Risk of adverse events after covid-19 in Danish children and adolescents and effectiveness of BNT162b2 in adolescents: cohort study

Abstract

Objectives To assess the risk of acute and post-acute adverse events after SARS-CoV-2 infection in children and adolescents in Denmark and to evaluate the real world effectiveness of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) among adolescents. Design Cohort study. Setting Nationwide Danish healthcare registers. Participants All Danish people younger than 18 years who were either tested for SARS-CoV-2 using reverse transcriptase polymerase chain reaction (RT-PCR) or vaccinated with BNT162b2 to 1 October 2021. Main outcome measures Risk of hospital admissions (any hospital contact of ≥12 hours); intensive care unit (ICU) admissions; serious complications, including multisystem inflammatory syndrome in children (MIS-C), myocarditis, and neuroimmune disorders; and initiating drug treatment and health service use up to six months after being tested. Vaccine effectiveness in vaccine recipients compared with unvaccinated peers was evaluated as one minus the risk ratio at 20 days after the first dose and 60 days after the second dose. Results Of 991 682 children and adolescents tested for SARS-CoV-2 using RT-PCR in Denmark, 74 611 (7.5%) were positive. The risk of hospital admission with any variant for ≥12 hours was 0.49% (95% confidence interval 0.44% to 0.54%; 361/74 350), and 0.01% (0.01% to 0.03%; 10/73 187) of participants were admitted to an ICU within 30 days of testing positive. The risk of MIS-C within two months of SARS-CoV-2 infection was 0.05% (0.03% to 0.06%; 32/70 666), whereas no participants had myocarditis outside of MIS-C or encephalitis and fewer than five had Guillain-Barré syndrome. In the post-acute phase (1-6 months after infection), participants who tested positive for SARS-CoV-2 showed a 1.08-fold (95% confidence interval 1.06-fold to 1.10-fold) increase in rate of contacts with general practitioners compared with a reference cohort sampled among all children tested for SARS-CoV-2 during the study period. Overall, 278 649 adolescents received BNT162b2. Compared with unvaccinated adolescents, the estimated vaccine effectiveness among 229 799 adolescents vaccinated with one dose was 62% (95% confidence interval 59% to 65%) after 20 days, and among 175 176 vaccinated with two doses was 93% (92% to 94%) after 60 days during a period when delta was the dominant variant. Conclusions The absolute risks of adverse events after SARS-CoV-2 infection were generally low in Danish children and adolescents, although MIS-C occurred in 0.05% (32/70 666) of participants with RT-PCR confirmed SARS-CoV-2 infection. In adjusted analyses, rates of general practitioner visits were slightly increased in SARS-CoV-2 positive children and adolescents, which could indicate persisting symptoms. BNT162b2 appeared to be effective in reducing the risk of SARS-CoV-2 infection with the delta variant in adolescents.

Parents' reasons to vaccinate their children aged 5–11 years against COVID-19 in Italy

“…This is consistent with the findings of several previous studies, local and abroad, also regarding the willingness or hesitancy of the vaccination ( 11 – 13 , 21 , 22 ). However, this finding is surprising particularly because it has been observed worldwide that the most reported adverse events of the COVID-19 vaccination in children and adolescents, particularly with the mRNA vaccines, were mild in severity and short in duration ( 23 , 24 ). These results highlight the responsibility of policymakers in addressing the critical issue of educating the public on the safety of the vaccination.…”

Myocarditis and myopericarditis cases following COVID-19 mRNA vaccines administered to 12–17-year olds in Victoria, Australia

“…The case phenotype includes chest pain as the most common symptom, but also includes fever, shortness of breath and other non-specific symptoms such as headache, myalgia and vomiting. Common investigation findings include a raised troponin, abnormal ECG with ST or T wave changes and late gadolinium enhancement or myocardial oedema seen on cardiac MRI 8–11…”

Effectiveness of the BNT162b2 vaccine against SARS-CoV-2 infection among children and adolescents in Qatar

“…These findings are consistent with evidence on vaccine protection among children and adolescents in other countries. 2,[29][30][31][32][33] This study has limitations. With the lower severity of SARS-CoV-2 infection among children 32,34 and the lower severity of Omicron infections, 35,36 there were too few severe, 12 critical, 12 or fatal 13 COVID-19 cases to estimate vaccine effectiveness against severe forms of COVID-19.…”

“…This study has limitations. With the lower severity of SARS-CoV-2 infection among children 32,34 and the lower severity of Omicron infections, 35,36 there were too few severe, 12 critical, 12 or fatal 13 COVID-19 cases to estimate vaccine effectiveness against severe forms of COVID-19. We investigated incidence of documented infections, but other infections may have occurred and gone undocumented.…”