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Importance: Bivalent mRNA COVID-19 vaccines were recommended in the US for children and adolescents aged 12 years or older on September 1, 2022, and for children aged 5 to 11 years on October 12, 2022; however, data demonstrating the effectiveness of bivalent COVID-19 vaccines are limited., Objective: To assess the effectiveness of bivalent COVID-19 vaccines against SARS-CoV-2 infection and symptomatic COVID-19 among children and adolescents., Design, Setting, and Participants: Data for the period September 4, 2022, to January 31, 2023, were combined from 3 prospective US cohort studies (6 sites total) and used to estimate COVID-19 vaccine effectiveness among children and adolescents aged 5 to 17 years. A total of 2959 participants completed periodic surveys (demographics, household characteristics, chronic medical conditions, and COVID-19 symptoms) and submitted weekly self-collected nasal swabs (irrespective of symptoms); participants submitted additional nasal swabs at the onset of any symptoms., Exposure: Vaccination status was captured from the periodic surveys and supplemented with data from state immunization information systems and electronic medical records., Main Outcome and Measures: Respiratory swabs were tested for the presence of the SARS-CoV-2 virus using reverse transcriptase-polymerase chain reaction. SARS-CoV-2 infection was defined as a positive test regardless of symptoms. Symptomatic COVID-19 was defined as a positive test and 2 or more COVID-19 symptoms within 7 days of specimen collection. Cox proportional hazards models were used to estimate hazard ratios for SARS-CoV-2 infection and symptomatic COVID-19 among participants who received a bivalent COVID-19 vaccine dose vs participants who received no vaccine or monovalent vaccine doses only. Models were adjusted for age, sex, race, ethnicity, underlying health conditions, prior SARS-CoV-2 infection status, geographic site, proportion of circulating variants by site, and local virus prevalence., Results: Of the 2959 participants (47.8% were female; median age, 10.6 years [IQR, 8.0-13.2 years]; 64.6% were non-Hispanic White) included in this analysis, 25.4% received a bivalent COVID-19 vaccine dose. During the study period, 426 participants (14.4%) had laboratory-confirmed SARS-CoV-2 infection. Among these 426 participants, 184 (43.2%) had symptomatic COVID-19, 383 (89.9%) were not vaccinated or had received only monovalent COVID-19 vaccine doses (1.38 SARS-CoV-2 infections per 1000 person-days), and 43 (10.1%) had received a bivalent COVID-19 vaccine dose (0.84 SARS-CoV-2 infections per 1000 person-days). Bivalent vaccine effectiveness against SARS-CoV-2 infection was 54.0% (95% CI, 36.6%-69.1%) and vaccine effectiveness against symptomatic COVID-19 was 49.4% (95% CI, 22.2%-70.7%). The median observation time after vaccination was 276 days (IQR, 142-350 days) for participants who received only monovalent COVID-19 vaccine doses vs 50 days (IQR, 27-74 days) for those who received a bivalent COVID-19 vaccine dose., Conclusion and Relevance: The bivalent COVID-19 vaccines protected children and adolescents against SARS-CoV-2 infection and symptomatic COVID-19. These data demonstrate the benefit of COVID-19 vaccine in children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.

Background: Antibody responses to non-egg-based standard-dose cell-culture influenza vaccine (containing 15 µg hemagglutinin [HA]/component) and recombinant vaccine (containing 45 µg HA/component) during consecutive seasons have not been studied in the United States., Methods: In a randomized trial of immunogenicity of quadrivalent influenza vaccines among healthcare personnel (HCP) aged 18-64 years over 2 consecutive seasons, HCP who received recombinant-HA influenza vaccine (RIV) or cell culture-based inactivated influenza vaccine (ccIIV) during the first season (year 1) were re-randomized the second season of 2019-2020 (year 2 [Y2]) to receive ccIIV or RIV, resulting in 4 ccIIV/RIV combinations. In Y2, hemagglutination inhibition antibody titers against reference cell-grown vaccine viruses were compared in each ccIIV/RIV group with titers among HCP randomized both seasons to receive egg-based, standard-dose inactivated influenza vaccine (IIV) using geometric mean titer (GMT) ratios of Y2 post-vaccination titers., Results: Y2 data from 414 HCP were analyzed per protocol. Compared with 60 IIV/IIV recipients, 74 RIV/RIV and 106 ccIIV/RIV recipients showed significantly elevated GMT ratios (Bonferroni corrected P < .007) against all components except A(H3N2). Post-vaccination GMT ratios for ccIIV/ccIIV and RIV/ccIIV were not significantly elevated compared with IIV/IIV except for RIV/ccIIV against A(H1N1)pdm09., Conclusions: In adult HCP, receipt of RIV in 2 consecutive seasons or the second season was more immunogenic than consecutive egg-based IIV for 3 of the 4 components of quadrivalent vaccine. Immunogenicity of ccIIV/ccIIV was similar to that of IIV/IIV. Differences in HA antigen content may play a role in immunogenicity of influenza vaccination in consecutive seasons., Clinical Trials Registration: NCT03722589., Competing Interests: Potential conflicts of interest. M. G. reports grants from the unrelated CDC (US Ambulatory Flu/COVID Vaccine Effectiveness Network, Hospitalized Adult Influenza Vaccine Effectiveness Network [HAIVEN], Refining Effectiveness Estimates of Influenza Vaccines Synergizing Epidemiolgy and Incidence Methods for Influenza and Other Acute Respiratory Viral Illness [SYNERGY] Studies), unrelated CDC-Abt Associates (Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel [RECOVER] and Pediatric Research Observing Trends and Exposures in COVID-19 Timelines [PROTECT] cohort studies), unrelated CDC–Vanderbilt University Medical Center (Influenza and Other Viruses in the Acutely Ill [IVY] Study), unrelated CDC-Westat (Virtual Network: Investigating the Risk of COVID-19-Associated Outcomes and COVID-19 Vaccine Effectiveness Using Integrated Medical and Public Health Records [VISION-COVID] Study), unrelated Janssen (RSV Severity Birth Cohort Study), and unrelated Pfizer (Education for Men B Vaccine in Adolescents); being the co-chair of the Texas Pediatric Society's (Texas Chapter of the American Academy of Pediatrics) Infectious Diseases and Immunization Committee (2016–2022). A. L. N. reports funding from Pfizer and Vir Biotechnology for unrelated studies. 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.)

This study assesses the potential impact of drought on arsenic exposure from private domestic wells by using a previously developed statistical model that predicts the probability of elevated arsenic concentrations (>10 μg per liter) in water from domestic wells located in the conterminous United States (CONUS). The application of the model to simulate drought conditions used systematically reduced precipitation and recharge values. The drought conditions resulted in higher probabilities of elevated arsenic throughout most of the CONUS. While the increase in the probability of elevated arsenic was generally less than 10% at any one location, when considered over the entire CONUS, the increase has considerable public health implications. The population exposed to elevated arsenic from domestic wells was estimated to increase from approximately 2.7 million to 4.1 million people during drought. The model was also run using total annual precipitation and groundwater recharge values from the year 2012 when drought existed over a large extent of the CONUS. This simulation provided a method for comparing the duration of drought to changes in the predicted probability of high arsenic in domestic wells. These results suggest that the probability of exposure to arsenic concentrations greater than 10 μg per liter increases with increasing duration of drought. These findings indicate that drought has a potentially adverse impact on the arsenic hazard from domestic wells throughout the CONUS.