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Multisystemic inflammatory syndrome in children and the BNT162b2 vaccine: a nationwide cohort study

Naama Schwartz1,2, Ronit Ratzon3,4, Itay Hazan3

  • 1Public Health Services, Israel Ministry of Health, Jerusalem, Israel. Naama.stat@gmail.com.

European Journal of Pediatrics
|May 9, 2024
PubMed

Insights

COVID-19 vaccination for children and adolescents significantly reduced the risk of Multisystemic Inflammatory Syndrome in Children (MIS-C). This study confirms vaccine effectiveness in preventing severe post-infectious complications in pediatric populations.

Area of Science:

  • Pediatric Infectious Diseases
  • Vaccinology
  • Public Health

Background:

  • Multisystemic Inflammatory Syndrome in Children (MIS-C) is a rare but severe post-infectious hyperinflammatory condition following COVID-19 infection.
  • Existing vaccine effectiveness literature often relies on small case-control studies, limiting comprehensive risk assessment for MIS-C in vaccinated versus unvaccinated children.
  • Underdiagnosis of COVID-19 in children, who may present with mild or no symptoms, poses a challenge in accurately estimating MIS-C risk.

Purpose of the Study:

  • To evaluate the risk reduction of MIS-C and severe MIS-C following Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccination in children and adolescents.
  • To provide a nationwide assessment of vaccine effectiveness against MIS-C using a large cohort.

Main Methods:

  • A nationwide cohort study in Israel included 526,685 PCR-confirmed COVID-19 cases in individuals under 19 years old, with 14,118 fully vaccinated before infection.
  • MIS-C cases were identified from all Israeli hospitals between April 2020 and November 2021.
  • MIS-C rates were calculated for estimated COVID-19 cases (PCR-confirmed and presumed), and risk differences (RD) between vaccinated and unvaccinated groups were analyzed, including sensitivity analyses for underdiagnosed COVID-19 rates.

Main Results:

  • A total of 233 MIS-C cases were diagnosed in individuals under 19 during the study period.
  • The estimated MIS-C risk difference ranged from 1.0 to 2.1 per 10,000 COVID-19 cases.
  • For severe MIS-C, the risk difference ranged from 0.8 to 1.6 per 10,000 COVID-19 cases, with significant risk reduction observed in the vaccinated group across various assumptions of underdiagnosed COVID-19.

Conclusions:

  • COVID-19 vaccination in children and adolescents significantly reduced the risk of developing MIS-C and severe MIS-C during the study period.
  • The findings demonstrate a favorable risk difference for the vaccinated group, even when accounting for potential underdiagnosis of COVID-19.

Keywords:
COVID-19Pediatric inflammatory multisystem syndromeVaccine

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