The next big question about COVID vaccination in children

Finally some good news —finally-Seems to be on the horizon of About 28 million Of the youngest resident of the United States. Following yesterday’s advisory meeting, the FDA could turn a child-sized dose of Pfizer’s COVID-19 vaccine for Americans aged 5 to 11 green. Month being created..

After the agency’s expected emergency permit, Pfizer’s official requires a recommendation from CDC director Rochelle Walensky, who is expected to weigh next week after her own advisory board votes. will do. But the country is ready: already Pediatric dose for 15 million people Pfizer vaccine One-third of the amount given to adults— The state can now pre-order.

Yesterday’s discussion was, of course, tense. These immunizations represent one of the few major means left by the government to protect both the children who obtain them and the people they interact with and to engage in the fight against the coronavirus. However, as the age eligibility of the COVID-19 vaccine continues to decline, Risk and profit calculation It will be tougher and more emotional. This age group is far less likely to be infected with serious cases of COVID-19 than other age groups.Stacked with its relative resilience Two rare but serious vaccine side effects: Myocarditis Pericarditis, or inflammation of the heart and surrounding tissues. These are common in boys and young men who have been vaccinated with the mRNA-based COVID-19 vaccine. Most cases are relatively minor and less severe than, for example, heart inflammation that can follow SARS-CoV-2 infection, but this phenomenon is still poorly understood.

FDA original analysis of(Somewhat limited) Data for this age group announced at yesterday’s meeting came out agreement It’s okay to give a pediatric shot officially.After all, COVID is now Top 10 Causes of Death Between children aged 5 to 11; the disease has also been particularly devastating to black, Latin and native children. However, side effects that are “less risky than COVID” can still be a source of concern. Maybe the vaccine should only be given to a subset of children, some committee members argued-for example, those who have a medical condition that increases their chances of getting a serious illness. Nevertheless, the Commission unanimously agreed with the vaccine, with one member abstaining.

Read: Vaccine data for children under the age of 5 is coming “by the end of the year”

There is a difficult part here. It is actually putting the inoculation in a small arm. It’s not a slam dunk. When shots are available, parents must opt ​​in and receive their children just before the holidays. In addition to the recommended seasonal flu shots, side effects may occur, Durability discussed.. Adopting new health interventions requires gambling, which can be particularly frustrating. We still don’t know much about COVID-19, the youngest of us, and the vaccines we use to protect them.

I caught up to help understand the following Sally Pelmer, Director of Pediatrics at Weill Cornell Medicine, Director of Pediatrics at New York Elderly Hospital in New York. Our interview has been lightly edited for length and clarity.

Catherine J. Woo: The FDA will probably approve the vaccine within the next few days before ACIP, the CDC’s advisory board. Meet next week.. Assuming you have succeeded in persuading your parents to apply for a shot to your children, what is the greatest potential impact this has on the overall pandemic?

Sally Pelmer: Most important to me, this vaccine allows us to deal with children, take three new illnesses that we consistently see in our health system, and prevent them with the vaccine. is. The first is severe COVID-19, a rare respiratory illness in children. But it still happens, especially in our adolescents and high-risk people... The second is MIS-C, [inflammatory] The condition Occurs in about 1 in 3,000 people Infectious diseases in children, [and is most common] In the age group of 5-11 years. And the third is long COVID, where children continue to suffer for months afterwards due to persistent symptoms.

The second biggest advantage is About communication..Children can be protected with a mask and will probably be infected less frequently [than adults].. But children can definitely be part of the transmission chain, especially at home, and even in environments where precautions are taken.

Vaccination of children will allow them to regain school as we once knew. Children can choose who they want to sit at the lunch table and face in any direction of the classroom. You are not a certain distance from your neighbor. — Maybe even think about whether the kids can safely return to school without a mask. Masks may still be a good idea when everyone is indoors and has a runny nose during the winter. However, you can regain many of the restrictions that have been enforced so far.I can’t even think about it until I get high [vaccine] Coverage of our children.

Wu: That sounds great, but we don’t guarantee a licensed vaccine Vaccine administered. You are a pediatrician — how was your senses How parents receive this news??

Palmer: Expect a lot of time to be spent in the coming weeks [navigating] that. Parents want to make the best decisions for their children. And they want to make a very careful decision and want to consider all the information available.that teeth Scary to think: If I choose vaccination and my child has rare side effects, how do I feel about it? It definitely goes through the hearts of parents.

It is rare for your child to have a severe COVID infection. It is also quite rare for your child to have MIS-C. Not many people know who has a child in the hospital with COVID.However Even more unusual The vaccine can have adverse effects. We must educate about those numbers.

Not vaccination is still a risk and is more risky than vaccination of a child.In fact, I don’t even know if myocarditis is a concern [in 5-to-11-year-olds]..there were There is no case for that age group of [Pfizer’s efficacy trial].. Myocarditis is common in older children. Therefore, given what we know, it is assumed that there is not much to worry about in this young age group. And I’m very excited to say that there was all this work done to identify the age-specific doses for this population. We want to achieve the immune response needed for protection at the lowest dose to reduce side effects. That’s what we should do for all new vaccines in the future.

One of the questions I often get is ” 11 years old I will be 12 years old in 3 weeks. Should I wait? It seems that the higher the dose, the better, right? First of all, don’t wait for more doses-you never know when COVID will enter your life or your child’s life. Secondly, I would actually prefer to have them at lower doses. The pediatric immune system is configured to respond to low doses. They may achieve a better response. We have been studying this for several years in the world of HIV vaccines. Low doses in the younger age group can achieve a better immune response than high doses.I’m not surprised when I go Even lower doses With Youngest age group..

Read: Why does it take so long to get a vaccine for children?

Wu: That sounds really promising.At the same time, but we don’t have certainty Still about side effects. Pfizer’s exam was small. It’s too small to detect a reliable signal of myocarditis, so you have to wait to see what happens when the vaccine is deployed to a much larger group. How should parents weigh the risk of rare side effects against the risk of COVID-19, which is less common among young children? And should certain children be prioritized for vaccines and should other children be advised to wait?

Palmer: If you are playing numbers and reading data, you will give your child a vaccine every time. [The alternative] Take unknown risks and know how to protect them Make a reason not to protect your child from known risks.

Severe infections were rare in children and it was a blessing. However, we do not know what predicts who will develop MIS-C. Hopefully we will move forward and identify them. We have some idea of ​​who may be at risk for severe respiratory COVID. [kids with] Obesity, diabetes. However, some children do not know what put them at risk of infection. This is also seen in the flu. Perfectly healthy children get very serious illnesses. Perfectly healthy children are so ill that they cannot put their fingers on them.

Wu: Will vaccinated children be less urgent if the infection rate plummets?

Palmer: One of the things we know is There is a new variant of this virus.. If the patterns apply, they are more susceptible to transmission. They may even be vaccine resistant.Why many adolescent parents eventually got vaccinated [this summer] It was that the number of cases increased significantly More contagious delta variant.. That’s great, but it was too late. Takes 5-6 weeks [from the first dose] Get fully immunized. Therefore, we need to anticipate that there are other variants we deal with. My hope is to have a high degree of vaccination of this last segment, which can slow down the variant. But you shouldn’t count new variants, you have to anticipate them.

Read: Delta is bad news for kids

Wu: It took a long time to vaccinate young children For a very long time And we haven’t reached the crowd under the age of five yet. What can we learn from now on? Did you have to do this?

Palmer: In the future, this will need to be done differently. It is a tragedy that we sent our children back to school without access to this vaccine while adults benefited from vaccine immunity and went to restaurants with their vaccine cards.we Don’t leave the child to the end.. In the future, we may be able to start testing age groups in parallel.