Should children be vaccinated against COVID-19?

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A new Pediatric respiratory exams A study from Israel examines issues related to children aged 5 to 11 who are eligible for vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, the researchers offer a detailed overview of the factors that could influence the decision to take or abstain from vaccination.

Study: Covid-19 in children 5 to 11 years old: review of issues surrounding vaccination and public health policy. Image Credit: hedgehog94 / Shutterstock.com

Introduction

In many developed countries, most adults have been vaccinated against coronavirus disease 2019 (COVID-19), leaving children as the largest group of susceptible individuals in the population. Thus, not only are children at risk of SARS-CoV-2 infection, but they are also often required to wear masks, cannot travel freely, must be tested regularly, and may be isolated after exposure to the virus. virus.

The Pfizer/BioNTech COVID-19 vaccine received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) in late October 2021 for use in children ages 5-11. Results from the company’s clinical trials showed an impressive 91% efficacy against symptomatic infection in children who received one-third the adult dose.

The trial group reported no cases of severe COVID-19 in the study or placebo groups. Additionally, the number of participants was not large enough to detect rare events such as myocarditis, which is a major adverse event associated with the adult vaccine.

Nevertheless, more than eight million children have already received the vaccine, including more than 25% of the American population. Almost the same proportion of Israeli children were also vaccinated with one or more doses.

The US Centers for Disease Control and Prevention (CDC) estimates that pediatric vaccination of children aged five to 11 can prevent 80 to 226 hospitalizations during a peak transmission situation, as well as prevent deaths from COVID-19. and long-term sequelae.

Are children at risk?

In general, children are at low risk of serious or fatal illness from SARS-CoV-2 infection. Additionally, the US CDC estimates a case fatality rate (CFR) of less than one in ten thousand in children between the ages of five and 11.

However, since this is based only on known pediatric cases, the true CFR is likely much lower. In fact, the Israeli Ministry of Health (MOH) has stated that between 50-70% of children who test positive for COVID-19 have asymptomatic illness, confirming this supposition.

The mortality rate among the population in children ranges from 0.8 to 5 per million in different parts of the world, which is comparable to that of seasonal flu. In contrast, adults have a mortality rate of 1,000 to 3,000 per million.

COVID-19-related hospitalization rates are also low in this patient population compared to adults, at less than eight in a thousand. More than 40% of these children had comorbidities, such as obesity, lung disease or premature birth. These children should be prioritized for the vaccine.

Israeli data shows just 11 deaths among children up to age 19 out of nearly 550,000 cases. Thus, the mortality risk of the population is less than 0.0004%, with a CFR of 0.002%.

Importantly, two of those deaths were newborns born to mothers with severe COVID-19. Overall, 460 hospitalizations were for children between the ages of five and 11, including 72 for moderate to critical illness and three deaths.

When compared to the number of critical illness hospitalizations across all age groups, it appears that the severity of illness is much higher among older people.

Isolation requirements

In addition to serious and critical illnesses, millions of quarantines have been imposed since the start of the pandemic. In Israel, more than 280,000 children have been quarantined due to exposure to an infected person since the start of the school year. The most affected are those aged 5 to 11 years.

More than 80% of people aged 16 or older have been vaccinated with one or more doses of the vaccine in Israel, which is comparable to 57% of people aged 12 to 15. In most age groups, severe disease and risk of ventilation are much higher after SARS-CoV-2 infection than following vaccination. The striking exception is in young men, with those aged 16-19 having a high risk of 12 per 100,000, although the number of events is relatively high in all male age groups.

In fact, of the 146 documented events of post-vaccination myocarditis, only 18 occurred in women. The risk in young boys of this adverse event is therefore equivalent to the risk of ventilation. Notably, the highest rate of myocarditis follows the second dose of the vaccine.

Consequences

Taken together, available data from two years of the COVID-19 pandemic indicate that the risk of death or serious illness from infection is low among young children, who contribute a large proportion of cases but few deaths. . Worldwide, only 8,700 deaths have occurred among children.

In this case, why advise the COVID-19 vaccination for children? One of the reasons is the occurrence of long-term non-fatal sequelae, such as multisystem inflammatory syndrome in children (MIS-C), or long COVID. MISC has affected more than 5,000 children in the United States, nearly 1 in 100 of whom have died.

Long COVID in children has been reported to affect 1% of infected children in Israel; however, some researchers do not consider this to be above the expected level. Given the higher risk of complications in children with comorbidities, particularly those with obesity and chronic lung disease or immunosuppression, these subgroups should be given high priority for vaccine.

While the vaccine reduces the already low risk of hospitalization or serious illness, even with the SARS-CoV-2 Omicron variant, which is believed to have immune evasion capabilities, the cost-effectiveness of this measure deserves further debate. . This is especially true given the overwhelming evidence that most children infected with SARS-CoV-2 experience asymptomatic infection.

To date, more than four million children have been vaccinated against COVID-19 in North America, and no significant adverse events have been reported in the past year. The risk of myocarditis reduces the benefit of the vaccine in young men; however, most cases are mild and resolve on their own.

The UK’s Royal College of Pediatrics and Child Health recorded its opinion saying: ‘The risks and benefits of COVID-19 vaccination for children and young people are more finely balanced than for age groups older.” In contrast, the American Association of Pediatrics encourages pediatricians to actively promote the vaccine.

At best, the benefit for children is indirect, as it reduces overall viral transmission, promotes uninterrupted schooling, and reduces the cost of the pandemic to society. One study noted that quarantining students after exposure to SARS-CoV-2 at school where everyone wore masks was not supported by scientific evidence due to very low transmission rates. The scientists commented that the student quarantine was ripe for discontinuation, as it “further disrupts in-person learning with uncertain benefits.”

Providing vaccines to children when many countries have still been able to provide sufficient doses for the adult population is controversial – but if vaccines for children are provided, perhaps they should be targeted at those most at risk. risk.”

Journal reference:

  • Myers, V., Saban, M. and Wilf-Miron, R. (2022). Covid-19 in children aged 5 to 11: a review of issues surrounding vaccination and public health policy. Pediatric respiratory exams. doi:10.1016/j.prrv.2022.03.002.
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