vaccination series, 3) had a COVID-19 hospitalization within the preceding 60 days, 4) had an unverifiable vaccination status, or 5) received a positive influenza test result.¶¶ Given subsequent findings of low (3%) bivalent vaccination coverage and no reported receipt of updated (2023–2024 formula) monovalent doses, children who received updated formulations were post hoc excluded from VE analyses.
Statistical Analysis and Vaccine Effectiveness Estimation
Bivariate associations between sociodemographic factors and both case or control status and vaccination status among case- and control patients were assessed using chi-square tests for binomial or categorical variables or Wilcoxon rank-sum tests for continuous variables. VE was estimated among all hospitalized patients and among patients without documented immunocompromising conditions*** and calculated as (1 − adjusted odds ratio) × 100% by time between last vaccine dose and hospitalization and by age,††† using multivariable logistic regression,§§§ including hospital site as a repeated effect using generalized estimating equations, and adjusting for the presence of one or more underlying medical condition, age (in years), month and year of hospitalization, U.S. Census Bureau region of hospital, social vulnerability index (SVI; i.e., continuous ranging from 0–1, with higher scores indicating increased vulnerability), and race and ethnicity. SAS software (version 9.4; SAS Institute) was used to conduct all analyses. This activity was reviewed by CDC, deemed not research, and conducted consistent with applicable federal law and CDC policy.¶¶¶
Results
Characteristics of Enrolled Population
During December 19, 2021–October 29, 2023, a total of 3,348 patients were enrolled, including 1,551 (46%) case-patients and 1,797 (54%) control patients.**** Only 3% of case-patients and of control patients had received bivalent COVID-19 vaccine, and none reported receipt of an updated monovalent dose; therefore, VE for these specific formulations could not be estimated. Case- and control patients were similar in age, sex, hospital U.S. Census Bureau region,†††† presence of any underlying respiratory condition (e.g., asthma or chronic lung disease), and clinical support received (Table 1). The presence of at least one underlying health condition was more common among case-patients (82%) than among control patients (73%) (p-value <0.001). Critical illness occurred in 294 (19%) case-patients and 322 (18%) control patients (p = 0.43). Patients living in lower SVI areas were more frequently vaccinated (Table 2).
Vaccine Effectiveness
VE of original monovalent mRNA COVID-19 vaccines against COVID-19–related hospitalization was 52% (95% CI = 33–66) when the most recent vaccine dose was received 7–119 days before hospitalization, 19% (95% CI = 2–32) when it was received 120–364 days before hospitalization, and 31% (95% CI = 18–43) if the last dose was received any time within the previous year. VE against critical COVID-19–related illness was 57% (95% CI = 21–76) when the last dose was 7–119 days before hospitalization, not significant when it was received 120–364 days before hospitalization, and 38% (95% CI = 15–55) when the most recent dose was received at any point within the previous year. During the peak of pediatric COVID-19 hospitalizations (December 19, 2021–March 19, 2022), VE was 55% (95% CI = 38–67) against COVID-19–related hospitalizations when the last dose was received a median of 129 days before hospitalization (IQR = 47–198 days) and 79% (95% CI = 59–89) against critical COVID-19–related illness when the last dose was received a median of 132 days before hospitalization (IQR = 46–215) (Supplementary Table, https://stacks.cdc.gov/view/cdc/152988). Estimates were similar after excluding children and adolescents with documented immunocompromising conditions (Table 3).
Discussion
During the period of SARS-CoV-2 Omicron predominance, receipt of ≥2 original monovalent COVID-19 vaccine doses was associated with fewer COVID-19–related hospitalizations in children and adolescents aged 5–18 years; however, protection from original vaccines was not sustained over time, necessitating increased coverage with updated vaccines. Most children and adolescents in this analysis who were hospitalized with COVID-19 were unvaccinated, and few had received updated vaccine doses despite a high prevalence of underlying comorbidities associated with more severe disease. Vaccination frequency declined with increasing social vulnerability, highlighting disparities in vaccination coverage comparable with published estimates from at least one other U.S. public health surveillance network (5). This finding might be driven by factors including vaccine hesitancy or barriers to accessing vaccines among more vulnerable populations (5).
VE of original monovalent doses against COVID-19–related pediatric hospitalizations was lower than previous VE estimates reported by the Overcoming COVID-19 Network before Omicron emergence (2). However, VE estimates from this report among children and adolescents hospitalized during December 19, 2021–March 19, 2022, were similar to previously published VE estimates from this network among children and adolescents hospitalized within the same date range (2). In a separate U.S. study of children and adolescents aged 5–15 years, VE against symptomatic SARS-CoV-2 infections was reported to wane in the months after a second dose, with improved VE observed after receipt of a booster dose (4). Effectiveness of bivalent vaccine formulations against pediatric hospitalizations was not estimable in this investigation; however, two recent studies report that receipt of a bivalent vaccine was associated with higher VE against symptomatic pediatric infections (6) and COVID-19–related hospitalizations in immunocompetent adults (7).
Limitations
The findings in this report are subject to at least four limitations. First, SARS-CoV-2 infection-induced immunity was not assessed (8); increased seroprevalence after Omicron BA.1 emergence (9) might have influenced observed VE. Second, limited viral sequencing data prevented consideration of subvariant-attributed immune evasion (10). Third, limited coverage with bivalent vaccines and currently recommended updated monovalent vaccines precluded the estimation of VE of these formulations. Finally, previously healthy children and adolescents accounted for <20% of case-patients, limiting generalizability.
Implications for Public Health Practice
Among approximately 1,500 children and adolescents aged 5–18 years with a COVID-19–related hospitalization, including nearly 300 with critical illness, original monovalent COVID-19 vaccines were associated with fewer hospitalizations, particularly within the first 4 months after vaccination. To address low coverage of updated vaccines and waning effectiveness of the original monovalent vaccine, children and adolescents should remain up to date with COVID-19 vaccination, including the current CDC recommendation for all persons aged ≥6 months to receive vaccination with updated (2023–2024) COVID-19 vaccines (1).
Overcoming COVID-19 Investigators
Meghan Murdock; Heather Kelley; Candice Colston; Ronald C. Sanders; Laura Miron; Masson Yates; Ashlyn Madding; Alexa Dixon; Michael Henne; Kathleen Sun; Jazmin Baez Maidana; Natalie Triester; Jaycee Jumarang; Daniel Hakimi; Kennis-Grace Mrotek; Liria Muriscot Niell; Natasha Baig; Elizabeth Temte; Lexi Petruccelli; Heidi Sauceda; Nicolette Gomez; Mark D. Gonzalez; Caroline R. Ciric; Jong-Ha C. Choi; Elizabeth G. Taylor; Grace X. Li; Nadine Baida; Heather E. Price; Mary Stumpf; Suden Kucukak; Eve Listerud; Maya Clark; Rylie Dittrich; Allison Zaff; Patrick Moran; Jessica C. Peterson; Noelle M. Drapeau; Lora Martin; Lacy Malloch; Maygan Martin; Cameron Sanders; Kayla Patterson; Melissa Sullivan; Shannon Pruitt; Elizabeth Ricciardi; Celibell Y. Vargas; Raul A. Silverio Francisco; Ana Valdez de Romero; Sheila Joshi; Merry Tomcany; Nicole Twinem; Chelsea C. Rohlfs; Amber Wolfe; Rebecca Douglas; Kathlyn Phengchomphet; Jenny Bush; Alanah Mckelvey; Mickael Boustany; Fatima A. Mohammed; Laura S. Stewart; Kailee Fernandez; Leenah Abojaib; Molly J. Kyles; Amanda Adler
1Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; 2Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts; 3Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; 4Division of Infectious Diseases, Children’s Hospital Los Angeles, Los Angeles, California; 5Department of Pediatrics, University of California, San Diego, San Diego, California; 6Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California; 7Department of Pediatrics, Baylor College of Medicine, Immunization Project, Texas Children’s Hospital, Houston, Texas; 8The Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Atlanta, Georgia; 9Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; 10Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; 11Division of Pediatric Hospital Medicine, UC San Diego-Rady Children’s Hospital, San Diego, California; 12Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado; 13Children’s Hospital Colorado, Aurora, Colorado; 14Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, Arkansas; 15Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri; 16Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina; 17Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; 18Division of Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois; 19Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital, Columbus, Ohio; 20Division of Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio; 21Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah; 22Primary Children’s Hospital, Salt Lake City, Utah; 23Department of Pediatrics, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi; 24Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey; 25Division of Pediatric Critical Care Medicine, Children’s Hospital of Michigan, Central Michigan University, Detroit, Michigan; 26Department of Pediatrics, Division of Cardiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana; 27Children’s Hospital of New Orleans, New Orleans, Louisiana; 28Department of Pediatrics, University of North Carolina at Chapel Hill Children’s Hospital, Chapel Hill, North Carolina; 29Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; 30Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; 31Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota; 32Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; 33Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York, New York; 34Department of Population and Family Health, Mailman School of Public Health Columbia University, New York, New York; 35New York-Presbyterian Morgan Stanley Children’s Hospital; New York, New York; 36Division of Critical Care and Hospital Medicine, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; 37Division of Pediatric Critical Care, Department of Pediatrics, Children’s Nebraska, Omaha, Nebraska; 38Division of Pediatric Critical Care Medicine, Department of Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, Michigan; 39Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; 40Division of Critical Care Medicine, UCSF Benioff Children’s Hospital, Oakland, California; 41Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California San Francisco, San Francisco, California; 42Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children’s Medical Center Dallas, Texas; 43Division of Pediatric Infectious Diseases, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington; 44Department of Pediatrics, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon; 45Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida; 46Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts; 47Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
References
- Regan JJ, Moulia DL, Link-Gelles R, et al. Use of updated COVID-19 vaccines 2023–2024 formula for persons aged ≥6 months: recommendations of the Advisory Committee on Immunization Practices—United States, September 2023. MMWR Morb Mortal Wkly Rep 2023;72:1140–6. https://doi.org/10.15585/mmwr.mm7242e1 PMID:37856366
- Price AM, Olson SM, Newhams MM, et al.; Overcoming Covid-19 Investigators. BNT162b2 Protection against the Omicron variant in children and adolescents. N Engl J Med 2022;386:1899–909. https://doi.org/10.1056/NEJMoa2202826 PMID:35353976
- Olson SM, Newhams MM, Halasa NB, et al.; Overcoming Covid-19 Investigators. Effectiveness of BNT162b2 vaccine against critical Covid-19 in adolescents. N Engl J Med 2022;386:713–23. https://doi.org/10.1056/NEJMoa2117995 PMID:35021004
- Fleming-Dutra KE, Britton A, Shang N, et al. Association of prior BNT162b2 COVID-19 vaccination with symptomatic SARS-CoV-2 infection in children and adolescents during Omicron predominance. JAMA 2022;327:2210–9. https://doi.org/10.1001/jama.2022.7493 PMID:35560036
- Dalton AF, Weber ZA, Allen KS, et al. Relationships between social vulnerability and coronavirus disease 2019 vaccination coverage and vaccine effectiveness. Clin Infect Dis 2023;76:1615–25. https://doi.org/10.1093/cid/ciad003 PMID:36611252
- Feldstein LR, Britton A, Grant L, et al. Effectiveness of bivalent mRNA COVID-19 vaccines in preventing SARS-CoV-2 infection in children and adolescents aged 5 to 17 years. JAMA 2024;331:408–16. https://doi.org/10.1001/jama.2023.27022 PMID:38319331
- Link-Gelles R, Weber ZA, Reese SE, et al. Estimates of bivalent mRNA vaccine durability in preventing COVID-19–associated hospitalization and critical illness among adults with and without immunocompromising conditions—VISION network, September 2022–April 2023. MMWR Morb Mortal Wkly Rep 2023;72:579–88. https://doi.org/10.15585/mmwr.mm7221a3 PMID:37227984
- Kahn R, Schrag SJ, Verani JR, Lipsitch M. Identifying and alleviating bias due to differential depletion of susceptible people in postmarketing evaluations of COVID-19 vaccines. Am J Epidemiol 2022;191:800–11. https://doi.org/10.1093/aje/kwac015 PMID:35081612
- Marks KJ, Whitaker M, Anglin O, et al.; COVID-NET Surveillance Team. Hospitalizations of children and adolescents with laboratory-confirmed COVID-19—COVID-NET, 14 states, July 2021–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:271–8. https://doi.org/10.15585/mmwr.mm7107e4 PMID:35176003
- Cao Y, Yisimayi A, Jian F, et al. BA.2.12.1, BA.4 and BA.5 escape antibodies elicited by Omicron infection. Nature 2022;608:593–602. https://doi.org/10.1038/s41586-022-04980-y PMID:35714668
Characteristic (no. with known information) | No. (%) | p-value* | |
---|---|---|---|
Case-patients (n = 1,551) |
Control patients (n = 1,797) |
||
Age group, yrs | |||
5–11 | 853 (55) | 1,042 (58) | 0.08 |
12–18 | 698 (45) | 755 (42) | |
Median age, yrs, IQR | 11.3 (7.7–15.1) | 10.5 (7.3–14.7) | 0.01 |
Female sex | 712 (46) | 857 (48) | 0.59 |
Race and ethnicity | |||
Asian, non-Hispanic | 71 (5) | 41 (2) | <0.001 |
Black or African American, non-Hispanic | 403 (26) | 438 (24) | |
White, non-Hispanic | 571 (37) | 675 (38) | |
Hispanic or Latino, any race | 406 (26) | 485 (27) | |
Multiple or other races, non-Hispanic | 47 (3) | 65 (4) | |
Unknown | 53 (3) | 93 (5) | |
Median social vulnerability index, IQR (3,345)† | 0.58 (0.37–0.78) | 0.57 (0.33–0.77) | 0.10 |
U.S. Census Bureau region§ | |||
Northeast | 253 (16) | 272 (15) | 0.35 |
Midwest | 364 (23) | 466 (26) | |
South | 565 (36) | 628 (35) | |
West | 369 (24) | 431 (24) | |
Circulating Omicron subvariant during hospitalization¶ | |||
Omicron BA.1/BA.1.1 | 638 (41) | 776 (43) | 0.23 |
Omicron BA.2/BA.4/BA.5/XBB.1.5/XBB.1.6 | 913 (59) | 1021 (57) | |
Underlying health conditions | |||
None | 275 (18) | 489 (27) | <0.001 |
One or more | 1,276 (82) | 1,308 (73) | |
Respiratory, including asthma | 619 (40) | 744 (41) | 0.38 |
Cardiac | 235 (15) | 172 (10) | <0.001 |
Neurologic or neuromuscular | 524 (34) | 352 (20) | <0.001 |
Immunocompromising conditions** | 273 (18) | 165 (9) | <0.001 |
Endocrine, including diabetes | 195 (13) | 181 (10) | 0.02 |
Multiple | 526 (34) | 382 (21) | <0.001 |
COVID-19 vaccination status | |||
Unvaccinated | 1,137 (73) | 1,210 (67) | <0.001 |
Original monovalent dose, 7–119 days before hospitalization†† | 94 (6) | 207 (12) | |
Original monovalent dose, 120−364 days before hospitalization | 277 (18) | 322 (18) | |
Bivalent dose§§ | 43 (3) | 58 (3) | |
Clinical course | |||
ICU admission (3,347) | 404 (26) | 500 (28) | 0.25 |
Critical illness (3,343)¶¶ | 294 (19) | 322 (18) | 0.43 |
Invasive mechanical ventilation | 107 (7) | 129 (7) | 0.75 |
Noninvasive mechanical ventilation (BiPAP or CPAP) (3,347) | 222 (14) | 228 (13) | 0.17 |
Vasoactive infusion | 83 (5) | 86 (5) | 0.46 |
Extracorporeal membrane oxygenation | 9 (1) | 10 (1) | 0.93 |
Died (3,343) | 10 (1) | 9 (1) | 0.58 |
Median hospital days (IQR) (3,340) | 4 (2–7) | 4 (3–7) | 0.79 |
Characteristic (no. with known information if less than total N) | COVID-19 vaccination status, no. (%) | |||||
---|---|---|---|---|---|---|
Case-patients (n = 1,508)* | Control patients (n = 1,739)† | |||||
Unvaccinated (n = 1,137) |
Original monovalent dose, 7–364 d§ (n = 371) |
p-value¶ | Unvaccinated (n = 1,210) |
Original monovalent dose, 7–364 d§ (n = 529) |
p-value¶ | |
Median age, yrs (IQR) | 10.1 (7.2–14.0) | 14.4 (11.0–16.6) | <0.001 | 9.3 (6.9–13.7) | 13.3 (9.0–15.9) | <0.001 |
Age group, yrs | ||||||
5–11 | 718 (86) | 114 (14) | <0.001 | 806 (80) | 207 (20) | <0.001 |
12–18 | 419 (62) | 257 (38) | 404 (56) | 322 (44) | ||
Sex (3,246)** | ||||||
Female | 508 (74) | 183 (26) | 0.26 | 569 (68) | 263 (32) | 0.30 |
Male | 628 (77) | 188 (23) | 641 (71) | 266 (29) | ||
Race and ethnicity | ||||||
Asian, non-Hispanic | 41 (59) | 28 (41) | 0.008 | 16 (40) | 24 (60) | <0.001 |
Black or African American, non-Hispanic | 312 (79) | 83 (21) | 327 (77) | 97 (23) | ||
White, non-Hispanic | 409 (73) | 149 (27) | 447 (69) | 206 (32) | ||
Hispanic or Latino, any race | 301 (77) | 89 (23) | 310 (66) | 163 (34) | ||
Multiple or other races, non-Hispanic | 37 (82) | 8 (18) | 50 (81) | 12 (19) | ||
Unknown | 37 (73) | 14 (27) | 60 (69) | 27 (31) | ||
Median SVI (IQR) (3,244)†† | 0.60 (0.38–0.79) | 0.55 (0.32–0.76) | 0.01 | 0.59 (0.38–0.78) | 0.52 (0.26–0.76) | <0.001 |
U.S. Census Bureau region§§ | ||||||
Northeast | 154 (63) | 91 (37) | <0.001 | 143 (55) | 118 (45) | <0.001 |
Midwest | 289 (82) | 65 (18) | 330 (73) | 121 (27) | ||
South | 457 (82) | 99 (18) | 476 (78) | 135 (22) | ||
West | 237 (67) | 116 (33) | 261 (63) | 155 (37) | ||
Underlying health conditions¶¶ | ||||||
None | 214 (78) | 59 (22) | 0.20 | 342 (71) | 138 (29) | 0.35 |
One or more underlying condition | 923 (75) | 312 (25) | 868 (69) | 391 (31) | ||
Respiratory, including asthma | 445 (75) | 147 (25) | 0.87 | 505 (71) | 207 (29) | 0.31 |
Cardiac | 156 (69) | 71 (31) | 0.01 | 103 (62) | 63 (38) | 0.03 |
Neurologic or neuromuscular | 379 (75) | 127 (25) | 0.75 | 207 (63) | 122 (37) | 0.004 |
Immunocompromising conditions*** | 188 (71) | 76 (29) | 0.08 | 99 (62) | 61 (38) | 0.03 |
Endocrine, including diabetes | 131 (71) | 54 (29) | 0.12 | 115 (66) | 59 (34) | 0.29 |
Obesity | 140 (75) | 47 (25) | 0.86 | 114 (67) | 56 (33) | 0.45 |
Multiple | 355 (71) | 145 (29) | 0.005 | 231 (64) | 130 (36) | 0.01 |
Subgroup* | No. vaccinated/Total no. (%) | Interval from last vaccine dose to hospitalization, days, median (IQR) | VE against COVID-19 hospitalization, % (95% CI)† | |
---|---|---|---|---|
Case-patients | Control patients | |||
Hospitalizations among all patients | ||||
Any original monovalent dose | 371/1,508 (25) | 529/1,739 (30) | 169 (86 to 237) | 31 (18 to 43) |
7–119 days since last dose | 94/1,231 (8) | 207/1,417 (15) | 53 (32 to 86) | 52 (33 to 66) |
120–364 days since last dose | 277/1,414 (20) | 322/1,532 (21) | 212 (169 to 275) | 19 (2 to 32) |
Any dose, ages 5–11 yrs | 114/832 (14) | 207/1,013 (20) | 120 (46 to 224) | 40 (22 to 53) |
Any dose, ages 12–18 yrs | 257/676 (38) | 322/726 (44) | 181 (121 to 245) | 28 (6 to 44) |
Hospitalizations among patients without documented immunocompromising conditions§,¶ | ||||
Any original monovalent dose | 295/1,244 (24) | 468/1,579 (30) | 173 (88 to 243) | 34 (22 to 44) |
7–119 days since last dose | 62/1,011 (6) | 183/1,294 (14) | 53 (33 to 84) | 61 (40 to 75) |
120–364 days since last dose | 233/1,182 (20) | 285/1,396 (20) | 213 (171 to 278) | 17 (0 to 31) |
Ages 5–11 yrs | 84/684 (12) | 191/933 (20) | 120 (46 to 222) | 48 (29 to 61) |
Ages 12–18 yrs | 211/560 (38) | 277/646 (43) | 187 (129 to 252) | 23 (2 to 40)** |
Critical illness†† among all patients | ||||
Any original monovalent dose | 65/278 (23) | 91/307 (30) | 175 (79 to 253) | 38 (15 to 55) |
7–119 days since last dose | 16/229 (7) | 35/251 (14) | 51 (36 to 74) | 57 (21 to 76)§§ |
120–364 days since last dose | 49/262 (19) | 56/272 (21) | 218 (172 to 287) | 25 (–9 to 49)§§ |
Critical illness†† among patients without documented immunocompromising conditions§ | ||||
Any original monovalent dose | 59/253 (23) | 85/288 (30) | 171 (73 to 247) | 36 (17 to 50) |
7–119 days since last dose | 13/207 (6) | 34/237 (14) | 51 (36 to 71) | 63 (35 to 79)** |
120–364 days since last dose | 46/240 (19) | 51/254 (20) | 218 (170 to 287) | 16 (–20 to 41)**,§§ |
Suggested citation for this article: Zambrano LD, Newhams MM, Simeone RM, et al. Durability of Original Monovalent mRNA Vaccine Effectiveness Against COVID-19 Omicron–Associated Hospitalization in Children and Adolescents — United States, 2021–2023. MMWR Morb Mortal Wkly Rep 2024;73:330–338. DOI: http://dx.doi.org/10.15585/mmwr.mm7315a2.
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