The following are notes taken during the virtual event, Kids and the COVID Vaccine, hosted by The Colorado Sun. The event was moderated by Sun co-founder John Ingold and included a panel with Drs. Matthew Daley, Pamela Valenza, and Anuj Mehta. The notes below provide a basic overview of the information that the moderator and panelists shared throughout the presentation, including responses to attendee questions. The following information was recorded to the best of my ability, but there is always a chance that I misheard or misunderstood a comment. As such, I highly recommend viewing the recording of the event that will be available in the near future.
COVID-19 Stats and Vaccine Concerns
Dr. Valenza provided an overview of statistics regarding pediatric cases, hospitalizations, and deaths.
4+ million children infected with COVID-19 (and this is likely to be a vast underestimate)
Overall rate is ~5,000 cases / 100,000 children in the population
1 in 3 children and teens hospitalized with COVID-19 require treatment in the intensive care unit
As a reference point, there were 144-199 pediatric deaths from influenza (2017-2020) and only 1 pediatric death from influenza in 2021. This is primarily due to the precautions put in place for COVID-19 (masking, hand-washing, staying home).
The biggest concerns she hears from patients, families, and community members are focused on safety (immediate side effects, long-term effects, speed of vaccine development) as well as weighing the risks of getting COVID-19 vs. getting the vaccine.
Dr. Mehta provided a brief history of mRNA-based technology, including the research history of mRNA-based vaccines. He referenced an important breakthrough in mRNA research coming in 2005 and that research over the last 5-10 years provided the foundation for developing the delivery system for getting the mRNA to survive in the vaccinated individual (the human body is excellent at destroying mRNAs) long enough to produce the proteins of interest (in the case of COVID-19, that is the Spike protein).
Importantly, Dr. Mehta noted that the mRNA in these vaccines does not interfere with DNA and the vaccines do not pose a risk for altering an individual’s genetic code.
Of note, neither the mRNA nor the Spike proteins persist in the body for long periods of time.
Later in the discussion, Dr. Valenza also discussed that the vaccines do not impact fertility nor the growth and development of children.
She also points out that not only do the vaccines not cause harm regarding fertility, but that vaccinated pregnant patients are giving birth to babies with antibodies.
Dr. Mehta notes that Long COVID cases exist even in patients who experienced mild cases and that we still do not know what the long-term effects will be for children or adults who have COVID-19.
He followed that with the caution that there are other considerations aside from the illness itself and that we need to also keep in mind that isolation is not healthy for adults or children and that we must also look at mental health as well as food and housing security, etc.
Vaccine Safety & Monitoring
Dr. Daley discussed the initial clinical trials and the fact that they were considerably larger than typical clinical trials for new vaccines (30-60k individuals as opposed to ~5k).
He also pointed out that we are a full year out from the initial trial participants receiving the vaccines and, as such, now have data on 1-year post-vaccine.
Dr. Daley also highlighted the fact that 300+ million adults (>12yo) will have been vaccinated by the time the vaccines are given to children.
Lastly, Dr. Daley described the U.S. safety monitoring systems in place (the good and the bad) and how/why these systems work to identify any concerns. Of note, it’s important to understand that because the VAERS system is open to any side effects, reactions, or occurrences that may follow the vaccination, secondary and tertiary reviews are necessary to determine if the report is truly tied to the vaccination.
An update on myocarditis/pericarditis
Dr. Daley presented descriptions of myo- and pericarditis
Myocarditis is inflammation of the heart muscle; pericarditis is inflammation of the lining of the heart muscle
He reported that the mRNA vaccines can cause myocarditis but that these cares are rare, mild, and resolvable.
The current estimate is that there are ~12 cases per 1 million vaccine doses and that the cases are slightly more likely in male patients and in the 12-29 years-old age range.
The myocarditis cases appear to mild with the most common symptom being chest pain 3-4 days following the second dose. These patients typically undergo physician watch and are released, fully recovered, and are able to return to normal activities.
Finally, the benefits of the vaccines far outweigh the risks as COVID-19 illness is associated with more severe heart and lung risks as well as hospitalizations and deaths.
Dr. Mehta also adds that he sees severe myocarditis, pericarditis, and other heart damage (in addition to lung damage) in adult patients and that it is likely to see similar effects in pediatric COVID-19 cases.
Dr. Daley notes that he is unaware of any myocarditis-related deaths in vaccinated pediatric cases.
Delta variant
Dr. Valenza provided an update on the significant rise in Delta variant COVID-19 cases in Colorado and this variant is highly contagious and can lead to severe disease.
She also notes that while the vaccines continue to provide incredible protection, there is some evidence that the protection against the Delta variant is lower than previous variants.
Dr. Daley also points out that both adults and children who experienced COVID-19 are still at risk for getting sick with other variants. In contrast, that risk is far less for those who are vaccinated.
Dr. Mehta also mentioned that, anecdotally, children in India were sicker than expected during the period of the Delta variant. Though as he pointed out, the focus was on treating people and less on testing/sequencing strains.
Boosters
Dr. Mehta briefly discussed that boosters are not unique to COVID-19 and referenced other immunizations that occur in series (Hepatitis B, MMR, etc.)
He also mentioned a recent study that showed preliminary evidence that the COVID-19 vaccines may lead to longer-term immunity.
Dr. Daley discussed two events that could lead to a need for boosters:
If vaccine effectiveness appears to be declining.
If there are severe breakthrough disease shows up in the vaccinated population.
Vaccine information for <12yo
Dr. Mehta discussed the state of the <12yo vaccine trials (including a brief description of randomized, double-blind, placebo studies).
He mentioned that Pfizer is currently enrolling 5-11yos and that they hope to have data early in fall 2021 as they prepare for EUA.
The Pfizer trials for the 6mo-4yo will follow and Moderna is expected to be on a similar schedule.
Dr. Daley agreed that the trials (which are studying a lower dose than the >12yo) are looking good and that the hope is to have updated information in September.
Preparing for the <12yo group
Dr. Daley mentioned that the vaccine recommendation will apply to nearly all children who are eligible for a vaccine. There will be a very small group of children who have contraindications (reasons that they should not receive the vaccine).
Of note, he mentioned that issues like severe food allergies or immunosuppression will likely not be a reason to forego the vaccines (and, in some cases, may strengthen the need to be vaccinated) and that any concerns should be discussed with the doctor or provider.
He also briefly discussed side effects and that they appear to follow the most common symptoms experienced by adults (soreness at the site of injection, mild fever, headache, etc.)
He also suggested that parents follow their gut instincts and to always seek care if any symptoms seem above and beyond the expected mild symptoms.
How to protect children <12yo & making decisions about daycares/schools
Dr. Valenza promoted the continued practices of mask-wearing, hand-washing, and limiting exposure.
Individuals and families have to balance risks while also recognizing that full isolation is not healthy for adults or children.
She also discussed that individuals and families can look at what precautions are in place for mask-wearing, quarantines, and other COVID-related issues.
Dr. Mehta also supported the idea that these are individual/family decisions and that everyone has to weigh risks based on their situations.
He discussed the topic of daycares and schools and mentioned that his children were in person for the past year and continue to diligently wear masks.
He also discussed that while mandates may be political in nature, recommendations are science- or evidence-based (in reference to the efficacy of continuing with mask-wearing).
Dr. Daley also added that the American Academy of Pediatrics weighed in on the school topic and their recommendation is that in-person learning is important.
Children who already had COVID-19
Dr. Mehta raised the point that children who have already had COVID-19 will still need to be vaccinated.
This gets back to the earlier point that Dr. Daley made regarding the fact that adults and children who’ve had COVID-19 are still at risk for getting sick from another variant (whereas this is lessened considerably in vaccinated individuals).
Dr. Valenza adds that the recommendation is that children wait ~3 months after the infection to receive the vaccine.
