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Young boy gets vaccination

CDC studies highlight COVID vaccine effectiveness for young children, low uptake

February 16, 2023

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Only 5% of children under 5 years have gotten a full COVID-19 vaccine primary series, and rates are especially low among Black and Hispanic children.

The low uptake comes despite this age group experiencing more than 3 million infections and more than 500 associated deaths, according to data from the Centers for Disease Control and Prevention (CDC).

Meanwhile, new data confirm the vaccines provide protection against symptomatic infections among young children for several months. The findings were part of three new studies on COVID vaccine uptake and effectiveness published today in the Morbidity and Mortality Weekly Report.

Vaccine coverage among children under 5 years

Researchers from the CDC looked at vaccine uptake in children ages 6 months through 4 years from the time of authorization in June 2022 through the end of the year. They found 10% of children in this age group have received at least one dose, and 5% have completed a primary series.

Uptake among young children lags far behind older children and adolescents. About 24% of children ages 5-11 years and 33% of children ages 12-15 years had received at least one dose within two months of authorization, according to the study.

The team found disparities by location and by race. Completion of a primary series for children under 5 years ranged from just under 1% in Mississippi to about 21% in Washington, D.C. About 3.4% of children under 5 in rural areas had received at least one dose compared to 10.5% in urban areas.

About 7% of young children receiving one dose are Black, even though they constitute 14% of the population in this age group. Likewise, 20% of young children receiving one dose are Hispanic while they constitute 26% of the population. White and Asian children made up 55.3% and 13.4% of vaccine recipients, respectively, while they their shares of the population were 48.4% and 5.7%, respectively.

Authors noted Black and Hispanic children are more likely to live in poverty, affecting their access to vaccination locations and trusted providers who could recommend the vaccines.

A previous study of children ages 5-17 also showed racial disparities in COVID vaccination. Rates in those age groups were highest among Asian youths, while Black children had some of the lowest rates, especially among young children.

Authors of the new report called on health care, school and government officials to “decrease barriers to vaccination and increase confidence in COVID-19 vaccines, which can help reduce COVID-19-associated morbidity and mortality among the nation’s youngest children.”

COVID vaccine effectiveness in children ages 3-5

Another new CDC study released today looked at vaccine effectiveness in children ages 3-5 years.

A complete Moderna primary series was about 60% effective in preventing symptomatic infection two weeks to two months after the second dose. Three to four months after the second dose, effectiveness was 36%.

The monovalent Pfizer-BioNTech primary series for children ages 3 and 4 years was 31% effective in preventing symptomatic infection in the two weeks to four months after the third dose. The data could not break down effectiveness into smaller time increments like the Moderna calculations.

The data were collected from Aug. 1, 2022, to Feb. 5, 2023, for Moderna and Sept. 19, 2022, to Feb. 5, 2023, for Pfizer-BioNTech, and the two vaccines should not be compared, according to the CDC.

Authors also noted about 90% of U.S. children ages 6 months through 4 years had evidence of a previous infection that may have conferred some protection by the end of 2022.

Bivalent doses are now available for children, which may help with waning protection and circulating omicron strains. The AAP’s dosing guide has details on eligibility and timing.

Bivalent booster coverage among adolescents

Bivalent COVID vaccine boosters have been available for adolescents and adults 12 years and older since September 2022. However, 18.5% of adolescents ages 12-17 years who had received a primary series had received a bivalent booster as of the end of 2022. Just over half of eligible teens who had not received a bivalent booster had parents who were open to it, according to a new CDC report.

Among the adolescents whose parents were open to them getting a booster, about one-third hadn’t received a recommendation from a provider, and 12% had safety concerns.

About 10% of Black adolescents, 15% of Hispanic adolescents and 14% of other race/multiracial adolescents received a bivalent booster compared to 23% of White adolescents. Rates also were lowest for those who were uninsured or living in rural areas.

Authors stressed the importance of recommendations from trusted health care providers as well as community partnerships.

“To improve coverage, communities should partner with medical providers, schools, and community organizations to administer bivalent booster vaccination onsite or provide a referral for vaccination, reduce barriers to receipt of vaccination, employ trusted messengers to discuss vaccine safety and effectiveness with adults or parents and guardians of adolescents, and emphasize the importance of staying up to date with their COVID-19 vaccination,” authors wrote.


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