Update on COVID-19 vaccination in pediatric solid organ transplant recipients
Corresponding Author
Daniel E. Dulek
Vanderbilt University Medical Center, Nashville, Tennessee, USA
Correspondence
Daniel E. Dulek, Vanderbilt University Medical Center, Nashville, TN, USA.
Email: [email protected]
Search for more papers by this authorMonica I. Ardura
Nationwide Children’s Hospital & The Ohio State University, Columbus, Ohio, USA
Search for more papers by this authorMichael Green
UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorMarian G. Michaels
UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorAbanti Chaudhuri
Stanford University, Palo Alto, California, USA
Search for more papers by this authorLuciola Vasquez
Hospital Guillermo Almenara Irigoyen, Lima, Peru
Search for more papers by this authorLara Danziger-Isakov
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
Search for more papers by this authorKlara M. Posfay-Barbe
Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Search for more papers by this authorMignon I. McCulloch
Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Search for more papers by this authorArnaud G. L’Huillier
Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Search for more papers by this authorChristian Benden
University of Zurich Faculty of Medicine, Zurich, Switzerland
Search for more papers by this authorCorresponding Author
Daniel E. Dulek
Vanderbilt University Medical Center, Nashville, Tennessee, USA
Correspondence
Daniel E. Dulek, Vanderbilt University Medical Center, Nashville, TN, USA.
Email: [email protected]
Search for more papers by this authorMonica I. Ardura
Nationwide Children’s Hospital & The Ohio State University, Columbus, Ohio, USA
Search for more papers by this authorMichael Green
UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorMarian G. Michaels
UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
Search for more papers by this authorAbanti Chaudhuri
Stanford University, Palo Alto, California, USA
Search for more papers by this authorLuciola Vasquez
Hospital Guillermo Almenara Irigoyen, Lima, Peru
Search for more papers by this authorLara Danziger-Isakov
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
Search for more papers by this authorKlara M. Posfay-Barbe
Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Search for more papers by this authorMignon I. McCulloch
Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Search for more papers by this authorArnaud G. L’Huillier
Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Search for more papers by this authorChristian Benden
University of Zurich Faculty of Medicine, Zurich, Switzerland
Search for more papers by this authorAbstract
Background
COVID-19 vaccination has been successful in decreasing rates of SARS-CoV-2 infection in areas with high vaccine uptake. Cases of breakthrough SARS-CoV-2 infection remain infrequent among immunocompetent vaccine recipients who are protected from severe COVID-19. Robust data demonstrate the safety, immunogenicity, and effectiveness of several COVID-19 vaccine formulations. Importantly, Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine studies have now included children as young as 5 years of age with safety, immunogenicity, and effectiveness data publicly available. In the United States, emergency use authorization by the Federal Drug Administration and approval from the Centers for Disease Control/Advisory Committee on Immunization Practices have been provided for the 5- to 11-year-old age group.
Methods
Members of the International Pediatric Transplant Association (IPTA) provide an updated review of current COVID-19 vaccine data with focus on pediatric solid organ transplant (SOT)-specific issues.
Results
This review provides an overview of current COVID-19 immunogenicity, safety, and efficacy data from key studies, with focus on data of importance to pediatric SOT recipients. Continued paucity of data in the setting of pediatric transplantation remains a challenge.
Conclusions
Further studies of COVID-19 vaccination in pediatric SOT recipients are needed to better understand post-vaccine COVID-19 T-cell and antibody kinetics and determine the optimal vaccine schedule. Increased COVID-19 vaccine acceptability, uptake, and worldwide availability are needed to limit the risk that COVID-19 poses to pediatric solid organ transplant recipients.
Open Research
DATA AVAILABILITY STATEMENT
There is no data statement for this manuscript as no data were generated.
REFERENCES
- 1Siegel DA, Reses HE, Cool AJ, et al. Trends in COVID-19 cases, emergency department visits, and hospital admissions among children and adolescents aged 0–17 years - United States, august 2020-august 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(36): 1249-1254.
- 2Delahoy MJ, Ujamaa D, Whitaker M, et al. Hospitalizations associated with COVID-19 among children and adolescents - COVID-NET, 14 States, march 1, 2020-august 14, 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(36): 1255-1260.
- 3 American Academy of Pediatrics (AAP). Children and COVID-19: state-level data report. September 9, 2021. Available at: https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/. Accessed September 18, 2021.
- 4 Center for Disease Control and Prevention. National center for health statistics. weekly updates by select demographic and geographic characteristics. Available at: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#SexAndAge. Accessed September 18, 2021.
- 5Riffe T, Acosta E. Team TC-D. Data resource profile: COVerAGE-DB: a global demographic database of COVID-19 cases and deaths. Int J Epidemiol. 2021; 50(2): 390-f.
- 6Available at: https://data.unicef.org/resources/covid-19-confirmed-cases-and-deaths-dashboard/. Accessed November 10, 2021.
- 7 Unicef. COVID-19 and children. unicef data hub. Available at: https://data.unicef.org/covid-19-and-children/. Accessed September 18, 2021.
- 8Headey D, Heidkamp R, Osendarp S, et al. Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality. Lancet. 2020; 396(10250): 519-521.
- 9 UNICEF data: child mortality and COVID-19. Available at: https://data.unicef.org/topic/child-survival/covid-19/. Accessed September 18, 2021.
- 10Radtke T, Ulyte A, Puhan MA, Kriemler S. Long-term symptoms after SARS-CoV-2 infection in children and adolescents. JAMA. 2021; 326(9): 869.
- 11Molteni E, Sudre CH, Canas LS, et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health. 2021; 5(10): 708-718.
- 12 GOV.UK. Department of Health & Social Care. Independent Report: JCVI statement on COVID-19 vaccination of children and young people aged 12 to 17 years. Published August 4. 2021. Available at: https://www.gov.uk/government/publications/jcvi-statement-august-2021-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years/jcvi-statement-on-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-4-august-2021. Accessed September 18, 2021.
- 13Frenck RW Jr, Klein NP, Kitchin N, et al. Safety, immunogenicity, and efficacy of the BNT162b2 Covid-19 vaccine in adolescents. N Engl J Med. 2021; 385(3): 239-250.
- 14Olson SM, Newhams MM, Halasa NB, et al. Effectiveness of pfizer-BioNTech mRNA vaccination against COVID-19 hospitalization among persons aged 12–18 years — United States, June–September 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(42): 1483-1488.
- 15Available at: https://www.ema.europa.eu/en/news/covid-19-vaccine-spikevax-approved-children-aged-12-17-eu. Accessed November 9, 2021
- 16 Committee VaRBPA. EUA amendment request for Pfizer-BioNTech COVID-10 Vaccine for use in children 5 through 11 years of age, 2021. October 26, 2021.
- 17 Food and Drug Administration. FDA approves first COVID-19 vaccine. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine
- 18Walter EB, Talaat KR, Sabharwal C, et al. Evaluation of the BNT162b2 Covid-19 vaccine in children 5 to 11 years of age. N Engl J Med. 2022; 386(1): 35-46.
- 19 Food and Drug Administration, Food and Drug Administration. Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic. Released May 10,2021; Accessed November 10, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use
- 20Woodworth KR, Moulia D, Collins JP, et al. The advisory committee on immunization practices’ interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years - United States, November 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(45): 1579-1583.
- 21 European Medicine Agency. Cominarty. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/comirnaty
- 22 Food and Drug Administration. Moderna COVID-19 Vaccine. Available at: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/moderna-covid-19-vaccine
- 23 The Boston Globe. R.I. approves Moderna COVID-19 vaccine for teens ahead of FDA authorization. Available at: https://www.bostonglobe.com/2021/07/13/metro/ri-approves-moderna-covid-19-vaccine-teens-ahead-fda-authorization-will-continue-administer-johnson-johnson-doses/
- 24 European Medicine Agency. Spikevax. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/spikevax
- 25Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel. N Engl J Med. 2021; 385(23): 2140-2149.
- 26Witberg G, Barda N, Hoss S, et al. Myocarditis after Covid-19 vaccination in a large health care organization. N Engl J Med. 2021; 385(23): 2132-2139.
- 27Simone A, Herald J, Chen A, et al. Acute myocarditis following COVID-19 mRNA vaccination in adults aged 18 years or older. JAMA Intern Med. 2021; 181(12): 1668.
- 28Singer ME, Taub IB, Kaelber DC. Risk of myocarditis from COVID-19 infection in people under age 20: a population-based analysis. medRxiv. 2021. doi:10.1101/2021.07.23.21260998
10.1101/2021.07.23.21260998 Google Scholar
- 29 National Advisory Committee on Immunization (NACI). Recommendation on the use of mRNA COVID-19 vaccines in adolescents 12 to 17 years of age. Publication Date: August 27, 2021. Available at: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/mrna-adolescents.html#b6
- 30Shimabukuro T. OVID-19 Vaccine safety updates [slides presented at Advisory Committee on Immunization Practices (ACIP) meeting] [Internet]. Centers for Disease Control and Prevention (CDC); 2021. Jun 23. Available at: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-06/03-COVID-Shimabukuro-508.pdf
- 31 Reuters. Finland joins sweden and denmark in limiting moderna COVID-19 vaccine. https://www.reuters.com/world/europe/finland-pauses-use-moderna-covid-19-vaccine-young-men-2021-10-07/
- 32 Ontario’s Ministry of Health. COVID-19 Vaccine Information Sheet: For Youth (age 12-17). Available at: https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/COVID-19_vaccine_information_sheet_youth.pdf
- 33Ou MT, Boyarsky BJ, Motter JD, et al. Safety and reactogenicity of 2 doses of SARS-CoV-2 vaccination in solid organ transplant recipients. Transplantation. 2021; 105(10): 2170-2174.
- 34Del Bello A, Marion O, Delas A, Congy-Jolivet N, Colombat M, Kamar N. Acute rejection after anti-SARS-CoV-2 mRNA vaccination in a patient who underwent a kidney transplant. Kidney Int. 2021; 100(1): 238-239.
- 35Werbel WA, Boyarsky BJ, Ou MT, et al. Safety and immunogenicity of a third dose of SARS-CoV-2 vaccine in solid organ transplant recipients: a case series. Ann Intern Med. 2021; 174(9): 1330-1332.
- 36Kamar N, Abravanel F, Marion O, Couat C, Izopet J, Del Bello A. Three doses of an mRNA Covid-19 vaccine in solid-organ transplant recipients. N Engl J Med. 2021; 385(7): 661-662.
- 37Kumar D, Kimball P, Gupta G. COVID-19 vaccine does not alter panel reactive antibody or flow cytometric cross match in kidney transplant candidates. Transpl Immunol. 2021; 69: 101469.
- 38Available at. https://www.myast.org/covid-19-vaccine-faq-sheet. Accessed October 29, 2021.
- 39Boyarsky BJ, Werbel WA, Avery RK, et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. JAMA. 2021; 325(21): 2204-2206.
- 40Boyarsky BJ, Werbel WA, Avery RK, et al. Immunogenicity of a single dose of SARS-CoV-2 messenger RNA vaccine in solid organ transplant recipients. JAMA. 2021; 325(17): 1784-1786.
- 41Yi SG, Knight RJ, Graviss EA, et al. Kidney transplant recipients rarely show an early antibody response following the first COVID-19 vaccine administration. Transplantation. 2021; 105(7): e72-e73.
- 42Peled Y, Ram E, Lavee J, et al. BNT162b2 vaccination in heart transplant recipients: clinical experience and antibody response. J Heart Lung Transplant. 2021; 40(8): 759-762.
- 43Narasimhan M, Mahimainathan L, Clark AE, et al. Serological response in lung transplant recipients after two doses of SARS-CoV-2 mRNA vaccines. Vaccines (Basel). 2021; 9(7): 708.
- 44Hall VG, Ferreira VH, Ku T, et al. Randomized trial of a third dose of mRNA-1273 vaccine in transplant recipients. N Engl J Med. 2021; 385(13): 1244-1246.
- 45Chavarot N, Morel A, Leruez-Ville M, et al. Weak antibody response to three doses of mRNA vaccine in kidney transplant recipients treated with belatacept. Am J Transplant. 2021; 21(12): 4043-4051.
- 46Embi PJ, Levy ME, Naleway AL, et al. Effectiveness of 2-dose vaccination with mRNA COVID-19 vaccines against COVID-19-associated hospitalizations among immunocompromised Adults - Nine States, January-September 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(44): 1553-1559.
- 47Malinis M, Cohen E, Azar MM. Effectiveness of SARS-CoV-2 vaccination in fully vaccinated solid organ transplant recipients. Am J Transplant. 2021; 21(8): 2916-2918.
- 48Anjan S, Natori Y, Fernandez Betances AA, et al. Breakthrough COVID-19 infections after mRNA vaccination in solid organ transplant recipients in Miami, Florida. Transplantation. 2021; 105(10): e139-e141.
- 49Wadei HM, Gonwa TA, Leoni JC, Shah SZ, Aslam N, Speicher LL. COVID-19 infection in solid organ transplant recipients after SARS-CoV-2 vaccination. Am J Transplant. 2021; 21(10): 3496-3499.
- 50Qin CX, Moore LW, Anjan S, et al. Risk of breakthrough SARS-CoV-2 infections in adult transplant recipients. Transplantation. 2021; 105(11): e265-e266.
- 51Schmidt T, Klemis V, Schub D, et al. Cellular immunity predominates over humoral immunity after homologous and heterologous mRNA and vector-based COVID-19 vaccine regimens in solid organ transplant recipients. Am J Transplant. 2021; 21(12): 3990-4002.
- 52Hall VG, Ferreira VH, Ierullo M, et al. Humoral and cellular immune response and safety of two-dose SARS-CoV-2 mRNA-1273 vaccine in solid organ transplant recipients. Am J Transplant. 2021; 21(12): 3980-3989.
- 53Crane C, Phebus E, Ingulli E. Immunologic response of mRNA SARS-CoV-2 vaccination in adolescent kidney transplant recipients. Pediatr Nephrol. 2021. doi:10.1007/s00467-021-05256-9. Online ahead of print.
- 54Qin CX, Auerbach SR, Charnaya O, et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccination in pediatric solid organ transplant recipients. Am J Transplant. 2021. doi:10.1111/ajt.16841. Online ahead of print.
- 55Mathieu E, Ritchie H, Ortiz-Ospina E, et al. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021; 5(7): 947-953.
- 56Sallam M. COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates. Vaccines (Basel). 2021; 9(2): 160.
- 57Available at: https://www.as-coa.org/articles/are-kids-all-right-look-vaccine-age-eligibility-latin-america. Accessed November 8, 2021.
- 58Available at: https://www.reuters.com/world/india/india-recommends-emergency-use-bharat-biotechs-covid-19-shot-kids-2021-10-12/. Accessed October 30, 2021.
- 59Dyer O. Covid-19: US and China prepare for mass vaccination of children under 12. BMJ. 2021; 375: n2631.
- 60Han B, Song Y, Li C, et al. Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine (CoronaVac) in healthy children and adolescents: a double-blind, randomised, controlled, phase 1/2 clinical trial. Lancet Infect Dis. 2021; 21(12): 1645-1653.
- 61Cevik M, Grubaugh ND, Iwasaki A, Openshaw P. COVID-19 vaccines: keeping pace with SARS-CoV-2 variants. Cell. 2021; 184(20): 5077-5081.
- 62Pouwels KB, Pritchard E, Matthews PC, et al. Effect of delta variant on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK. Nat Med. 2021; 7(12): 2127-2135.
- 63Tang P, Hasan MR, Chemaitelly H, et al. BNT162b2 and mRNA-1273 COVID-19 vaccine effectiveness against the SARS-CoV-2 Delta variant in Qatar. Nat Med. 2021; 27(12): 2136-2143.
- 64 Team CC-R. SARS-CoV-2 B.1.1.529 (Omicron) variant - United States, December 1-8, 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(50): 1731-1734.
- 65Abdullah F, Myers J, Basu D, et al. Decreased severity of disease during the first global omicron variant covid-19 outbreak in a large hospital in Tshwane, South Africa. Int J Infect Dis. 2021; 116: 38-42.
- 66Laurie MT, Liu J, Sunshine S, et al. SARS-CoV-2 variant exposures elicit antibody responses with differential cross-neutralization of established and emerging strains including Delta and Omicron. J Infect Dis. 2022: jiab635. https://doi.org/10.1093/infdis/jiab635. Online ahead of print.
- 67Dejnirattisai W, Shaw RH, Supasa P, et al. Reduced neutralisation of SARS-CoV-2 omicron B.1.1.529 variant by post-immunisation serum. Lancet. 2021; 399(10321): 234-236.
- 68Lu L, Mok BW, Chen LL, et al. Neutralization of SARS-CoV-2 Omicron variant by sera from BNT162b2 or Coronavac vaccine recipients. Clin Infect Dis. 2021: ciab1041.
- 69Ledford H. How severe are omicron infections? Nature. 2021; 600(7890): 577-578.
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