The youngest Americans yet — children ages 5 to 11 — are now eligible to be vaccinated against COVID-19.
The recent drop in coronavirus infections has left some parents wondering whether they should vaccinate their elementary school-age children. The answer from pediatricians and public health experts is an unequivocal yes.
”I understand the apprehension to anything new or novel,” said Dr. Purva Grover, medical director of Cleveland Clinic Children’s Pediatric Emergency Departments. “To parents who are still on the fence, I would say follow the science, and in this case the science is loud and clear.”
U.S. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky on Tuesday approved an emergency use authorization to administer a reduced dose of Pfizer’s two-part mRNA vaccine to that age group. In Florida, 1.7 million more children can now get vaccinated.
Walensky’s decision was the final regulatory hurdle to extend vaccinations to children as young as 5 and opens a new front in the nation’s vaccination effort against the 20-month-long pandemic.
Safe and effective
U.S. health officials relied on a Pfizer study of about 3,000 children between 5 and 11, which found that its vaccine was 90.7 percent effective in preventing symptomatic COVID-19 infections at least seven days after the second dose.
Children in that age group will receive one-third the dose given to those 12 and over. Otherwise the vaccine is identical to the one given to adults. The scaled-down dose is intended to minimize side effects while still providing a powerful immune response.
None of the vaccinated participants in the Pfizer study experienced severe COVID symptoms or the rare immune response known as multisystem inflammatory syndrome in children, or MIS-C, which causes life-threatening inflammation in the heart, lungs and other internal organs.
“To be clear, it does not mean that the vaccine is 91 percent effective in preventing exposure to the disease,” Grover said. But she said it greatly reduces the chance of symptomatic infection, hospitalization and death, “and that is the key in helping us get society back to normal for all of us.”
Despite the lower dose, the vaccine was shown to be as effective, if not more so, in ages 5 to 11 as it is for those 12 and over. Early studies reported a 91.3 percent efficacy rate of the Pfizer vaccine for adults, but that was before the spread of the highly-infectious delta variant this past summer.
It’s not just COVID-19 that should worry parents. The virus is also associated with chronic illnesses, including MIS-C and mental fogging.
The vaccine could also alleviate the mental health effects of the pandemic: Quarantining away from friends, family and schoolmates, on top of the risk of physical illness, also takes its toll on children, experts said.
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“Mental health breakdowns are also an increasing crisis in that age group,” Grover said.
She said at times children have lacked such “basic needs” as social time with peers, access to in-person resources at school and relief from the ongoing stress of the pandemic. It may take time, Grover said, “but this vaccine gives us a chance to get back to normal and to give these kids a chance to grow as they should.”
Children who participated in the Pfizer study reported milder side effects than teens and adults did. “Parents might be a bit apprehensive considering how they felt after their vaccine,” Grover said. “But rest assured that this is an extremely safe and efficacious vaccine with minimal side effects.”
The study was too small to observe rare side effects such as myocarditis, a swelling of the heart muscle, which can occur after the Pfizer vaccine, especially in adolescent boys. One Israeili study found that about 11 out of every 100,000 males between 16 and 29 experienced a swelling of the heart in the week following vaccination. The risk of myocarditis was lower among women and those over 29.
It’s too early to rule out such side effects for younger boys completely, experts say, but they expect such instances will be extremely rare.
COVID still a risk to children
Parents still worried about the risks the vaccine might pose to their children, experts said, should keep in mind the even greater risks of being unvaccinated. Nearly 330,000 Florida children under 12 have been infected since the start of the pandemic, accounting for 9 percent of all infections.
Children under 12 have had among the highest infection rates in Florida since the first week of August, according to the state’s weekly reports. The most recent report, issued last week, showed the infection rate for those under 12 was 4.6 percent, more than 50 percent higher than for those over 60.
However, children have the lowest fatality rate of any age group: 29 children under 16 have died from COVID in Florida since the start of the pandemic, and most had one or more underlying illnesses.
But no one knows which child will succumb to the virus: About 1 in 4 of the children who died from COVID in the U.S. were healthy before they got infected, said Dr. Sonja Rasmussen, a pediatrician and professor with the University of Florida College of Medicine.
“We’re not very good at predicting which kids those are going to be,” she said. “And as a parent, I would not want to take that risk.”
Last year COVID killed over three times as many children as rubella and the rotavirus in the years before vaccines were developed for those viruses, according to analysis presented at Tuesday’s CDC meeting.
The vaccine won’t just protect children. “It also reduces the chance that the child will pass the virus on to a family member who may not have responded as well (to the vaccine),” said Rasmussen.
That includes elderly grandparents, people with suppressed immune systems and children 4 and under who still can’t get vaccinated. A CDC analysis predicts an 8 percent decline in total U.S. COVID infections once children 5 to 11 are vaccinated.
Now is the time to act
Experts warn that parents shouldn’t wait to get their kids vaccinated, especially with the holidays and winter approaching.
“Based on our experience last year, when we get together during the holidays, it’s possible for numbers to spike again,” Rasmussen said. “For kids to be protected, they need to get vaccinated soon.”
There are two main reasons to vaccinate young children, she said. One is that people tend to congregate with friends and family over the holidays. And that means more chances to spread the virus.
A vaccinated child is less likely to become seriously ill with the virus, Rasmussen said, and less likely to spread the virus to any vulnerable or unvaccinated people they come in contact with.
The second reason is to prevent illness, especially during flu season. “Kids at school can pick up everything,” Rasmussen said. This time of year “there’s a lot of viruses that circulate in schools, including the virus that causes COVID-19.”
Last year’s flu season was mild, mostly due to masking and social distancing measures put in place due to COVID-19, experts say. This year could be different, they warn. Experts fear simultaneous flu and COVID-19 outbreaks could overwhelm Florida hospitals.
It will take weeks to vaccinate the 1.7 million Florida kids who are now eligible to get the vaccine. Vaccinations have fallen by nearly 75 percent since August, excluding booster shots. Fewer than 120,000 Floridians got their first or second shot last week, in a state where more than 5.2 million eligible residents remain unvaccinated.
That’s why experts say parents should continue taking precautions to keep their kids safe. The vaccine works quickly, but children don’t reach peak immunity until a week or two after their second dose, according to Pfizer’s study.
Wearing masks in schools can definitely help, said Dr. Juan Dumois, a pediatric infectious disease physician at Johns Hopkins All Children’s Hospital in St. Petersburg. He worries that the most vulnerable children may also be the least likely to be vaccinated.
“In a lot of cases, children are following the example of their parents,” he said. “We see that parents who refuse vaccination often are also discounting other protective measures, like wearing a mask and social distancing.”
This means families should continue to avoid indoor gatherings with young children until they are fully vaccinated. Masking and social distancing in public are still highly recommended, and sick family members should quarantine as much as possible.
More vaccines on the way
There will be more options for children in the coming months.
Moderna is still waiting for the FDA to approve its vaccine for teenagers under 18 years old. The company announced on Oct. 25 that a low dose of its COVID-19 vaccine appears to be safe and effective among ages 6 to 11. However, the FDA recently told Moderna that it will require more time to review its request to look into the rate of myocarditis in young males.
Johnson & Johnson is still conducting trials for children ages 12 to 17.
In the meantime, Florida’s 1.1 million children under 5 will have to keep waiting to find out when they can get vaccinated. Pfizer is already moving ahead with separate trials of its vaccine for ages 2 to 4 and children over 6 months.
Pfizer CEO Albert Bourla told the Today show vaccines for those age groups should be ready “before the end of the year.”
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Where to vaccinate kids
The reduced Pfizer dose designed for children ages 5 to 11 is available wherever COVID-19 vaccines are being administered: doctors’ offices, clinics, pharmacies, grocery stores and public vaccination sites. Many allow appointments to be booked online.
Find a site: Visit vaccines.gov to find vaccination sites in your zip code.
More help: Call the National COVID-19 Vaccination Assistance Hotline.
Phone: 800-232-0233. Help is available in English, Spanish and other languages.
Disability Information and Access Line: Call 888-677-1199 or email DIAL@n4a.org.
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