ABERDEEN PROVING GROUND, Md. – As the latest COVID-19 Omicron variant wave recedes across the country, it is human nature to begin hoping for a return to a pre-pandemic normal. After all, spring is just around the corner and just about everyone is experiencing pandemic fatigue. If you are a parent of a child aged 5 – 17, there may still be something you can do to help achieve a return to normal: Make sure your child gets the COVID-19 vaccine.
According to the Centers for Disease Control and Prevention COVID Data Tracker, as of mid-March 65.3 percent of the U.S. population is fully vaccinated. Of which, 75 percent of U.S. adults (225.8 million) 18 and older are fully vaccinated. There are approximately 28 million children ages 5 – 11, and an additional 25 million adolescents ages 12 – 17 in the U.S. population. Achieving the same vaccination rates among children (ages 5 – 11) and adolescents (ages 12 – 17) as the vaccination rate in adults would add an additional 39.8 million Americans fully vaccinated against COVID-19.
In CDC parlance, “fully vaccinated” means a person has received their primary series of COVID-19 vaccines. For individuals to be “up to date” they also should have received all recommended COVID-19 vaccine doses, including any booster dose(s) when eligible.
Currently, the CDC recommends that everyone ages 12+ should get a booster dose at least 5 months after the last dose in their primary series. At this time, the only FDA-authorized vaccine booster for adolescents aged 12–17 is the Pfizer-BioNTech COVID-19 Vaccine booster.
Okay, why all the stats? They paint a picture of a significant difference between the total number of fully vaccinated adults in the U.S. versus the total number of fully vaccinated children and adolescents. As of mid-March, only 26.9 percent of eligible children aged 5-11 were fully vaccinated and just 58 percent of eligible adolescents aged 12-17 were fully vaccinated.
Some parents may feel with the highly-transmissible strain of Omicron circulating that they and their children are likely to become infected with COVID-19 regardless of vaccination status. Wouldn’t it be better to just let children become naturally infected as they generally aren’t as likely to suffer severe outcomes?
“Recovering from COVID-19 can offer some protection, also known as ‘natural immunity,’ but the level of protection can vary person-to-person depending on the severity of illness, time since infection, underlying health status and age,” said Jouelle Lamaute, a Public Health nurse with the Army Public Health Center. “While children have been less affected by COVID-19 compared to adults, some children and adolescents develop severe illness. Children and teens infected with COVID-19 may be sick for several days resulting in missing school and opportunities to play, but some may go on to develop long COVID-19 and severe complications like multisystem inflammatory syndrome (MIS-C), require hospitalization, or die from their disease.”
The CDC recommends everyone 5 years and older, including those who have already had COVID-19 infection or who have tested positive without symptoms, should get vaccinated. Children who are exposed or have tested positive for COVID-19 should wait to be vaccinated until they meet the criteria to stop quarantine or isolation.
“Infection plus vaccination provides far greater immune protection than infection alone,” said John Ambrose, APHC senior advisor for Clinical Public Health & Epidemiology.
Here are a few more stats.
A recently published CDC study of children and adolescents aged 5–15 years who were tested for SARS-CoV-2 weekly, irrespective of symptoms, for seven months found that receipt of two doses of the Pfizer-BioNTech vaccine was effective in preventing both asymptomatic and symptomatic SARS-CoV-2 infection with the Omicron variant. Specifically:
- Approximately one half of Omicron infections in unvaccinated children and adolescents were asymptomatic.
- Two doses of Pfizer-BioNTech COVID-19 vaccine reduced the risk of Omicron infection by 31 percent among children aged 5–11 years and by 59 percent among persons aged 12–15 years.
According to the CDC, among adolescents aged 12 -17, the rate of hospitalization was 8 times higher among unvaccinated adolescents compared to vaccinated adolescents.
“Vaccination is extremely effective in preventing severe COVID-19 infection that can lead to hospitalization among all those who are eligible for vaccine,” said Lamaute. “Getting children ages 5 and older vaccinated against COVID-19 is the best way to protect them as well as stopping the spread of COVID-19 in their community.”
MIS-C
Here's a little more information on MIS-C.
MIS-C remains extremely rare, with just 316 cases per 1 million children infected with the coronavirus, said Ambrose. MIS-C is a multisystem disease and may be deadly. It is a condition in which more than two organs are involved (heart, kidneys, lungs, blood, gastrointestinal tract, skin or nervous system).
“The diagnosis requires proven COVID-19 infection within the 4 weeks prior to the onset of symptoms,” said Ambrose. “The child may have been infected from an asymptomatic contact and, in some cases, the child and their caregivers may not even know they had been infected.”
Ambrose says the cause of MIS-C is still unknown, but it appears to be an excessive immune response to the virus that causes COVID-19 (SARS-CoV-2), causing inflammation that damages the organs. It’s also possible that the antibodies children make to the COVID-19 virus, or some of their immune cells, are causing the illness. Since only a small number of children develop MIS-C, it is also possible that there are genetic factors that make some children more susceptible.
Ambrose recommends parents contact their child’s healthcare provider if their child experiences persistent fever, stomach pain, vomiting, skin rash, oral lesions, bloodshot eyes, diarrhea, dizziness or lightheadedness, headache, low blood pressure, difficulty breathing, confusion, pain or pressure in the chest or severe fatigue. He explained not all children will have the same symptoms, and some children may have symptoms not listed here. MIS-C may begin between two and six weeks (four weeks on average) after COVID-19 infection.
“Fortunately, MIS-C is a treatable condition and most children fully recover from this illness,” said Ambrose.
Lamaute notes that during the Pfizer COVID-19 vaccine trials for children ages 5 – 11, there were no cases of MIS-C among those who were vaccinated.
A study published in the Jan. 14, 2022, edition of the CDC’s Morbidity and Mortality Weekly Report showed of the hospitalized 12–18-year-olds in 20 U.S. states, COVID-19 vaccination was 91 percent effective against MIS-C. By contrast, between July and December 2021, 95 percent of adolescents hospitalized for MIS-C were unvaccinated, and accounted for 100 percent of the cases that required life support. Children under 12 could not be evaluated in that study because they were not yet eligible for vaccination, said Lamaute.
Vaccine Safety
Some parents may be reluctant to vaccinate their children against COVID-19 because of concerns about the vaccine’s safety.
“The COVID-19 vaccine is safe for children ages 5 through 11,” said Lamaute. “Clinical trials were conducted on thousands of children in this age range and no serious safety concerns were identified.”
Lamaute says based on the clinical trial data, some children may experience side effects from COVID-19 vaccination, similar to the side effects experienced with routine childhood vaccinations. Some children may not experience side effects at all. But side effects are a normal sign that the child’s body is building protection, and should go away after a few days.
Parents of healthy teens are also concerned about reports of boys aged 12-15 who may be more likely to be diagnosed with vaccine-related myocarditis or pericarditis, which in some cases can lead to hospitalization.
Rare cases of myocarditis and pericarditis were reported to the Vaccine Adverse Event Reporting System (VAERS) in children ages 12-17 after receiving a dose of a COVID-19 vaccine, said Lamaute. These reported rare cases occurred more often after receiving the second dose of the Pfizer or Moderna COVID-19 vaccine than after the first dose and within a week of the vaccination.
According to the CDC, in one study, “the risk of myocarditis after the second dose of Pfizer-BioNTech in the week following vaccination was around 54 cases per million doses administered to males ages 12 through 17 years.”
Adolescents and young adults who developed myocarditis and pericarditis after the COVID-19 vaccination responded to medical treatments and were able to resume their normal activities after symptoms improved, said Lamaute.
“If your child or teen develops chest pain, shortness of breath, and feelings of having a fast-beating, fluttering, or pounding heart within a week after receiving a COVID-19 vaccine, seek medical care immediately and report this adverse reaction to VAERS,” said Lamaute. “The CDC is actively monitoring reports of myocarditis and pericarditis after COVID-19 vaccination. Serious side effects that could cause long-term health problems are extremely rare following any vaccination, including COVID-19.”
The CDC still recommends that everyone ages 5 and older get vaccinated because the benefits of the COVID-19 vaccine outweigh the known and potential complications.
“Most importantly, the rate of myocarditis and pericarditis after vaccination is far lower and milder than after a community acquired COVID-19 infection,” said Ambrose
Lamaute also notes the vaccine given to children ages 5 – 11 is different than that given to teens and adults in a few different ways:
- The COVID-19 vaccine dose is less than that given to adults and teens. Unlike other medications, the Pfizer COVID-19 vaccine dose is based on the age of the child on the day of vaccination and not weight.
- The COVID-19 vaccine comes in a different vial with a different colored cap to ensure that the age-appropriate vaccine is given to children ages 5 – 11.
- However, the COVID-19 vaccine for children ages 5 - 11 has the same active ingredients as the vaccine given to teens and adults, just at a different dose.
Booster doses
Some parents of adolescents who were fully vaccinated but experienced breakthrough COVID-19 infections during the Omicron wave are wondering whether their children should still receive the vaccine booster.
“At a population level, the public health focus should be vaccinating as many unvaccinated children and adults as possible,” said Lamaute. “This is the fastest and most effective way to control the pandemic so as to decrease further community disease transmission. At an individual level, the CDC recommends that everyone who completed an initial vaccine series get a booster shot approximately 5 months after their initial vaccine series. If you initially received Pfizer, everyone 12 and older should get a booster, and if you received Moderna or Johnson & Johnson, everyone 18 and older should get a booster.”
Lamaute also said adolescents or teens who experienced breakthrough infections during the Omicron wave should still get their boosters.
“The CDC recommends individuals 12 years of age and older who are fully vaccinated but experienced a breakthrough infection should still receive a COVID-19 booster dose,” said Lamaute. “
The CDC guidance for the booster dose following a breakthrough infection is that it should be deferred until the individual has recovered from COVID-19 and has met criteria to discontinue isolation, said Lamaute. The criteria to discontinue isolation is as follows:
- Stay home for at least 5 days and isolate from others.
- If the individual had symptoms, end isolation after 5 full days if fever free for 24 hours (without fever reducing medication) and symptoms are improving.
- If the individual did not have symptoms, end isolation after at least 5 full days after the positive test result.
- If severely ill with COVID-19 or immunocompromised, isolate for 10 days and contact a healthcare provider before ending isolation.
- Take precautions until day 10 by wearing a well fitted mask if others are inside the house or in public, don’t travel, and avoid being around others who are high risk.
The bottom line is vaccinating all eligible populations, including children aged 5 years old and up, remains the best step parents can take to reduce the severe risks of COVID-19.
The U.S. Army Public Health Center enhances Army readiness by identifying and assessing current and emerging health threats; developing and communicating public health solutions; and assuring the quality and effectiveness of the Army’s Public Health Enterprise.
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