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Ebrahim S, Blose N, Gloeck N, Hohlfeld A, Balakrishna Y, Muloiwa R, Gray A, Parrish A, Cohen K, Lancaster R, Kredo T. Effectiveness of the BNT162b2 vaccine in preventing morbidity and mortality associated with COVID-19 in children aged 5 to 11 years: A systematic review and meta-analysis. PLOS Glob Public Health 2023; 3:e0002676. [PMID: 38048340 PMCID: PMC10695397 DOI: 10.1371/journal.pgph.0002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023]
Abstract
A rapid systematic review, based on Cochrane rapid review methodology was conducted to assess the effectiveness of two 10μg doses of BNT162b2 vaccine in preventing morbidity and mortality associated with COVID-19 in children aged 5 to 11 years. We searched the Cochrane Library COVID-19 study register, the COVID-NMA living review database and the McMaster University Living Evidence Synthesis for pre-appraised trials and observational studies up to 7 December 2022. Records were screened independently in duplicate. Where appraisal was not available, these were done in duplicate. Meta-analysis was conducted using RevMan 5.3 presenting risk ratios/odds ratios/inverse vaccine efficacy with 95% confidence intervals (CI). GRADE for assessing the overall certainty of the evidence was done in Gradepro. We screened 403 records and assessed 52 full-text articles for eligibility. One randomised controlled trial (RCT) and 24 observational studies were included. The RCT reported that BNT162b2 was likely safe and 91% efficacious, RR 0.09 (95% CI 0.03 to 0.32) against incident COVID-19 infection (moderate certainty evidence). In absolute terms, this is 19 fewer cases per 1,000 vaccines delivered (ranging from 15 to 21 fewer cases). Observational studies reported vaccine effectiveness (VE) against incident COVID-19 infection of 65% (OR 0.35, 95% CI 0.26 to 0.47) and 76% against hospitalisation (OR 0.24, 95% CI 0.13 to 0.42) (moderate certainty evidence). The absolute effect is 167 fewer cases per 1,000 vaccines given (ranging from 130 fewer to 196 fewer cases) and 4 fewer hospitalisations per 10,000 children (from 3 fewer to 5 fewer hospitalisations). Adverse events following vaccination with BNT162b2 were mild or moderate and transient. The evidence demonstrated a reduction in incident COVID-19 cases and small absolute reduction in hospitalisation if a two-dose BNT162b2 vaccine regimen is offered to children aged 5 to 11 years, compared to placebo. PROSPERO registration: CRD42021286710.
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Affiliation(s)
- Sumayyah Ebrahim
- Department of Surgery, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntombifuthi Blose
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Natasha Gloeck
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ameer Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Andy Gray
- Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Essential Medicines List Ministerial Advisory Committee on COVID-19 Therapeutics, National Department of Health, Pretoria, South Africa
| | - Andy Parrish
- National Essential Medicines List Ministerial Advisory Committee on COVID-19 Therapeutics, National Department of Health, Pretoria, South Africa
- Department of Internal Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Karen Cohen
- National Essential Medicines List Ministerial Advisory Committee on COVID-19 Therapeutics, National Department of Health, Pretoria, South Africa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ruth Lancaster
- Affordable Medicines Directorate, National Department of Health, Pretoria, South Africa
| | - Tamara Kredo
- National Essential Medicines List Ministerial Advisory Committee on COVID-19 Therapeutics, National Department of Health, Pretoria, South Africa
- Division of Clinical Pharmacology, Department of Medicine, and Division of Biostatistics and Epidemiology, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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