Majority of 15–19-year-olds wanted COVID jab
IMAGE: STEFAN NILSSON, UNIVERSITY OF GOTHENBURG, SAHLGRENSKA ACADEMY view more
CREDIT: PHOTO BY CECILIA HEDSTRÖM
Unconcerned for themselves — but willing to protect others. These attitudes were expressed by many teenagers on being asked whether they wanted to get vaccinated against COVID-19. The study, from the University of Gothenburg, shows that a majority were in favor of the idea.
The study, published in the scientific journal Vaccine: X, is based on questionnaire responses from 702 adolescents in Sweden, aged 15–19, between July and November 2020. The survey was thus carried out before the country’s vaccination program began.
The study was led by University of Gothenburg researchers in collaboration with colleagues at University West, Karolinska Institutet and Umeå University. The study participants came from various parts of Sweden, and the results are both qualitative and quantitative in nature.
The questionnaire survey results show that 54.3 percent were willing to be vaccinated, while 30.5 percent were undecided. Anxiety about getting vaccinated, which was more marked in girls than in boys, was a factor associated with reluctance to get vaccinated.
Many of the adolescent respondents stated that they had pondered the pros and cons of the COVID vaccine. Overall, their attitude was positive, while they said they needed to know more about it. In many cases, this perceived lack of knowledge was crucial to their decision.
Skepticism passed on from parents
One misgiving expressed was the rapid development and fast-tracking of the vaccine; here, respondents mentioned their worry about serious side effects. Some referred to the mass vaccinations against swine flu in 2009/10, when in some cases the vaccine caused narcolepsy.
This particular aspect took Stefan Nilsson by surprise. An associate professor and senior lecturer at the University’s Institute of Health and Care Sciences at Sahlgrenska Academy, Nilsson is the study’s first and corresponding author.
“They were small children when the swine flu vaccinations came along, so it must have been their parents or other elders who influenced them, or else they’ve read about it. Clearly, that experience of the swine flu vaccine influences the younger generation as well,” he says.
At the time of the data collection, there were no reports of COVID-related deaths among young people in Sweden. For their own part, moreover, many of the teenage respondents were unafraid of becoming infected and falling ill.
Wish to protect others
Many, on the other hand, voiced altruistic motives for getting vaccinated and thereby protecting others whose health was more fragile. A further indication that the adolescents were willing to get the jab for other people’s sake was that this attitude was found to be linked to the practice of social distancing.
“The results suggest what steps need taking to make it easier for young people to make an informed decision ahead of getting vaccinated. They need factual information that the risks of COVID’s adverse effects are greater than the risks of any side effects of the jab,” Nilsson says.
“And the information needs to be spread through information channels that reach adolescents. What’s more, it’s important for there to be discussion forums where the young can meet experts who can discuss and answer their questions.”
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JOURNAL
Vaccine X
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
To be or not to be vaccinated against COVID-19 – the adolescents’ perspective – a mixed-methods study in Sweden
ARTICLE PUBLICATION DATE
19-Oct-2021
COVID-19 vaccination strongly protected 12- to 18-year-olds during Delta
Two studies find that the Pfizer-BioNTech vaccine prevents COVID-19 infection and severe illness
Peer-Reviewed PublicationTwo new studies report that COVID-19 vaccination strongly protects against both infection and serious illness, respectively among adolescents age 12 to 18. Both studies covered periods when the highly contagious Delta variant was the predominant circulating strain.
A CDC-supported study, led by Boston Children’s Hospital and published in the Morbidity & Mortality Weekly Report (MMWR) on October 19, focused on severe COVID-19 disease requiring hospitalization. It found that two doses of the Pfizer-BioNTech COVID-19 vaccine were 93 percent effective at preventing COVID-19 hospitalization.
The investigation used a case-control design. The cases were 179 vaccine-eligible patients hospitalized for COVID-19, ages 12-18 years; the 285 controls, matched for age, tested negative for COVID-19 or had asymptomatic infections and were hospitalized for other reasons. All patients were hospitalized in 16 U.S. states from June 1, 2021 to September 30, 2021, a period when pediatric hospitalizations were surging, especially in the southern U.S. where 61 percent of the cases were enrolled.
Of the 179 patients hospitalized for COVID-19, only 3 percent were vaccinated, versus 33 percent of controls. Of the adolescents hospitalized for COVID-19, 43 percent were admitted to an intensive care unit, 16 percent required life support, and two died.
All patients requiring ICU care or life support, including the two who died, were unvaccinated. Of the 3 percent of vaccinated adolescents hospitalized for COVID-19, none developed critical illness.
“These findings show that COVID-19 is not a benign disease in 12- to 18-year-olds, and reinforce the importance of vaccinating adolescents to protect them,” says Adrienne Randolph, MD, MSc of Boston Children’s, senior author on the report and principal investigator on the larger Overcoming COVID-19 study. “We hope these new data will encourage more teens to get vaccinated.”
Reduced COVID-19 infections
Boston Children’s also collaborated on a large study of 12- to 18-year-olds in Israel, led by the Clalit Research Institute. This study focused on COVID-19 infection in general. Using health record databases, the investigators compared 94,354 Pfizer-vaccinated adolescents with 94,354 matched unvaccinated controls from June 8, 2021 through September 14, 2021.
Fully vaccinated adolescents had a 93 percent decreased risk for symptomatic COVID-19 and a 90 percent decreased risk for documented infection. The findings are published as a letter in The New England Journal of Medicine.
“This careful epidemiological study provides reliable information on vaccine effectiveness, which we hope will be helpful to those who have not yet decided about vaccination,” says co-first author Ben Reis, PhD, director of the Predictive Medicine Group of the Boston Children’s Computational Health Informatics Program.
Both teams of researchers hope the new data will help ease vaccine hesitancy. To date, COVID-19 vaccination rates have been relatively low in U.S. adolescents. As of October 12, only 45 percent of U.S. 12- to 15-year-olds and 53 percent of 16- to 17-year-olds were fully vaccinated against COVID-19, according to the CDC’s COVID Data Tracker.
About Boston Children’s Hospital
Boston Children’s Hospital is ranked the #1 children’s hospital in the nation by U.S. News & World Report and is the primary pediatric teaching affiliate of Harvard Medical School. Home to the world’s largest research enterprise based at a pediatric medical center, its discoveries have benefited both children and adults since 1869. Today, 3,000 researchers and scientific staff, including 10 members of the National Academy of Sciences, 25 members of the National Academy of Medicine and 12 Howard Hughes Medical Investigators comprise Boston Children’s research community. Founded as a 20-bed hospital for children, Boston Children’s is now a 415-bed comprehensive center for pediatric and adolescent health care. For more, visit our Answers blog and follow us on social media @BostonChildrens, @BCH_Innovation, Facebook and YouTube.
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JOURNAL
New England Journal of Medicine
ARTICLE PUBLICATION DATE
19-Oct-2021
COVID-19 vaccine effectiveness in adolescents
Largest real-world study of COVID-19 vaccine effectiveness in Adolescents published by Israel's Clalit Research Institute in The New England Journal of Medicine
Peer-Reviewed PublicationThe Clalit Research Institute, in collaboration with researchers from Harvard University, analyzed one of the world’s largest integrated health record databases to examine the effectiveness of the Pfizer/BioNTech BNT162B2 vaccine against the Delta variant of SARS-CoV-2 among adolescents. The study provides the largest peer-reviewed evaluation of the effectiveness of a COVID-19 vaccine among adolescents in a nationwide mass-vaccination setting, and the first such study where the Delta variant was dominant. The study was conducted in Israel, an early global leader in COVID-19 vaccination rates.
The results of this study validate and complement the previously reported findings of a Pfizer/BioNTech Phase-III randomized clinical trial, which focused on symptomatic infections in the face of non-Delta variants, and which, with 1,983 vaccinated adolescents between the ages of 12 and 15 years, could not precisely assess vaccine effectiveness. The present study’s large size allows a more precise assessment of the vaccine’s effectiveness across different time periods.
The study took place from June 8, 2021 through September 14, 2021. It coincided with Israel’s fourth wave of coronavirus infection and illness, during which the Delta (B.1.617.2) variant was the dominant strain in the country for new infections.
Researchers reviewed data from 94,354 vaccinated adolescents aged 12 to 18. These adolescents were carefully matched with 94,354 unvaccinated adolescents based on an extensive set of demographic, geographic and health-related attributes associated with risk of infection, risk of severe disease, health status and health seeking behavior. Individuals were assigned to each group dynamically based on their changing vaccination status (13,423 individuals moved from the unvaccinated cohort into the vaccinated cohort during the study). Multiple sensitivity analyses were conducted to ensure that the estimated vaccine effectiveness was robust to potential biases.
The results show that in fully vaccinated adolescents (7 to 21 days after the second dose), the risk of symptomatic COVID-19 decreased by 93% compared with the unvaccinated, while the risk of documented infection decreased by 90%. In the period immediately preceding the second dose (days 14-20 after the first dose), vaccine effectiveness was lower, but still substantial -- the risk of symptomatic COVID-19 decreased by 57% in vaccinated individuals, and the risk of documented infection by 59%. There was insufficient data to provide an estimate on the reduction in the incidence of severe disease, hospitalization and mortality, as these outcomes are rare among adolescents.
The research was conducted by Dr. Noam Barda, Dr. Noa Dagan, Michael Leshchinsky, Dr. Eldad Kepten, and Prof. Ran Balicer from the Clalit Research Institute, as well as Prof. Miguel Hernán and Prof. Marc Lipsitch of the Harvard T.H. Chan School of Public Health, and Prof. Ben Reis of Boston Children’s Hospital and Harvard Medical School.
“The extensive nationwide rollout of Israel’s COVID-19 vaccination campaign to adolescents at the very beginning of the delta variant wave, provided the Clalit Research Institute with a unique opportunity to assess, through its rich and comprehensive digital datasets, the effectiveness of the vaccine for adolescents against delta in a real-world setting,” said Prof. Ran Balicer, senior author of the study, Director of the Clalit Research Institute and Chief Innovation Officer for Clalit. “These results show convincingly that one week after the second dose, this vaccine is highly effective in adolescents against symptomatic COVID-19 and against all documented infections. These data should facilitate informed individual risk-benefit decision-making, and, in our view, make a strong argument in favor of opting-in to get vaccinated, especially in countries where the virus is currently widespread,” added Prof. Balicer, who also serves as Chairman of Israel's National Expert Advisory Team on COVID-19 response.
Prof. Ben Reis, Director of the Predictive Medicine Group at the Boston Children’s Hospital Computational Health Informatics Program and Harvard Medical School, said, “To date, one of the main drivers of vaccine hesitancy has been a lack of information regarding the effectiveness of the vaccine. This careful epidemiological study provides reliable information on vaccine effectiveness, which we hope will be helpful to those who have not yet decided about vaccination.”
Prof. Miguel Hernán, Director of the CAUSALab and Professor at the Harvard T.H. Chan School of Public Health, said, “This research is a perfect example of how randomized trials and observational healthcare databases complement each other. The adolescent-focused trial of the Pfizer/BioNTech vaccine provided compelling evidence of its effectiveness to prevent symptomatic infection, but the estimates for severe disease and specific age groups were too imprecise. This analysis of Clalit’s high-quality database emulates the design of the original trial, uses its findings as a benchmark, and expands upon them to confirm the vaccine’s effectiveness in adolescents. This combination of evidence from randomized trials and observational studies is a model for efficient medical research, something which is especially important in COVID times.”
Prof. Marc Lipsitch, Director of the Center for Communicable Disease Dynamics and Professor at the Harvard T.H. Chan School of Public Health, said, “In all studies of vaccine effectiveness, a major challenge is to ensure that those we are comparing to identify the vaccine’s effect are similar in the other characteristics that may predict whether they get infected or ill. This is especially hard in the context of a rapidly growing, age-targeted vaccine campaign. Clalit’s extraordinary database made it possible to design a study that addressed these challenges in a way that provides tremendous confidence in the inferences that come out of the study.”
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The research was funded in part by the newly announced Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute. “The strengthening of the scientific collaboration between Harvard and Clalit made possible by the Berkowitz Living Laboratory Collaboration is already bearing fruit and giving us a foretaste of the value of healthcare systems instrumented for research,” said Prof. Isaac Kohane, Chair of the Department of Biomedical Informatics at Harvard Medical School and co-Director of the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration along with Professor Balicer. “Israel offers a unique environment in which to study the vaccine and its effects, and this study is an excellent example of what can be accomplished through such close scientific collaborations.”
JOURNAL
New England Journal of Medicine
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Effectiveness of the BNT162b2 COVID-19 Vaccine against the B.1.617.2 (Delta) Variant in Adolescents
ARTICLE PUBLICATION DATE
19-Oct-2021
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