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COVID-19 Vaccination in Children 5-11 years of Age

By Jessica Graham, M.D., Pediatric Emergency Physician, MCS Parent and Thomas Hanff, M.D., Heart Failure Cardiologist, MCS Parent

Pfizer recently performed an mRNA vaccine trial in children aged 5-11. After study results were released, an emergency use authorization (EUA) was approved for children in this age range. However, some parents still have questions or concerns. 

Reason for Hesitation Facts About COVID-19 and Vaccination
COVID infection is mild in most kids. The Delta surge has increased hospitalization five-fold among childrena
8300 kids 5-11 have been hospitalized due to COVID-19b,c
30% of kids hospitalized with COVID-19 had no underlying health conditionsb
172 kids aged 5-11 have died from COVID-19 b
2316 kids aged 5-11 have developed MIS-C after COVID-19 
2% of kids who get COVID experience post-acute "long-COVID" sequelae
d
I'm concerned the vaccine will cause my child to have myocarditis.There were zero cases of myocarditis in Pfizer's mRNA vaccine trials in kids aged 5-11e*
When they occur in older children, the cardiac effects of the COVID virus and MIS-C are more severe than those from the vaccinef 
I think I'll just wait to see how other kids do.Utah's COVID-19 numbers are still high, with holidays coming up and your child in school, there is a chance they would get COVID while waiting to see what happens to kids getting vaccine
Getting vaccinated helps keep vulnerable members of the community (babies, immunocompromised, those who cannot get vaccinated) safec
I don't want to negatively affect my child's fertility.There is no evidence that the COViD-19 vaccine causes fertility problemsg
I don't want my kid to have to suffer from the side effects.The CDC recommends vaccination in children who have had SARS-CoV-2 infectionc
Antibody responses to immunization are generally more robust and predictable, and potentially longer lasting, than natural immunity from the infection
My child is really good at wearing a mask.Masks are very helpful at helping prevent infection, but not perfect, especially when infected people aren't wearing themh
I looked at the Vaccine Adverse Event Reporting System and saw some scary side effects .VAERS is solely a place for people to report things that happen around the time when they get the vaccine; it does not guarantee causationi
I'm concerned the vaccine may alter my child's DNA.COVID-19 vaccines do not change or interact with DNA in any wayi
The vaccine development and testing process was rushed.Coronavirus and mRNA vaccines have been studied and developed for over 2 decadesj
I plan to wait until my 11-year-old is 12 so they can get the higher dose.The lower dose led to just as robust an immune response with fewer side effectsk

Trial Detailsl

  • Trial included ~3100 children
  • Children received 10-mcg dose (1/3 the adult dose)
  • Vaccine efficacy 91% (high compared with many other vaccines)

*In older children (16-29 years), the incidence of myopericarditis after vaccine is 1 per 5,750. Therefore, it is possible that because even if myopericarditis were going to occur at the same rate in the 5-11 age group, the trial would not pick it up because the total number of children in the trial was less than this. 

However:

  • Most cases of myopericarditis have occurred between 16-29 years; Rates of myopericarditis after vaccination are much lower in the 12-15 year age group in studies done in Israel and the U.S
  • It is hypothesized that the lower dose used in children 5-11 is less likely to cause myocarditis
  • In general, the incidence of myocarditis from other causes is lower in this age groupf; myocarditis mostly happens in post-pubertal kids
  • Even if it does occur, the cases of myopericarditis have overall been mild and children have recovered well 

Our gratitude to Jessica and Thomas for writing this very helpful article.  

References

https://www.cdc.gov/mmwr/volumes/70/wr/mm7036e2.htm

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/03-COVID-Jefferson-508.pdf

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/children-teens.html

https://secure.jbs.elsevierhealth.com/action/getSharedSiteSession?redirect=https%3A%2F%2Fwww.thelancet.com%2Fjournals%2Flanchi%2Farticle%2FPIIS2352-4642%2821%2900198-X%2Ffulltext&rc=0

https://publications.aap.org/aapnews/news/17751/FDA-panel-Benefits-of-COVID-19-vaccine-for-ages-5?autologincheck=redirected

f Vaccine-related myocarditis is milder compared to MIS-C (Comparison of MIS-C Related Myocarditis, Classic Viral Myocarditis, and COVID-19 Vaccine related Myocarditis in Children. Trisha Patel, Michael Kelleman, Zachary West, Andrew Peter, Matthew Dove, AreneButto, Matthew E. Oster; medRxiv 2021.10.05.21264581; doi:https://doi.org/10.1101/2021.10.05.21264581)

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/planning-for-pregnancy.html

h https://publichealth.jhu.edu/2021/the-long-history-of-mrna-vaccines

An evidence review of face masks against COVID-19, Jeremy Howard, Austin Huang, Zhiyuan Li, Zeynep Tufekci, Vladimir Zdimal, Helene-Mari van der Westhuizen, Arne von Delft, Amy Price, Lex Fridman, Lei-Han Tang, Viola Tang, Gregory L. Watson, Christina E. Bax, ReshamaShaikh, Frederik Questier, Danny Hernandez, Larry F. Chu, Christina M.Ramirez, Anne W. Rimoin. Proceedings of the National Academy of Sciences Jan 2021, 118 (4) e2014564118; DOI:10.1073/pnas.2014564118

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html

j https://publichealth.jhu.edu/2021/the-long-history-of-mrna-vaccines

k https://www.healthline.com/health-news/should-11-year-olds-wait-until-they-are-12-to-get-a-covid-19-vaccine

l https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age 

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