State COVID-19 vaccination rates may influence pediatric asthma cases

A young Black boy wearing a surgical mask is receiving a shot in the arm by a Black healthcare worker also wearing a mask.

New research suggests that children who have asthma and live in states with high COVID-19 vaccination rates may fare better, as it’s likely they received the shot. The data emerged from parent-reported pediatric symptoms between 2018-2019 and 2020-2021.

The findings of the study, “COVID-19 Vaccination and Parent-Reported Symptomatic Child Asthma Prevalence,” were released in a letter to JAMA Network Open by Nemours Children’s Health in Jacksonville, Florida, and Endeavor Health in Chicago.

“Asthma is one of the most common chronic illnesses among children in the United States, with about 4.7 million children experiencing symptoms each year,” said lead author Matthew M. Davis, MD, MAPP, executive vice president, enterprise physician-in-chief and chief scientific officer of Nemours Children’s Health. “Whether asthma is mild or severe, it affects children’s quality of life. So, anything we can do to help kids avoid flare-ups is beneficial.”

In the early part of 2020, when the COVID-19 pandemic was ramping up, social distancing and school closures were credited with fewer pediatric asthma exacerbations. Later, Dr. Davis and co-author Lakshmi Halasyamani, MD, chief clinical officer of Endeavor, wondered whether that benefit extended into 2021 during the rollout of the first vaccines.

In the study, Drs. Davis and Halasyamani compared the change in parent-reported childhood asthma symptoms between 2018-2019 and 2020-2021. They combined that data with the Centers for Disease Control and Prevention (CDC) state COVID-19 vaccination rates for people ages five and up from 2020-2021.  

According to the study, with each 10% increase in COVID-19 vaccination coverage, parent-reported child asthma symptoms decreased by 0.36%.

States in the highest quarter of COVID-19 vaccination rates overall had a decrease in asthma symptoms of 1.7%, nearly three times more favorable than states in the lowest quarter of COVID-19 vaccination rates overall. Those states saw an average decrease in asthma symptoms of only 0.6% between 2020-2021, compared with 2018-2019.

According to the co-authors, several factors could have contributed to the reduction in asthma symptoms. Community-level immunity, also called “herd immunity,” in states with higher vaccination rates may have helped reduce children’s risk of contracting COVID-19 and developing asthma complications. Another possibility is that children living in states with higher COVID-19 vaccination rates may have been more likely to get the shots soon after immunizations were approved for their age groups.

These findings also raise the possibility that COVID-19 vaccinations may effectively fight other illnesses that stem from coronaviruses, including the common cold, they said.

“Ongoing vaccination against COVID-19 may offer direct benefits for children with a history of asthma, but this must be confirmed with further research,” said Dr. Halasyamani. “It also raises the question of whether broader population-level COVID-19 vaccination among children and adults can help protect children with asthma, too.”

One limitation of the study, they said, is that it did not measure vaccination rates specifically in children with asthma, only the states. In addition, while parent-reported data is considered a meaningful measure of patient experience, additional data such as hospital stays or emergency department visits could be useful in verifying these findings.

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