OBJECTIVES: To assess the public health impact of pediatric BNT162b2 XBB.1.5 adapted COVID-19 vaccination, compared to no vaccination in the United States.

METHODS: A combined Markov and decision tree model was used to estimate the public health impact of vaccination in the pediatric population aged 6 months-17 years (subgroups aged 6 months-4 years, 5-11 years, and 12-17 years) over a one-year time horizon. Age-stratified annual attack, hospitalization, and vaccine coverage rates were informed by public health surveillance data. Other age-stratified clinical, cost, and vaccine effectiveness parameters were informed by the literature. Parameter uncertainty was examined through scenario and sensitivity analyses. Conservatively, indirect effects of vaccination on reduced community infection rates were not considered.

RESULTS: For those aged 6 months-17 years, the model projected that compared to no vaccination, the Pfizer-BioNTech XBB.1.5-adapted BNT162b2 COVID-19 Vaccine resulted in ~49,000 fewer symptomatic cases, 1,000 fewer hospitalizations, 7 fewer deaths, and $115,000,000 in direct treatment cost savings. The majority of the impact was among those aged 12-17 years (65% of cases, 50% of hospitalizations, 59% of deaths, and 69% of treatment costs) due to higher expected vaccine coverage in this group (17.6% versus 5.6% and 8.3% among those aged 6 months-4 years and 5-11 years, respectively). Results were sensitive to variation in symptomatic rate of infection, hospitalization rate, and the expected vaccine coverage. Increasing vaccine coverage to 25% in all three groups resulted in ~106,000 fewer symptomatic cases, 2,6000 fewer hospitalizations, 17 fewer deaths, and $240,000,000 in direct treatment cost savings.

CONCLUSIONS: Increasing BNT162b2 XBB.1.5-adapted COVID-19 vaccination coverage among those aged 6 months to 17 years in the US could generate notable reductions in symptomatic cases, hospitalizations and deaths and result in treatment cost savings. Increased vaccination coverage should be an important public health goal.