Children are as vulnerable to the novel coronavirus as adults. Studies have shown that infection and transmission in children and adults are similar. Even though most children have asymptomatic or mild infection, they are an important source of transmission to others. Severe infections and mortality have frequently been reported in young infants and children with comorbidities, largely post 3-6 weeks of asymptomatic or symptomatic infection. The incidence of Multisystem inflammatory syndrome (MIS-C) is a rare but life-threatening complication of Covid 19 infection which may rarely lead to long term coronary artery changes.
Vaccination status in various countriesSeveral countries have begun giving vaccines to children, while others have commenced with clinical trials in children. In India, so far only the Covaxin vaccine trials in children have been initiated for the age group of 12 to 16 years and recruitment for clinical trials for the age group 6 to 12 years and 2 to 6 years. However, it will take several months before this trial is completed. The United States had in May 2021 approved the use of the Pfizer – BioNTech vaccine for children above 12 years of age. Germany, Poland, Canada, UAE, Italy, Singapore are the other countries that approved vaccination for those above 12 years of age. The UAE has begun vaccination trials with Sinopharm in children aged 3 -17 years, whereas China has approved emergency use of the Sinovac vaccine for children 3 -17 years of age.
Concerns about vaccinating childrenAll the vaccines currently being used have obtained an emergency use authorization (EUA) for vaccinating people. Covid-19 cases are now on the decline and most cases reported in children are mild. With the report of myocarditis in adolescents older than 16 years of age and young adults (16 -30 / 1 million dose), 1 week after the 2nd dose (causal link not established) many experts feel Covid-19 vaccines for children should be considered under BLA (biological license application) and not EUA so that the agency considers data from a year or two before approval. All those who developed myocarditis have recovered quickly to treatment. The Centers for Disease Control and Prevention (CDC) recommends the continuation of vaccination in those above 12 years of age as known, as potential benefits of Covid-19 vaccination are considered to outweigh the risks.
What are the options?Most countries are using the Pfizer – BioNTech Covid 19 vaccine in children above 12 years of age (100% efficacy and robust antibody response – study in 2260 Covid adolescents, 1171 were vaccinated - the same dose as for adults 2 doses, 21 days apart and 1089 were not). None of the vaccinated developed disease while out of the 1089 unvaccinated adolescents, 16 developed Covid-19. This mRNA vaccine, therefore, had good efficacy and a safety profile in children consistent with the adult studies. The Moderna trials in 6500 adolescents are in the final phase – adult dose- 2 doses, 28 days apart. In China, the Sinovac vaccine is being used for 3 years of age and above.
So far, The World Health Organization does not recommend vaccination for children below 16 years of age. Parents, caregivers, and pediatricians should focus on prevention and avoid any sort of unguided advice. For the time being, in India where nearly 40 % of the population is less than 18 years of age, the best option to prevent disease in children is to vaccinate parents and other household contacts, who are the main source of infection in children during this lockdown period.
Authored by Dr. Jeeson C Unni, Consultant Paediatrician, Aster Medcity, Aster DM Healthcare
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