Effectiveness of Maternal Vaccination With mRNA COVID-19 Vaccine During Pregnancy Against COVID-19–Associated Hospitalization in Infants Aged <6 Months

17 States, July 2021-January 2022

Natasha B. Halasa, MD; Samantha M. Olson, MPH; Mary A. Staat, MD; Margaret M. Newhams, MPH; Ashley M. Price, MPH; Julie A. Boom, MD; Leila C. Sahni, PhD; Melissa A. Cameron, MD; Pia S. Pannaraj, MD; Katherine E. Bline, MD; Samina S. Bhumbra, MD; Tamara T. Bradford, MD; Kathleen Chiotos, MD; Bria M. Coates, MD; Melissa L. Cullimore, MD; Natalie Z. Cvijanovich, MD; Heidi R. Flori, MD; Shira J. Gertz, MD; Sabrina M. Heidemann, MD; Charlotte V. Hobbs, MD; Janet R. Hume, MD; Katherine Irby, MD; Satoshi Kamidani, MD; Michele Kong, MD; Emily R. Levy, MD; Elizabeth H. Mack, MD; Aline B. Maddux, MD; Kelly N. Michelson, MD; Ryan A. Nofziger, MD; Jennifer E. Schuster, MD; Stephanie P. Schwartz, MD; Laura Smallcomb, MD; Keiko M. Tarquinio, MD; Tracie C. Walker, MD; Matt S. Zinter, MD; Suzanne M. Gilboa, PhD; Kara N. Polen, MPH; Angela P. Campbell, MD; Adrienne G. Randolph, MD; Manish M. Patel, MD

Disclosures

Morbidity and Mortality Weekly Report. 2022;71(7):264-270.

Discussion

During July 2021–January 2022, maternal completion of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy was associated with reduced risk for COVID-19 hospitalization among infants aged <6 months in a real-world evaluation at 20 U.S. pediatric hospitals during a period of Delta and Omicron variant circulation. Among 176 infants aged <6 months hospitalized with COVID-19, 148 (84%) were born to mothers who were not vaccinated during pregnancy. Although booster doses are recommended for pregnant women, VE of maternal booster doses received during pregnancy could not be assessed because of small sample size, which likely underestimated VE. Overall, these findings indicate that maternal vaccination during pregnancy might help protect against COVID-19 hospitalization among infants aged <6 months.

COVID-19 during pregnancy is associated with severe illness and death,^[7] and pregnant women with COVID-19 are more likely to experience preterm birth, stillbirth, and other pregnancy complications.^[8] Vaccination is recommended for pregnant women to prevent COVID-19, including severe illness and death. COVID-19 vaccination is safe and effective when administered during pregnancy.^[9,10] Receipt of COVID-19 vaccination during pregnancy is associated with detectable maternal antibodies in maternal sera at delivery, breast milk, and infant sera indicating transfer of maternal antibodies.^[3–5] The higher VE point estimates among infants born to women vaccinated later in pregnancy are consistent with the possibility of transplacental transfer of SARS-CoV-2–specific antibodies that might provide protection to infants. The optimal timing of maternal vaccination for the transfer of antibodies to protect the infant is currently uncertain, and the direct effect of maternal COVID-19 vaccination in preventing severe COVID-19 in infants has not previously been described. Further, with infants not currently age-eligible for vaccination and infant hospitalization rates remaining at the highest levels of the pandemic,*** this study suggests that maternal COVID-19 vaccination during pregnancy might protect infants aged <6 months from COVID-19–related hospitalization.

The findings in this report are subject to at least seven limitations. First, VE could not be assessed directly against specific variants. Second, the sample was too small to assess VE by pregnancy trimester of vaccination, and the small sample size resulted in wide confidence intervals for some estimates that should be interpreted with caution. Third, the analysis did not assess whether pregnant women were infected with SARS-CoV-2 before or during pregnancy, which might have provided maternal antibodies. Fourth, residual confounding such as additional differences in behaviors between vaccinated and unvaccinated mothers, including whether mothers had prenatal care, that might affect risk for infection cannot be excluded, and potential confounders (e.g., breastfeeding, child care attendance, and prematurity) could not be accounted for in the model because this information was not available for all infants. Fifth, because this analysis included self-reported data for a few participants, maternal vaccination status might be misclassified for a few infants, or there might be imperfect recollection of whether the mother completed COVID-19 vaccination during pregnancy. Sixth, immunocompromising maternal conditions were not collected to determine whether mothers needed an additional mRNA COVID-19 vaccine dose to complete their primary series. Finally, VE of maternal booster doses received during pregnancy could not be assessed because of small sample size.

Completion of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy was associated with reduced risk for COVID-19–associated hospitalization among infants aged <6 months, and protection was higher among infants whose mothers were vaccinated later in pregnancy. Additional evaluation should examine timing of vaccination before pregnancy compared with during pregnancy. CDC recommends that women who are pregnant, are breastfeeding, are trying to get pregnant now, or might become pregnant in the future get vaccinated and stay up to date with COVID-19 vaccination.^†††

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***https://gis.cdc.gov/grasp/covidnet/COVID19_5.html
^††† https://emergency.cdc.gov/han/2021/han00453.asp

Table 1. Characteristics of infants aged <6 months hospitalized with COVID-19 (case-infants) and without COVID-19 (control-infants) — 20 pediatric hospitals, 17 states,* July 2021–January 2022
Characteristic (no. missing)	Case status, n/N^† (column %)		p-value^§
Characteristic (no. missing)	Case-infants (N = 176)	Control-infants (N = 203)	p-value^§
Median age, mos (IQR)	2 (1–3)	2 (1–3)	0.96
Age group, mos
0–2	129 (73.3)	153 (75.4)	0.64
3–5	47 (26.7)	50 (24.6)	0.64
Sex
Female	84 (47.7)	83 (40.9)	0.18
Race and ethnicity
Black, non-Hispanic	32 (18.2)	19 (9.4)	0.02
White, non-Hispanic	56 (31.8)	82 (40.4)
Other, non-Hispanic	10 (5.7)	21 (10.3)
Hispanic, any race	60 (34.1)	56 (27.6)
Unknown	18 (10.2)	25 (12.3)
Social Vulnerability Index,^¶ (IQR) (1)	0.71 (0.39–0.86)	0.61 (0.29–0.83)	0.06
U.S. Census region*
Northeast	30 (17.1)	29 (14.3)	0.08
Midwest	44 (25.0)	60 (29.6)
South	54 (30.7)	42 (20.7)
West	48 (27.3)	72 (35.5)
Month of admission
July	10 (5.7)	5 (2.5)	0.14
August	23 (13.1)	26 (12.8)
September	16 (9.1)	25 (12.3)
October	10 (5.7)	21 (10.3)
November	18 (10.2)	30 (14.8)
December	59 (33.5)	51 (25.1)
January**	40 (22.7)	45 (22.2)
Underlying health condition in infants
At least one underlying condition (5)	34/174 (19.5)	46/200 (23.0)	0.42
Respiratory disorder (6)	9/174 (5.2)	9/199 (4.5)	0.77
Cardiovascular system disorder (5)	15/174 (8.6)	19/200 (9.5)	0.77
Neurologic/Neuromuscular disorder (5)	4/174 (2.3)	7/200 (3.5)	0.49
Immunosuppression or autoimmune (5)	0/174 (—)	2/200 (1.0)	0.50
Other chronic conditions^†† (6)	18/174 (10.3)	23/199 (11.6)	0.71
Preterm birth (born <37 weeks gestation) (50)	34/146 (23.3)	38/183 (20.8)	0.58
Maternal vaccination during pregnancy^§§	28 (15.9)	65 (32.0)	<0.01
Timing of maternal vaccination^¶¶ (3)
Early pregnancy (first 20 weeks)	17/165 (10.3)	26/164 (15.9)	0.14
Late pregnancy (21 weeks–14 days before delivery)	9/157 (5.7)	38/176 (21.6)	<0.01
Maternal vaccine type
Pfizer-BioNTech	20 (71.4)	35 (53.9)	0.11
Moderna	8 (28.6)	30 (46.2)	0.11
Behavioral factors***
Breastfeeding (103)	76/138 (55.1)	90/138 (65.2)	0.09
Child care (108)	6/135 (4.4)	9/136 (6.6)	0.43

Abbreviation: SVI = Social Vulnerability Index.
*Infants were enrolled from 20 pediatric hospitals in 17 states. Northeast: Boston Children's Hospital (Massachusetts), Cooperman Barnabas Medical Center (New Jersey), and Children's Hospital of Philadelphia (Pennsylvania); Midwest: Akron Children's Hospital (Ohio), Nationwide (Ohio), Children's Mercy Kansas City (Missouri), Mayo Clinic (Minnesota), Riley Children's (Indiana), Lurie Children's Hospital (Illinois), Minnesota Masonic (Minnesota), and Children's Hospital of Michigan (Michigan); South: Arkansas Children's Hospital (Arkansas), University of North Carolina at Chapel Hill Children's Hospital (North Carolina), Medical University of South Carolina Children's Health (South Carolina), Texas Children's Hospital (Texas), Children's Hospital of New Orleans (Louisiana), and Children's Healthcare of Atlanta, Emory (Georgia); West: Children's Hospital Colorado (Colorado), Children's Hospital Los Angeles (California), and University of California San Diego-Rady Children's Hospital (California).
^†If N is less than total.
^§Testing for statistical significance was conducted using the Pearson chi-square test and Fisher's exact test for comparisons with fewer than five observations. Wilcoxon rank-sum tests were used to compare continuous data.
^¶CDC/Agency for Toxic Substances and Disease Registry SVI documentation is available at https://www.atsdr.cdc.gov/placeandhealth/svi/index.html. Median SVI for case-infants and control-infants are based on 2018 U.S. SVI data. The SVI ranges from 0 to 1.0, with higher scores indicating greater social vulnerability. One control-infant was missing an SVI score.
**January numbers do not reflect the entire month. Patients included were admitted through January 17, 2022.
^††Other chronic conditions included rheumatologic/autoimmune disorder, hematologic disorder, renal or urologic dysfunction, gastrointestinal/hepatic disorder, metabolic or confirmed or suspected genetic disorder, or atopic or allergic condition.
^§§COVID-19 vaccination status included the following two categories: 1) unvaccinated (mothers who did not receive COVID-19 vaccine doses before their infant's hospitalization) or 2) vaccinated (mothers who completed their 2-dose primary mRNA COVID-19 vaccination series during pregnancy and ≥14 days before delivery).
^¶¶Timing of vaccination is based on date of receipt of the second dose of a 2-dose primary mRNA COVID-19 vaccine series during pregnancy.
***Behavioral factors are reported during interview with mother or proxy. Breastfeeding included any breastfeeding (either exclusive or partial).

Table 2. Clinical outcomes and severity among case-infants aged <6 months hospitalized with COVID-19, by maternal vaccination status during pregnancy* — 20 pediatric hospitals, 17 states, ^† July 2021–January 2022
Characteristic (no. unknown)	Maternal vaccination status during pregnancy, n/N (%)
Characteristic (no. unknown)	Total (N = 176)	Unvaccinated (n = 148)	Vaccinated (2-doses of mRNA COVID-19 vaccine) (n = 28)
Intensive care unit admission	43/176 (24.4)	38/148 (25.7)	5/28 (17.9)
Critically ill infants on life support (4)	25/172 (14.5)	21/144 (14.6)	4/28 (14.3)
Invasive mechanical ventilation (4)	11/172 (6.4)	10/144 (6.9)	1/28 (3.6)
Noninvasive mechanical ventilation (4)	18/172 (10.5)	15/144 (10.4)	3/28 (10.7)
Vasoactive infusions (4)	6/172 (3.5)	5/144 (3.5)	1/28 (3.6)
Extracorporeal membrane oxygenation (4)	1/172 (0.6)	1/144 (0.7)	0/28 (—)
Infants with discharge data, n/total N (%)	170/176 (96.6)	142/148 (96.0)	28/28 (100)
Hospital length of stay, median days^§ (IQR) (8)	2 (1–3)	2 (1–3)	2 (1–5)
Died before discharge (6)	1/170 (0.6)	1/142 (0.7)	0/28 (—)

*COVID-19 vaccination status included the following two categories: 1) unvaccinated (mothers who did not receive COVID-19 vaccine doses before their infant's hospitalization) or 2) vaccinated (mothers who completed their 2-dose primary mRNA COVID-19 vaccination series during pregnancy and ≥14 days before delivery).
^†Infants were enrolled from 20 pediatric hospitals in 17 states. Northeast: Boston Children's Hospital (Massachusetts), Cooperman Barnabas Medical Center (New Jersey), and Children's Hospital of Philadelphia (Pennsylvania); Midwest: Akron Children's Hospital (Ohio), Nationwide (Ohio), Children's Mercy Kansas City (Missouri), Mayo Clinic (Minnesota), Riley Children's (Indiana), Lurie Children's Hospital (Illinois), Minnesota Masonic (Minnesota), and Children's Hospital of Michigan (Michigan); South: Arkansas Children's Hospital (Arkansas), University of North Carolina at Chapel Hill Children's Hospital (North Carolina), Medical University of South Carolina Children's Health (South Carolina), Texas Children's Hospital (Texas), Children's Hospital of New Orleans (Louisiana), and Children's Healthcare of Atlanta, Emory (Georgia); West: Children's Hospital Colorado (Colorado), Children's Hospital Los Angeles (California), and University of California San Diego-Rady Children's Hospital (California).
^§Hospital length of stay was missing for eight case-infants born to unvaccinated mothers.

Table 3. Effectiveness* of maternal 2-dose primary mRNA COVID-19 vaccination against COVID-19-associated hospitalization in infants aged <6 months, by timing of maternal vaccination during pregnancy ^† — 20 pediatric hospitals, 17 states, ^§ July 2021–January 2022
Timing of maternal vaccination during pregnancy^†	No. vaccinated^¶/Total (%)		Vaccine effectiveness,* % (95% CI)
Timing of maternal vaccination during pregnancy^†	Case-infants	Control-infants	Vaccine effectiveness,* % (95% CI)
Any time	28/176 (15.9)	65/203 (32.0)	61 (31 to 78)
Early (first 20 weeks)	17/165 (10.3)	26/164 (15.9)	32 (–43 to 68)
Late (21 weeks' gestation through 14 days before delivery)	9/157 (5.7)	38/176 (21.6)	80 (55 to 91)

*Vaccine effectiveness estimates were based on odds of antecedent maternal vaccination during pregnancy in case-infants versus control-infants, adjusted for U.S. Census region, admission date (biweekly intervals), continuous age, sex, and race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic other, Hispanic of any race, or unknown).
^†Timing of vaccination is based on date of receipt of the second dose of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy. Gestational age was missing for seven of 90 (7.8%) infants born to vaccinated mothers with known timing of the second dose, and for these infants classification of vaccination timing was based on gestational age of 40 weeks.
^§Infants were enrolled from 20 pediatric hospitals in 17 states. Northeast: Boston Children's Hospital (Massachusetts), Cooperman Barnabas Medical Center (New Jersey), and Children's Hospital of Philadelphia (Pennsylvania); Midwest: Akron Children's Hospital (Ohio), Nationwide (Ohio), Children's Mercy Kansas City (Missouri), Mayo Clinic (Minnesota), Riley Children's (Indiana), Lurie Children's Hospital (Illinois), Minnesota Masonic (Minnesota), and Children's Hospital of Michigan (Michigan); South: Arkansas Children's Hospital (Arkansas), University of North Carolina at Chapel Hill Children's Hospital (North Carolina), Medical University of South Carolina Children's Health (South Carolina), Texas Children's Hospital (Texas), Children's Hospital of New Orleans (Louisiana), and Children's Healthcare of Atlanta, Emory (Georgia); West: Children's Hospital Colorado (Colorado), Children's Hospital Los Angeles (California), and University of California San Diego-Rady Children's Hospital (California).
^¶COVID-19 vaccination status included the following two categories: 1) unvaccinated (mothers who did not receive COVID-19 vaccine doses before their infant's hospitalization) or 2) vaccinated (mothers who completed their 2-dose primary mRNA COVID-19 vaccination series during pregnancy and ≥14 days before delivery).

Authors and Disclosures

Natasha B. Halasa, MD^1,*, Samantha M. Olson, MPH^2,*, Mary A. Staat, MD³, Margaret M. Newhams, MPH⁴, Ashley M. Price, MPH², Julie A. Boom, MD⁵, Leila C. Sahni, PhD⁵, Melissa A. Cameron, MD⁶, Pia S. Pannaraj, MD⁷, Katherine E. Bline, MD⁸, Samina S. Bhumbra, MD⁹, Tamara T. Bradford, MD¹⁰, Kathleen Chiotos, MD¹¹, Bria M. Coates, MD¹², Melissa L. Cullimore, MD¹³, Natalie Z. Cvijanovich, MD¹⁴, Heidi R. Flori, MD¹⁵, Shira J. Gertz, MD¹⁶, Sabrina M. Heidemann, MD¹⁷, Charlotte V. Hobbs, MD¹⁸, Janet R. Hume, MD¹⁹, Katherine Irby, MD²⁰, Satoshi Kamidani, MD²¹, Michele Kong, MD²², Emily R. Levy, MD²³, Elizabeth H. Mack, MD²⁴, Aline B. Maddux, MD²⁵, Kelly N. Michelson, MD¹², Ryan A. Nofziger, MD²⁶, Jennifer E. Schuster, MD²⁷, Stephanie P. Schwartz, MD²⁸, Laura Smallcomb, MD²⁹, Keiko M. Tarquinio, MD³⁰, Tracie C. Walker, MD²⁸, Matt S. Zinter, MD³¹, Suzanne M. Gilboa, PhD², Kara N. Polen, MPH², Angela P. Campbell, MD², Adrienne G. Randolph, MD^4,32,† and Manish M. Patel, MD^2,†, Overcoming COVID-19 Investigators

¹Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; ²CDC COVID-19 Emergency Response Team; ³Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ⁴Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; ⁵Department of Pediatrics, Baylor College of Medicine, Immunization Project, Texas Children's Hospital, Houston, Texas; ⁶Division of Pediatric Hospital Medicine, UC San Diego-Rady Children's Hospital, San Diego, California; ⁷Division of Infectious Diseases, Children's Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, California; ⁸Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio; ⁹The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; ¹⁰Department of Pediatrics, Division of Cardiology, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans, Louisiana; ¹¹Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ¹²Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; ¹³Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska; ¹⁴Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, California; ¹⁵Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan; ¹⁶Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey; ¹⁷Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan; ¹⁸Department of Pediatrics, Department of Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi; ¹⁹Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota; ²⁰Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas; ²¹The Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine; Atlanta, Georgia; ²²Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; ²³Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; ²⁴Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina; ²⁵Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; ²⁶Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio; ²⁷Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri; ²⁸Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, North Carolina; ²⁹Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; ³⁰Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia; ³¹Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California San Francisco, San Francisco, California; ³²Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts.

Corresponding author
Samantha M. Olson, ylz8@cdc.gov.

Overcoming COVID-19 Network
Laura D. Zambrano, CDC; Meghan Murdock, Children's of Alabama, Birmingham, Alabama; Mary Glas Gaspers, University of Arizona, Tucson, Arizona; Connor P. Kelley, University of Arizona, Tucson, Arizona; Katri V. Typpo, University of Arizona, Tucson, Arizona; Peter M. Mourani, Arkansas Children's Hospital, Little Rock, Arkansas; Ronald C. Sanders, Arkansas Children's Hospital, Little Rock, Arkansas; Chelsea Smith, Arkansas Children's Hospital, Little Rock, Arkansas; Masson Yates, Arkansas Children's Hospital, Little Rock, Arkansas; Katheryn Crane, Rady Children's Hospital, San Diego, California; Geraldina Lionetti, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California; Juliana Murcia-Montoya, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California; Denise Villarreal-Chico, University of California San Francisco Benioff Children's Hospital, San Francisco, California; Daniel Hakimi, Children's Hospital Los Angeles, Los Angeles, California; Adam L. Skura, Children's Hospital Los Angeles, Los Angeles, California; Imogene Carson, Children's Hospital Colorado, Aurora, Colorado; Justin M. Lockwood, Children's Hospital Colorado, Aurora, Colorado; Emily Port, Children's Hospital Colorado, Aurora, Colorado; Brandon M. Chatani, Holtz Children's Hospital, Miami, Florida; Nadine Baida, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia; Laila Hussaini, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia; Hassan A. Khan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Simone T. Rhodes, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Courtney M. Rowan, Riley Hospital for Children, Indianapolis, Indiana; Mary Stumpf, Riley Hospital for Children, Indianapolis, Indiana; Marla S. Johnston, Children's Hospital of New Orleans, New Orleans, Louisiana; Laura Berbert, Boston Children's Hospital, Boston, Massachusetts; Benjamin J. Boutselis, Boston Children's Hospital, Boston, Massachusetts; Sabrina R. Chen, Boston Children's Hospital, Boston, Massachusetts; Jie He, Boston Children's Hospital, Boston, Massachusetts; Suden Kucukak, Boston Children's Hospital, Boston, Massachusetts; Timothy P. McCadden, Boston Children's Hospital, Boston, Massachusetts; Amber O. Orzel, Boston Children's Hospital, Boston, Massachusetts; Edie Weller, Boston Children's Hospital, Boston, Massachusetts; Patrick Moran, University of Michigan CS Mott Children's Hospital, Ann Arbor, Michigan; Ellen R. Bruno, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota; Lexie A. Goertzen, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota; Supriya Behl, Mayo Clinic, Rochester, Minnesota; Noelle M. Drapeau, Mayo Clinic, Rochester, Minnesota; Lacy Malloch, Children's Hospital of Mississippi, Jackson, Mississippi; Lora Martin, Children's Hospital of Mississippi, Jackson, Mississippi; April Palmer, Children's Hospital of Mississippi, Jackson, Mississippi; Roberto P. Santos, Children's Hospital of Mississippi, Jackson, Mississippi; Abigail Kietzman, Children's Mercy Kansas City, Kansas City, Missouri; Melissa Sullivan, Children's Mercy Kansas City, Kansas City, Missouri; Lauren A. Hoody, Children's Hospital & Medical Center, Omaha, Nebraska; Valerie H. Rinehart, Children's Hospital & Medical Center, Omaha, Nebraska; Paris C. Bennett, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Merry L. Tomcany, Akron Children's Hospital, Akron, Ohio; Nicole A. Twinem, Akron Children's Hospital, Akron, Ohio; Chelsea C. Rohlfs, Cincinnati Children's Hospital, Cincinnati, Ohio; Amber Wolfe, Nationwide Children's Hospital, Columbus, Ohio; Rebecca L. Douglas, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Kathlyn Phengchomphet, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Megan M. Bickford, Medical University of South Carolina Children's Health, Charleston, South Carolina; Lauren E. Wakefield, Medical University of South Carolina Children's Health, Charleston, South Carolina; Meena Golchha, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; Laura S. Stewart, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; Jennifer N. Oates, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; Cindy Bowens, University of Texas Southwestern, Children's Medical Center Dallas, Dallas, Texas; Mia Maamari, University of Texas Southwestern, Children's Medical Center Dallas, Dallas, Texas

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Adrienne G. Randolph reports institutional support from the National Institute of Allergy and Infectious Diseases and National Institutes of Health (NIH) and being the UpToDate Pediatric Critical Care Section Editor. Matt S. Zinter reports institutional support from the National Heart, Lung, and Blood Institute (NHLBI), NIH and the American Thoracic Society. Laura Smallcomb reports support from the Medical University of South Carolina for conference attendance. Jennifer E. Schuster reports institutional support from Merck. Ryan A. Nofziger reports institutional support from NIH. Emily R. Levy reports institutional support from NIH. Michele Kong reports institutional support from NIH. Satoshi Kamidani reports institutional support from NIH and Pfizer. Janet R. Hume reports institutional support from the National Institute for Child Health and Development, NIH, and serving on a data safety monitoring board for an institutional study of magnesium for analgesia in complex medical patients. Charlotte V. Hobbs reports consultant fees from BioFire (bioMérieux). Natalie Z. Cvijanovich reports institutional support from NIH. Bria M. Coates reports institutional support from NHLBI, NIH, the American Lung Association, and the American Thoracic Society. Kathleen Chiotos reports institutional support from the Agency for Healthcare Research and Quality and serving as the Society for Healthcare Epidemiology of America Research Network Chair. Samina S. Bhumbra reports receipt of an NIH, National Institute for Allergy and Infectious Diseases training grant. Pia S. Pannaraj reports institutional support from AstraZeneca and Pfizer, consulting fees from Sanofi-Pasteur and Seqirus, payment from law firms for expert testimony, serving in the Division of Microbiology and Infectious Diseases, and unpaid service on the California Immunization Coalition. Mary A. Staat reports institutional support from NIH and receipt of lecture fees from the American Academy of Pediatrics for PREP ID Course. Natasha B. Halasa reports grant support from Sanofi and Quidel and honoraria from Genentech. No other potential conflicts of interest were disclosed.

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Effectiveness of Maternal Vaccination With mRNA COVID-19 Vaccine During Pregnancy Against COVID-19–Associated Hospitalization in Infants Aged <6 Months

17 States, July 2021-January 2022

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