What to Know About the Covid Vaccine for Little Kids

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Millions of US parents – including many of my friends with children under 5 – are crossing their fingers again this week that Covid-19 vaccines will soon be available for younger age groups. An advisory panel to the Food and Drug Administration voted unanimously on Wednesday to recommend that the agency authorize the Pfizer-BioNTech and Moderna vaccines for use in very young children.

On Friday and Saturday, a Centers for Disease Control and Prevention advisory committee will meet to finalize their recommendations. After multiple delays in the review process of Pfizer’s vaccine, pediatricians are hopeful that both vaccines will become available early next week. The Pfizer vaccine would cover children aged 6 months through 4 years old, and the Moderna vaccine would cover children aged 6 months through 5 years old. Five million doses of each vaccine were made available for pharmacies and other medical establishments to order starting two weeks ago, so if the vaccines are authorized, they will be ready to go into arms immediately.

Understandably, many parents of young children have questions about the vaccines and the expected rollout. I talked with three infectious disease pediatricians to get answers.

The Moderna vaccine is likely to be authorized as two doses spaced four weeks apart, said Dr. Debbie-Ann Shirley, a pediatric infectious disease physician at the University of Virginia. Pfizer will most likely be authorized as a three-dose series, with the first two shots spaced three weeks apart, and the third shot given at least eight weeks later. (Pfizer’s third shot is not considered a booster. It is likely that Moderna and Pfizer will eventually authorize an additional booster dose for young children.) Both vaccines are at lower doses than the vaccines given to older children and adults, and for young children, the Pfizer vaccine provides a lower dose than the Moderna vaccine.

The CDC is still deciding on when kids will be considered fully vaccinated, but it’s likely to be two weeks after their final dose, Dr. Shirley said.

Preliminary data released by Moderna in April suggested that two shots were 51 percent effective at preventing Covid-19 infection among kids aged 6 months through 1 year, and that two shots were 37 percent effective at preventing infection among kids aged 2 through 5 years. Pfizer’s three-dose series was found to be 80 percent effective at preventing Covid-19 infection among kids aged 6 months through 4 years old, although that estimate is based on a small number of children who received the third dose. Kids – especially those under 2 – will be at least somewhat protected after getting the second dose of the Pfizer vaccine, too, Dr. Shirley said.

The data so far suggest that the side effects in younger kids are milder than those in older kids, probably because a lower dose of the vaccine is given, Dr. Shirley said. Among children under 5, “the side effects were the sorts of things that we might expect in children after receiving a vaccine,” she added, including increased fussiness, sleepiness and pain at the injection site. Comparing the two vaccines, Pfizer’s resulted in fewer side effects overall, probably because it uses such a low dose.

No children in the vaccine trials developed heart issues like myocarditis, a form of heart inflammation that was seen in a small number of older children who received the vaccine, Dr. Shirley said. “It is possible there will be some cases once the vaccines are given to enough kids, but experts do not expect to see a significant number, because myocarditis” occurs more frequently in teenagers and young adults than younger kids, “said Dr. Ibukun Kalu, an infectious disease pediatrician at the Duke University School of Medicine. “I would not expect high rates of vaccine-related myocarditis in the under 5s,” she added. Dr. Kalu also pointed out that the risk of myocarditis is much higher among kids who catch Covid-19 than it is among those who get the vaccine.

It’s important to note that when the FDA did not authorize the two-dose Pfizer vaccine back in February, that was because it did not work well enough, not because of any safety issues. (And that’s ultimately why the vaccine now has a three-dose regimen.)

According to the CDC, kids who recently had Covid can get the vaccine as soon as they are out of isolation and are feeling better, Dr. Kalu said. But because “reinfection appears to be rare after the first few months of recovering from a Covid infection,” Dr. Shirley added, it’s not unreasonable to wait up to 90 days after the infection before getting them vaccinated.

Still, you may want to get them the shot sooner if cases are climbing in your community, if you are traveling to areas with high Covid rates, or if your child is immunocompromised or has underlying risk factors, Dr. Shirley said. If you’re not sure what to do, “reaching out to a trusted health care provider is always a good way to talk through some of those issues,” she added.

Yes. According to the CDC, kids 5 and over can get Covid-19 vaccines and other inoculations, including flu vaccines, at the same time. Experts do not anticipate this recommendation will change for children under 5.

It is true that Covid-19 is far less risky for kids than it is for those who are older. But more than 440 children aged 4 and under have died from Covid-19 since January 2020, and the infection is “one of the top 10 causes of death in children in the United States,” Dr. Maldonado said. Also, Covid-related hospitalization rates are higher for children 4 and younger than they are for older children, and more than half of pediatric hospitalizations among kids ages six months through 4 years occur in children with no known underlying risk factors. “I had a number of friends who are health care providers whose children have wound up in the hospital, some on oxygen in the ICU, who have no risk factors,” Dr. Maldonado said.

“Vaccines are the most effective way that we have as clinicians to help prevent patients from developing severe forms of Covid,” Dr. Shirley said – and that includes little kids.


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Read more:
How Long Does Covid Immunity Last? Will a Second Illness Be Worse? How Can I Prepare?


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Stay well!