Disparities in First Dose COVID-19 Vaccination Coverage among Children 5-11 Years of Age, United States

Patterns in COVID-19 vaccination among children aged 5-11 years in Alberta, Canada: Lessons for future vaccination campaigns

Objectives

In Alberta, Canada, the COVID-19 vaccination program for children aged 5-11 years was launched on November 26, 2021. Our objectives were to determine the cumulative vaccine coverage, stratified by age, during the first thirteen months of vaccine availability, and investigate factors associated with vaccine uptake.

Study design

This retrospective cohort study used population-based administrative health data.

Methods

We determined cumulative vaccine coverage among 5-11 year olds, stratified by year of age, during the first thirteen months of vaccine availability and used a modified Poisson regression to evaluate factors associated with vaccine uptake.

Results

Of 377,103 eligible children, 44.8 % (n = 168,761) received one or more doses of COVID-19 vaccine during the study period (9.7 % received only one dose, while 35.1 % received 2 doses). Almost 90 % of initial doses were received within the first two months of vaccine availability. We found a step-wise relationship between increasing child age and higher vaccine coverage.

Conclusions

Plateaued vaccine uptake indicates a need to adapt programmatic efforts to encourage parents to act on positive vaccination intentions, and reach the large contingent of parents who have reported that they remain undecided. In order to promote vaccine uptake, messaging around vaccine safety and need should be tailored to child age, rather than uniformly applied across the 5-11 year age range.

Association between COVID-19 Booster Vaccination and COVID-19 Outcomes among U.S. Adults

Understanding the association between booster vaccination and COVID-19 outcomes can help strengthen post-pandemic messaging and strategies to increase vaccination and reduce severe and long-term consequences of COVID-19. Using the Household Pulse Survey data collected from U.S. adults from 9 December 2022 to 13 February 2023 (n = 214,768), this study assessed the relationship between COVID-19 booster vaccination and COVID-19 outcomes (testing positive for COVID-19, moderate/severe COVID-19, and long COVID). Disparities were found in COVID-19 outcomes (e.g., testing positive for COVID-19, moderate/severe COVID-19, and long COVID) by sociodemographic characteristics, region of residence, food insecurity status, mental health status, disability status, and housing type. Receipt of a COVID-19 booster vaccination was negatively associated with testing positive for COVID-19 (aOR = 0.75, 95%CI: 0.72,0.79), having moderate/severe COVID-19 (aOR = 0.92, 95%CI: 0.88, 0.97), or having long COVID (aOR = 0.86 (0.80, 0.91)). Even among those who tested positive for COVID-19, those who received the booster vaccine were less likely to have moderate/severe COVID-19 and less likely to have long COVID. Communicating the benefits of COVID-19 booster vaccination, integrating vaccination in patient visits, and reducing access barriers can increase vaccination uptake and confidence for all individuals and protect them against the severe negative outcomes of COVID-19.

Uptake of COVID-19 vaccinations amongst 3,433,483 children and young people: meta-analysis of UK prospective cohorts

SARS-CoV-2 infection in children and young people (CYP) can lead to life-threatening COVID-19, transmission within households and schools, and the development of long COVID. Using linked health and administrative data, we investigated vaccine uptake among 3,433,483 CYP aged 5-17 years across all UK nations between 4th August 2021 and 31st May 2022. We constructed national cohorts and undertook multi-state modelling and meta-analysis to identify associations between demographic variables and vaccine uptake. We found that uptake of the first COVID-19 vaccine among CYP was low across all four nations compared to other age groups and diminished with subsequent doses. Age and vaccination status of adults living in the same household were identified as important risk factors associated with vaccine uptake in CYP. For example, 5-11 year-olds were less likely to receive their first vaccine compared to 16-17 year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06-0.19)), and CYP in unvaccinated households were less likely to receive their first vaccine compared to CYP in partially vaccinated households (aHR: 0.19, 95%CI 0.13-0.29).

Effect of information provision on parental intention toward COVID-19 vaccination for children: a nationwide survey experiment

The reluctance of parents to vaccinate their children against COVID-19 was prevalent particularly when uncertainty over vaccination outcomes prevailed. We conducted a nationwide randomized online survey experiment to assess the effect of information provision on parental intention for COVID-19 vaccination before the government started vaccination for children in South Korea. Parents of elementary school children were provided with either no information (Control), information on vaccine profile (vaccine informed group; VI), or COVID-19 (disease informed group; DI). Among 359,110 participants, parental intention for vaccination of children was significantly higher in both VI and DI groups compared with the Control group. In terms of effect size, information on COVID-19 vaccine increased likelihood to vaccinate by 1620 per 100,000 parents and reduced vaccine hesitancy by 1340 per 100,000 parents. Consistently with the positive effect on vaccination intention, both VI and DI interventions increased participants' perceptions on vaccination benefits being higher than its risks and vaccination risks being lower than health risks of COVID-19 infection, and self-reported trust in COVID-19 information. Our results lend strong support to the claim that the provision of targeted, tailored information on COVID-19 vaccine and infection increases parental intention to vaccinate children and reduces vaccine hesitancy.

Systematic review of socioeconomic factors and COVID-19 in children and adolescents

AIM

To systematically review the evidence on Covid-19 infection risk, severity and vaccination uptake among children and adolescents by socioeconomic status.

METHODS

We conducted a systematic literature review, using the PubMed database. We searched for articles published from January 2020 to January 2022 using "MeSH" words and titles. The key terms were "COVID", "social status", "socioeconomic factor" and "children". We also searched secondary sources such as published reports and other databases.

RESULTS

The search identified 15 relevant articles and reports. This review shows that children of lower socioeconomic status have a higher risk of COVID-19 infection and a higher risk of being hospitalised. Mortality in a global setting was also higher in children with low socioeconomic status, though not observed in high-resourced countries. These children are also less likely to be vaccinated against the SARS-CoV-2 virus.

CONCLUSIONS

The higher risk of COVID-19 infection and hospitalisation and lower vaccination coverage in children and adolescents from lower socioeconomic backgrounds demonstrate health disparities also in young age. These disparities should inform health authorities in planning for future pandemics.

COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust

For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.

Disparities in child and adolescent COVID-19 vaccination coverage and parental intent toward vaccinations for their children and adolescents

INTRODUCTION

Despite recommendations for COVID-19 primary series completion and booster doses for children and adolescents, coverage has been less than optimal, particularly in some subpopulations. This study explored disparities in childhood/adolescent COVID-19 vaccination, parental intent to vaccinate their children and adolescents, and reasons for non-vaccination in the US.

METHODS

Using the U.S. Census Bureau's Household Pulse Survey (HPS), we analyzed households with children aged <18 years using data collected from September 14 to November 14, 2022 (n = 44,929). Child and adolescent COVID-19 vaccination coverage (≥1 dose, completed primary series, and booster vaccination) and parental intentions toward vaccination were assessed by sociodemographic characteristics. Factors associated with child and adolescent vaccination coverage were examined using multivariable regression models. Reasons for non-vaccination were assessed overall, by the child's age group and respondent's age group.

RESULTS

Overall, approximately half (50.1%) of children aged < 18 years were vaccinated against COVID-19 (≥1 dose). Completed primary series vaccination was 44.2% among all children aged <18 years. By age group, completed primary series was 13.2% among children <5 years, 43.9% among children 5-11 years, and 63.3% among adolescents 12-17 years. Booster vaccination among those who completed the primary series was 39.1% among children 5-11 years and 55.3% among adolescents 12-17 years. Vaccination coverage differed by race/ethnicity, educational attainment, household income, region, parental COVID-19 vaccination status, prior COVID-19 diagnosis, child's age group, and parental age group. Parental reluctance was highest for children aged <5 years (46.8%). Main reasons for non-vaccination among reluctant parents were concerns about side effects (53.3%), lack of trust in COVID-19 vaccines (48.7%), and the belief that children do not need a COVID-19 vaccine (38.8%).

CONCLUSION

Disparities in COVID-19 vaccination coverage among children and adolescents continue to exist. Further efforts are needed to increase COVID-19 primary series and booster vaccination and parental confidence in vaccines.

Paediatric COVID-19 vaccination coverage and associated factors among migrant and non-migrant children aged 5-11 years in Aotearoa New Zealand: A population-level retrospective cohort study

OBJECTIVE

Children with migrant and refugee backgrounds may experience immunisation inequities due to barriers to accessing and accepting vaccines. In Aotearoa New Zealand (NZ), national reporting can mask inequities in coverage by migration background. This study explored paediatric COVID-19 vaccine uptake among children with migrant and refugee backgrounds.

METHODS

This population-level retrospective cohort study compared rates and determinants of paediatric COVID-19 vaccine uptake as of July 2022 amongst migrant and non-migrant children who were aged between 5 and 11 years as of January 2022. Linked de-identified administrative and health data available in Statistics NZ's Integrated Data Infrastructure were used, and univariate and multivariable logistic regression were conducted to determine associations.

RESULTS

Of the total study population (N = 451,323), 3.5% were overseas-born migrant children, 31.3% were NZ-born migrant children, and 65.3% were NZ-born non-migrant children. Only 50.8% (229,164 out of 451,323) of children had received at least one dose. Migrant children were significantly more likely to have received a COVID-19 vaccination than non-migrant children. Logistic modelling revealed that all factors, including ethnicity, gender, age, family type, household income, deprivation, region, parent COVID-19 vaccination status, and child's previous COVID-19 infection, significantly influenced COVID-19 vaccine uptake. The largest contributing factor was parents' COVID-19 vaccination status.

CONCLUSIONS

The findings suggest that NZ's paediatric COVID-19 vaccination programme was able to address logistical and motivational barriers commonly identified amongst migrants and refugees.

IMPLICATIONS FOR PUBLIC HEALTH

As parents' vaccination status is an important factor in vaccinating their own children, continuous efforts are needed to support confident parental COVID-19 vaccine decision-making. To address social inequities, engagement with marginalised communities to co-design tailored and localised approaches is recommended.

COVID-19 vaccines for children: Racial and ethnic disparities in New York City

Vaccination is an indispensable tool to reduce negative outcomes due to COVID-19. Although COVID-19 disproportionately affected lower income and Black and Hispanic communities, these groups have had lower population-level uptake of vaccines. Using detailed cross-sectional data, we examined racial and ethnic group differences in New York City schoolchildren becoming fully vaccinated (two doses) within 6 months of vaccine eligibility. We matched school enrollment data to vaccination data in the Citywide Immunization Registry, a census of all vaccinations delivered in New York City. We used ordinary least squares regression models to predict fully vaccinated status, with key predictors of race and ethnicity using a variety of different control variables, including residential neighborhood or school fixed effects. We also stratified by borough and by age. The sample included all New York City public school students enrolled during the 2021-2022 school year. Asian students were most likely to be vaccinated and Black and White students least likely. Controlling for student characteristics, particularly residential neighborhood or school attended, diminished some of the race and ethnicity differences. Key differences were also present by borough, both overall and by racial and ethnic groups. In sum, racial and ethnic disparities in children's COVID-19 vaccination were present. Vaccination rates varied by the geographic unit of borough; controlling for neighborhood characteristics diminished some disparities by race and ethnicity. Neighborhood demographics and resources, and the attributes, culture and preferences of those who live there may affect vaccination decisions and could be targets of future efforts to increase vaccination rates.

COVID-19 vaccination dynamics in the US: coverage velocity and carrying capacity based on socio-demographic vulnerability indices in California's pediatric population

Introduction

COVID-19 vaccine inequities have been widespread across California, the United States, and globally. As COVID-19 vaccine inequities have not been fully understood in the youth population, it is vital to determine possible factors that drive inequities to enable actionable change that promotes vaccine equity among vulnerable minor populations.

Methods

The present study used the social vulnerability index (SVI) and daily vaccination numbers within the age groups of 12-17, 5-11, and under 5 years old across all 58 California counties to model the growth velocity and the anticipated maximum proportion of population vaccinated.

Results

Overall, highly vulnerable counties, when compared to low and moderately vulnerable counties, experienced a lower vaccination rate in the 12-17 and 5-11 year-old age groups. For age groups 5-11 and under 5 years old, highly vulnerable counties are expected to achieve a lower overall total proportion of residents vaccinated. In highly vulnerable counties in terms of socioeconomic status and household composition and disability, the 12-17 and 5-11 year-old age groups experienced lower vaccination rates. Additionally, in the 12-17 age group, high vulnerability counties are expected to achieve a higher proportion of residents vaccinated compared to less vulnerable counterparts.

Discussion

These findings elucidate shortcomings in vaccine uptake in certain pediatric populations across California and may help guide health policies and future allocation of vaccines, with special emphasis placed on vulnerable populations, especially with respect to socioeconomic status and household composition and disability.

Within-Country Inequality in COVID-19 Vaccination Coverage: A Scoping Review of Academic Literature

Since December 2020, COVID-19 vaccines have become increasingly available to populations around the globe. A growing body of research has characterised inequalities in COVID-19 vaccination coverage. This scoping review aims to locate, select and assess research articles that report on within-country inequalities in COVID-19 vaccination coverage, and to provide a preliminary overview of inequality trends for selected dimensions of inequality. We applied a systematic search strategy across electronic databases with no language or date restrictions. Our inclusion criteria specified research articles or reports that analysed inequality in COVID-19 vaccination coverage according to one or more socioeconomic, demographic or geographic dimension of inequality. We developed a data extraction template to compile findings. The scoping review was carried out using the PRISMA-ScR checklist. A total of 167 articles met our inclusion criteria, of which half (n = 83) were conducted in the United States. Articles focused on vaccine initiation, full vaccination and/or receipt of booster. Diverse dimensions of inequality were explored, most frequently relating to age (n = 127 articles), race/ethnicity (n = 117 articles) and sex/gender (n = 103 articles). Preliminary assessments of inequality trends showed higher coverage among older population groups, with mixed findings for sex/gender. Global research efforts should be expanded across settings to understand patterns of inequality and strengthen equity in vaccine policies, planning and implementation.

COVID-19 Vaccination Coverage and Demographic Characteristics of Infants and Children Aged 6 Months-4 Years - United States, June 20-December 31, 2022

Although severe COVID-19 illness and hospitalization are more common among older adults, children can also be affected (1). More than 3 million cases of COVID-19 had been reported among infants and children aged <5 years (children) as of December 2, 2022 (2). One in four children hospitalized with COVID-19 required intensive care; 21.2% of cases of COVID-19-related multisystem inflammatory syndrome in children (MIS-C) occurred among children aged 1-4 years, and 3.2% of MIS-C cases occurred among infants aged <1 year (1,3). On June 17, 2022, the Food and Drug Administration issued an Emergency Use Authorization (EUA) of the Moderna COVID-19 vaccine for children aged 6 months-5 years and the Pfizer-BioNTech COVID-19 vaccine for children aged 6 months-4 years. To assess COVID-19 vaccination coverage among children aged 6 months-4 years in the United States, coverage with ≥1 dose* and completion of the 2-dose or 3-dose primary vaccination series^† were assessed using vaccine administration data for the 50 U.S. states and District of Columbia submitted from June 20 (after COVID-19 vaccine was first authorized for this age group) through December 31, 2022. As of December 31, 2022, ≥1-dose COVID-19 vaccination coverage among children aged 6 months-4 years was 10.1% and was 5.1% for series completion. Coverage with ≥1 dose varied by jurisdiction (range = 2.1% [Mississippi] to 36.1% [District of Columbia]) as did coverage with a completed series (range = 0.7% [Mississippi] to 21.4% [District of Columbia]), respectively. By age group, 9.7 % of children aged 6-23 months and 10.2% of children aged 2-4 years received ≥1 dose; 4.5% of children aged 6-23 months and 5.4% of children aged 2-4 years completed the vaccination series. Among children aged 6 months-4 years, ≥1-dose COVID-19 vaccination coverage was lower in rural counties (3.4%) than in urban counties (10.5%). Among children aged 6 months-4 years who received at least the first dose, only 7.0% were non-Hispanic Black or African American (Black), and 19.9% were Hispanic or Latino (Hispanic), although these demographic groups constitute 13.9% and 25.9% of the population, respectively (4). COVID-19 vaccination coverage among children aged 6 months-4 years is substantially lower than that among older children (5). Efforts are needed to improve vaccination coverage among children aged 6 months-4 years to reduce COVID-19-associated morbidity and mortality.

Impact of the COVID-19 Vaccination Program on case incidence, emergency department visits, and hospital admissions among children aged 5-17 Years during the Delta and Omicron Periods-United States, December 2020 to April 2022

BACKGROUND

In the United States, national ecological studies suggest a positive impact of COVID-19 vaccination coverage on outcomes in adults. However, the national impact of the vaccination program on COVID-19 in children remains unknown. To determine the association of COVID-19 vaccination with U.S. case incidence, emergency department visits, and hospital admissions for pediatric populations during the Delta and Omicron periods.

METHODS

We conducted an ecological analysis among children aged 5-17 and compared incidence rate ratios (RRs) of COVID-19 cases, emergency department visits, and hospital admissions by pediatric vaccine coverage, with jurisdictions in the highest vaccine coverage quartile as the reference.

RESULTS

RRs comparing states with lowest pediatric vaccination coverage to the highest pediatric vaccination coverage were 2.00 and 0.64 for cases, 2.96 and 1.11 for emergency department visits, and 2.76 and 1.01 for hospital admissions among all children during the Delta and Omicron periods, respectively. During the 3-week peak period of the Omicron wave, only children aged 12-15 and 16-17 years in the states with the lowest versus highest coverage, had a significantly higher rate of emergency department visits (RR = 1.39 and RR = 1.34, respectively).

CONCLUSIONS

COVID-19 vaccines were associated with lower case incidence, emergency department visits and hospital admissions among children during the Delta period but the association was weaker during the Omicron period. Pediatric COVID-19 vaccination should be promoted as part of a program to decrease COVID-19 impact among children; however, vaccine effectiveness may be limited when available vaccines do not match circulating viral variants.

Estimated BNT162b2 Vaccine Effectiveness Against Infection With Delta and Omicron Variants Among US Children 5 to 11 Years of Age

IMPORTANCE

Data describing the vaccine effectiveness (VE) and durability of BNT162b2 among children 5 to 11 years of age are needed.

OBJECTIVE

To estimate BNT162b2 VE against SARS-CoV-2 infection among children aged 5 to 11 years during Delta and Omicron variant-predominant periods and to further assess VE according to prior SARS-CoV-2 infection status and by sublineage during the Omicron variant-predominant period.

DESIGN, SETTING, AND PARTICIPANTS

This test-negative case-control study was conducted from November 2 to December 9, 2021 (Delta variant), and from January 16 to September 30, 2022 (Omicron variant), among 160 002 children tested at a large national US retail pharmacy chain, for SARS-CoV-2 via polymerase chain reaction (PCR); 62 719 children were tested during the Delta period, and 97 283 were tested during the Omicron period.

EXPOSURE

Vaccination with BNT162b2 before SARS-CoV-2 testing vs no vaccination.

MAIN OUTCOMES AND MEASURES

The primary outcome was SARS-CoV-2 infection confirmed by PCR (regardless of the presence of symptoms), and the secondary outcome was confirmed symptomatic infection. Adjusted estimated VE was calculated from multilevel logistic regression models.

RESULTS

A total of 39 117 children tested positive and 131 686 tested negative for SARS-CoV-2 (total, 170 803; 84 487 [49%] were boys; mean [SD] age was 9 [2] years; 74 236 [43%] were White non-Hispanic or non-Latino; and 37 318 [22%] were Hispanic or Latino). Final VE analyses included 160 002 children without SARS-CoV-2 infection less than 90 days prior. The VE of 2 doses of BNT162b2 against Delta was 85% (95% CI, 80%-89%; median follow-up, 1 month) compared with the Omicron period (20% [95% CI, 17%-23%]; median follow-up, 4 months). The adjusted VE of 2 doses against Omicron at less than 3 months was 39% (95% CI, 36%-42%), and at 3 months or more, it was -1% (95% CI, -6% to 3%). Protection against Omicron was higher among children with vs without infection 90 days or more prior but decreased in all children approximately 3 months after the second dose (58% [95% CI, 49%-66%] with infection vs 37% [95% CI, 34%-41%] without infection at <3 months; 27% [95% CI, 17%-35%] with infection vs -7% [95% CI, -12% to -1%] at ≥3 months without infection). The VE of 2 doses of BNT162b2 at less than 3 months by Omicron sublineage was 40% (95% CI, 36%-43%) for BA.1, 32% (95% CI, 21%-41%) for BA.2/BA.2.12.1, and 50% (95% CI, 37%-60%) for BA.4/BA.5. After 3 months or more, VE was nonsignificant for BA.2/BA.2.12.1 and BA.4/BA.5. The VE of a booster dose was 55% (95% CI, 50%-60%) against Omicron, with no evidence of waning at 3 months or more.

CONCLUSIONS AND RELEVANCE

This study suggests that, among children aged 5 to 11 years, 2 doses of BNT162b2 provided modest short-term protection against Omicron infection that was higher for those with prior infection; however, VE waned after approximately 3 months in all children. A booster dose restored protection against Omicron and was maintained for at least 3 months. These findings highlight the continued importance of booster vaccination regardless of history of prior COVID-19.

Sociodemographic Variation in Early Uptake of COVID-19 Vaccine and Parental Intent and Attitudes Toward Vaccination of Children Aged 6 Months-4 Years - United States, July 1-29, 2022

COVID-19 vaccines are safe and effective for infants and young children, and on June 18, 2022, CDC recommended COVID-19 vaccination for infants and children (children) aged 6 months-4 years (1,2). As of November 9, 2022, based on administrative data reported to CDC,* 5.9% of children aged <2 years and 8.8% of children aged 2-4 years had received ≥1 dose. To better understand reasons for low coverage among children aged <5 years, CDC analyzed data from 4,496 National Immunization Survey-Child COVID Module (NIS-CCM) interviews conducted during July 1-29, 2022, to examine variation in receipt of ≥1 dose of COVID-19 vaccine and parental intent to vaccinate children aged 6 months-4 years by sociodemographic characteristics and by parental beliefs about COVID-19; type of vaccination place was also reported. Among children aged 6 months-4 years, 3.5% were vaccinated; 59.3% were unvaccinated, but the parent was open to vaccination; and 37.2% were unvaccinated, and the parent was reluctant to vaccinate their child. Openness to vaccination was higher among parents of Hispanic or Latino (Hispanic) (66.2%), non-Hispanic Black or African American (Black) (61.1%), and non-Hispanic Asian (Asian) (83.1%) children than among parents of non-Hispanic White (White) (52.9%) children and lower among parents of children in rural areas (45.8%) than among parents of children in urban areas (64.1%). Parental confidence in COVID-19 vaccine safety and receipt of a provider recommendation for COVID-19 vaccination were lower among unvaccinated than vaccinated children. COVID-19 vaccine recommendations from a health care provider, along with dissemination of information about the safety of COVID-19 vaccine by trusted persons, could increase vaccination coverage among young children.

Where are children ages 5-17 years receiving their COVID-19 vaccinations? Variations over time and by sociodemographic characteristics, United States

BACKGROUND

Knowing the settings where children ages 5-17 years received COVID-19 vaccination in the United States, and how settings changed over time and varied by socio-demographics, is of interest for planning and implementing vaccination programs.

METHODS

Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess place of COVID-19 vaccination among vaccinated children ages 5-17 years. Interviews from July 2021 thru May 2022 were included in the analyses for a total of n = 39,286 vaccinated children. The percentage of children receiving their COVID-19 vaccine at each type of setting was calculated overall, by sociodemographic characteristics, and by month of receipt of COVID-19 vaccine.

RESULTS

Among vaccinated children ages 5-11 years, 46.9 % were vaccinated at a medical place, 37.1 % at a pharmacy, 8.1 % at a school, 4.7 % at a mass vaccination site, and 3.2 % at some other non-medical place. Among vaccinated children ages 12-17 years, 35.1 % were vaccinated at a medical place, 47.9 % at a pharmacy, 8.3 % at a mass vaccination site, 4.8 % at a school, and 4.0 % at some other non-medical place. The place varied by time among children ages 12-17 years but minimally for children ages 5-11 years. There was variability in the place of COVID-19 vaccination by age, race/ethnicity, health insurance, urbanicity, and region.

CONCLUSION

Children ages 5-17 years predominantly received their COVID-19 vaccinations at pharmacies and medical places. The large proportion of vaccinated children receiving vaccination at pharmacies is indicative of the success in the United States of expanding the available settings where children could be vaccinated. Medical places continue to play a large role in vaccinating children, especially younger children, and should continue to stock COVID-19 vaccine to keep it available for those who are not yet vaccinated, including the newly recommended group of children < 5 years.

Vaccines, Variants, and Vigilance: Strengthening the Coronavirus Disease 2019 (COVID-19) Public Health Response Through Partnerships and Collaborations

The US Centers for Disease Control and Prevention (CDC); state, tribal, local, and territorial health departments; other US government departments and agencies; the private sector; and international partners have engaged in a real-time public health response to the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccination, variants, and vigilance were themes that arose in the second year of pandemic response in the United States. The findings included in this supplement emerged from these themes and represent some of the many collaborative efforts to improve public health knowledge and action to reduce transmission, infection, and disease severity.