Comparative Safety of the BNT162b2 Messenger RNA COVID-19 Vaccine vs Other Approved Vaccines in Children Younger Than 5 Years

IMPORTANCE

SARS-CoV-2 vaccines are authorized for use in most age groups. The safety of SARS-CoV-2 vaccines is unknown in children younger than 5 years.

OBJECTIVE

To retrospectively evaluate the safety of the BNT162b2 vaccine used off-label in children younger than 5 years compared with the safety of non-SARS-CoV-2 vaccines in the same sample.

DESIGN, SETTING, AND PARTICIPANTS

This investigator-initiated retrospective cohort study included parents or caregivers who registered children for SARS-CoV-2 vaccination in outpatient care facilities in Germany. The study was performed as an authenticated online survey. A total of 19 000 email addresses were contacted from vaccination registration databases between April 14 and May 9, 2022. Inclusion criteria were child age younger than 5 years at the first BNT162b2 vaccination and use of a correct authentication code to prove invitation.

EXPOSURES

Off-label BNT162b2 vaccination and on-label non-SARS-CoV-2 vaccinations.

MAIN OUTCOMES AND MEASURES

Reported short-term safety data of 1 to 3 doses of 3 to 10 μg BNT162b2 in children from birth to younger than 60 months are presented. Coprimary outcomes were the frequencies of 11 categories of symptoms after vaccination with bivariate analyses and regression models adjusting for age, sex, weight, and height.

RESULTS

The study included 7806 children (median age, 3 years [IQR, 2-4 years]; 3824 [49.0%] female) who were followed up of for a mean (SD) of 91.4 (38.8) days since first BNT162b2 vaccination (survey response rate, 41.1%). A 10-μg dosage was more frequently associated with local injection-site symptoms compared with lower dosages. In the active-comparator analysis, the probability of any symptoms (odds ratio [OR], 1.62; 95% CI, 1.43-1.84), local symptoms (OR, 1.68; 95% CI, 1.38-2.05), musculoskeletal symptoms (OR, 2.55; 95% CI, 1.32-4.94), dermatologic symptoms (OR, 2.18; 95% CI, 10.7-4.45), or otolaryngologic symptoms (OR, 6.37; 95% CI, 1.50-27.09) were modestly elevated after BNT162b2 compared with non-SARS-CoV-2 vaccines, whereas the probabilities of general symptoms (OR, 0.77; 95% CI, 0.63-0.95) and fever (OR, 0.42; 95% CI, 0.32-0.55) were lower after BNT162b2. Symptoms requiring hospitalization (n = 10) were reported only at BNT162b2 dosages above 3 μg.

CONCLUSIONS AND RELEVANCE

In this cohort study, the symptoms reported after BNT162b2 administration were comparable overall to those for on-label non-SARS-CoV-2 vaccines in this cohort of children younger than 5 years. The present data may be used together with prospective licensure studies of BNT162b2 efficacy and safety and could help guide expert recommendations about BNT162b2 vaccinations in this age group.

Spatial working memory deficits and clinical symptoms in schizophrenia: a 4-month follow-up study

BACKGROUND

Our goal was to examine spatial working memory function in relation to clinical symptoms of schizophrenia over a period of 4 months.

METHODS

We assessed spatial working memory, spatial detection and clinical symptoms in 34 acutely psychotic schizophrenia patients within the first 2 weeks of hospitalization, and 4 months later. Spatial working memory was assessed by a delayed response task. A spatial control task was included to rule out simple sensorimotor deficits. Positive and negative symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS). Thirty-nine matched normal control subjects were also examined on the same tasks over the same period.

RESULTS

Patients showed deficits in working memory, but they performed well on the spatial control task. Both positive and negative symptoms improved at the 4-month follow up. Spatial working memory also improved over time but there was still a significant deficit at the follow-up session.

CONCLUSIONS

These results indicate that both symptoms and spatial working memory improved 4 months after the initial hospitalization but spatial working memory, hypothesized to be mediated by the dorsolateral prefrontal system, did not normalize. Thus, spatial working memory deficit may be a stable marker for schizophrenia.

Speaking behavior and speech sound characteristics in acute schizophrenia

Based on a sample of 45 hospitalized, acute-schizophrenic patients and 45 carefully matched controls, we investigated the non-verbal characteristics of schizophrenic speech by means of an 'acoustic' speech analysis and determined the extent to which speaking behavior and speech sound characteristics had adjusted toward normal values at the time of hospital release. Using a multivariate discriminant function derived from a previous study of chronic schizophrenics, totally 77 (85.6%) individuals of our patient and control sample could be correctly classified by a set of 12 acoustic variables at entry into study. At hospital release, the majority of patients (64.4%) still exhibited speech impairment although acute psychopathology had significantly improved. A configuration of 6 acoustic variables, assessed at the time point of entry into study, predicted at high reliability the severity of the negative syndrome at hospital release. Acute medication effects did not explain these findings, thus underlining the potential diagnostic relevance of the speech analysis method. With respect to the relationship between speech characteristics and acute psychopathology throughout the time course of recovery, our results suggest that changes in speaking behavior and speech sound characteristics may be distinct aspects of schizophrenia that can persist in a subgroup of patients over a long period, mostly beyond the time point of hospital release. Accordingly, the speech analysis method might become very useful in detailing the nature and severity of deficits in patients after remission of positive symptoms.

Speaking behavior and voice sound characteristics associated with negative schizophrenia

Based on a sample of 42 chronic schizophrenic patients and 42 carefully matched controls, we investigated potential relationships between acoustic variables on the one hand, and negative syndromes, positive syndromes and affective disturbances, on the other. A set of 12 acoustic variables automatically assessed in a standardized experimental setting allowed an almost perfect discrimination between schizophrenic patients and normal subjects. Acute side-effects of medication did not explain this finding. However, the question of whether the observed changes in speaking behavior and voice sound characteristics were caused by long-term neuroleptic treatment, for example, as a consequence of tardive dyskinesia, could not be answered by our investigation. In view of a biological validation of the negative-positive model of schizophrenia, the reliability of various psychopathological subscales was tested through repeated assessments at 14 day intervals. We found most psychopathology scores to be sufficiently stable and reproducible over time, thus representing a suitable basis for the estimation of severity with respect to the negative and positive component of schizophrenia. Using the first measurements as training samples and the second measurements of 14 days later as test samples, discriminant analysis yielded conclusive proof of a close relationship between acoustic variables and the severity of the negative and positive component of schizophrenia. In particular, by means of "objective" acoustic variables and under the constraint of reproducibility, 75.9% of patients were correctly classified as low or high scorers with respect to the negative syndrome, 71.9% of patients with respect to the positive syndrome, and 79.4% of patients with respect to their depressive symptomatology.

The Benton-Van Allen faces: a lateralized tachistoscopic study

The Benton-Van Allen Facial Recognition Test (FRT) was adapted to a lateralized same-different task. The lateralized same targets were either physically identical to the central upright faces or had the same face identity but were transformed (3/4-views or shadowed faces). Faces were also modified to include or exclude external features. There was a left hemifield (right hemisphere) advantage only for the most difficult, shadowed faces. The absence of a left hemifield advantage for the matching of upright faces to identical or 3/4-view faces shows bilateral competence for face processing, both by physical and by face identity, and confirms previous observations that the FRT does not discriminate left from right hemisphere-damaged patients. Removal of external features affected performance in the right but not the left visual field, suggesting that the left hemisphere uses a less feature-dependent mechanism than the right hemisphere. This effect was only present in females, who were more lateralized than males.

[Hepatitis and imported infectious diseases. A. Hepatitis. 1. Virologic findings in acute hepatitis]

The properties of the hepatitis-A-virus and the hepatitis-B-virus are described. The authors refer to the fact that despite the far-reaching development, particularly in the field of the hepatitis-B-infection up to a usable active immunoprophylaxis many questions concerning the natural history, pathogenesis and epidemiology are still unclarified. The development of demonstration methods of the 3rd generation and their use in the diagnostics of hepatitis rendered possible the gain of new realizations. The authors contributed to the introduction of these methods essentially by own developments, as for instance of ELISA for the demonstration of HBeAg and anti-HBe. The solution of some still open questions can be expected only by the successful establishment of a suitable virus-host-cell system.

[Corrective surgery for kyphosis in bekhterev's disease - indication, technique, results (author's transl)]

14 patients suffering from Bechterew's disease with a marked kyphotic deformity of their spine have been subject to extension osteotomy. Follow-up of 12 patients ranges from 7 to 33 months. Results have been good in 10 and satisfactory in 2 cases. Increase in body length has been between 2 to maximally 26 cm. Surgical procedure, results and complications have been demonstrated. Possibility of early spondylodesis in Bechterew's disease for elimination of pain and avoidance of progressing deformity is discussed.