Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021

Havers, Fiona; Whitaker, Michael; Self, Julie L.; Chai, Shua J.; Kirley, Pam Daily; Alden, Nisha; Kawasaki, Breanna; Meek, James; Yousey‐Hindes, Kimberly; Anderson, Evan J.; Openo, Kyle P.; Weigel, Andrew; Teno, Kenzie; Monroe, Maya; Ryan, Patricia; Reeg, Libby; Kohrman, Alexander; Lynfield, Ruth; Como‐Sabetti, Kathryn; Poblete, Mayvilynne; McMullen, Chelsea; Muse, Alison; Spina, Nancy; Bennett, Nancy M.; Gaitán, Maria; Billing, Laurie M; Shiltz, Jess; Sutton, Melissa; Abdullah, Nasreen; Schaffner, William; Talbot, H. Keipp; Crossland, Melanie; George, Andrea; Patel, Kadam; Pham, Huong; Milucky, Jennifer; Anglin, Onika; Ujamaa, Dawud; Hall, Aron J.; Garg, Shikha; Taylor, Christopher A.; Rothrock, Gretchen; Reingold, Arthur; Tsegaye, Millen; McLafferty, Sarah; Maslar, Amber; Clogher, Paula; Misiorski, Adam; Parisi, Christina; Corrêa, Maria Lopes; Carter, Tessa; Lyons, Carol; Kim, Daewi; Brar, Gaggan; Fawcett, Emily; Roebling, Allison; Ward, Katelyn; Manning, Jana; Joseph, Asmith; Surell, Chandler; Pizarro, Daniel; Williams, Jeremiah; Ceaser, Rayna; Lehman, S Nusinoff; Eisenstein, Taylor; Chambers, Gracie; Kallas, Grayson; Russell, Lauren; Segler, Suzanne; Blythe, David; Brooks, Alicia; Bye, Erica; Danila, Richard; Cline, Cory; Ropp, Susan L.; Smelser, Chad; Sosin, Daniel M.; Torres, Salina; Angeles, Kathy; Christian, Melissa; Eisenberg, Nancy; Flores, Kristina; Habrun, Caroline A.; Hancock, Emily B.; Khanlian, Sarah A.; Novi, Meaghan; Phipps, Erin C; Rudin, Dominic; Salazar-Sanchez, Yadira; Segall, Judith M.; Davis, Sarah Shrum; Barney, Grant; Felsen, Christina B.; Bushey, Sophrena; Popham, Kevin; Cafferky, Virginia; Long, Christine; Kurtz, RaeAnne; West, Nicole; Owusu-Dommey, Ama; McArdle, Breanna; Youngers, Emily; Seeley, Kylie; Markus, Tiffanie; Carter, Amanda; Price, Andrea; Haraghey, Andrew; Swain, Ashley; Shaw, Caitlin; Buchta, I.; Ortega, Jake; McCullough, Laine; Chatelain, Ryan; Riedesel, Tyler

doi:10.15585/mmwr.mm7023e1

Cited by 91 publications

(94 citation statements)

References 10 publications

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“…Given the very low risk of severe disease or death due to COVID-19 in adolescents, it is necessary to consider that rare but potentially severe adverse events following COVID-19 vaccination could outweigh the risk-benefits of vaccinating adolescents, even in those with comorbidities, who also invariably recover uneventfully after developing COVID-19 28 . In a recent US study of adolescents hospitalised primarily for COVID-19 during the first 3 months of 2021, the weekly hospitalisation rate was only 0.6-2.1 per 100,000 adolescents- 70% had an underlying comorbidity and, while 31% were admitted to an intensive care unit, only 5% required mechanical ventilation and none died 15 . Similarly, unlike many of the earlier studies with serious methodological flaws that reported high rates of long COVID 18 , more recent studies with inclusion of appropriate control groups have indicated that the outcomes of COVID-19 in children are similar to other respiratory viral illnesses, with only a small minority reporting persistent symptoms beyond eight weeks 8 .…”

Section: Introductionmentioning

confidence: 98%

“…Likewise, most of the comorbidities defined within the priority risk-groups for vaccinating adults are also likely to apply to adolescents. Although their overall risk remains very low, adolescents can still develop severe COVID-19 and require hospitalisation, especially if they have underlying comorbidities 15 , and nearly all childhood deaths in high-income countries have occurred in adolescents rather than younger children 16 . Of those who recover from their acute infection, too, a small proportion may develop persistent and prolonged symptoms 8 , including Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), just like with other respiratory viruses 17 .…”

Section: Introductionmentioning

confidence: 99%

“…At the same time, however, it is not possible to identify children who might be at increased risk of PIMS-TS or long COVID and, therefore, vaccination cannot be targeted specifically towards children at risk for these complications. Whether vaccination should be recommended based on factors such as non-white ethnicity, obesity, or lower socio-economic status, which have all been associated with an increased risk of COVID-19 15 , is debatable and certainly challenging to implement as part of a national immunisation programme, as would recommending vaccination for younger children with comorbidities that have been associated with an increased risk of severe COVID-19 in adolescents and adult.…”

Section: Introductionmentioning

confidence: 99%

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Crossing the Rubicon: A fine line between waiting and vaccinating adolescents against COVID-19

Ladhani

2021

Journal of Infection

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Crossing the Rubicon: A fine line between waiting and vaccinating adolescents against COVID-19

Ladhani

2021

Journal of Infection

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“…2 Although Covid-19 illness is generally milder in children than adults, children can have severe disease leading to hospitalization. 3 , 4 Approximately one third of adolescents hospitalized because of Covid-19 were admitted to an intensive care unit, and 4.9% received invasive mechanical ventilation. 4 Multisystem inflammatory syndrome in children (MIS-C) is a serious but rare condition associated with Covid-19 that occurs in children who present with fever, rash, conjunctival injection, and gastrointestinal symptoms.…”

mentioning

confidence: 99%

“… 3 , 4 Approximately one third of adolescents hospitalized because of Covid-19 were admitted to an intensive care unit, and 4.9% received invasive mechanical ventilation. 4 Multisystem inflammatory syndrome in children (MIS-C) is a serious but rare condition associated with Covid-19 that occurs in children who present with fever, rash, conjunctival injection, and gastrointestinal symptoms. 5 The opening of schools may indirectly be associated with a 26% increase in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from children and teenagers.…”

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confidence: 99%

Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents

Ali¹,

et al. 2021

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Background The incidence of coronavirus disease 2019 (Covid-19) among adolescents between 12 and 17 years of age was approximately 900 per 100,000 population from April 1 through June 11, 2021. The safety, immunogenicity, and efficacy of the mRNA-1273 vaccine in adolescents are unknown. Methods In this ongoing phase 2–3, placebo-controlled trial, we randomly assigned healthy adolescents (12 to 17 years of age) in a 2:1 ratio to receive two injections of the mRNA-1273 vaccine (100 μg in each) or placebo, administered 28 days apart. The primary objectives were evaluation of the safety of mRNA-1273 in adolescents and the noninferiority of the immune response in adolescents as compared with that in young adults (18 to 25 years of age) in a phase 3 trial. Secondary objectives included the efficacy of mRNA-1273 in preventing Covid-19 or asymptomatic severe acute respiratory syndrome coronavirus 2 infection. Results A total of 3732 participants were randomly assigned to receive mRNA-1273 (2489 participants) or placebo (1243 participants). In the mRNA-1273 group, the most common solicited adverse reactions after the first or second injections were injection-site pain (in 93.1% and 92.4%, respectively), headache (in 44.6% and 70.2%, respectively), and fatigue (in 47.9% and 67.8%, respectively); in the placebo group, the most common solicited adverse reactions after the first or second injections were injection-site pain (in 34.8% or 30.3%, respectively), headache (in 38.5% and 30.2%, respectively), and fatigue (in 36.6% and 28.9%, respectively). No serious adverse events related to mRNA-1273 or placebo were noted. The geometric mean titer ratio of pseudovirus neutralizing antibody titers in adolescents relative to young adults was 1.08 (95% confidence interval [CI], 0.94 to 1.24), and the absolute difference in serologic response was 0.2 percentage points (95% CI, −1.8 to 2.4), which met the noninferiority criterion. No cases of Covid-19 with an onset of 14 days after the second injection were reported in the mRNA-1273 group, and four cases occurred in the placebo group. Conclusions The mRNA-1273 vaccine had an acceptable safety profile in adolescents. The immune response was similar to that in young adults, and the vaccine was efficacious in preventing Covid-19. (Funded by Moderna and the Biomedical Advanced Research and Development Authority; Teen COVE ClinicalTrials.gov number, NCT04649151 .)

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Myocarditis Occurring After Immunization With mRNA-Based COVID-19 Vaccines

2021

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Two reports in the current issue of JAMA Cardiology describe cases of acute myocarditis that occurred among persons who received the BNT162b2-mRNA (Pfizer-BioNTech) or mRNA-1273 (Moderna) messenger RNA (mRNA)-based COVID-19 vaccines authorized for use in the US. 1,2 During the clinical evaluations of these patients, alternative etiologies for myocarditis were not detected.The first report describes 4 cases of myocarditis with symptom onset 1 to 5 days after receipt of a second dose of mRNA-based COVID-19 vaccine (2 receiving the BNT162b2-mRNA vaccine and 2 receiving the mRNA-1273 vaccine) who were evaluated in a single tertiar y care medical center (Duke University Medical Center) that attempted to define its c atchment population. 1 Three cases occurred in men aged 23 to 36 years and the fourth in a 70-year-old woman; details about the medical history of the fourth patient were not provided, but she received coronary angiography during her evaluation and no atherosclerosis was found. All presented with severe acute chest pain, had abnormal electrocardiogram results, and had evidence of myocardial injury demonstrated by elevated troponin levels. Cardiac magnetic resonance imaging was performed in these 4 patients on days 3 through 5 after vaccine receipt, and the findings were consistent with acute myocarditis as defined by recent expert consensus guidelines. 3 The second, larger case report comes from the US Military Health System and describes 23 individuals with acute myocarditis who presented within 4 days after mRNA-based COVID-19 vaccination. 2 All patients were male, 22 of 23 were on active duty, and the median (range) age was 25 (20-51) years; 20 cases occurred after receipt of a second dose of an mRNAbased COVID-19 vaccine. Clinical presentations and laboratory findings were similar to those described in the smaller case series 1 ; 8 of 23 patients in this series received cardiac magnetic resonance imaging, and all 8 demonstrated findings again consistent with acute myocarditis. 2 A separate case report published by Marshall et al 4 provides additional context in a younger population. They report 7 US male adolescents aged 14 to 19 years who presented with myocarditis or myopericarditis within 4 days after receipt of a second dose of the BNT162b2-mRNA COVID-19 vaccine. 4 These adolescents were found to have elevated troponin levels, abnormal electrocardiogram results, and findings on cardiac magnetic resonance imaging consistent with acute myocarditis.

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Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021

Cited by 91 publications

References 10 publications

Crossing the Rubicon: A fine line between waiting and vaccinating adolescents against COVID-19

Crossing the Rubicon: A fine line between waiting and vaccinating adolescents against COVID-19

Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents

Myocarditis Occurring After Immunization With mRNA-Based COVID-19 Vaccines

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