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CME / ABIM MOC / CE

Does Parental Vaccination Status Provide Protection for Children?

  • Authors: News Author: Jake Remaly; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 3/11/2022
  • Valid for credit through: 3/11/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

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    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for all primary care physicians, pediatricians, infectious disease specialists, nurses, pharmacists, and other members of the healthcare team who care for households at risk for COVID-19.

The goal of this activity is to assess the efficacy of parental vaccination against COVID-19 on the rate of COVID-19 among young children in the same household.

Upon completion of this activity, participants will:

  • Assess variables associated with increased household transmission of SARS-CoV-2
  • Analyze the efficacy of parental vaccination against COVID-19 on the rate of COVID-19 among young children in the same household
  • Outline implications for the healthcare team


Disclosures

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News Author

  • Jake Remaly

    Freelance writer, Medscape

    Disclosures

    Disclosure: Jake Remaly has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: GlaxoSmithKline; Johnson & Johnson

Editor/CME Reviewer/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

CME/CE Reviewer

  • Lisa Simani, APRN, MS, ACNP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Lisa Simani, APRN, MS, ACNP, has no relevant financial relationships.


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CME / ABIM MOC / CE

Does Parental Vaccination Status Provide Protection for Children?

Authors: News Author: Jake Remaly; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 3/11/2022

Valid for credit through: 3/11/2023

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Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to COVID-19 vaccines may be provided in this activity to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

Many cases of COVID-19 begin with an infected person within a household, and a systematic review and meta-analysis by Madewell and colleagues evaluated the household transmission patterns of SARS-CoV-2. They included 87 studies in their meta-analysis, which was published in the August 2, 2021 issue of JAMA Network Open.[1]These studies included 1,249,163 household contacts in 30 countries.

The overall secondary attack rate (SAR) in households was 18.9%. Researchers found that the SAR increased from the period January to February 2020 (13.4%) vs July 2020 to March 2021 (31.1%). Adults had a higher SAR vs children, and the SAR for contacts with comorbidities was particularly high (50%). Households with a higher number of COVID-19 contacts had a higher SAR, but sex, index case age, and the presence of fever or cough failed to significantly affect the SAR.

Children younger than age 5 years are still waiting for vaccine approval against SARS-CoV-2. Is it possible that parental vaccination can help to reduce the risk for COVID-19 among young children who have not been vaccinated? The current study by Hayek and colleagues addresses this issue.

Study Synopsis and Perspective

Parents who keep up to date with their COVID-19 vaccines may help protect their unvaccinated children from the disease in the process, new research shows.

Having one fully vaccinated parent reduced the risk for infection with the original strain of SARS-CoV-2 in children by 26% whereas having 2 fully vaccinated parents cut the risk by nearly 72%, according to the researchers. Against the Delta strain of the virus, having one fully vaccinated parent -- including a booster dose -- was associated with a 20.8% decreased risk for infection in children whereas having 2 fully vaccinated parents was associated with a 58.1% decreased risk.

"Vaccination not only provides direct protection, it also provides indirect protection to unvaccinated individuals living with the vaccinated individuals in the same household," said coauthor Samah Hayek, DrPH, an epidemiologist with Clalit Research Institute in Ramat Gan, Israel, in a statement.[2] "This study highlights the indirect protection provided by vaccinated parents to their unvaccinated children, irrespective of household size or the child's age, for both the Alpha and the Delta variants."

Hayek's group published their findings online January 27 in Science.[3]

The investigators focused on households that had 2 parents, unvaccinated children, and no prior infection during 2 periods of the pandemic: between January 17, 2021 and March 28, 2021, amid the Alpha variant wave of the pandemic; and between July 11, 2021 and September 30, 2021, when the Delta variant dominated.

All vaccinated parents in the study received at least 2 doses of the BNT162b2 [Pfizer] mRNA vaccine.

Vaccinated parents were less likely to have a documented infection, but they also were less likely to transmit the infection to a family member if they were infected, the study showed.

For the first period, the researchers had data from 400,733 unvaccinated children and adolescents in 155,305 distinct households. For the second period, they analyzed data from 181,307 unvaccinated children from 76,621 distinct households.

The results were generally consistent regardless of household size and across different age groups of children, including children too young to be eligible to receive COVID-19 vaccines, according to the researchers.

The study did not assess the effectiveness of the vaccine against the Omicron strain of the virus.

The dynamics of Omicron likely differ, said Yi Du, MPH, MS, a researcher at University of Nebraska Medical Center, Omaha, Nebraska, who has tracked the effectiveness of vaccinations there.[4]

Amid Omicron, although cases increased, "we still observed the vaccine effectiveness in reducing hospitalization and mortality," Du told Medscape Medical News.

Vaccinated parents and grandparents may be asymptomatic if they are infected whereas unvaccinated children could remain at risk.

Waning immunity for vaccinated parents is another concern.

"Boosters are highly recommended," he said.

The research was funded in part by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute. Study authors disclosed institutional grants to Clalit Research Institute from Pfizer Inc. outside the submitted work and unrelated to COVID-19. One author reported grants from Pfizer Inc. and financial or unpaid advisory ties to other pharmaceutical companies, foundations, and government agencies. Du had no relevant disclosures.

Study Highlights

  • Researchers used a large health database in Israel to answer their study question.[3] Third-dose booster vaccines against COVID-19 were initiated there on July 11, 2021. The vaccine was available to children aged ≥ 5 years in November 2021.
  • Researchers focused on 2 periods during the pandemic:
    • January 17, 2021 through March 18, 2021. This period corresponds with a surge of the Alpha variant of SARS-CoV-2.
    • July 11, 2021 through September 30, 2021. This period corresponds with a surge of the Delta variant of SARS-CoV-2.
  • The main study outcome was the incidence of COVID-19 among primarily young, unvaccinated children in a household in which someone was infected. The study variable was parental vaccination status. Full vaccination was considered 2 doses of the Pfizer-BioNTech vaccine during the early phase. Researchers compared parents who received 3 doses of the COVID-19 vaccine with parents who received 2 doses for the late phase analysis.
  • The early study period included data on 400,733 unvaccinated children, and the later study period added data from 181,307 children. The average age of children was between 5 and 6 years, and slightly more than half were male.
  • During the early period, a single vaccinated parent was associated with a 26% (95% CI: 14., 36.2) lower risk for infection among children. Having both parents vaccinated was associated with a respective 71.7% (95% CI: 68.6, 74.6) reduction in infections among children. These effects were stable regardless of age groups or size of household.
  • During the late period, a single parent with 3 vaccine doses was associated with a 20.8% (95% CI: 11.4, 29.1) lower risk for infection among children. Having both parents vaccinated with 3 doses was associated with a respective 58.1% (95% CI; 53.1, 62.6) reduction in infections among children. Younger children in particular received greater protection through parental vaccination during this period.
  • Most of the efficacy of vaccination was derived from a direct effect of reduction in transmission of COVID-19 to a vaccinated parent, but the indirect effect of protection of children based on parental vaccination was significant as well.
  • In a sensitivity analysis designed to detect potential confounding variables, parental vaccination status had no effect on the prevalence of bacterial diarrhea among children in the same household.

Clinical Implications

  • In a previous study by Madewell and colleagues, adults had a higher secondary attack rate (SAR) for COVID-19 vs children, and the SAR for contacts with comorbidities was particularly high. Households with a higher number of COVID-19 contacts had a higher SAR, but sex, index case age, and the presence of fever or cough failed to significantly affect the SAR.
  • The current study by Hayek and colleagues demonstrates that parental vaccination was effective in the prevention of transmission of COVID-19 to children during the Alpha and Delta surges of the pandemic. This was particularly the case when both parents had been vaccinated.
  • Implications for the healthcare team: The healthcare team should emphasize the potential benefits of the COVID-19 vaccine to protect the individual being vaccinated and their household as well.

 

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