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We recently sat down with Nina Alfieri, MD, MS, FAAP, Advanced General Pediatrics and Primary Care, to answer commonly asked questions and to address concerns from parents and caregivers about the COVID-19 vaccine for children under 12.
Many parents that jumped at chance to get themselves vaccinated are feeling apprehensive about getting their younger children who fall into the 5-11 age group vaccinated. How do you address vaccine hesitancy among parents?
First of all - there is nothing wrong with parents feeling apprehensive and having questions about the COVID-19 vaccine. The pandemic has been a time of uncertainty and challenge for everyone, but we have learned a lot in the last 18 months and we have done it together. We are at the point now that have a highly safe and effective vaccine that is proven to decrease virus transmission, decrease hospitalizations and prevent deaths from Sars-COV-2 and this is something worth celebrating!
Parents love their child(ren) and want to do what’s best for them, and that is something that really resonates with us as pediatricians – we also want to do what’s best for kids.
We as pediatricians have been following the COVID-19 vaccine safety and efficacy trials and vaccine rollout process very closely, and we see our role as trusted messengers who can provide this information for families so that parents can make the best decision possible for their child.
If you have concerns about the vaccine, reach out to your child’s pediatrician or healthcare provider, and check out trustworthy sources of information on the COVID-19 vaccine, such as the CDC website and healthychildren.org (from the American Academy of Pediatrics).
Can a young child receive regular childhood immunizations at the same time as receiving the COVID-19 vaccine?
Yes! Children can receive the COVID-19 vaccine at the same time as other routine childhood vaccines and the flu shot. There has been extensive research on co-administration of the most widely used vaccines that has shown similar antibody production rates and safety as when the vaccines are given separately. This is also being monitored with the people who are currently receiving the COVID-19 vaccine along with other vaccines. Because of this, the CDC has recommended that that COVID-19 vaccines may be administered without regard to timing of other vaccines- which means that vaccines can be given together on the same day.
We saw almost no flu last year. Won’t it be the same this season? Does my child really need to get the flu vaccine on top of a COVID vaccine? Is getting both safe?
We highly recommend flu shots for everyone 6 months and above. With more interaction and more people “out and about” this year, we are expecting a flu season and are already seeing increased numbers of other viruses circulating this year that we didn’t see last year, such as RSV (respiratory synctitial virus), parainfluenza, rhinovirus, etc.
It is safe to get both the influenza vaccine and the COVID-19 vaccine, and we recommend that all children who are eligible for each vaccine receive it when they can.
Does a child 5-11 years old need the COVID-19 vaccine especially if we have such good cocooning with older individuals getting vaccinated?
The term “cocooning” is a vaccination strategy that protects infants and children from vaccine-preventable illnesses by vaccinating family members and close contacts who are around the child. A common example of this is having grandparents receive the Tdap vaccine if they will be around an infant, to help protect the baby from pertussis.
While “cocooning” is a great strategy, it is not as strong of a preventive strategy as being able to develop your own immunity in your own body – and this is why children should receive the COVID-19 vaccine themselves, even if their family members are vaccinated.
Since children are regularly interfacing with people outside of their family, having their own antibody protection will prevent them from getting seriously ill, being hospitalized, dying and having long-term sequelae from a COVID-19 infection.
To bring it back to the Pertussis story – this is exactly why pregnant mothers are vaccinated with Tdap during late pregnancy: mothers create antibodies against Pertussis as a result of receiving the Tdap vaccine, that are directly passed to the infant through the placenta during the last few weeks of pregnancy. This layer of direct protection saves lives from Pertussis infections, just like direct protection can help prevent COVID-19 illness in children.
What about adverse effects and the long-term side effects? My child is so young. I worry that they will have more potential to experience serious side effects from the COVID-19 vaccine.
The COVID-19 vaccine that will be available for children 5-11 is the same Pfizer BioNtech vaccine that has been extensively studied and widely distributed to millions of people. There is extensive data showing that this vaccine is both safe and effective. In addition, the dose for children is 1/3 the amount of the dose for adolescents and adults, with the same effectiveness (ie, the same amount of antibody is produced by children who receive this smaller dose, as adults who receive the full adult dose).
What about the amount of the dose? Will it vary based off ages? Will my 5-year-old receive less than my 11-year-old? How do you really know what dose is safe and effective? Is it based on weight and height more than age?
The dose of the Pfizer BioNtech vaccine that is likely to be approved for children varies by age. The dose for the 5-11 age group will be 10 micrograms, while the dose for adolescents 12+ and adults is 30 micrograms. This makes sense, because we know that younger children are able to create a more robust immune response to vaccines and produce more antibodies, compared to older children and adults.
The dosage for the pediatric vaccine was determined by studying the effects of giving different vaccine doses for >2000 children ages 5-11, and comparing antibody levels that the study participants developed after receiving the various doses of vaccine. The study found that the 10 microgram dose in younger children produced the same amount of neutralizing (or COVID fighting) antibody as the 30 microgram dose when given to adults.
Weight based dosing is not necessary for most vaccines. Vaccine doses are carefully chosen based on early phase 1 and 2 trials, and confirmed in phase 3 trials – so all of these decisions are made based on extensive research and careful consideration by the FDA, CDC and ACIP (advisory committee on immunization practices).
Will my child’s pediatrician have the COVID-19 vaccine?
Yes, many pediatric offices will be offering the COVID-19 vaccine. Call your pediatrician or regular care provider, or check their website/communications to ask about their plans for the COVID-19 vaccine.
Will kids 5-11 need two doses like adults?
Yes. Children will need two doses of the 10 microgram vaccine that is specific to the 5-11 pediatric age group.
Is vaccine efficacy the same for children as it is for adults?
In clinical trials in children, effectiveness against symptomatic COVID-19 infection was as good or better than that seen for COVID-19 vaccines in adults. Further, the antibody responses in the blood of children 5-11 years old after the vaccine were similar to vaccinated adolescents and young adults.
If I have a child who is about to turn 12, should I hold out on scheduling the vaccine for when they’re 12? Is there a difference between the dosage for this age group, and the previously approved 12- to 17-year-old age group?
Studies have confirmed that a lower dose in children younger than 12 years generates antibody responses similar to adolescents and young adults who receive the high dose. For these reasons, we advise that your child should receive COVID-19 vaccine as soon as it is available rather than waiting until your child turns 12 years old. If your child turns 12 between the first dose and second dose, your child should receive the lower pediatric dose for dose 1 and the higher adolescent dose for dose 2.
How big of a concern are reports of myocarditis in young people?
Cases of myocarditis are extremely rare, and studies have shown that the risk of myocarditis is higher in those infected with the COVID-19 virus than those who received COVID-19 vaccine. In clinical trials of COVID-19 vaccine in children 5-11 years old, no cases of myocarditis were observed in the 1500 children who received vaccine.
Can we expect vaccines to be available for babies and toddlers under the age of 5?
Yes; COVID-19 vaccine studies in infants and pre-school age children are ongoing. Although a date for authorization is not yet known, we expect vaccine to be authorized for this age group in late winter or early spring.
Are the potential side effects the same for children as they are for adults? Should I anticipate my child experiencing COVID-19 symptoms following their vaccine?
In clinical trials of COVID-19 vaccine in children, side effects were similar to that experienced by adolescents and young adults. The most common side effects were similar to those seen with other childhood vaccines, including pain at the injection site, headache, and fatigue. A small proportion of children experienced fever. These side effects were more common after dose 2 and resolved within a short period of time.
For more information on vaccine appointments available at Lurie Children's, visit our COVID-19 vaccine page.