Adolescents aged 12 to 17 years had generally mild-to-moderate—and transient—reactions after Pfizer-BioNTech booster vaccination, about the same or slightly stronger than the second primary dose, according to a new study. Of note, myocarditis was less frequently reported, however, after a booster dose than a second primary dose.

Adults were less likely to report adverse reactions after getting a homologous Pfizer-BioNTech COVID-19 booster dose than after the second primary dose, the Morbidity & Mortality Weekly Report advises.

"Health care providers, parents, and adolescents should be advised that local and systemic reactions are expected among adolescents after a homologous Pfizer-BioNTech booster vaccination and that serious adverse events are rare," suggested authors from the CDC and FDA.

The CDC reviewed adverse events (AEs) and health impact assessments during the week after receipt of a homologous Pfizer-BioNTech booster dose reported to v-safe, a voluntary smartphone-based safety surveillance system for AEs after COVID-19 vaccination, and AEs reported to the Vaccine Adverse Event Reporting System (VAERS), a passive vaccine safety surveillance system managed by the CDC and FDA.

Reports to v-safe after receipt of a booster dose in an adolescent were generally similar to those previously described for adults, although reactions among adolescents were reported to v-safe with equal or slightly higher frequency after receipt of a booster dose than after dose 2. The authors noted that reactions reported after dose 2 and the booster dose of the vaccination were mostly mild to moderate in severity.

The most common AEs reported to VAERS in this age group were administration errors—none of them involving AEs linked to incorrect dosages—and events such as dizziness related to syncope, a vasovagal response to vaccination that is common among adolescents after any vaccination.

The CDC pointed out that 32 of the 64 VAERS reports of myocarditis—a rare AE that has been associated with mRNA-based COVID-19 vaccines—had been confirmed after the Pfizer-BioNTech booster dose vaccination among adolescents.

"The reporting rate of confirmed cases of myocarditis among adolescent boys after Pfizer-BioNTech booster dose vaccination (11.4 per 1 million doses administered) was lower than for dose 2 Pfizer-BioNTech vaccination for boys aged 12-15 years (70.7 per 1 million doses administered) or 16-17 years (105.9 per 1 million doses administered)," the authors wrote.

The Advisory Committee on Immunization Practices recommends that everyone aged 12 years and older receive a booster dose of COVID-19 vaccine 5 or more months after the second dose of the mRNA vaccine primary series.

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