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. 2024 Apr 1;7(4):e248192.
doi: 10.1001/jamanetworkopen.2024.8192.

Safety of Ancestral Monovalent BNT162b2, mRNA-1273, and NVX-CoV2373 COVID-19 Vaccines in US Children Aged 6 Months to 17 Years

Mao Hu  1 , Azadeh Shoaibi  2 , Yuhui Feng  1 , Patricia C Lloyd  2 , Hui Lee Wong  2 , Elizabeth R Smith  1 , Kandace L Amend  3 , Annemarie Kline  4 , Daniel C Beachler  5 , Joann F Gruber  2 , Mahasweta Mitra  1 , John D Seeger  3 , Charlalynn Harris  4 , Alex Secora  6 , Joyce Obidi  2 , Jing Wang  1 , Jennifer Song  3 , Cheryl N McMahill-Walraven  4 , Christian Reich  6 , Rowan McEvoy  1 , Rose Do  1 , Yoganand Chillarige  1 , Robin Clifford  3 , Danielle D Cooper  4 , Richard A Forshee  2 , Steven A Anderson  2
Affiliations

Safety of Ancestral Monovalent BNT162b2, mRNA-1273, and NVX-CoV2373 COVID-19 Vaccines in US Children Aged 6 Months to 17 Years

Mao Hu et al. JAMA Netw Open. .

Abstract

Importance: Active monitoring of health outcomes after COVID-19 vaccination provides early detection of rare outcomes that may not be identified in prelicensure trials.

Objective: To conduct near-real-time monitoring of health outcomes after COVID-19 vaccination in the US pediatric population.

Design, setting, and participants: This cohort study evaluated 21 prespecified health outcomes after exposure before early 2023 to BNT162b2, mRNA-1273, or NVX-CoV2373 ancestral monovalent COVID-19 vaccines in children aged 6 months to 17 years by applying a near-real-time monitoring framework using health care data from 3 commercial claims databases in the US (Optum [through April 2023], Carelon Research [through March 2023], and CVS Health [through February 2023]). Increased rates of each outcome after vaccination were compared with annual historical rates from January 1 to December 31, 2019, and January 1 to December 31, 2020, as well as between April 1 and December 31, 2020.

Exposure: Receipt of an ancestral monovalent BNT162b2, mRNA-1273, or NVX-CoV2373 COVID-19 vaccine dose identified through administrative claims data linked with Immunization Information Systems data.

Main outcomes and measures: Twenty-one prespecified health outcomes, of which 15 underwent sequential testing and 6 were only monitored descriptively due to lack of historical rates.

Results: Among 4 102 016 vaccinated enrollees aged 6 months to 17 years, 2 058 142 (50.2%) were male and 3 901 370 (95.1%) lived in an urban area. Thirteen of 15 sequentially tested outcomes did not meet the threshold for a statistical signal. Statistical signals were detected for myocarditis or pericarditis after BNT162b2 vaccination in children aged 12 to 17 years and seizure after vaccination with BNT162b2 and mRNA-1273 in children aged 2 to 4 or 5 years. However, in post hoc sensitivity analyses, a statistical signal for seizure was observed only after mRNA-1273 when 2019 background rates were selected; no statistical signal was observed when 2022 rates were selected.

Conclusions and relevance: In this cohort study of pediatric enrollees across 3 commercial health insurance databases, statistical signals detected for myocarditis or pericarditis after BNT162b2 (ages 12-17 years) were consistent with previous reports, and seizures after BNT162b2 (ages 2-4 years) and mRNA-1273 vaccinations (ages 2-5 years) should be further investigated in a robust epidemiologic study with confounding adjustment. The US Food and Drug Administration concludes that the known and potential benefits of COVID-19 vaccination outweigh the known and potential risks of COVID-19 infection.

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Conflict of interest statement

Conflict of Interest Disclosures: Messrs Hu, McEvoy, and Chillarige; Mss Smith, Mitra, and Wang; and Dr Do reported being employees of Acumen LLC, which is a contractor for the BEST Initiative. Dr Amend reported being an employee of and having equity or stocks in OptumInsight Life Sciences outside the submitted work. Ms Kline reported receiving funds from the US Food and Drug Administration (FDA) as part of the BEST Initiative contract and being employed by CVS Health during the conduct of the study. Dr Beachler reported being employed by Elevance Health Employment outside the submitted work. Dr Seeger reported receiving grants from the FDA and being employed by Optum during the conduct of the study. Ms Song reported being employed by United Health outside the submitted work. Dr McMahill-Walraven reported being employed by CVS Health. No other disclosures were reported.

Figures

Figure.
Figure.. Distribution of Ancestral Monovalent Doses of BNT162b2, mRNA-1273, and NVX-CoV2373 COVID-19 Vaccines Administered Over Time by Age Group From All Data Sources
Data are combined from Optum through April 2023, Carelon Research through March 2023, and CVS Health through February 2023.
See this image and copyright information in PMC

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