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An increase in teenage hospitalizations in March and April led the U.S. Centers for Disease Control and Prevention (CDC) to urge parents to vaccinate their teens against COVID-19. Nathan Price, MD, assistant professor at the College of Medicine – Tucson Department of Pediatrics, answers common questions parents ask about children and vaccines.
What steps have been taken to test the COVID-19 vaccine on children?
Every time we bring a new vaccine, drug or medical device to the public, it goes through rigorous testing. Depending on the disease, the test begins with healthy adult volunteers and then moves on to others. It takes some time for testing to include children, as they do not have the legal capacity to make decisions about their health, so there is an extra level of precaution to be taken. Once testing for the COVID-19 vaccine transferred to children, researchers began with the older age group, 16 to 18 years old. Of these, very few children who received the vaccine were infected compared to those who received the placebo. The children who received the vaccine had more side effects than the placebo, but they were generally underage. They also had measurable antibodies and they were less likely to be infected. When this phase of testing was deemed safe and effective, researchers began including 12 and 15 year olds.
Scientists tested around 2,000 patients between the ages of 12 and 15: 1,000 received the vaccine and 1,000 were in the placebo group. None of the children in the vaccinated group were infected and they had measurable antibodies compatible with immunity. They also had side effects, such as headaches, chills, or fatigue, but no serious reactions. Continuous evaluation continues to be done to look for rarer or more serious side effects.
What are the side effects in children?
Common side effects include arm pain, feeling tired for a day or two, and mild fever. The allergic reaction is rare and can occur with any drug or vaccine, not just COVID-19 vaccines. The more people you vaccinate, the more you will see these side effects over time. To put it in perspective, you are much more likely to have a bad reaction to the disease than to the vaccine.
What is the prognosis for children infected with the virus?
Although the number of children with severe infection is a small percentage compared to adults in the United States, it is a mistake that children who contract COVID-19 do not get sick.
Recent figures show that more and more adolescents are falling ill from the disease. In the first three months of the year, CDC researchers found that nearly a third of teens hospitalized with COVID-19 required admission to an intensive care unit, and although there was no no deaths associated with these admissions, 5% of these patients required invasive mechanical ventilation. In addition, the CDC reported that hospitalization rates for teens aged 12 to 17 increased from March 1 to April 24 after decreasing in January and February.
Even when children have resisted infection well, there is a rare post-infection inflammatory syndrome called childhood multisystem inflammatory syndrome, or MIS-C, which can make them very sick. Symptoms may include fever, difficulty breathing, rash, chest pain or pressure, confusion or inability to stay awake, and abdominal pain.
What is myocarditis and is there a risk of myocarditis after vaccination?
Myocarditis is inflammation of the heart. It can cause chest pain, difficulty breathing, irregular heartbeat and, in some cases, death. Most cases are treatable, and many have been mild.
Recently, the CDC received reports of an increase in myocarditis cases in people who received mRNA vaccines (Moderna and Pfizer / BioNTech). Most cases have occurred in adolescent and young adult males. They are still investigating whether this is related to having received a vaccine or to a coincidence.
In general, myocarditis due to COVID-19 and MIS-C in this age group is much more common than in people who have been vaccinated. More information can be found here: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html
What advice would you give to parents who are considering COVID-19 vaccination for their children?
COVID-19 vaccines are working. There are side effects, but they are usually minor and temporary. For people who are worried about their children, I totally understand. At home, I received my vaccine and my two older teenagers received theirs. Now I am waiting for my two youngest children to get the vaccine. I trust the vaccine. Do not be too long. Now is the time to do it.
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