Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of COVID-19 vaccines among children and adolescents against SARS-CoV-2 variants: a meta-analysis

  • REVIEW
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

This systematic review and meta-analysis aimed to evaluate the effectiveness of COVID-19 vaccines among children and adolescents against SARS-CoV-2 variants. We searched PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov for studies published on or before June 20, 2023. Studies evaluating the effectiveness of COVID-19 vaccines in children and adolescents (≤ 18 years of age) were included. Data extraction, quality assessment, and analysis were conducted following PRISMA guidelines. Ten studies were included, comprising five cohort studies (527,778 participants) and four case-control studies (1,477,422 participants). The overall vaccine effectiveness (VE) against SARS-CoV-2 variants was 68% (95% CI = 60–74%). In terms of age, the VE was higher in adolescents aged 12–18 years [69%(95% CI = 61–75%)] than in children aged 5–11 years [44%(95% CI = 1–68%)]. “Fully vaccinated” may offer greater protection than “partially vaccinated,” with a VE of 71% (95%CI = 59–79%) and 66% (95%CI = 51–76%), respectively.

   Conclusion: This meta-analysis presents moderate-quality evidence that the COVID-19 vaccine is effective in safeguarding children and adolescents from the SARS-CoV-2 variant. Being fully vaccinated may offer greater protection than being partially vaccinated. Nevertheless, additional high-quality controlled trials are required to verify this finding.

What is Known:

• The COVID-19 pandemic has led to the rapid development and deployment of vaccines worldwide. Children and adolescents are a unique population for vaccination, and the effectiveness of vaccines against SARS-CoV-2 variants in this age group is of concern.

What is New:

• The COVID-19 vaccine is effective in protecting children and adolescents against the SARS-CoV-2 variant. Being fully vaccinated may offer greater protection than being partially vaccinated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data analyzed in this study is available from the corresponding author on reasonable request.

References

  1. Voysey M, Costa Clemens SA, Madhi SA, Weckx LY, Folegatti PM, Aley PK et al (2021) Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials. Lancet 397(10277):881–891. https://doi.org/10.1016/S0140-6736(21)00432-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R et al (2021) Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 384(5):403–416. https://doi.org/10.1056/NEJMoa2035389

    Article  CAS  PubMed  Google Scholar 

  3. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S et al (2020) Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 383(27):2603–2615. https://doi.org/10.1056/NEJMoa2034577

    Article  CAS  PubMed  Google Scholar 

  4. Logunov DY, Dolzhikova IV, Shcheblyakov DV, Tukhvatulin AI, Zubkova OV, Dzharullaeva AS et al (2021) Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia. Lancet 397(10275):671–681. https://doi.org/10.1016/S0140-6736(21)00234-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hall VJ, Foulkes S, Saei A, Andrews N, Oguti B, Charlett A et al (2021) COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Lancet 397(10286):1725–1735. https://doi.org/10.1016/S0140-6736(21)00790-X

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dagan N, Barda N, Kepten E, Miron O, Perchik S, Katz MA et al (2021) BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting. N Engl J Med 384(15):1412–1423. https://doi.org/10.1056/NEJMoa2101765

    Article  CAS  PubMed  Google Scholar 

  7. Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J et al (2021) Interim estimates of vaccine effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines in preventing SARS-CoV-2 infection among health care personnel, first responders, and other essential and frontline workers - eight U.S. locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 70(13):495–500. https://doi.org/10.15585/mmwr.mm7013e3

  8. Gao P, Kang LY, Liu J, Liu M (2023) Immunogenicity, effectiveness, and safety of COVID-19 vaccines among children and adolescents aged 2–18 years: an updated systematic review and meta-analysis. World J Pediatr 1–14. https://doi.org/10.1007/s12519-022-00680-9

  9. Denina M, Pruccoli G, Scolfaro C, Mignone F, Zoppo M, Giraudo I et al (2020) Sequelae of COVID-19 in hospitalized children: a 4-months follow-up. Pediatr Infect Dis J 39(12):e458–e459. https://doi.org/10.1097/INF.0000000000002937

    Article  PubMed  Google Scholar 

  10. Bottino I, Patria MF, Milani GP, Agostoni C, Marchisio P, Lelii M et al (2021) Can asymptomatic or non-severe SARS-CoV-2 infection cause medium-term pulmonary sequelae in children. Front Pediatr 9:621019. https://doi.org/10.3389/fped.2021.621019

  11. Cao Y, Wang J, Jian F, Xiao T, Song W, Yisimayi A et al (2022) Omicron escapes the majority of existing SARS-CoV-2 neutralizing antibodies. Nature 602(7898):657–663. https://doi.org/10.1038/s41586-021-04385-3

    Article  CAS  PubMed  Google Scholar 

  12. García JE, González-López VA, Tasca GH (2022) Multiple partition Markov model for B.1.1.7, B.1.351, B.1.617.2, and P.1 variants of SARS-CoV 2 virus. Comput Stat :1–37. https://doi.org/10.1007/s00180-022-01291-8

  13. Garcia-Beltran WF, Lam EC, St Denis K, Nitido AD, Garcia ZH, Hauser BM et al (2021) Multiple SARS-CoV-2 variants escape neutralization by vaccine-induced humoral immunity. Cell 184(9):2372-2383.e9. https://doi.org/10.1016/j.cell.2021.03.013

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Planas D, Veyer D, Baidaliuk A, Staropoli I, Guivel-Benhassine F, Rajah MM et al (2021) Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization. Nature 596(7871):276–280. https://doi.org/10.1038/s41586-021-03777-9

    Article  CAS  PubMed  Google Scholar 

  15. Wang CS, Doma R, Westbrook AL, Johnson J, Anderson EJ, Greenbaum LA et al (2023) Vaccine attitudes and COVID-19 vaccine intention among parents of children with kidney disease or primary hypertension. Am J Kidney Dis 81(1):25-35.e1. https://doi.org/10.1053/j.ajkd.2022.04.011

    Article  PubMed  Google Scholar 

  16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

  17. Sterne J, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898

  18. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

  19. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fleming-Dutra KE, Britton A, Shang N, Derado G, Link-Gelles R, Accorsi EK et al (2022) Association of prior BNT162b2 COVID-19 vaccination with symptomatic SARS-CoV-2 infection in children and adolescents during omicron predominance. JAMA 327(22):2210–2219. https://doi.org/10.1001/jama.2022.7493

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Florentino P, Alves F, Cerqueira-Silva T, Oliveira VA, Júnior J, Jantsch AG et al (2022) Vaccine effectiveness of CoronaVac against COVID-19 among children in Brazil during the Omicron period. Nat Commun 13(1):4756. https://doi.org/10.1038/s41467-022-32524-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Tartof SY, Frankland TB, Slezak JM, Puzniak L, Hong V, Xie F et al (2022) Effectiveness associated with BNT162b2 vaccine against emergency department and urgent care encounters for Delta and Omicron SARS-CoV-2 infection among adolescents aged 12 to 17 years. JAMA Netw Open 5(8):e2225162. https://doi.org/10.1001/jamanetworkopen.2022.25162

  23. Oliveira CR, Niccolai LM, Sheikha H, Elmansy L, Kalinich CC, Grubaugh ND et al (2022) Assessment of clinical effectiveness of BNT162b2 COVID-19 vaccine in US adolescents. JAMA Netw Open 5(3):e220935. https://doi.org/10.1001/jamanetworkopen.2022.0935

  24. Ng OT, Koh V, Chiew CJ, Marimuthu K, Thevasagayam NM, Mak TM et al (2022) Impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and pediatric age on Delta variant household transmission. Clin Infect Dis 75(1):e35–e43. https://doi.org/10.1093/cid/ciac219

    Article  PubMed  Google Scholar 

  25. Ionescu IG, Skowronski DM, Sauvageau C, Chuang E, Ouakki M, Kim S et al (2023) BNT162b2 effectiveness against Delta and Omicron variants of SARS-CoV-2 in adolescents aged 12–17 years, by dosing interval and duration. J Infect Dis. https://doi.org/10.1093/infdis/jiad006

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tartof SY, Slezak JM, Fischer H, Hong V, Ackerson BK, Ranasinghe ON et al (2021) Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study. Lancet 398(10309):1407–1416. https://doi.org/10.1016/S0140-6736(21)02183-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Reis BY, Barda N, Leshchinsky M, Kepten E, Hernán MA, Lipsitch M et al (2021) Effectiveness of BNT162b2 vaccine against Delta variant in adolescents. N Engl J Med 385(22):2101–2103. https://doi.org/10.1056/NEJMc2114290

    Article  PubMed  Google Scholar 

  28. Lutrick K, Rivers P, Yoo YM, Grant L, Hollister J, Jovel K et al (2021) Interim estimate of vaccine effectiveness of BNT162b2 (Pfizer-BioNTech) vaccine in preventing SARS-CoV-2 infection among adolescents aged 12–17 years - Arizona, July-December 2021. MMWR Morb Mortal Wkly Rep 70(5152):1761–1765. https://doi.org/10.15585/mmwr.mm705152a2

  29. Powell AA, Kirsebom F, Stowe J, Ramsay ME, Lopez-Bernal J, Andrews N (2023) Protection against symptomatic infection with delta (B.1.617.2) and omicron (B.1.1.529) BA.1 and BA.2 SARS-CoV-2 variants after previous infection and vaccination in adolescents in England, August 2021-March, et al 2022 a national, observational, test-negative, case-control study. Lancet Infect Dis 23(4):435–444. https://doi.org/10.1016/S1473-3099(22)00729-0

  30. Dunkle LM, Kotloff KL, Gay CL, Áñez G, Adelglass JM, Barrat Hernández AQ et al (2022) Efficacy and safety of NVX-CoV2373 in adults in the United States and Mexico. N Engl J Med 386(6):531–543. https://doi.org/10.1056/NEJMoa2116185

    Article  CAS  PubMed  Google Scholar 

  31. Smith LE, Amlôt R, Weinman J, Yiend J, Rubin GJ (2017) A systematic review of factors affecting vaccine uptake in young children. Vaccine 35(45):6059–6069. https://doi.org/10.1016/j.vaccine.2017.09.046

    Article  PubMed  Google Scholar 

  32. Galanis P, Vraka I, Siskou O, Konstantakopoulou O, Katsiroumpa A, Kaitelidou D (2022) Willingness, refusal and influential factors of parents to vaccinate their children against the COVID-19: a systematic review and meta-analysis. Prev Med 157:106994. https://doi.org/10.1016/j.ypmed.2022.106994

  33. Wiysonge CS, Ndwandwe D, Ryan J, Jaca A, Batouré O, Anya BM et al (2022) Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future. Hum Vaccin Immunother 18(1):1–3. https://doi.org/10.1080/21645515.2021.1893062

    Article  CAS  PubMed  Google Scholar 

  34. Wang K, Wong EL, Cheung AW, Chung VC, Wong CH, Dong D et al (2022) Impact of information framing and vaccination characteristics on parental COVID-19 vaccine acceptance for children: a discrete choice experiment. Eur J Pediatr 181(11):3839–3849. https://doi.org/10.1007/s00431-022-04586-6

    Article  PubMed  PubMed Central  Google Scholar 

  35. Liu E, Smyth RL, Li Q, Qaseem A, Florez ID, Mathew JL et al (2022) Guidelines for the prevention and management of children and adolescents with COVID-19. Eur J Pediatr 181(12):4019–4037. https://doi.org/10.1007/s00431-022-04615-4

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zeng B, Gao L, Zhou Q, Yu K, Sun F (2022) Effectiveness of COVID-19 vaccines against SARS-CoV-2 variants of concern: a systematic review and meta-analysis. BMC Med 20(1):200. https://doi.org/10.1186/s12916-022-02397-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Thanks to all authors for their contributions to this article.

Funding

This study was supported by the National Natural Science Foundation of China (No. U22A20285), the National Natural Science Foundation of China (No. 82160433), the Key R&D Project of Autonomous Region (No. 2023BEG02018), the Ningxia Medical University General Hospital “Medical Engineering Special” (No. NYZYYG-001), the Scientific Research Project of Ningxia Universities (No. NYG-2022033), and the Key R&D Project of Autonomous Region (No. 2021BEG02037).

Author information

Authors and Affiliations

  1. Ningxia Medical University, The General Hospital of Ningxia Medical University, 804 Shengli South Street, Ningxia Hui Autonomous Region, 750004, Yinchuan, China

    Zhibin Lan, Jiangbo Yan, Yang Yang, Zhiqun Tang & Qunhua Jin

  2. Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China

    Zhibin Lan, Jiangbo Yan, Yang Yang & Qunhua Jin

  3. Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, China

    Xuefang Guo & Zhiqiang Wu

Authors
  1. Zhibin Lan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiangbo Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yang Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhiqun Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xuefang Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhiqiang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qunhua Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JQH and LZB developed the search searches, extracted the data, assessed the study quality, performed the statistical analysis, and wrote the manuscript. YJB, YY and TZQ conceived and designed the study. WZQ and GXF cross-checked the collection and organization of data. All the authors revised and approved the final version of the manuscript.

Corresponding author

Correspondence to Qunhua Jin.

Ethics declarations

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Gregorio Milani

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lan, Z., Yan, J., Yang, Y. et al. Effectiveness of COVID-19 vaccines among children and adolescents against SARS-CoV-2 variants: a meta-analysis. Eur J Pediatr 182, 5235–5244 (2023). https://doi.org/10.1007/s00431-023-05216-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-023-05216-5

Keywords

Search

Navigation