Vaccine hesitancy, reactogenicity and immunogenicity of BNT162b2 and CoronaVac in pediatric patients with neuromuscular diseases (preprint)

Introduction COVID-19 causes global health and psychosocial devastation, particularly to high-risk patients such as those with neuromuscular diseases (NMDs). The mRNA-based BNT162b2 and inactivated whole-virus CoronaVac are two novel COVID-19 vaccines widely used across the world that confer immune protection to healthy individuals. However, hesitancy towards COVID-19 vaccination was common for patients with NMDs early in the pandemic due to the paucity of data on the safety and efficacy in this specific patient population. Therefore, we examined the underlying factors associated with vaccine hesitancy across time for these patients and included the assessment of the reactogenicity and immunogenicity of these two vaccines. Methods Pediatric patients were screened from our NMD registry. For the vaccine hesitancy arm, those aged 8-18 years with no cognitive delay were invited to complete surveys in January and April 2022. For the reactogenicity and immunogenicity arm, patients aged 2-21 years were enrolled for COVID-19 vaccination between June 2021 to April 2022. Participants recorded adverse reactions (ARs) for 7 days after vaccination. Peripheral blood was obtained before BNT162b2 or CoronaVac and within 49 days after vaccination to measure their serological antibody responses as compared to healthy children and adolescents. Results Forty-one patients completed vaccine hesitancy surveys for both timepoints, and 22 joined our reactogenicity and immunogenicity arm of the study. Two or more family members vaccinated against COVID-19 was positively associated with intention of vaccination (odds ratio 11.7, 95% CI 1.81-75.1, p=0.010). Pain at the injection site, fatigue and myalgia were the commonest ARs. Most ARs were mild (75.5%, n=71/94). All 19 patients seroconverted against the wildtype SARS-CoV-2 after two doses of BNT162b2 or CoronaVac, although there was lower neutralization against the Omicron BA.1 variant. Discussion This study demonstrated vaccine hesitancy amongst patients with NMDs was influenced by family members and changed across time. BNT162b2 and CoronaVac were safe and immunogenic even for patients on low-dose corticosteroids. Future research is required to assess the durability of the COVID-19 vaccines, the effectiveness of booster doses and other routes of administration against emerging SARS-CoV-2 variants for these patients.

Impact of COVID-19 pandemic on the psychosocial well-being of children with neuromuscular disorders (preprint)

To examine the impact of COVID-19 on the psychosocial wellbeing in children with neuromuscular disorders (NMD), the parents of 41 children with NMD aged 3-12 years completed a survey during COVID-19 pandemic. The findings were compared to those of the parents of 164 matched typically-developed (TD) children. Health-related quality of life and lifestyle habits of the NMD group were compared with the TD group using independent two-sample t-test. Children with NMD with uninterrupted disease-modifying treatments showed higher PedsQL total scores during the pandemic compared to the pre-pandemic state (p=0.012). PedsQL total score in the NMD group was significantly lower than the TD group (p<0.001). Those with disrupted rehabilitation training (73.8% of NMD group) had significant lower PedsQL scores compared to those with continuous training (p = 0.012). Parental guidance on the usage of electronic devices was significantly associated with the total score of PedsQL, particularly in the NMD group (p=0.007). In conclusion, children with NMD have had a poorer quality of life than TD children during the COVID-19 pandemic. Our study highlights the importance of parental guidance on electronic device usage, the continuation of drug treatment, and rehabilitation training for the psychosocial wellbeing of children with NMD during the pandemic.