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COVID-19 Epidemiology, Immunity, and Vaccine Development in Children: A Review

ORCID
0000-0002-1111-0892
Affiliation
Driscoll Children’s Hospital, Corpus Christi, TX 78411, USA
Fergie, Jaime;
Affiliation
Pfizer Inc., Collegeville, PA 19426, USA
Moran, Mary M.;
Affiliation
Pfizer Inc., Collegeville, PA 19426, USA
Cane, Alejandro;
Affiliation
BioNTech, D-55131 Mainz, Germany
Pather, Shanti;
Affiliation
BioNTech, D-55131 Mainz, Germany
Türeci, Ӧzlem;
Affiliation
Pfizer Inc., Cambridge, MA 02139, USA
Srivastava, Amit

Although pediatric populations experienced lower COVID-19 severity and mortality than adults, the epidemiology of this disease continues to evolve. COVID-19 clinical manifestations in pediatrics commonly include fever and cough, but may differ from adults and by variant. Serious complications, including MIS-C, rarely occur. Although early data showed a decreased likelihood of COVID-19 transmission from children versus adults, outbreaks and viral shedding studies support pediatric transmission potential. Children may mount more robust initial immune responses to SARS-CoV-2 versus adults. COVID-19 vaccines with available pediatric data include BNT162b2, mRNA-1273, CoronaVac, and BBIBP-CorV. Depending on age group and jurisdiction, BNT162b2 and mRNA-1273 have received full approval or emergency/conditional authorization in the United States and European Union from 6 months of age. Clinical trials have shown BNT162b2 and mRNA-1273 safety and high efficacy in pediatric populations, with demonstrably noninferior immune responses versus young adults. Real-world studies further support BNT162b2 safety and effectiveness against the Delta variant. mRNA vaccination benefits are considered to outweigh risks, including myocarditis; however, pediatric vaccination rates remain relatively low. Given a growing body of clinical trial and real-world data showing vaccine safety and effectiveness, pediatric vaccination should be prioritized as an important strategy to control the pandemic.

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