Hesitancy, reactogenicity and immunogenicity of the mRNA and whole-virus inactivated Covid-19 vaccines in pediatric neuromuscular diseases

Abstract

The mRNA-based BNT162b2 and inactivated whole-virus CoronaVac are two widely used COVID-19 vaccines that confer immune protection to healthy individuals. However, hesitancy toward COVID-19 vaccination appeared to be common for patients with neuromuscular diseases (NMDs) due to the paucity of data on the safety and efficacy in this high-risk patient population. Therefore, we examined the underlying factors associated with vaccine hesitancy across time for NMDs and assessed the reactogenicity and immunogenicity of these two vaccines. Patients aged 8–18 years with no cognitive delay were invited to complete surveys in January and April 2022. Patients aged 2–21 years were enrolled for COVID-19 vaccination between June 2021 and April 2022, and they recorded adverse reactions (ARs) for 7 days after vaccination. Peripheral blood was obtained before and within 49 days after vaccination to measure serological antibody responses compared to healthy children and adolescents. Forty-one patients completed vaccine hesitancy surveys for both timepoints, while 22 joined the reactogenicity and immunogenicity arm of the study. Two or more family members vaccinated against COVID-19 was positively associated with intention of vaccination (odds ratio 11.7, 95% CI 1.81–75.1, p = .010). Pain at the injection site, fatigue, and myalgia were the commonest ARs. Most ARs were mild (75.5%, n = 71/94). All 19 patients seroconverted against the wildtype SARS-CoV-2 after two doses of either vaccine, similar to 280 healthy counterparts. There was lower neutralization against the Omicron BA.1 variant. BNT162b2 and CoronaVac were safe and immunogenic for patients with NMDs, even in those on low-dose corticosteroids.

Immunogenicity of coronavirus disease 2019 vaccines in children: A review with ChatGPT

“…17,19,80 There are minimal data on optimal immunization for those with immunocompromized conditions and comorbidities, which are absolutely necessary for protecting these vulnerable, high-risk patients. [81][82][83][84] As primary vaccination rates have peaked with satisfactory coverage in most geographical regions by this time, newer generations of polyvalent vaccines must be thoroughly investigated in the future, especially in unvaccinated infants who have not been exposed to the virus on which there is currently minimal research. 1,[49][50][51][52]85 This will be essential to inform policymakers on their decision to incorporate COVID-19 vaccines in national immunization programs.…”

Superior antibody and membrane protein-specific T-cell responses to CoronaVac by intradermal versus intramuscular routes in adolescents

“…This aligns with the World Health Organization’s most recent recommendation on 28 March 2023 that this high priority group should receive an additional COVID-19 booster vaccination 6–12 months after the last dose. Many older adults, young children or those with debilitating chronic diseases are hesitant towards receiving novel monovalent or bivalent mRNA vaccines due to systemic adverse effects, risks of myocarditis and potentially higher association with ischaemic stroke [ 14 , 50 – 52 ]. As this study demonstrated more frequent but tolerable local adverse effects only, it is possible that these individuals would be more accepting of ID inactivated vaccines.…”