BNT162b2 mRNA Vaccination Against Coronavirus Disease 2019 is Associated With a Decreased Likelihood of Multisystem Inflammatory Syndrome in Children Aged 5–18 Years—United States, July 2021 – April 2022
Authors: Zambrano Laura D , Newhams Margaret M , Olson Samantha M , Halasa Natasha B , Price Ashley M , Orzel Amber O , Young Cameron C , Boom Julie A , Sahni Leila C , Maddux Aline B , Bline Katherine E , Kamidani Satoshi , Tarquinio Keiko M , Chiotos Kathleen , Schuster Jennifer E , Cullimore Melissa L , Heidemann Sabrina M , Hobbs Charlotte V , Nofziger Ryan A , Pannaraj Pia S , Cameron Melissa A , Walker Tracie C , Schwartz Stephanie P , Michelson Kelly N , Coates Bria M , Flori Heidi R , Mack Elizabeth H , Smallcomb Laura , Gertz Shira J , Bhumbra Samina S , Bradford Tamara T , Levy Emily R , Kong Michele , Irby Katherine , Cvijanovich Natalie Z , Zinter Matt S , Bowens Cindy , Crandall Hillary , Hume Janet R , Patel Manish M , Campbell Angela P , Randolph Adrienne G ,   for the Overcoming COVID-19 Investigators, Kong Michele , Murdock Meghan , Gaspers Mary Glas , Typpo Katri V , Kelley Connor P , Irby Katherine , Sanders Ronald C , Yates Masson , Smith Chelsea , Cameron Melissa A , Crane Katheryn , Cvijanovich Natalie Z , Lionetti Geraldina , Murcia-Montoya Juliana , Zinter Matt S , Villarreal-Chico Denise , Pannaraj Pia S , Skura Adam L , Hakimi Daniel , Peralta Harvey , Sea Yea Ji , Mrotek Kennis-Grace , Maddux Aline B , Lockwood Justin M , Port Emily , Carson Imogene , Chatani Brandon M , Kamidani Satoshi , Tarquinio Keiko M , Hussaini Laila , Baida Nadine , Michelson Kelly N , Coates Bria M , Rhodes Simone T , Khan Hassan A , Bhumbra Samina S , Rowan Courtney M , Stumpf Mary , Bradford Tamara T , Johnston Marla S , Randolph Adrienne G , Newhams Margaret M , Kucukak Suden , Orzel Amber O , Young Cameron C , Chen Sabrina R , Boutselis Benjamin J , McCadden Timothy P , Stewart Kasey R , Weller Edie , Berbert Laura , He Jie , Heidemann Sabrina M , Flori Heidi R , Moran Patrick , Hume Janet R , Bruno Ellen R , Goertzen Lexie A , Levy Emily R , Behl Supriya , Drapeau Noelle M , Hobbs Charlotte V , Martin Lora , Malloch Lacy , Harrison Virginia Austin , Sanders Cameron , Patterson Kayla , Chikere Chidinma A , Schuster Jennifer E , Kietzman Abigail , Sullivan Melissa , Cullimore Melissa L , Rinehart Valerie H , Hoody Lauren A , Gertz Shira J , Schwartz Stephanie P , Walker Tracie C , Bennett Paris C , Nofziger Ryan A , Twinem Nicole A , Tomcany Merry L , Staat Mary Allen , Rohlfs Chelsea C , Bline Katherine , Wolfe Amber , Chiotos Kathleen , Douglas Rebecca L , Phengchomphet Kathlyn , Mack Elizabeth H , Bickford Megan M , Wakefield Lauren E , Smallcomb Laura , Halasa Natasha B , Hayek Haya , Romero Yesenia , Boom Julie A , Sahni Leila C , Oates Jennifer N , Maamari Mia , Bowens Cindy , Crandall Hillary , Olson M , Price Ashley M , Zambrano Laura D , Campbell Angela P , Patel Manish M 
Published: August 2022

Abstract

Background
Multisystem inflammatory syndrome in children (MIS-C), linked to antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with considerable morbidity. Prevention of SARS-CoV-2 infection or coronavirus disease 2019 (COVID-19) by vaccination might also decrease MIS-C likelihood.

Methods
In a multicenter, case-control, public health investigation of children ages 5–18 years hospitalized from 1 July 2021 to 7 April 2022, we compared the odds of being fully vaccinated (2 doses of BNT162b2 vaccine ≥28 days before hospital admission) between MIS-C case-patients and hospital-based controls who tested negative for SARS-CoV-2. These associations were examined by age group, timing of vaccination, and periods of Delta and Omicron variant predominance using multivariable logistic regression.

Results
We compared 304 MIS-C case-patients (280 [92%] unvaccinated) with 502 controls (346 [69%] unvaccinated). MIS-C was associated with decreased likelihood of vaccination (adjusted OR [aOR]: .16; 95% CI: .10–.26), including among children ages 5–11 years (aOR: .22; 95% CI: .10–.52), ages 12–18 years (aOR: .10; 95% CI: .05–.19), and during the Delta (aOR: .06; 95% CI: .02–.15) and Omicron (aOR: .22; 95% CI: .11–.42) variant-predominant periods. This association persisted beyond 120 days after the second dose (aOR: .08; 95% CI: .03–.22) in 12–18-year-olds. Among all MIS-C case-patients, 187 (62%) required intensive care unit admission and 280 (92%) vaccine-eligible case-patients were unvaccinated.

Conclusions
Vaccination with 2 doses of BNT162b2 is associated with reduced likelihood of MIS-C in children ages 5–18 years. Most vaccine-eligible hospitalized patients with MIS-C were unvaccinated.