Covid-19 Is A Vaccine-Preventable Disease For Kids Aged Five And Older
(A sentence I'm thrilled to write.)
This is a milestone week for the health of children. It’s a week that will be written in history books. And you, dear friend, are part of this incredible story.
Covid-19 is now a vaccine-preventable disease for an additional 28 million children in the U.S. After extensive and thorough review, the CDC has extended an EUA to the Pfizer Covid vaccine for children aged 5-11 years.
The Hot Take
The evidence of direct benefit to children from Covid vaccination is strong, including prevention of death and long-term disability.
Detailed analyses and duration of clinical studies were adequate to establish vaccination safety and efficacy.
Top tier American experts in epidemiology, infectious disease, public health and child health unanimously support the Covid vaccine for this age group.
With all we know about the Covid vaccine and the disease it protects against, it is without hesitation that I enthusiastically recommend the Pfizer Covid vaccine for my patients 5 years and over.
The Details
The Pfizer vaccine for 5-11-year-olds is given as a 2-dose series, spaced at least 21 days apart. The vaccine dose is lower for these children —10 micrograms — than the adult dose. Expected side effects from the vaccine are similar to adults; pain or redness at the injection site, fatigue, and headache.
Vaccines are currently being delivered and distributed. As of this letter, vaccine has been ordered but has not yet arrived to my office. However, other local vaccine distribution sites have received product and are scheduling appointments. These include CVS, Walgreens, local grocery store pharmacies and health departments.
There is enough vaccine available to vaccinate every eligible child in this Country. Please practice patience.
Vaccines are NOT dosed by weight, but by immune system maturity. Under EUA, there are strict administration requirements. If your child is 5-years-old to 11 years and 364 days old, they will receive the lower dose product. The opposite is also true — pediatric vaccine should not be offered to any child aged 12 years or older. Immunogenicity cannot be guaranteed for children who get a dose of vaccine outside of their recommended (and thoroughly studied) age range. Expect this guidance to change over time, especially if full FDA approval for the vaccine is offered.
Children who have had Covid disease should still get vaccinated. Survivor immunity is less consistent and less durable than vaccine-induced immunity. Vaccinating after natural infection is a way to boost and broaden a child’s immune coverage in anticipation of their body seeing the Sars-CoV-2 virus again. And again. Oh, and again.
Each time a child gets infected with Sars-CoV-2 and its band of variants, they are at risk of long Covid and MIS-C. Studies have been ongoing since the Delta wave, but current data suggests up to 12-14% of children aged 2-16 years are experiencing long-term health effects after symptomatic and asymptomatic Covid infection. In my practice, I have seen children with Covid toes, unexplainable and persistent weight loss, intractable headaches, chronic fatigue, acute changes to concentration and memory, and new onset skin conditions after natural infection. This vaccine matters because if a child does not get Covid, they can’t get long Covid.
The age group most affected by MIS-C are kids 5-11-years-old. If a child does not get Covid, then they can’t get MIS-C. We expect rates of this multi-system inflammatory syndrome to decrease as more children in this age group are vaccinated. The CDC estimates for every 1M vaccine doses delivered, 260 cases of MIS-C can be avoided. Additionally, ninety-four children in this age group have died of Covid since the Delta wave. Any additional childhood death in this age group is unacceptable and preventable.
MIS-C and Covid infection can both lead to myocarditis. There is a rare and real risk of vaccine-associated myocarditis after the Pfizer covid vaccination. The risk is increased after the second dose of vaccine in males over the age of 16 years. Although unclear, the increase in risk is thought to be due to the presence of testosterone (males over 16 years.)
The risk of myocarditis is lower in pre-pubertal children, the age we are now able to vaccinate. We expect the risk of vaccine-associated myocarditis to be lower in this age group by natural history and because we are offering lower stimulus (lower dose) to these kids. I assure you, this side effect will be intensely followed in the coming months. Until then, Dr. Matt Oster (catch his presentation here) states it nicely, saying “getting Covid is much riskier to the heart.”
I believe we have a responsibility to deliver this vaccine to children. We are fighting a disease that is ravishing the world and has no treatment. A disease whose long-term effects are not known. A virus that is not going away. This vaccine series will preserve the quality of life-years that my patients are designed to live. Protecting them now, protects their future.
If you have questions about the Covid vaccine for your child, please ask your trusted pediatrician. We are here to help.
Onward,
