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
Laura D Zambrano, Margaret M. Newhams, Samantha M. Olson, Natasha Halasa, Ashley M. Price, Amber Orzel, Cameron C. Young, Julie A. Boom, Leila C. Sahni, Aline B. Maddux, Katherine Bline, Satoshi Kamidani, Keiko M. Tarquinio, Kathleen Chiotos, Jennifer E. Schuster, Melissa L. Cullimore, Sabrina M. Heidemann, Charlotte V. Hobbs, Ryan A. Nofziger, Pia S. Pannaraj, Melissa A. Cameron, Tracie C. Walker, Stephanie P. Schwartz, Kelly N Michelson, Bria M. Coates, Heidi R. Flori, Elizabeth H. Mack, Laura Smallcomb, Shira J. Gertz, Samina S. Bhumbra, Tamara T. Bradford, Emily R. Levy, Michele Kong, Katherine Irby, Natalie Z. Cvijanovich, Matt S. Zinter, Cindy Bowens, Hillary Crandall, Janet R. Hume, Manish M Patel, Angela P. Campbell, Adrienne G. Randolph, for the Overcoming COVID-19 Investigators, Michele Kong, Meghan Murdock, Mary Glas Gaspers, Katri Typpo, Connor P. Kelley, Katherine Irby, Ronald C. Sanders, Masson Yates, Chelsea Smith, Melissa A. Cameron, Katheryn Crane, Natalie Z. Cvijanovich, Geraldina Lionetti, Juliana Murcia-Montoya, Matt S. Zinter, Denise Villarreal-Chico, Pia S. Pannaraj, Adam L. Skura, Daniel Hakimi, Harvey Peralta, Yea Ji Sea, Kennis-Grace Mrotek, Aline B. Maddux, Justin M. Lockwood, Emily Port, Imogene A. Carson, Brandon Chatani, Satoshi Kamidani, Keiko M. Tarquinio, Laila Hussaini, Nadine Baida, Kelly N Michelson, Bria M. Coates, Simone T. Rhodes, Hassan A Khan, Samina S. Bhumbra, Courtney M. Rowan, Mary Stumpf, Tamara T. Bradford, Marla Johnston, Adrienne G. Randolph, Margaret M Newhams, Suden Kücükak, Amber O Orzel, Cameron C. Young, Sabrina R. Chen, Benjamin J. Boutselis, Timothy P. McCadden, Kasey R Stewart, Edie Weller, Laura Berbert, Jie He, Sabrina M. Heidemann, Heidi R. Flori, Patrick Moran, Janet R. Hume, Ellen R. Bruno
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.