Q&A: What to Know About COVID-19 Vaccines for Kids and Teens

On May 10, Pfizer announced that its COVID-19 vaccine had been granted emergency-use authorization for kids ages 12 to 15. Trials are underway, and the vaccines are expected to be available for younger children by early 2022. Since the announcement, surveys have shown that some parents are worried about giving their kids the vaccine, even if the parents have taken it themselves. They’re concerned about possible longer-term side effects and wonder if it’s worth the risk given that, in most cases, the virus only causes minor symptoms in young patients. 

Two of MedShadow’s Medical Advisory Board members, Kevin Zacharoff, MD, a pain and preventive medicine specialist at Stony Brook University, who is also a member of the American Academy of Pediatrics, and Vickie Karian, RN, a pediatric nurse practitioner at Boston Children’s Hospital, answered our questions, which aim to help you make the best decision for your family.

Editor’s Note: After the Q&A, the CDC announced that some teens had experienced myocarditis after vaccination. It’s not yet clear whether or not the events were related to the shots and about 10-20 out of every 100,000 people experience the condition each year under normal circumstances. The American Heart Association released a statement that the benefits of vaccination still outweigh the risks for teens. Karian commented, “my understanding is that the incidence of myocarditis in vaccinated teens is not significantly different than the incidence of myocarditis in the general population. The cases were also very mild. I don’t think that’s a reason to not vaccinate.”

  1. What do we know about how the virus affects children and those around them? Also, is what we know changing?

Zacharoff:  More than 1.5 million adolescents ages 12 to 17 have been diagnosed with COVID-19, with more than 13,000 of them needing to be hospitalized. What this means, is that if we consider that as many as five to 10 times the number of diagnosed cases may be the actual number of asymptomatic cases of infection, we are talking about a significant population at risk. I don’t think we know what that means to those around them. What we do know is that information is changing all the time.

Karian: For the majority of children with the COVID-19 virus, the cases are mild or asymptomatic and do not need hospitalization or specialized care. Some children do develop a severe COVID-19 illness and these tend to be those children and adolescents who have underlying conditions that make them susceptible, [which is] similar [in] adults. Another group of children and adolescents between the ages of 1 and 14 (average age, 9 years) can develop the rare multisystem inflammatory syndrome, or MIS-C. These patients need hospitalization, and often critical care. MIS-C can appear a month after a COVID-19 infection, mostly in children who are healthy and often test positive to COVID-19, but are asymptomatic. MIS-C can inflame different parts of the body, including the heart, lungs, brain and gastrointestinal system, with a variety of symptoms, [such as] abdominal pain to diarrhea or other systemic illness. Mortality is very low, but there can be some longer-term morbidity, with some children needing rehabilitation or supportive care at home. Medical professionals are watching closely whether there are higher infection rates in children and adolescents with the variants that are now being seen.

  1. Is there reason to believe the COVID vaccine for kids and teens would cause different (or more- or less-intense side effects) than it does for adults? 

Karian: In the adolescents studied, there were similar side effects to those experienced by young adults, especially [after] the second dose. Many had pain at the injection site (91%), and within 24 hours, experienced fatigue (78%), headache (76%), chills (48%), muscle pain (42%) and, less frequently, fever, joint pain or nausea. Side effects are related to mounting an immune response, but not having symptoms does not mean the person’s [body] is not also mounting a response.

Zacharoff: There were no reports of blood clots, serious allergic reactions or facial paralysis in these vaccinated children. What that says is that what we have seen in vaccinated adults is what we should expect to see in vaccinated children, which, in my opinion, is very encouraging, along with the fact that vaccine effectiveness was 100%.

  1. Are there any contraindications specific to children and teens?

Zacharoff: The contraindications seem to be the same as those for adults; vaccination should only take place after a discussion with the child’s pediatrician. If there is any medical history of being immune-compromised (being more susceptible to infections, for example), the decision [should] be made on a case-by-case basis, again, with the child’s pediatrician and other physicians [or both] caring for the child.

Karian: It’s the same as with adults: allergy to any of the ingredients. 

  1. What is your advice to parents about when to get the COVID vaccine for their kids?

Karian: Vaccinate your children when it is available, to protect yourself, your family, [their] schoolmates and teachers, and to protect those in society who are vulnerable (immunosuppressed, unable to be vaccinated). People can still be infected with the virus, even if vaccinated, but generally the illness will be much milder. People who have [an] underlying illness would have more severe cases, even if vaccinated, and need to be protected.

Zacharoff: My advice to parents would be to use the same judgment about the decision to vaccinate as they would for themselves. I completely understand the concerns about all of the unknowns we still have today regarding the coronavirus pandemic and the desire to know more before we make important decisions about our own and, especially, our children’s health. One thing that we need to strongly consider is the potentially negative social and psychological impact that the pandemic has had on children and consider that as an adverse effect, too. With nothing else really on the horizon, it seems as if vaccination is the single best answer we have right now, and that means that the “when” is now.

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