As supply now exceeds demand, there is strong pressure to expand COVID-19 vaccines to younger populations, including children.
Adult vaccination has significantly reduced new cases (95%), hospitalizations (87%) and deaths (90%) from COVID-19 in the past 6 months. The motivation behind vaccinating young people is to protect them while keeping transmission low and preventing the development of variants.
More than 54% of adults are now fully immunized, while more than 7 million adolescents have received at least one dose via emergency use authorization (EUA).
This week, the Centers for Disease Control and Prevention (CDC) convene their advisory committee to investigate nearly 800 reports of heart inflammation following COVID-19 mRNA vaccination, half of which have occurred in those under 30 years.
A CDC PANEL TO DISCUSS COVID-19 VACCINATION, RARE HEART PROBLEMS
Fewer than 6,000 children aged 12 to 15 were included in the initial trials of the Pfizer and Moderna vaccines, so it is expected that rare events will occur after more people receive the vaccine, such as inflammation of the heart. Public health authorities in Israel recognized the link between mRNA vaccines in young adults and heart inflammation last month, around the time the US CDC began reviewing the cases.
People under the age of 18 make up nearly a quarter of the U.S. population, but less than 1% of deaths from COVID-19. Knowing this, the debate arises as to whether children should be vaccinated under the EUA.
The death rate from infection in young children from COVID-19 is less than 0.008%, probably lower due to a subtest. This number is lower than that of influenza (0.01%) and significantly lower than that of measles (up to 3% in unimmunized populations), which is why pediatric vaccines against these other pathogenic viruses are essential. .
But death isn’t the only concern about children and COVID-19.
FORMER CDC CHIEF URGES COVID-19 CHILD VACCINATION AS AGENCY TESTS RARE HEART PROBLEMS
Multisystem inflammatory syndrome in children (MIS-C) is a condition seen in children within 4 weeks of testing positive for SARS-CoV-2, affecting various parts of the body including eyes, heart, skin and kidneys.
More than 4,000 children have been diagnosed with MIS-C, 36 of whom have died. According to CDC data, more than 65% of cases of MIS-C have occurred in children under 12 years old, including 58% under 10 years old. Almost two-thirds of the children who developed post-viral syndrome were minorities (Hispanic / Latino or Black) with disproportionate rates of childhood obesity, a known risk factor for severe consequences of SARS-CoV-2.
As a doctor and a mother of three boys, my question is: if the vaccine successfully induces an immune response, which some studies have shown may be more robust than natural exposure to the virus, could the vaccine then trigger the inflammatory reaction causing the MIS-C. ?
If so, would it be more frequent or more severe if the immune response is stronger? Couldn’t that put healthy children at risk for a serious vaccine outcome who had an extremely low probability of getting sick at all?
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I am not alone in my worries. Pediatric vaccine expert Dr Peter Hoetz said in a recent interview: “What may slow the pace of clinical trials in younger people is that we have seen this syndrome, caused by Covid MIS-C … Probably due to host immunity. response, may be due to antibodies. This fact will probably slow people down on how quickly we immunize small children and monitor that. “
So what will the data from clinical trials tell us?
With MIS-C having a penetrance of 0.1% after infection, if we use the same seroprevalence data in adults, it is likely that the actual incidence of MIS-C is closer to 0.02%. A sample size to statistically populate the study to capture the low incidence of such a rare event would require approximately 100 times the number of participants than expected to be enrolled.
As new infections have dropped sharply in recent months, the weekly rate of new cases of MIS-C has fallen to zero. Yet campaigns for universal adolescent vaccination persist under the EUA, with many schools and colleges even requiring vaccination as the fall semester approaches despite increasing cases of post-vaccine inflammatory disease.
The data from the current trial is not powerful enough to capture the low penetrance of MIS-C and other rare side effects. Further data will be available but should be presented in the form of full FDA approval and not through the EUA. Without sufficient safety data and the parallel decline in MIS-C cases, I am still not convinced of the usefulness of universal COVID-19 vaccination in children at this time.
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Universal vaccination campaigns should be halted among adolescents and even young adults until more safety information becomes available, especially as transmission of cases remains low in much of the country. The decision to vaccinate under the EUA should be made on an individual basis, only after weighing the known benefits of vaccinating people at high risk against the possible risks of the vaccine.
From a public health perspective, we shouldn’t just be thinking about community viral transmission, the number of new cases and death rates; it is also necessary to consider the well-being of the child as a whole. An accelerated vaccine for HEALTHY children, who have almost no risk of serious illness and death from COVID-19, may seem like a solution looking for a problem.
Editor’s Note: Dr. Nicole Saphier’s opinions on this subject are her own. They are separated and separated from his post as physician at Memorial Sloan Kettering Cancer Center.
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