Vaccine Effectiveness, School Reopening, and Risk of Omicron Infection Among Adolescents Aged 12–17 Years



      The BNT162b2 (Pfizer-BioNTech) is approved for adolescents aged 12–17 years. We estimated BNT162b2 vaccine effectiveness (VE) and a booster dose effectiveness in adolescents aged 12–17 years and the impact of opening schools and the Omicron variant on risk of SARS-CoV-2 infection in adolescents.


      We used logistic regression with a test-negative design controlling for gender and race to estimate BNT162b2 VE and the effectiveness of a booster dose in adolescents aged 12–17 years. To evaluate the effect of school opening on Omicron transmission, we used Cox proportional hazards regression to compare adolescents to a reference group of adults aged 22–33 or aged 65+ years, investigating whether risk for adolescents increased relative to the reference group after school opened.


      We found that adolescents who received two BNT162b2 doses had significant protection against Omicron infection in the first three months following their second dose (VE = 54.5%, confidence interval [CI]: [17.8%–76.9%], p = .014) but no protection afterwards. Receiving a booster dose was associated with lower risk of infection (odds ratio = 0.48, CI: [0.33–0.69], p < .0001) and restored efficacy to a similar level (VE = 56.3%, CI: [36.5%–70.6%], p < .0001). We observed a statistically significant increase (p = .04) in adolescent infection risk relative to adults in the period of Omicron predominance.


      The BNT162b2 vaccine is effective at preventing SARS-CoV-2 infection in adolescents but immunity against Omicron wanes rapidly and booster doses are needed to retain protection. More research is needed to determine the effect of school reopening on spread in the Omicron-dominant period.


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        • FDA
        Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 vaccine for Emergency Use in adolescents in Another important Action in Fight against pandemic.
        (Accessed April 25, 2021)
        • FDA
        Coronavirus (COVID-19) Update: FDA Expands Eligibility for Pfizer-BioNTech COVID-19 booster dose to 16- and 17-Year-Olds.
        (Accessed April 25, 2021)
        • FDA
        Coronavirus (COVID-19) Update: FDA Takes multiple Actions to Expand Use of Pfizer-BioNTech COVID-19 vaccine.
        (Accessed April 25, 2021)
        • Reis B.Y.
        • Barda N.
        • Hernán M.A.
        • Dagan N.
        Effectiveness of BNT162b2 vaccine against Delta variant in adolescents.
        N Engl J Med. 2021; 385: 2101-2103
        • Price A.M.
        • Olson S.M.
        • Newhams M.M.
        • et al.
        BNT162b2 protection against the omicron variant in children and adolescents.
        N Engl J Med. 2022; 386: 2346
        • Fowlkes A.L.
        • Yoon S.K.
        • Lutrick K.
        • et al.
        Effectiveness of 2-dose BNT162b2 (Pfizer BioNTech) mRNA vaccine in preventing SARS-CoV-2 infection among children aged 5–11 Years and adolescents aged 12–15 Years — PROTECT Cohort, July 2021–February 2022.
        MMWR Morb Mortal Wkly Rep. 2022; 71: 422-428
        • Dorabawila V.
        • Hoefer D.
        • Bauer U.E.
        • et al.
        Effectiveness of the BNT162b2 vaccine among children 5-11 and 12-17 years in New York after the Emergence of the omicron variant.
        medRxiv. 2022;
        • Goldstein E.
        • Lipsitch M.
        • Cevik M.
        On the effect of age on the transmission of SARS-CoV-2 in households, schools, and the Community.
        J Infect Dis. 2021; 223: 362-369
        • Viner R.M.
        • Mytton O.T.
        • Bonell C.
        • et al.
        Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: A Systematic Review and Meta-analysis.
        JAMA Pediatr. 2021; 175: 143-156
        • Lessler J.
        • Grabowski M.K.
        • Grantz K.H.
        • et al.
        Household COVID-19 risk and in-person schooling.
        Science. 2021; 372: 1092-1097
        • Kozlov M.
        Does omicron hit kids harder? Scientists are trying to find out.
        Nature. 2022;
        • Andrews N.
        • Stowe J.
        • Kirsebom F.
        • et al.
        Covid-19 vaccine effectiveness against the omicron (B.1.1.529) variant.
        N Engl J Med. 2022; 386: 1532-1546
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.
        J chronic Dis. 1987; 40: 373-383
        • Jørgensen S.B.
        • Nygård K.
        • Kacelnik O.
        • Telle K.
        Secondary attack rates for omicron and Delta variants of SARS-CoV-2 in Norwegian households.
        JAMA. 2022; 327: 1610-1611