BNT162b2 mRNA Vaccination Against Coronavirus Disease 2019 is Associated With a Decreased Likelihood of Multisystem Inflammatory Syndrome in Children Aged 5–18 Years—United States, July 2021 – April 2022

Author:

Zambrano Laura D1ORCID,Newhams Margaret M2,Olson Samantha M1ORCID,Halasa Natasha B3,Price Ashley M1,Orzel Amber O2,Young Cameron C2,Boom Julie A4,Sahni Leila C4,Maddux Aline B5,Bline Katherine E6,Kamidani Satoshi7ORCID,Tarquinio Keiko M8,Chiotos Kathleen9,Schuster Jennifer E10,Cullimore Melissa L11,Heidemann Sabrina M12,Hobbs Charlotte V13,Nofziger Ryan A14,Pannaraj Pia S15,Cameron Melissa A16,Walker Tracie C17,Schwartz Stephanie P17,Michelson Kelly N18,Coates Bria M18,Flori Heidi R19,Mack Elizabeth H20,Smallcomb Laura21,Gertz Shira J22,Bhumbra Samina S23,Bradford Tamara T24,Levy Emily R25,Kong Michele26,Irby Katherine27,Cvijanovich Natalie Z28,Zinter Matt S29,Bowens Cindy30,Crandall Hillary31,Hume Janet R32,Patel Manish M1,Campbell Angela P1,Randolph Adrienne G233,Kong Michele,Murdock Meghan,Gaspers Mary Glas,Typpo Katri V,Kelley Connor P,Irby Katherine,Sanders Ronald C,Yates Masson,Smith Chelsea,Cameron Melissa A,Crane Katheryn,Cvijanovich Natalie Z,Lionetti Geraldina,Murcia-Montoya Juliana,Zinter Matt S,Villarreal-Chico Denise,Pannaraj Pia S,Skura Adam L,Hakimi Daniel,Peralta Harvey,Sea Yea Ji,Mrotek Kennis-Grace,Maddux Aline B,Lockwood Justin M,Port Emily,Carson Imogene,Chatani Brandon M,Kamidani Satoshi,Tarquinio Keiko M,Hussaini Laila,Baida Nadine,Michelson Kelly N,Coates Bria M,Rhodes Simone T,Khan Hassan A,Bhumbra Samina S,Rowan Courtney M,Stumpf Mary,Bradford Tamara T,Johnston Marla S,Randolph Adrienne G,Newhams Margaret M,Kucukak Suden,Orzel Amber O,Young Cameron C,Chen Sabrina R,Boutselis Benjamin J,McCadden Timothy P,Stewart Kasey R,Weller Edie,Berbert Laura,He Jie,Heidemann Sabrina M,Flori Heidi R,Moran Patrick,Hume Janet R,Bruno Ellen R,Goertzen Lexie A,Levy Emily R,Behl Supriya,Drapeau Noelle M,Hobbs Charlotte V,Martin Lora,Malloch Lacy,Harrison Virginia Austin,Sanders Cameron,Patterson Kayla,Chikere Chidinma A,Schuster Jennifer E,Kietzman Abigail,Sullivan Melissa,Cullimore Melissa L,Rinehart Valerie H,Hoody Lauren A,Gertz Shira J,Schwartz Stephanie P,Walker Tracie C,Bennett Paris C,Nofziger Ryan A,Twinem Nicole A,Tomcany Merry L,Staat Mary Allen,Rohlfs Chelsea C,Bline Katherine,Wolfe Amber,Chiotos Kathleen,Douglas Rebecca L,Phengchomphet Kathlyn,Mack Elizabeth H,Bickford Megan M,Wakefield Lauren E,Smallcomb Laura,Halasa Natasha B,Hayek Haya,Romero Yesenia,Boom Julie A,Sahni Leila C,Oates Jennifer N,Maamari Mia,Bowens Cindy,Crandall Hillary,Olson M,Price Ashley M,Zambrano Laura D,Campbell Angela P,Patel Manish M,

Affiliation:

1. CDC COVID-19 Response Team , Atlanta, Georgia , USA

2. Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital , Boston, Massachusetts , USA

3. Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center , Nashville, Tennessee , USA

4. Department of Pediatrics, Baylor College of Medicine, Immunization Project, Texas Children’s Hospital , Houston, Texas , USA

5. Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado , USA

6. Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital , Columbus, Ohio , USA

7. The Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia , USA

8. Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta , Atlanta, Georgia , USA

9. Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia , Philadelphia, Pennsylvania , USA

10. Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City , Kansas City, Missouri , USA

11. Division of Pediatric Critical Care, Department of Pediatrics, Children’s Hospital and Medical Center , Omaha, Nebraska , USA

12. Division of Pediatric Critical Care Medicine, Children’s Hospital of Michigan, Central Michigan University , Detroit, Michigan , USA

13. Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center , Jackson, Mississippi , USA

14. Division of Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital , Akron, Ohio , USA

15. Division of Infectious Diseases, Children’s Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California , Los Angeles, California , USA

16. Division of Pediatric Hospital Medicine, UC San Diego–Rady Children’s Hospital , San Diego, California , USA

17. Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital , Chapel Hill, North Carolina , USA

18. Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois , USA

19. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children’s Hospital and University of Michigan , Ann Arbor, Michigan , USA

20. Division of Pediatric Critical Care Medicine, Medical University of South Carolina , Charleston, South Carolina , USA

21. Department of Pediatrics, Medical University of South Carolina , Charleston, South Carolina , USA

22. Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center , Livingston, New Jersey , USA

23. The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine , Indianapolis, Indiana , USA

24. Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children’s Hospital of New Orleans , New Orleans, Louisiana , USA

25. Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, Minnesota , USA

26. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham , Birmingham, Alabama , USA

27. Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital , Little Rock, Arkansas , USA

28. Division of Critical Care Medicine, UCSF Benioff Children's Hospital, Oakland, California , USA

29. Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, Department of Pediatrics, University of California, San Francisco , San Francisco, California , USA

30. Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children’s Medical Center, Dallas, Texas , USA

31. Division of Pediatric Critical Care, Department of Pediatrics, University of Utah , Salt Lake City, Utah , USA

32. Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital , Minneapolis, Minnesota , USA

33. Departments of Anesthesia and Pediatrics, Harvard Medical School , Boston, Massachusetts , USA

Abstract

Abstract Background Multisystem inflammatory syndrome in children (MIS-C), linked to antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with considerable morbidity. Prevention of SARS-CoV-2 infection or coronavirus disease 2019 (COVID-19) by vaccination might also decrease MIS-C likelihood. Methods In a multicenter, case-control, public health investigation of children ages 5–18 years hospitalized from 1 July 2021 to 7 April 2022, we compared the odds of being fully vaccinated (2 doses of BNT162b2 vaccine ≥28 days before hospital admission) between MIS-C case-patients and hospital-based controls who tested negative for SARS-CoV-2. These associations were examined by age group, timing of vaccination, and periods of Delta and Omicron variant predominance using multivariable logistic regression. Results We compared 304 MIS-C case-patients (280 [92%] unvaccinated) with 502 controls (346 [69%] unvaccinated). MIS-C was associated with decreased likelihood of vaccination (adjusted OR [aOR]: .16; 95% CI: .10–.26), including among children ages 5–11 years (aOR: .22; 95% CI: .10–.52), ages 12–18 years (aOR: .10; 95% CI: .05–.19), and during the Delta (aOR: .06; 95% CI: .02–.15) and Omicron (aOR: .22; 95% CI: .11–.42) variant-predominant periods. This association persisted beyond 120 days after the second dose (aOR: .08; 95% CI: .03–.22) in 12–18-year-olds. Among all MIS-C case-patients, 187 (62%) required intensive care unit admission and 280 (92%) vaccine-eligible case-patients were unvaccinated. Conclusions Vaccination with 2 doses of BNT162b2 is associated with reduced likelihood of MIS-C in children ages 5–18 years. Most vaccine-eligible hospitalized patients with MIS-C were unvaccinated.

Funder

Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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