OpenSAFELY: Effectiveness of COVID-19 Vaccination in Children and Adolescents

Colm D Andrews; Edward P K Parker; Elsie Horne; Venexia Walker; Tom Palmer; Andrea L Schaffer; Amelia Ca Green; Helen J Curtis; Alex J Walker; Lucy Bridges; Christopher Wood; Victoria Speed; Christopher Bates; Jonathan Cockburn; John Parry; Amir Mehrkar; Brian MacKenna; Sebastian Cj Bacon; Ben Goldacre; Miguel A Hernan; Jonathan Ac Sterne; William J Hulme; OpenSAFELY Collaborative

doi:10.1097/EDE.0000000000001908

OpenSAFELY: Effectiveness of COVID-19 Vaccination in Children and Adolescents

Colm D Andrews, Edward P K Parker, Elsie Horne, Venexia Walker, Tom Palmer, Andrea L Schaffer, Amelia Ca Green, Helen J Curtis, Alex J Walker, Lucy Bridges, Christopher Wood, Victoria Speed, Christopher Bates, Jonathan Cockburn, John Parry, Amir Mehrkar, Brian MacKenna, Sebastian Cj Bacon, Ben Goldacre, Miguel A HernanJonathan Ac Sterne, William J Hulme, OpenSAFELY Collaborative

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Background:
We assessed the safety and effectiveness of first and second dose BNT162b2 COVID-19 vaccination, offered as part of the national COVID-19 vaccine roll-out from September 2021, in children and adolescents in England.

Methods:
Our observational study using OpenSAFELY-TPP, included adolescents aged 12-15 years, and children aged 5-11 years. It compared individuals receiving i) first vaccination to unvaccinated controls and ii) second vaccination to single-vaccinated controls. We matched vaccinated individuals with controls on age, sex, and other important characteristics. Outcomes were positive SARS-CoV-2 test (adolescents only); COVID-19 accident and emergency (A&E) attendance; COVID-19 hospitalization; COVID-19 critical care admission; COVID-19 death, with safety outcomes A&E attendance, unplanned hospitalization, pericarditis, and myocarditis.

Results:
Amongst 820,926 previously unvaccinated adolescents, 20-week incidence rate ratios (IRR) comparing vaccination with no vaccination were 0.74 for positive SARS-CoV-2 test, 0.60 for COVID-19 A&E attendance and 0.58 for COVID-19 hospitalization. Amongst 441,858 adolescents who had received first vaccination IRRs comparing second dose with single-vaccination were 0.67 for positive SARS-CoV-2 test, 1.00 for COVID-19 A&E attendance and 0.60 for COVID-19 hospitalisation. In both children groups COVID-19-related outcomes were too rare to allow IRRs to be estimated precisely. Across all analyses there were no COVID-19-related deaths, and fewer than seven COVID-19-related critical care admissions. Myocarditis and pericarditis were documented only in the vaccinated groups, with rates of 27 and 10 cases/million after first and second doses respectively.

Conclusions:
BNT162b2 vaccination in adolescents reduced COVID-19 A&E attendance and hospitalisation, although these outcomes were rare. Protection against positive SARS-CoV-2 tests was transient.

Original language	English
Pages (from-to)	141-151
Number of pages	11
Journal	Epidemiology (Cambridge, Mass.)
Volume	37
Issue number	1
Early online date	23 Sept 2025
DOIs	https://doi.org/10.1097/EDE.0000000000001908
Publication status	Published - 1 Jan 2026

Bibliographical note

Publisher Copyright:
© 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1097/EDE.0000000000001908Licence: CC BY

Handle.net

Persistent link

Cite this

Andrews, C. D., Parker, E. P. K., Horne, E., Walker, V., Palmer, T., Schaffer, A. L., Green, A. C., Curtis, H. J., Walker, A. J., Bridges, L., Wood, C., Speed, V., Bates, C., Cockburn, J., Parry, J., Mehrkar, A., MacKenna, B., Bacon, S. C., Goldacre, B., ... OpenSAFELY Collaborative (2026). OpenSAFELY: Effectiveness of COVID-19 Vaccination in Children and Adolescents. Epidemiology (Cambridge, Mass.), 37(1), 141-151. https://doi.org/10.1097/EDE.0000000000001908

@article{523a73cb9ef5404a9ff189d763a93a2e,

title = "OpenSAFELY: Effectiveness of COVID-19 Vaccination in Children and Adolescents",

abstract = "Background: We assessed the safety and effectiveness of first and second dose BNT162b2 COVID-19 vaccination, offered as part of the national COVID-19 vaccine roll-out from September 2021, in children and adolescents in England. Methods: Our observational study using OpenSAFELY-TPP, included adolescents aged 12-15 years, and children aged 5-11 years. It compared individuals receiving i) first vaccination to unvaccinated controls and ii) second vaccination to single-vaccinated controls. We matched vaccinated individuals with controls on age, sex, and other important characteristics. Outcomes were positive SARS-CoV-2 test (adolescents only); COVID-19 accident and emergency (A\&E) attendance; COVID-19 hospitalization; COVID-19 critical care admission; COVID-19 death, with safety outcomes A\&E attendance, unplanned hospitalization, pericarditis, and myocarditis. Results: Amongst 820,926 previously unvaccinated adolescents, 20-week incidence rate ratios (IRR) comparing vaccination with no vaccination were 0.74 for positive SARS-CoV-2 test, 0.60 for COVID-19 A\&E attendance and 0.58 for COVID-19 hospitalization. Amongst 441,858 adolescents who had received first vaccination IRRs comparing second dose with single-vaccination were 0.67 for positive SARS-CoV-2 test, 1.00 for COVID-19 A\&E attendance and 0.60 for COVID-19 hospitalisation. In both children groups COVID-19-related outcomes were too rare to allow IRRs to be estimated precisely. Across all analyses there were no COVID-19-related deaths, and fewer than seven COVID-19-related critical care admissions. Myocarditis and pericarditis were documented only in the vaccinated groups, with rates of 27 and 10 cases/million after first and second doses respectively. Conclusions: BNT162b2 vaccination in adolescents reduced COVID-19 A\&E attendance and hospitalisation, although these outcomes were rare. Protection against positive SARS-CoV-2 tests was transient.",

author = "Andrews, \{Colm D\} and Parker, \{Edward P K\} and Elsie Horne and Venexia Walker and Tom Palmer and Schaffer, \{Andrea L\} and Green, \{Amelia Ca\} and Curtis, \{Helen J\} and Walker, \{Alex J\} and Lucy Bridges and Christopher Wood and Victoria Speed and Christopher Bates and Jonathan Cockburn and John Parry and Amir Mehrkar and Brian MacKenna and Bacon, \{Sebastian Cj\} and Ben Goldacre and Hernan, \{Miguel A\} and Sterne, \{Jonathan Ac\} and Hulme, \{William J\} and \{OpenSAFELY Collaborative\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2026",

month = jan,

day = "1",

doi = "10.1097/EDE.0000000000001908",

language = "English",

volume = "37",

pages = "141--151",

journal = "Epidemiology (Cambridge, Mass.)",

issn = "1044-3983",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

Andrews, CD, Parker, EPK, Horne, E, Walker, V , Palmer, T, Schaffer, AL, Green, AC, Curtis, HJ, Walker, AJ, Bridges, L, Wood, C, Speed, V, Bates, C, Cockburn, J, Parry, J, Mehrkar, A, MacKenna, B, Bacon, SC, Goldacre, B, Hernan, MA, Sterne, JA, Hulme, WJ & OpenSAFELY Collaborative 2026, 'OpenSAFELY: Effectiveness of COVID-19 Vaccination in Children and Adolescents', Epidemiology (Cambridge, Mass.), vol. 37, no. 1, pp. 141-151. https://doi.org/10.1097/EDE.0000000000001908

TY - JOUR

T1 - OpenSAFELY: Effectiveness of COVID-19 Vaccination in Children and Adolescents

AU - Andrews, Colm D

AU - Parker, Edward P K

AU - Horne, Elsie

AU - Walker, Venexia

AU - Palmer, Tom

AU - Schaffer, Andrea L

AU - Green, Amelia Ca

AU - Curtis, Helen J

AU - Walker, Alex J

AU - Bridges, Lucy

AU - Wood, Christopher

AU - Speed, Victoria

AU - Bates, Christopher

AU - Cockburn, Jonathan

AU - Parry, John

AU - Mehrkar, Amir

AU - MacKenna, Brian

AU - Bacon, Sebastian Cj

AU - Goldacre, Ben

AU - Hernan, Miguel A

AU - Sterne, Jonathan Ac

AU - Hulme, William J

AU - OpenSAFELY Collaborative

PY - 2026/1/1

Y1 - 2026/1/1

N2 - Background: We assessed the safety and effectiveness of first and second dose BNT162b2 COVID-19 vaccination, offered as part of the national COVID-19 vaccine roll-out from September 2021, in children and adolescents in England. Methods: Our observational study using OpenSAFELY-TPP, included adolescents aged 12-15 years, and children aged 5-11 years. It compared individuals receiving i) first vaccination to unvaccinated controls and ii) second vaccination to single-vaccinated controls. We matched vaccinated individuals with controls on age, sex, and other important characteristics. Outcomes were positive SARS-CoV-2 test (adolescents only); COVID-19 accident and emergency (A&E) attendance; COVID-19 hospitalization; COVID-19 critical care admission; COVID-19 death, with safety outcomes A&E attendance, unplanned hospitalization, pericarditis, and myocarditis. Results: Amongst 820,926 previously unvaccinated adolescents, 20-week incidence rate ratios (IRR) comparing vaccination with no vaccination were 0.74 for positive SARS-CoV-2 test, 0.60 for COVID-19 A&E attendance and 0.58 for COVID-19 hospitalization. Amongst 441,858 adolescents who had received first vaccination IRRs comparing second dose with single-vaccination were 0.67 for positive SARS-CoV-2 test, 1.00 for COVID-19 A&E attendance and 0.60 for COVID-19 hospitalisation. In both children groups COVID-19-related outcomes were too rare to allow IRRs to be estimated precisely. Across all analyses there were no COVID-19-related deaths, and fewer than seven COVID-19-related critical care admissions. Myocarditis and pericarditis were documented only in the vaccinated groups, with rates of 27 and 10 cases/million after first and second doses respectively. Conclusions: BNT162b2 vaccination in adolescents reduced COVID-19 A&E attendance and hospitalisation, although these outcomes were rare. Protection against positive SARS-CoV-2 tests was transient.

AB - Background: We assessed the safety and effectiveness of first and second dose BNT162b2 COVID-19 vaccination, offered as part of the national COVID-19 vaccine roll-out from September 2021, in children and adolescents in England. Methods: Our observational study using OpenSAFELY-TPP, included adolescents aged 12-15 years, and children aged 5-11 years. It compared individuals receiving i) first vaccination to unvaccinated controls and ii) second vaccination to single-vaccinated controls. We matched vaccinated individuals with controls on age, sex, and other important characteristics. Outcomes were positive SARS-CoV-2 test (adolescents only); COVID-19 accident and emergency (A&E) attendance; COVID-19 hospitalization; COVID-19 critical care admission; COVID-19 death, with safety outcomes A&E attendance, unplanned hospitalization, pericarditis, and myocarditis. Results: Amongst 820,926 previously unvaccinated adolescents, 20-week incidence rate ratios (IRR) comparing vaccination with no vaccination were 0.74 for positive SARS-CoV-2 test, 0.60 for COVID-19 A&E attendance and 0.58 for COVID-19 hospitalization. Amongst 441,858 adolescents who had received first vaccination IRRs comparing second dose with single-vaccination were 0.67 for positive SARS-CoV-2 test, 1.00 for COVID-19 A&E attendance and 0.60 for COVID-19 hospitalisation. In both children groups COVID-19-related outcomes were too rare to allow IRRs to be estimated precisely. Across all analyses there were no COVID-19-related deaths, and fewer than seven COVID-19-related critical care admissions. Myocarditis and pericarditis were documented only in the vaccinated groups, with rates of 27 and 10 cases/million after first and second doses respectively. Conclusions: BNT162b2 vaccination in adolescents reduced COVID-19 A&E attendance and hospitalisation, although these outcomes were rare. Protection against positive SARS-CoV-2 tests was transient.

U2 - 10.1097/EDE.0000000000001908

DO - 10.1097/EDE.0000000000001908

M3 - Article (Academic Journal)

C2 - 40985520

SN - 1044-3983

VL - 37

SP - 141

EP - 151

JO - Epidemiology (Cambridge, Mass.)

JF - Epidemiology (Cambridge, Mass.)

IS - 1

ER -

OpenSAFELY: Effectiveness of COVID-19 Vaccination in Children and Adolescents

Abstract

Bibliographical note

UN SDGs

Access to Document

Handle.net

Fingerprint

Cite this