COVID-19 Vaccination and Parent-Reported Symptomatic Child Asthma Prevalence

This cross-sectional study evaluates the association between COVID-19 vaccination and symptomatic child asthma.


Introduction
Asthma was considered a risk for COVID-19 infection and hospitalization early in the pandemic. 1cial distancing measures in 2020 were associated with lower rates of emergency visits and hospitalizations for asthma among children. 2 Individual-level risk of COVID-19 infection was reduced with vaccination against SARS-CoV-2 for adults and children in 2020 and 2021, and several states sustained other infection prevention efforts (eg, face mask requirements) into 2021. 3ether symptomatic asthma among children was associated with population-level COVID-19 illness exposure or mitigation strategies is not understood.We hypothesized that symptomatic asthma would be positively associated with population-level COVID-19 overall mortality (a proxy for SARS-CoV-2 exposure), and would be inversely associated with population-level completion of the COVID-19 primary vaccination series and with state face mask mandates.

Methods
This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.The institutional review board of Nemours Children's Health determined that the study was exempt from human participants review and the need for informed consent because data were publicly available.We used state-level data regarding parent-reported current asthma symptom prevalence in their children (  3 We calculated state-level change scores for parent-reported childhood asthma symptom prevalence for 2020 to 2021 vs 2018 to 2019 and then assessed state-level time trends using t tests. We evaluated trend associations with concurrent state-level variables (pairwise Pearson correlations and linear regression).All analyses were performed with StataSE version 16 (StataCorp), with statistical significance defined as 2-tailed α = .05.Data were analyzed in February 2024.
Based on linear regression, with each increase of 10 percentage points in COVID-19 vaccination coverage, parent-reported child asthma symptom prevalence decreased by 0.36 percentage points (P = .04)(Figure  but not in 2020 (r = −0.20;P = .16),and were positively correlated with face mask mandates (r = .49;P < .001).

Discussion
In this study, which is the first population-level parent-reported childhood asthma symptom prevalence and COVID-19 vaccination study we know of, we found that higher COVID-19 vaccination rates may confer protection against symptomatic asthma.COVID-19 vaccination yields prophylactic benefits against SARS-CoV-2 infection for individual children 4 and may also protect against other human coronaviruses through cross-reactive antibody responses. 5Community-level immunity in states with higher vaccination rates may have helped reduce children's asthma risk.In contrast, neither concurrent exposure to high population-level burden of COVID-19-attributed disease nor sustained state-level face mask requirements were associated with concurrent trends in parentreported symptomatic childhood asthma.
National Survey of Children's Health, 2018-2019 and 2020-2021); age-adjusted COVID-19 mortality rates (US Centers for Disease Control and Prevention [CDC]; 2020 and 2021); proportion of population aged 5 years and older who completed the COVID-19 primary vaccination series in 2020 to 2021 (CDC); and face mask requirements in enclosed spaces through August 2021 (20 states and District of Columbia).
). Parent-reported child asthma symptom prevalence was not associated with statelevel COVID-19 mortality or with face mask requirements.State-level COVID-19 vaccination rates

Table .
State-Level Prevalence of Parent-Reported Current Asthma Symptoms in Children, in 2018 to 2019 and 2020 to 2021 a (continued) Parents' affirmative answers regarding current asthma symptom prevalence were based on yes answers to a 2-question sequence in the National Survey of Children's Health regarding 1 randomly selected child in the household: (1) "Has a doctor or health care provider EVER told you that this child has asthma?"; and (2) If yes, "Does this child CURRENTLY have the condition?"Two-year combinations were used to generate robust prevalence estimates within each state, as recommended by the Data Resource Center for Child and Adolescent Health. a