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Background: Adults previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop short-term immunity and may have increased reactogenicity to coronavirus disease 2019 (COVID-19) vaccines. This prospective, multicenter, active-surveillance cohort study examined the short-term safety of COVID-19 vaccines in adults with a prior history of SARS-CoV-2., Methods: Canadian adults vaccinated between 22 December 2020 and 27 November 2021 were sent an electronic questionnaire 7 days post-dose 1, dose 2, and dose 3 vaccination. The main outcome was health events occurring in the first 7 days after each vaccination that prevented daily activities, resulted in work absenteeism, or required a medical consultation, including hospitalization., Results: Among 684 998 vaccinated individuals, 2.6% (18 127/684 998) reported a prior history of SARS-CoV-2 infection a median of 4 (interquartile range: 2-6) months previously. After dose 1, individuals with moderate (bedridden) to severe (hospitalized) COVID-19 who received BNT162b2, mRNA-1273, or ChAdox1-S vaccines had higher odds of a health event preventing daily activities, resulting in work absenteeism or requiring medical consultation (adjusted odds ratio [95% confidence interval]: 3.96 [3.67-4.28] for BNT162b2, 5.01 [4.57-5.50] for mRNA-1273, and 1.84 [1.54-2.20] for ChAdox1-S compared with no infection). Following dose 2 and 3, the greater risk associated with previous infection was also present but was attenuated compared with dose 1. For all doses, the association was lower or absent after mild or asymptomatic infection., Conclusions: Adults with moderate or severe previous SARS-CoV-2 infection were more likely to have a health event sufficient to impact routine activities or require medical assessment in the week following each vaccine dose., Competing Interests: Potential conflicts of interest. M. S. has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, Pfizer, Sanofi-Pasteur, Seqirus, Symvivo, and VBI Vaccines, outside the submitted work. All funds have been paid to his institution, and he has not received any personal payments; he is also the Chair/Deputy Chair of 2 Data Safety and Monitoring Boards (DSMBs) for coronavirus disease 2019 (COVID-19) vaccine trials, involving different vaccines. O. G. V. has been an investigator, coinvestigator, and/or expert panelist on projects funded by GlaxoSmithKline, Merck, Pfizer, and Seqirus, outside the submitted work, and reports grants or contracts from Pfizer Canada and a Pneumococcal Grant in AID (paid to their institution) and consulting fees from Merck, Pfizer, Seqirus, AstraZeneca, and Sanofi-Pasteur. J. D. K. has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, and Pfizer, outside the submitted work, and reports grants or contracts as Site Investigator for a phase 2/3, 2-part, open-label, dose-escalation, age de-escalation and randomized, observer-blind, placebo-controlled expansion study to evaluate the safety, tolerability, reactogenicity, and effectiveness of mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in healthy children 6 months to less than 12 years of age (mRNA-1273-P204 Study; ClinicalTrials.gov Identifier: NCT04796896); a DSMB, VIDO (University of Saskatchewan Vaccine and Infectious Disease Organization)–sponsored COVID-19 vaccine clinical trial, “A Randomized, Observer-Blind, Dose-Escalation, Phase 1/2 Clinical Trial of COVAC Vaccines in Healthy Adults” (unpaid volunteer position); a leadership or fiduciary role in other board, society, committee, or advocacy group; the Canadian COVID-19 Immunity Task Force: Member, Leadership Group; Co-chair, Field Studies Working Party; and Lead, Pediatric Network (unpaid volunteer position). All funds have been paid to his institution, and he has not received any personal payments. K. A. T. has been an investigator on projects funded by GlaxoSmithKline, outside the submitted work, and reports grants or contracts from Canadian Institutes of Health Research, Public Health Agency of Canada (payment to their institution for vaccine safety evaluation studies), and Coalition for Epidemic Preparedness Innovations (payment to their institution for a vaccine safety study); payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events for the Canadian Society of Allergy and Clinical Immunology (speaker’s fees on COVID-19 vaccines) and Family Practice Renewal Program (Newfoundland) (speaker’s fees for COVID-19 vaccines); consulting fees for the World Health Organization (payments to author for leading vaccines safety training in middle-income countries); support for attending meetings and/or travel from Canadian Public Health Association (support to attend in person and virtual Canadian Immunization Conference). All funds have been paid to her institution, and she has not received any personal payments. J. E. I. has been an investigator on projects funded by the Canadian Institutes of Health Research, Drug Evaluation Alliance of Nova Scotia, Dalhousie Pharmacy Endowment Fund, Shoppers Drug Mart, GlaxoSmithKline, Sanofi-Pasteur, Canadian Frailty Network, and Nova Scotia Health Research fund. All funds have been paid to her institution, and she has not received any personal payments. A. M. has been an investigator on projects funded by GlaxoSmithKline, Merck, Pfizer, Sanofi-Pasteur, and Seqirus, with funds paid to her institution, and has received honoraria for participation in advisory boards from AstraZeneca, GlaxoSmithKline, Medicago, Merck, Moderna, Pfizer, Sanofi-Pasteur, and Seqirus, and for presentations from AstraZeneca, and Moderna, including participation on a DSMB or advisory board for Pfizer, GlaxoSmithKline, Moderna, Medicago, Janssen, and AstraZeneca. G. D. S. and L. V. have been investigators on a project funded by Pfizer, outside the submitted work. All funds have been paid to their institution, and they have not received any personal payments. L. V. also reports being a co-founder and stockholder for Lumed, a company developing and commercializing expert systems in the fields of antimicrobial stewardship, infection control, and oncology. J. A. B. reports participation on an Advisory Committee for the National Advisory Committee on Immunization as a member (volunteer, unpaid participation). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Within 2 years after the start of the coronavirus disease 2019 (COVID-19) pandemic, novel severe acute respiratory syndrome coronavirus 2 vaccines were developed, rigorously evaluated in large phase 3 trials, and administered to more than 5 billion individuals globally. However, adverse events of special interest (AESIs) have been described post-implementation, including myocarditis after receipt of messenger RNA (mRNA) vaccines and thrombosis with thrombocytopenia syndrome after receipt of adenoviral vector vaccines. AESIs are rare (<1 to 10/100 000 vaccinees) and less frequent than COVID-19 complications, though they have associated morbidity and mortality. The diversity of COVID-19 vaccine platforms (eg, mRNA, viral vector, protein) and rates of AESIs both between and within platforms (eg, higher rate of myocarditis after mRNA-1273 vs BNT162b2 vaccines) present an important opportunity to advance vaccine safety science. The International Network of Special Immunization Services has been formed with experts in vaccine safety, systems biology, and other relevant disciplines to study cases of AESIs and matched controls to uncover the pathogenesis of rare AESIs and inform vaccine development., Competing Interests: Potential conflicts of interest. K. A. T. reports funding from the Canadian Institutes of Health Research and Public Health Agency of Canada for safety evaluation of coronavirus disease 2019 (COVID-19) vaccines and grants from GlaxoSmithKline outside the submitted work. O. L. is a named inventor on patents relating to adjuvants and human in vitro systems that predict vaccine safety assessments and reports grants for the Precision Vaccines Program from the Boston Children’s Hospital Department of Pediatrics and the Chief Scientific Office and consulting fees from Moody’s analytics. C. B. C. reports grants and contracts from the NIH and CDC for vaccine clinical trials including NIH Vaccine and Treatment Evaluation Unit (including the Moderna COVE study, Janssen ENSEMBLE study, Moderna KidCOVE study) and CDC Clinical Immunization Safety Assessment Network; grants from Merck; royalties for contributions to the UpToDate program; multiple small honoraria for lectures on COVID-19 vaccines and other vaccines; consultation fees from Altimmune (COVID-19 vaccine development), Janssen (respiratory syncytial virus vaccine development), Astellas (clinical trial data and safety monitoring board), Horizon Pharma (consultation related to care of children with chronic granulomatous disease), and Vir (influenza monoclonal antibody development); payment for expert testimony from multiple legal firms for general medical malpractice; US patent 10,981,979 B2; and serving as the president of the Pediatric Infectious Diseases Society. K. G. reports grants from the Task Force for Global Health and the CDC via the Global Vaccine Data Network for sentinel surveillance and personal fees from the CDC via the Global Vaccine Data Network for vaccine safety training materials. C. L. C. reports a grant from GAVI, the Vaccine Alliance, for vaccine safety surveillance and serving as a member of the Brighton Collaboration Scientific committee and the Institutional Biosafety committee. G. A. P. reports funding from ICW Ventures and the NIH (AI 48793, AI 33144, and AI 132348); consulting fees from Contec, Inc, 3D Communications, AstraZeneca UK Ltd, Bank of America Corporation, Eli Lily and Company, Emergent BioSolutions, Exelixis Inc, ExpertConnect, Genevant Sciences, Inc, GlaxoSmithKline, Janssen Global Services, LLC, Janssen Research & Development, LLC, Medicago USA, Medscape, LLC, Merck, Regeneron Pharmaceuticals Inc, Sanofi Pasteur SA, Syneos Health, and Vyriad; and participation on a data safety monitoring or advisory board for 3D Communications, AstraZeneca UK Ltd, Bavarian Nordic A/S, Dynavax Technologies, Genentech, Inc, GlaxoSmithKline, Janssen Global Services, LLC, and Janssen Pharmaceuticals, Inc. N. C. reports a Medical Research Future Fund grant and serving on a government advisory committee for the Australian Technical Advisory Group on Immunisation-ATAGI. B. C. reports a CDC grant and serving as a board member for the Rare Disease Foundation. R. T. C. reports grants from the Coalition for Epidemic Preparedness and Innovation and the CDC; travel support from Elsevier; honoraria payments from the Brighton Collaboration; serving as the scientific director at the Brighton Collaboration; and serving as a co-lead on the COVAX Vaccine Safety Working Group. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.)

Background: There is no uniform guideline for postchemotherapy vaccination of children with acute lymphoblastic leukemia (ALL). We evaluated waning immunity to 14 pneumococcal serotypes, pertussis toxin (PT), tetanus toxoid (TT) and varicella, and immunogenicity of postchemotherapy diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) and pneumococcal vaccination among previously vaccinated children treated for ALL., Methods: This was a multicenter trial of children with ALL enrolled 4-12 months postchemotherapy completion. Exclusion criteria included: infant ALL, relapsed ALL, and stem cell transplant recipients. Immunocompetent children were recruited as controls. Postchemotherapy participants received DTaP-IPV-Hib and 13-valent pneumococcal conjugate vaccine (PCV13) concurrently, followed by 23-valent pneumococcal polysaccharide vaccine (PPV23) 2 months later. Serology was measured at baseline, 2 and 12 months postvaccination. Adverse events were captured via surveys., Results: At enrollment, postchemotherapy participants (n = 74) were less likely than controls (n = 78) to be age-appropriately immunized with DTaP (41% vs 89%, P < .001) and PCV (59% vs 79%, P = .008). Geometric mean concentrations (GMCs) to TT, PT, PCV serotypes, and varicella were lower in postchemotherapy participants than controls after adjusting for previous vaccine doses (P < .001). Two months postvaccination, GMCs to TT, PT, and PCV serotypes increased from baseline (P < .001 for all antigens) and remained elevated at 12 months postvaccination. Antibody levels to PPV23 serotypes also increased postvaccination (P < .001). No serious adverse events were reported., Conclusions: Children treated for ALL had lower antibody levels than controls against pneumococcal serotypes, tetanus, pertussis, and varicella despite previous vaccination. Postchemotherapy vaccination with DTaP-IPV-Hib, PCV13, and PPV23 was immunogenic and well tolerated. Children with ALL would benefit from systematic revaccination postchemotherapy., Clinical Trials Registration: NCT02447718., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.)