COVID-19 Vaccination in Children: Lower Rates of Neurologic Adverse Events, MIS-C

SARS-CoV-2–related neurologic involvement among US children and adolescents who are hospitalized for COVID-19 or multisystem inflammatory syndrome in children
(MIS-C) persisted in 2021, with acute central nervous system (CNS) infection/acute disseminated encephalomyelitis (ADEM) accounting for more of the reported life-threatening cases than in 2020. These are the findings of a study published in JAMA Neurology.

Although COVID-19 vaccination became available for adolescents and children in 2021, most vaccine-eligible patients were unvaccinated. Researchers sought to provide an update on the spectrum of SARS-CoV-2–associated neurologic involvement among children and adolescents in 2021. The researchers conducted a current case series investigation of patients reported to public health surveillance at 55 US hospitals in 31 states to identify those with severe acute COVID-19 (admitted to an intensive care or step-down unit at a participating site) or those who fulfilled Centers for Disease Control and Prevention criteria for MIS-C and were hospitalized between December 15, 2020 and December 31, 2021, with follow-up available at discharge.

During the investigation period, a total of 2253 patients were enrolled in the study. Any individuals who were suspected of having MIS-C who did not fulfill the criteria were excluded from the study. Individuals aged younger than 21 years with positive SARS-CoV-2 test results (per reverse transcriptase-polymerase chain reaction and/or antibody testing) who met criteria for MIS-C or acute COVID-19 infection were included in the study.

Among a total of 2168 individuals with an acute SARS-CoV-2 infection (34%) or MIS-C (66%), 22% (476 of 2168) of them demonstrated neurologic involvement. Overall, 58% of the patients were male; median age, 10.3 years. Individuals with neurologic involvement were older and had more underlying neurologic disorders compared with no neurologic involvement. Seizures occurred more often in younger children, whereas loss of taste and smell occurred more frequently in adolescents.

Among patients with neurologic involvement, 91% exhibited non–life-threatening neurologic symptoms, which were most often fatigue/weakness, confusion, headache, and loss of taste/smell. In patients with non–life-threatening neurologic involvement, 90% survived without neurologic deficits, 5% died, and 4% were discharged alive with neurologic deficits associated with sequelae of critical illness.

A spectrum of life-threatening neurologic disorders and outcomes was revealed in 9% (42 of 476) of patients with non–life-threatening neurologic involvement, including 55% (23 of 42) of them with acute CNS infection/ADEM. Overall, 24% (10 of 42) of these individuals survived with new neurologic deficits at discharge and 19% (8 of 42) of them died. A total of 9 possible and 5 confirmed cases of encephalitis were reported. Abnormalities on electroencephalography included diffuse background slowing in 10 individuals and/or focal seizures or epileptic discharges in 5 individuals.

Among the 155 vaccine-eligible patients with neurologic involvement and confirmed vaccination status, 95% (147 of 155) of them were unvaccinated, including 94% (15 of 16) of individuals with life-threatening neurologic disorders.

Several limitations of the current study warrant mention. Since this was a public health surveillance investigation, the researchers were not able to explore the immunobiology underlying severe complications, including the Delta variant, or to evaluate the reasons for low vaccine uptake. Thus, it is possible that not all patients were captured in the analysis. Fatigue, headache, and weakness are all nonspecific symptoms that could lead to the overreporting of milder neurologic involvement.

The researchers concluded that “COVID-19 vaccination may prevent some SARS-CoV-2–related neurologic complications and merits further study.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.