COVID-19 VACCINATION FOR CHILDREN.
HEREDITY HEALTHCARE AND LIFE SCIENCES
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Written by:
Sweta Yadav
INTRODUCTION:
As
of early May 2021, nearly 4 million total cases of COVID-19 were reported in
children, representing 14% of all cases. With mass vaccination of adults,
increased rates of infection are being reported in the unvaccinated population.
Serious illness and death rates have been reported to be lower in children;
however, after infection (be it symptomatic or asymptomatic), they are highly
vulnerable to multisystem inflammatory syndrome (MIS-C). The COVID-19 pandemic
has not only disrupted children’s education but also has had a significant
effect on children’s physical, mental, and emotional health.The lack of attention for the young-aged people is mainly due
to the fact that COVID-19 infection in children has a benign and limited course,
with low to moderate fever and/or gastrointestinal manifestations. There
are, as of now, inadequate data on transmissibility of SARS-CoV-2 from children
to other children.
SEVERITY IN CHILDREN:
Children may be asymptomatic or too mildly
infected to draw medical attention and be tested and counted in observed cases
of COVID-19.In a very limited portion of young
patients, COVID-19 may be associated with a subsequent serious condition,
firstly reported as “Kawasaki-like disease,” and later has been recognized as
“multisystem inflammatory syndrome in children” (MIS-C). This syndrome involves
pediatric patients of all ages and in most of these cases it is not accompanied
by any preexisting medical conditions. It usually develops 2–4 weeks after a
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or a
close contact with an infected person, and is characterized by low to moderate
fever of short duration with prominent gastrointestinal, hematologic and
cardiac manifestations, including acute myocarditis, and coronary artery
aneurysms. At least half of these patients may require intensive care
treatment, with mortality ranging from 0 to 4%.
NEED FOR COVID-19
VACCINATION IN CHILDREN:
Data
suggest that vaccines are highly effective in preventing severe COVID-19
infection, also act against many new variants, and are incredibly safe.Although
severe COVID-19 disease has predominantly affected older adults, children have
also been affected. According to the Center for Disease Control and Prevention
about 1.5 million young people aged 11 to 17 have had covid-19 in the past year.
Although adolescents usually have a milder disease than adults, they still can
spread the infection.New COVID-19 variants, loosening of public health
measures, and lifting of restrictions on school activities are also driving
increased infections in children. Children can also experience post–COVID-19
syndrome and suffer from persistent symptoms at the post viral stage of the
disease.
MiguelaCaniza,
director of the infectious diseases programme at St Jude Children’s Research
Hospital in Memphis, Tennessee said, “Vaccinating children for COVID-19 is a
key component for reaching the two thirds threshold herd immunity and stop the
pandemic from continuing to spread and mutate”.She also pointed out that
“children and teenagers are a highly mobile population attending schools,
sports, extracurricular activities, and intersecting more often with various
age groups including caretakers and older family members.” Since a high
percentage of them are asymptomatic or have mild symptoms if they
are infected they may spread the disease, especially if they don’t take
precautions like masking, distancing and frequent hand washing.
MANDATING VACCINATION FOR CHILDREN:
The criterion that should be prioritized over
all others is: there must be evidence that a COVID-19 vaccine is safe for
children having an acceptable level of risk. To fulfill this criterion normally
both prelicensure safety data and post licensure safety data are required to
monitor the effects after the administration of vaccine to many people.
Accumulation of this data to fulfill this criterion often requires years of
research and testing.Although less stringent safety benchmarks may be used to
justify emergency or voluntary uses of COVID-19 vaccine, it is vital that any
policy mandating use of a COVID-19 vaccine follow the fullest assessment of its
safety.Itwould be a mistake to consider making a COVID-19 vaccine mandatory
without these data.
The R0 (i.e., the reproduction number) of SARS-CoV-2 is
2 to 2.5. It is easier to make the case for mandating a vaccine for an
infectious agent having higher R0 because higher the R0, the more individuals
with immunity are needed to prevent the spread of disease, and to achieve the
high herd immunity threshold required to provide wide community protection, a
vaccine mandate may be the only way.
AUTHORIZED VACCINES FOR CHILDREN:
Only
a minority of trials have been performed to test the efficacy and safety of
COVID-19 vaccination in children and a massive vaccination campaign for this
age range is still far to come.
The
Pfizer-BioNTech (mRNA) COVID-19 vaccine was initially authorized for those 16
years and older. Recently the Food and Drug Administration (FDA) provided
Emergency Use Authorization for adolescents 12 to 15 years old to receive the
Pfizer-BioNTech vaccination.
The
Moderna (mRNA) and Johnson and Johnson (adenovirus-vectored) vaccinations authorized
for those 18 years and older. Both Moderna and Johnson & Johnson, are
approved in the US and are testing their vaccines in children.
CONCLUSION:
Governments and drug
authorities should encourage studies for testing the safety and efficacy of
COVID-19 vaccination in children, considering also that in many underdeveloped
countries the proportion of population <15 years of age is dramatically
higher than in richest nations and that only a worldwide vaccination campaign
can efficaciously contain the disease, also by limiting the possibility of the
development of new SARS-CoV-2 variants. Lastly, if the vaccine will be proven
to be safe and efficacious in children, educational campaigns on the utility
and safety of vaccination amongst children should be promoted, this in order to
avoid suboptimal coverage and to prevent COVID-19- as well as MIS-C related death among children.
REFERENCES:
Coronavirus Disease 2019 Vaccine in Children. https://doi.org/10.1542/pir.2021-004979
Nisha S Mehta, Oliver T Mytton, Edward W S Mullins, Tom
A Fowler, Catherine L Falconer, Orla B Murphy, Claudia Langenberg, Wikum J P
Jayatunga, Danielle H Eddy, Jonathan S Nguyen-Van-Tam, SARS-CoV-2 (COVID-19):
What Do We Know About Children? A Systematic Review, Clinical Infectious Diseases,
Volume 71, Issue 9, 1 November 2020, Pages 2469–2479,https://doi.org/10.1093/cid/ciaa556
Opel, D. J., Diekema, D. S. & Ross, L. F. Should we
mandate a COVID-19 vaccine for children? JAMA Pediatr. 175, 125–6 (2021).
Tanne J H. Covid-19: FDA authorizes Pfizer vaccine for children 12-15 BMJ 2021; 373 :n1204
doi:10.1136/bmj.n1204
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