The impact of vaccinating adolescents and children on COVID-19 disease outcomes

  1. Kylie E. C. Ainslie
  2. Jantien Backer
  3. Pieter de Boer
  4. Albert Jan van Hoek
  5. Don Klinkenberg
  6. Hester Korthals Altes
  7. Ka Yin Leung
  8. Hester de Melker
  9. Fuminari Miura
  10. Jacco Wallinga

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Abstract

Introduction

Despite the high COVID-19 vaccination coverage among adults, there is concern over a peak in SARS-CoV-2 infections in the coming months. To help ensure that healthcare systems are not overwhelmed in the event of a new wave of SARS-CoV-2 infections, many countries have extended vaccination to adolescents (those aged 12-17 years) and may consider further extending to children aged 5-11 years. However, there is considerable debate about whether or not to vaccinate healthy adolescents and children against SARS-CoV-2 because, while vaccination of children and adolescents may limit transmission from these groups to other, more vulnerable groups, adolescents and children themselves have limited risk of severe disease if infected and may experience adverse events from vaccination. To quantify the benefits of extending COVID-19 vaccination beyond adults we compare daily cases, hospital admissions, and intensive care (IC) admissions for vaccination in adults only, those 12 years and above, and those 5 years and above.

Methods and Findings

We developed a deterministic, age-structured susceptible-exposed-infectious-recovered (SEIR) model to simulate disease outcomes (e.g., cases, hospital admissions, IC admissions) under different vaccination scenarios. The model is partitioned into 10-year age bands (0-9, 10-19, …, 70-79, 80+) and accounts for differences in susceptibility and infectiousness by age group, seasonality in transmission rate, modes of vaccine protection (e.g., infection, transmission), and vaccine characteristics (e.g., vaccine effectiveness). Model parameters are estimated by fitting the model piecewise to daily cases from the Dutch notification database Osiris from 01 January 2020 to 22 June 2021. Forward simulations are performed from 22 June 2021 to 31 March 2022. We performed sensitivity analyses in which vaccine-induced immunity waned.

We found that upon relaxation of all non-pharmaceutical control measures a large wave occurred regardless of vaccination strategy. We found overall reductions of 5.7% (4.4%, 6.9%) of cases, 2.0% (0.7%, 3.2%) of hospital admissions, and 1.7% (0.6%, 2.8%) of IC admissions when those 12 years and above were vaccinated compared to vaccinating only adults. When those 5 years and above were vaccinated we observed reductions of 8.7% (7.5%, 9.9%) of cases, 3.2% (2.0%, 4.5%) of hospital admissions, and 2.4% (1.2%, 3.5%) of IC admissions compared to vaccination in adults only. Benefits of extending vaccination were larger within the age groups included in the vaccination program extension than in other age groups. The benefits of vaccinating adolescents and children were smaller if vaccine protection against infection, hospitalization, and transmission (once infected) wanes.

Discussion

Our results highlight the benefits of extending COVID-19 vaccination programs beyond adults to reduce infections and severe outcomes in adolescents and children and in the wider population. A reduction of infections in school-aged children/adolescents may have the added benefit of reducing the need for school closures during a new wave. Additional control measures may be required in future to prevent a large wave despite vaccination program extensions. While the results presented here are based on population characteristics and the COVID-19 vaccination program in The Netherlands, they may provide valuable insights for other countries who are considering COVID-19 vaccination program extensions.

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    SciScore for 10.1101/2021.10.21.21265318: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The work presented here has some limitations. First, we do not account for population heterogeneity beyond 10-year age groups; therefore, we do not account for additional sources of heterogeneity such as individuals with differing levels of risk (due to factors other than age, e.g., co-morbidities) and geographic clustering in vaccination coverage or naturally-acquired immunity. Therefore, these results represent the average impacts of vaccinating adolescents in the population, but precise benefits may vary in subgroups of the population. Second, we assume that once individuals recover from infection, they cannot be re-infected. There is evidence that re-infection with SARS-CoV-2 [65] may be possible; therefore, we may be underestimating the number of infections. We also assume a final vaccination coverage of 75% in children and adolescents, which is consistent with the percent of adolescents willing to be vaccinated in The Netherlands [66]; however, this may be optimistic. If true vaccination coverage in children and adolescents is lower, then the impacts of vaccinating these groups will also be lower. Finally, we assume there is no change in the probability of severe disease upon infection over time or between variants. There is evidence that suggests increased disease severity after infection with the Delta variant [67]; therefore, we may be underestimating the number of severe infections. In conclusion, our results highlight the benefits to extending COVID-19 vaccination ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.10.21.21265318v1 on medRxiv