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FDA approves COVID vaccine for children 12 and older. What do parents need to know?

News & Observer - 5/11/2021

May 11—The U.S.Food and Drug Administration authorized emergency use of the Pfizer COVID-19 vaccine on Monday for children age 12 to 15.

Pending recommendation from the Centers for Disease Control and Prevention, which health officials expect Wednesday afternoon, parents can have their children vaccinated starting Thursday.

This only includes the Pfizer vaccine. Vaccines from Moderna and Johnson & Johnson have not yet been authorized for use in children.

Health experts from the state Department of Health and Human Services and private health care told The News & Observer that the benefits of child vaccination outweigh the risks.

Here's what parents need to know if they're considering having their child vaccinated.

Is the process different for vaccinating children?

Health officials say no.

Children, just like adults, would require two doses of the Pfizer vaccine given three weeks apart.

The dosage amount would also remain the same, though for children younger than 12, the dosage would be lower. But trials for that age group are still underway.

If the vaccine is recommended by the CDC, which is expected to happen on Wednesday, parents can take their child to a walk-in clinic or schedule an appointment for the Pfizer vaccine starting Thursday, just as they would for themselves.

"We would follow that recommendation and then communicate that out to our providers," said state health director Dr. Elizabeth Tolson in an interview. "There wouldn't be any extra step that North Carolina would have to take. Vaccinations could start as soon as that recommendation is made."

Are there higher vaccine risks for children?

The common side effects of the Pfizer vaccine — soreness, redness and swelling at the site of injection — are the same for children as they are for adults, according to clinical trials.

The efficacy rate of the vaccine is actually higher for children than adults, though the sample size of the children's trial was much lower than the adult trial.

About 2,300 children age 12 to 15 participated in the trial. About half received the vaccine, and the other half received a placebo, according to a press release from Pfizer.

Among the children who received the placebo, 18 contracted COVID-19. None of the children who received the vaccine contracted the virus.

Dr. Michael Smith, medical director of the Duke Children's Health Center Infectious Diseases Clinic, said at a media briefing on Tuesday that the efficacy rate would likely not be 100% due to the small sample size but the benefits of the vaccine compared to the risks would be the same for children as for adults.

"I wish I could say that if you get this vaccine, there's 0% you're going to get infection," Smith said. "There are going to be people who get this vaccine and get COVID, but just as we saw in the adult population, even if the vaccine does not prevent you from getting COVID, it's very, very effective at reducing severe disease and reducing hospitalization."

Smith said one difference expected to be seen in children is that they might see more pronounced side effects compared to adults due to the immune system typically being more robust in childhood.

"It's more likely to be a little bit more sore," Smith said in reference to the point of injection, "maybe a little bit more red and swollen the younger you are, but at this point, there's no reason to not give the vaccine to someone, even if they're on the smaller side."

What are the benefits of having my child vaccinated?

Health officials said that the benefits of the vaccine are mostly the same for children as for adults.

First and foremost, Tilson said, the vaccine will protect the child.

"Younger people often have more mild disease, but not always. Some younger people can definitely have severe disease, and also younger people can have the long-term effects, the kind of long haul or chronic effects of the disease," Tilson said.

While there isn't much data on the long-term effects of COVID-19 in children, Dr. David Wohl, infectious disease expert at UNC Health, said in an interview that he's concerned about that these long-term effects in children.

"Many kids who were even asymptomatic may have signs of post COVID complications, especially neurological complications," Wohl said. "If anything, it may be a greater indication for kids to get vaccinated to prevent them from getting mild infection and then long COVID that could really be devastating to them at a critical point in their lives, sapping energy, keeping kids from being cognitively engaged."

Will vaccinating children slow the spread of COVID-19?

Transmission, just as with adults, could be reduced in vaccinated children, health officials said.

Smith said that it's reasonable to assume that unvaccinated children can transmit the virus. He referenced some of the outbreaks associated with schools in Michigan related to sporting events.

Tilson said that even though transmission in schools is low due to preventative measures and children being a less severe transmitter of the virus than adults, the vaccine can still work to reduce transmission in sports-related and other non-school gatherings.

"We see spread in social settings outside of school, outside of house and actually among athletic teams, not so much the play on the field, but the team's socializing outside of that without a mask if they're not vaccinated," Tilson said.

Wohl said that high vaccination among children could result in preventative measures in schools, such as masking and social distancing, being eased.

"Those measures aren't going to last forever. Right? The whole idea is to get rid of those measures," Wohl said. "It's not impossible for children to get infected. It's not impossible then for kids to shed the virus and infect others. ... Vaccinating kids allows yet another route of transmission and a chain of transmission to be broken and allow schools to become more normal, like they were pre-pandemic, and that's what our goal is."

When and where can my child be vaccinated?

The CDC is expected to recommend the Pfizer vaccine for children as young as 12 Wednesday afternoon. After that recommendation, vaccinations for children in that age group can begin as early as Thursday.

Wohl said that that UNC Health will not turn down any children age 12 to 15 at their walk-in vaccine sites on Thursday.

He said he hopes appointments can be made for next week as early as late Thursday or early Friday.

Duke Health will accept vaccination appointments for children starting Thursday.

The Wake County Public Health Department will likely be able to vaccinate children in that age group at its sites starting Thursday, according to the county's COVID-19 vaccine website.

In a post on twitter, the Durham County Public Health Department said they would update after the CDC convenes to determine recommendation.

The Orange County Public Health Department will begin accepting vaccination appointments of children age 12 and older starting Thursday, pending CDC recommendation.

But the appointments may be delayed until next week, depending on if the county gets any shipments of the Pfizer vaccine this week, said Todd McGee, head of public affairs at the county's health department.

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