You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

CME / ABIM MOC / CE

How Effective Is the COVID-19 Vaccine in Preventing Pediatric Deaths?

  • Authors: News Author: Heidi Splete; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 1/20/2023
  • Valid for credit through: 1/20/2024
Start Activity

  • 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)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE: 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care providers, pediatricians, infectious disease specialists, nurses, pharmacists, physician assistants, and other members of the healthcare team who care for children and adolescents.

The goal of this activity is for learners to be better able to evaluate the efficacy of COVID-19 vaccination among children and adolescents.

Upon completion of this activity, participants will:

  • Analyze the relative vaccine efficacy of the bivalent COVID-19 vaccine booster
  • Evaluate the efficacy of COVID-19 vaccination among children and adolescents
  • Outline implications for the healthcare team


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


News Author

  • Heidi Splete

    Freelance writer, Medscape

    Disclosures

    Heidi Splete has 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

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Contact This Provider

    For Nurses

  • Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.

    Contact This Provider

    For Pharmacists

  • Medscape designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number: JA0007105-0000-23-023-H01-P).

    Contact This Provider

  • For Physician Assistants

    Medscape, LLC has been authorized by the American Academy of Pas (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 1/20/24. PAs should only claim credit commensurate with the extent of their participation.

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC / CE

How Effective Is the COVID-19 Vaccine in Preventing Pediatric Deaths?

Authors: News Author: Heidi Splete; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 1/20/2023

Valid for credit through: 1/20/2024

processing....

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 the approved COVID-19 vaccines are provided in this activity in an effort 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

The story of COVID-19 continues to evolve even as we complete 3 years since the world first learned about the SARS-CoV-2 virus. On September 1, the US Advisory Committee on Immunization Practices recommended application of a bivalent booster containing SARS-CoV-2 ancestral and Omicron BA.4/BA.5 strains, but how effective is this booster? A study by Link-Gelles and colleagues, which was published in the December 2 issue of Morbidity and Mortality Weekly Report,[1] addressed this issue.

Researchers used data from a US national database of COVID-19 testing sites and focused on the period from September 14 to November 11, 2022. A total of 360,626 tests were included, of which 34% were positive for SARS-CoV-2. Just 7% of all patients with a positive test had received a bivalent vaccine booster.

The relative vaccine efficacy (RVE) of the bivalent booster compared with at least 2 doses of COVID-19 vaccine increased as time since the last dose of COVID-19 vaccine grew, but it also declined with age. The RVE among persons 18 to 49 years of age was 56% if the last vaccine dose was more than 8 months before, but it dropped to 30% if the last dose was applied just 2 to 3 months ago. The respective RVE values for adults at ages 50 to 64 years were 48% and 31%, and the respective RVE for adults at age 65 years and older were 43% and 28%.

These data help us to counsel adults regarding the efficacy of the COVID-19 vaccine, but it does not include children in the sample. A new study from Argentina provides important information regarding the efficacy of the COVID-19 vaccine among children and adolescents.

Study Synopsis and Perspective

COVID-19 vaccines retained the ability to prevent deaths from COVID-19 in children and adolescents regardless of the dominant circulating variant, in a new study.

The vaccine's effectiveness against infection in the short term has been established, as has the waning effectiveness of the vaccine over time, wrote Juan Manuel Castelli, MD, of the Ministry of Health of Argentina, Buenos Aires, and colleagues, in the British Medical Journal.[2]

Still, data on the impact of vaccine effectiveness on mortality in children and adolescents are limited, especially during periods of Omicron variant dominance, the researchers said.

In their new study, the researchers reviewed data from 844,460 children and adolescents aged 3 to 17 years from the National Surveillance System and the Nominalized Federal Vaccination Registry of Argentina, during a time that included a period of Omicron dominance.

Argentina began vaccinating adolescents aged 12 to 17 years against COVID-19 in August 2021 and added children aged 3 to 11 years in October 2021. Youths aged 12 to 17 years who were considered fully vaccinated received 2 doses of either Pfizer-BioNTech and/or Moderna vaccines, and fully vaccinated 3- to 11-year-olds received 2 doses of Sinopharm vaccine.

The average time from the second vaccine dose to a COVID-19 test was 66 days for youths aged 12 to 17 years and 54 days for 3- to 11-year-olds. The researchers matched COVID-19 cases with uninfected control participants, and a total of 139,321 cases were included in the analysis.

Overall, the estimated vaccine effectiveness against COVID-19 was 64.2% during a period of Delta dominance (61.2% in children aged 3-11 years and 66.8% in adolescents aged 12-17 years).

During a period of Omicron dominance, estimated vaccine effectiveness was 19.9% across all ages (15.9% and 26% for younger and older age groups, respectively).

Effectiveness of the vaccine decreased over time, regardless of the dominant variant, but the decline was greater during the Omicron dominant period, the researchers noted. During the Omicron period, effectiveness in children aged 3 to 11 years decreased from 37.6% at 15 to 30 days postvaccination to 2% at 60 days or longer after vaccination. In adolescents aged 12 to 17 years, vaccine effectiveness during the Omicron period decreased from 55.8% at 15 to 30 days postvaccination to 12.4% at 60 days or longer after vaccination.

Despite the waning protection against infection, the vaccine's effectiveness against death from COVID-19 was 66.9% in children aged 3 to 11 years and 97.6% in adolescents aged 12 to 17 years during the period of Omicron dominance, the researchers noted.

"Our results suggest that the primary vaccination schedule is effective in preventing mortality in children and adolescents with COVID-19 regardless of the circulating SARS-CoV-2 variant," the researchers said.

Study Limitations and Strengths

The study was limited by several factors including the incomplete data on symptoms and hospital admissions, the possible impact of unmeasured confounding variables, and the observational design that prevents conclusions of causality, the researchers noted; however, the results were strengthened by the large sample size and access to detailed vaccination records, they said.

Both heterologous and homologous mRNA vaccine schedules showed similar effectiveness in preventing short-term infection and mortality from COVID-19 during periods of differing dominant variants, they noted.

The study findings support the vaccination of children against COVID-19 as an important public health measure to prevent mortality in children and adolescents, they concluded.

Data Support Value of Vaccination, Outside Experts Say

"COVID vaccines may not be as effective over time as the gene variants in the SARS-CoV-2 virus change," Adrienne G. Randolph, MD, a pediatrician at Harvard Medical School and Boston Children's Hospital, said in an interview. "Therefore, it is essential to assess vaccine effectiveness over time to look at effectiveness against variants and duration of effectiveness."

The take-home message for members of the healthcare team is that it is important to get children vaccinated against COVID-19 to prevent severe and life-threatening illness, said Randolph.

Tim Joos, MD, a Seattle-based physician who practices a combination of internal medicine and pediatrics, agreed that future research should continue to assess how the new COVID-19 boosters are faring against new variants, noting that the current study did not include data from children who received the new bivalent vaccine.

Commenting on other research showing an increasing ratio of COVID-19 deaths among vaccinated individuals compared to total COVID-19 deaths, he noted that this finding is "likely reflecting a denominator effect of rapidly declining COVID deaths overall," partly from the vaccines and partly from immunity after previous natural infection.

The study received no outside funding. The researchers, Randolph, and Joos had no financial conflicts to disclose. Joos serves on the Editorial Advisory Board of Pediatric News.

Study Highlights

  • Study authors used data from a national COVID-19 surveillance system in Argentina. Study participants were children between 3 and 17 years of age who presented for testing for COVID-19 from September 2021 to April 2022.
  • Argentina began vaccinating adolescents against SARS-CoV-2 between 12 and 17 years of age in August 2021, and younger children down to age 3 years were vaccinated beginning in October 2021.
  • Children aged 3 to 11 years were considered fully vaccinated if they had received 2 doses of the BBIBP-CorV (Sinopharm). Children aged 12 to 17 years were considered fully vaccinated if they received 2 doses of BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna) vaccines.
  • The main study outcome was a positive antigen or molecular test for SARS-CoV-2. The secondary outcome was COVID-19 mortality.
  • Children with a positive vs negative test for SARS-CoV-2 were more likely to be older and female, and they had more comorbid health conditions.
  • 139,321 cases positive for SARS-CoV-2 were compared with 231,181 control participants.
  • Vaccine effectiveness in the prevention of COVID-19 during the period of Delta variant predominance for all ages was 64.2% (95% CI: 61.6%, 66.5%). Vaccine effectiveness against infection was 61.2% (95% CI: 56.4%, 65.5%) among children from ages 3 to 11 years and 66.8% (95% CI: 63.9%, 69.5%) among adolescents aged 12 to 17 years.
  • Vaccine effectiveness declined precipitously during the period of Omicron variant predominance for all ages (19.9% [95% CI: 18%, 21.2%]). Vaccine effectiveness against infection was 15.9% (95% CI: 13.2%, 18.6%) among children from ages 3 to 11 years and 26% (95% CI: 23.2%, 28.8%) among adolescents aged 12 to 17 years.
  • There was a mild decline in vaccine effectiveness from 15 to 30 days postvaccination to ≥ 60 days after vaccination during the Delta-predominant period, but it was much steeper during the Omicron period. Vaccine effectiveness against the Omicron variant at ≥ 60 days fell to 2% (95% CI: 1.8%, 5.6%) among young children and 12.4% (95% CI: 8.6%, 16.1%) among adolescents.
  • There were 51 deaths related to COVID-19 recorded. Rates of vaccine effectiveness against mortality during the Delta and Omicron periods were 89.3% (95% CI: 73.9%, 95.6%) and 88.1% (95% CI: 70.7%, 95.2%), respectively.
  • Rates of vaccine effectiveness against mortality during among children and adolescents were 66.9% (95% CI: 6.4%, 89.8%) and 97.6% (95% CI: 81%, 99.7%), respectively.

Clinical Implications

  • In the previous study by Link-Gelles and colleagues, the RVE of the bivalent booster compared with ≥ 2 doses of COVID-19 vaccine increased as time since the last dose of COVID-19 vaccine grew, but it declined with age.
  • The current study by Castelli and colleagues demonstrates that the COVID-19 vaccine is effective in the prevention of mortality among children and adolescents; however, vaccine effectiveness against infection declined substantially with the advent of the Omicron variant, with sharply reduced vaccine efficacy ≥ 60 days after vaccination.
  • Implications for the healthcare team: The healthcare team should promote COVID-19 vaccination among children and adolescents but still also recommend behavioral measures to reduce the risk for infection.

 

Earn Credit

  • Print