Coronavirus Disease 2019 (COVID-19) Vaccination Coverage and Effectiveness Among Pediatric Transplant Recipients

IntroductionIn pediatric solid organ transplant and bone marrow transplant recipients, there is minimal data describing coronavirus disease 2019 (COVID-19) vaccine uptake and effectiveness.Research QuestionsWhat is the real-world experience of COVID-19 vaccination, subsequent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and vaccine efficacy in pediatric heart, liver, kidney and bone marrow transplant recipients?DesignThis observational cohort study assessed COVID-19 vaccination rates and outcomes between March 2020 and January 2024 among pediatric heart, liver, kidney, and bone marrow transplant recipients. This study was approved by the local institutional review board as exempt.ResultsOne hundred and thirty-three pediatric solid organ transplant or bone marrow recipients were included; 33 of 133 (24.8%) were unvaccinated, 100 and 133 (75.2%) had at least 1 dose, and 72 of 133 (54.1%) completed at least 3 doses of COVID-19 vaccination. Ninety-two SARS-CoV-2 infection episodes in 74 of 133 (55.6%) patients. Fifty-eight (63%) episodes were in those who were never vaccinated or before completion of 3 doses and 34 (36.9%) episodes were after completion of the primary series (P = 0.09). Hospitalization was required in 2 of 34 (5.9%) and 7 of 59 (11.9%) of the infections among vaccinated and unvaccinated patients. No severe cases occurred among vaccinated patients while severe infection was seen among those unvaccinated. Adjusted COVID-19 vaccine effectiveness against SARS-CoV-2 infection was estimated as 52.6% (95% CI 7.0% -72%).ConclusionCOVID-19 vaccine uptake remains suboptimal among pediatric transplant recipients and completion of primary series is low. Further studies to understand dynamics of vaccine acceptance and vaccine effectiveness among pediatric transplant patients are needed.