Covid-19 vaccines for children: Latest medical information-By Dr B.J.C.Perera
Source:Island
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal
In these days of evident uncertainty regarding the likely progress of the SARS-CoV-2, the causative virus of COVID-19, there is a state of apprehension and intense anxiety amongst the general populace of our country. With the added complication of several mutant variants, all designated by the letters of the Greek alphabet, the melting pot actually boils and even overflows.
In addition to scientific data and proper pedagogic assessments, there is a lot of misinformation and disinformation, particularly regarding the COVID-19 vaccines in all kinds of print and electronic media. Some totally unsubstantiated allegations, stipulations, postulations and prophesies of gloom, are being made and widely circulated for the consumption of the general public, particularly through social media. People who flatly refuse to take the vaccine, those who are hesitant to receive it and confirmed anti-vaxxers are having a field day in trying to dissuade the general public from taking the vaccine.
This situation is of particular concern when such false proclamations tend to intensely discourage children being given the vaccine. In this paradise isle, firstly it was the front-line healthcare workers and the tri-forces who were prioritised to receive the vaccine. Then came the over 60-year-olds, especially those who have on-going comorbid diseases. Following that, young adults and those under 60 years with coexisting other diseases were lined up. Then the authorities started to vaccinate all those from 19 to 60 years of age followed by students in the higher classes of 15 to 19 years of age and those over 12 years with coexistent diseases that make them vulnerable. The latest initiative of the government, based on medical advice, is to vaccinate all children from 12 to 15 years of age, starting from 07th January 2022.
The anti-vaxxers and their ilk have put forward many ‘faults and complications’ of the vaccines to dissuade others from taking the vaccine and also desist from giving it to their children. They, the antivaxxers, first blew up, out of all proportions, the issue of clotting disorders after COVID vaccinations. True enough it could occur but it is a very rare phenomenon. An erudite article published in the reputed journal Nature on 24th August 2021 estimated these clotting problems to occur in or less than 1 in 50,000 of those under 50 years of age who have received the Oxford-AstraZenica vaccine.
Then came the canard of reduced sexual prowess and sub-fertility induced by the vaccine in young people. This is a total myth and there is no scientific evidence whatsoever for this miserable contention. There is no authentic research communication to the veracity of it at all. This ‘rumour’ totally discouraged a lot of youth, young people and young adults from taking the vaccine, without any justification for that action at all.
The most recent adverse effect that has been brought to light is the occurrence of myocarditis and to a lesser extent, pericarditis, following the vaccine. The human heart is a muscular pump and myocarditis refers to inflammation of the specialised muscle fibres in the human heart. Pericarditis denotes inflammation of the membrane, the pericardium, that covers the external surface of the human heart. These inflammatory complications are seen in young adults and children and are extremely rare. An article in a Pre-print journal medRxiv, posted on 05th December 2021, estimated that these complications occurred in 297 out of a total of 19,740,741doses of the m-RNA vaccines administered. This gives a rate of 15 per million doses or 1.5 per one hundred thousand. Symptomatic myocarditis is relatively mild and does not cause long-term heart damage. Many scientific articles that have looked at this complication have not reported any deaths. In fact, COVID-19 disease itself could cause myocarditis, with an incidence of 28 percent (28,000 per 100,000) of all hospitalised patients with COVID-19. The considered opinion of the scientific community is that the complication rate of the disease itself is much more than the adverse effects such as myocarditis that could occur with the vaccine itself.
Yet for all that, one must always keep in mind that these complication rates cannot be superimposed on to given individuals. In other words, if for example, the hypothetical incidence is one in 50,000, when one looks at a single person who is to be given the vaccine, we have no way of knowing for sure whether that individual may or may not be the one to get the complication. The scientifically quoted rates only confirm their rarity or higher incidence and prevalence, as the case may be. Safe, effective vaccines against coronavirus disease 2019 (Covid-19) are urgently needed in children younger than 12 years of age. There are some recent developments regarding the feasibility of vaccinating children under 12 years. A phase 1, dose-finding study and an ongoing phase 2–3 randomised trial are being conducted to investigate the safety, immunogenicity, and efficacy of two doses of the BNT162b2 Pfizer vaccine administered 21 days apart to children six months to 11 years of age.
From the results of that study, in a scientific paper published in the most prestigious New England Journal of Medicine on 06th January 2022, the researchers have shown that a Covid-19 vaccination regimen consisting of two 10-microgram doses of the Pfizer vaccine, administered 21 days apart, was found to be safe, immunogenic and efficacious in children 5 to 11 years of age. It is noteworthy that the 10-microgram dose is one third of the adult dose of 30 microgram and two doses that are 21 days apart are needed.
In addition, the United States Centers for Disease Control and Prevention’s (CDC’s) latest Morbidity and Mortality Weekly Report details the preliminary safety findings for the administration of Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine among children aged five to 11 years.
To characterise safety of the vaccine in children aged 5 to 11 years, the CDC reviewed adverse events after receipt of Pfizer-BioNTech COVID-19 vaccine reported to the Vaccine Adverse Event Reporting System (VAERS), a passive vaccine safety surveillance system co-managed by CDC and United States Food and Drug Administration, from November 3 to December 19, 2021. Approximately 8.7 million doses of Pfizer-BioNTech COVID-19 vaccine were administered to children agedfive to 11 years during this period. They found that 97.6 percent of the adverse reactions reported were not serious. There were 11 children who developed myocarditis and all recovered with no long-term heart problems.
Currently in Sri Lanka, only a single dose of Pfizer vaccine is given to children and young people. This position will need to be re-evaluated and revisions made thereof, if and when more scientific information becomes available. We are continuously learning about COVID-19 on the go and nothing is written in stone to stay like that forever. Flexibility with decisions being made on robust scientific grounds would be the way to go in the future.
