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Master of Public Health

BNT162b2 mRNA Vaccination Against COVID-19 is Associated with Decreased Likelihood of Multisystem Inflammatory Syndrome in U.S. Children Ages 5-18 Years

AUTHORS

Zambrano LD , Newhams MM , Olson SM , Halasa NB , Price AM , Orzel AO , Young CC , Boom JA , Sahni LC , Maddux AB , Bline KE , Kamidani S , Tarquinio KM , Chiotos K , Schuster JE , Cullimore ML , Heidemann SM , Hobbs CV , Nofziger RA , Pannaraj PS , Cameron MA , Walker TC , Schwartz SP , Michelson KN , Coates BM , Flori HR , Mack EH , Smallcomb L , Gertz SJ , Bhumbra SS , Bradford TT , Levy ER , Kong M , Irby K , Cvijanovich NZ , Zinter MS , Bowens C , Crandall H , Hume JR , Patel MM , Campbell AP , Randolph AG , , . Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2022 8 4; ().

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 July 1, 2021 to April 7, 2022, we compared the odds of being fully vaccinated (two 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 (aOR, 0.16 95% CI, 0.10-0.26), including among children ages 5-11 years (aOR, 0.22 95% CI, 0.10-0.52), ages 12-18 years (aOR, 0.10 95% CI, 0.05-0.19), and during the Delta (aOR, 0.06 95% CI, 0.02-0.15) and Omicron (aOR, 0.22 95% CI, 0.11-0.42) variant-predominant periods. This association persisted beyond 120 days after the second dose (aOR, 0.08, 95% CI, 0.03-0.22) in 12-18 year-olds. Among all MIS-C case-patients, 187 (62%) required intensive care unit admission and 280 (92%) vaccine-eligible patients were unvaccinated.

CONCLUSIONS: Vaccination with two 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.

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