This preprint looking at the risk of vaccine-related side-effects vs COVID-19 infections for children has received a lot of attention, and people have been asking my opinions on it. So, a few thoughts 1/nhttps://twitter.com/TracyBethHoeg/status/1435796377188003841 …
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7/n In other words, it's not the likelihood of experiencing a post-vaccination CAE, but the likelihood of having a post-vaccination REPORT of a CAE per million children
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8/n This may sound like needless pedantry, but it isn't - media reporting and attention are a known confounder of passive reporting systems like VAERS. If you have a lot of news articles, you get more reports, even if those are not actually linked to the vaccinespic.twitter.com/J0qqHR2zP3
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9/n And it's interesting to note that, as the authors point out, the CDC (who use much more detailed information to calculate these rates) have a lower estimate of post-vaccine CAE than this preprintpic.twitter.com/NDesrnJ6jM
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10/n The second point that confuses me about the paper as it currently stands is comparing two numbers with very different denominators: 1. events per 1mil vaccines 2. events per 1mil children per 120 dayspic.twitter.com/KLl4a5qgbq
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11/n One way to think about this disparity is to simply equalize the denominators. We could do this by calculating the 120-day risk of CAE following vaccination for males aged 16-17 in the United Statespic.twitter.com/imxA8oxaxd
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12/n Based on the numbers in table 1, that would be 110 total events (doses 1+2), and a population of about 3 million, so very crudely 37 CAEs per 120 days This is lower than most of the calculated rates of COVID-19 related admissions in the paperpic.twitter.com/jLTkc744BI
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13/n Alternatively, we could compare the risk having a CAE after vaccination with the risk of hospitalization for kids per INFECTION Fortunately, there's already a great resource for doing this in a recent preprint https://www.medrxiv.org/content/10.1101/2021.07.29.21261282v1 …pic.twitter.com/7CBupMZGmT
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14/n From this preprint, the likelihood that a child aged 16-17 will experience an infection severe enough to warrant hospitalization is about 1 in 500, and the risk of needing ICU is about 1 in 4,000
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15/n So might reasonably compare the risk of 94-168 CAEs per million vaccinations posited by this paper with the risk of 2,400 hospitalizations expected per million infections with COVID-19
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16/n Now, it is worth noting that this assumes that the risk of eventually contracting COVID-19 is 100% for children who are not vaccinated, however as time moves on that is not, I think, entirely unreasonable
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17/n I think weighing the competing risks of vaccination vs infection is a very challenging thing to do, so I commend the authors on the preprint. I think these might be things to consider when updating it for future versions
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18/n That being said, I'm not sure I agree that this preprint shows vaccination to be riskier than immunization for these age groups/genders. Not an easy question to answer!
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19/n This piece from
@dfreedman7 is a fairly startling addition to the discussion. The implication appears to be that even the basic case definition the authors used was entirely useless, which is less than idealhttps://twitter.com/dfreedman7/status/1437229791380443139?s=20 …Show this thread
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