Booster Vaccines for Children: A Key Strategy to Mitigate COVID-19 Impact on Schools and Health

Children’s adverse outcomes of COVID-19, such as severe disease and hospitalization, can disrupt school attendance. As of March 2023, more than 185000 hospitalizations and 1700 deaths in the pediatric population were attributed to the COVID-19 pandemic.

Vaccination is a crucial tool in preventing COVID-19 transmission. Despite the challenges posed by waning protection and immune escape, a bivalent COVID-19 booster vaccine targeting highly transmissible Omicron subvariants is available.

One study estimated whether accelerating COVID-19 bivalent booster vaccination could reduce pediatric hospitalizations and school absenteeism. The investigators hypothesized that achieving high bivalent booster coverage among eligible individuals through vaccination campaigns could significantly reduce severe illness, deaths, school absenteeism, and subsequent educational disruptions.

The study, published in JAMA Network Open as a public health original investigation, utilized a simulations model to assess the impact of improving bivalent booster coverage among both children and adults. Using a decision analytical model, the investigators analyzed a simulation model of COVID-19 transmission based on reported incidence data from October 2020 to September 2022. The study focused on children under 18 years old, considering the entire age-stratified US population.

The age-stratified agent-based model of COVID-19 accounted for waning immunity from natural infection or vaccination. The population was stratified into 10 age groups, ranging from 0-4 years to 65 years or older, based on US demographics. The model incorporated age-specific risk of hospitalization, deaths, and contact patterns. The transmission dynamics considered the spread of 5 SARS-CoV-2 variants, including Iota, Alpha, Gamma, Delta, and Omicron, in addition to the original Wuhan wild-type strain. Parameters for the transmission dynamics were based on the most recent estimates.

The study simulated various scenarios of accelerated bivalent COVID-19 booster campaigns, aiming to achieve vaccination uptake either half or similar to the age-specific rates observed during the 2020-2021 seasonal influenza vaccination across all age groups.

Among children aged 5 to 17 years, a COVID-19 bivalent booster campaign with age-specific coverage similar to influenza vaccination could have averted an estimated 5448694 days of school absenteeism due to COVID-19 illness. Moreover, the booster campaign could have prevented approximately 10019 hospitalizations, with 2645 cases requiring intensive care, among the pediatric population aged 0-17 years.

A less ambitious booster campaign, achieving 50% of the age-specific uptake of influenza vaccination, could still avert significant school absenteeism (2875926 days) and 5791 hospitalizations, including 1397 cases requiring intensive care.

This decision analytical model demonstrated that a theoretical increased uptake of bivalent booster vaccination among eligible age groups can lead to reduced hospitalizations and school absenteeism among children.

The investigators noted although COVID-19 prevention strategies often target older Americans, booster campaigns for children could be very beneficial. These findings emphasize the importance of considering pediatric populations in COVID-19 prevention strategies.