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VOL. 45 | NO. 43 | Friday, October 22, 2021

Will vaccine hesitancy extend to little arms?

Medical experts weigh in as trials seek to soothe concerned parents

By Kathy Carlson

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Nashville dad Pierce Sandwith jumped at the chance to have his 2-year-old daughter vaccinated against COVID-19 as part of a clinical trial at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Their other child, a 4-year-old, is being treated there for leukemia – treatments that were first tested years ago in clinical trials – and is doing well, Sandwith says.

He and his wife, Maggie, talked about the vaccine trials and decided they “wanted to pay it forward. … What a blessing for our family.”

The minimum age for receiving a vaccine against COVID-19 outside of a clinical trial is 12, but the minimum age might drop to 5 as early as next month. Next week, Pfizer-BioNTech will share data with federal regulators on the performance of its vaccine in trials for children ages 5-11. If the vaccine is approved, it could be administered to children as young as 5 starting next month.

Pierce and Maggie Sandwith say they are anxious to get their 2-year-old vaccinated as a way of giving back for the medical care provided for their 4-year-old daughter.

-- Photo Provided

Clinical trials will continue for vaccinating children from age 6 months to 5 years.

Tennessee has yet to hit the halfway point for full vaccination. Through Oct. 16, 47.8% of Tennesseans were fully vaccinated, and 53.5% had received at least one dose, the Tennessee Department of Health reports. Of roughly 344,700 children ages 12-15 in Tennessee, about 31.4% were fully vaccinated through Oct. 17, and another 5.3% had received one shot and were partially vaccinated.

Sinard

Dentz

The divide on COVID-19 vaccines includes parents.

One group “can’t wait for the COVID vaccine to be approved for younger children,” and the other is “scared about the new vaccine and doesn’t intend to get it right away,” says Dr. Dorothy Sinard. She and her twin sister, Dr. Barbara Dentz, are pediatricians and work as child health and safety advocates in the Nashville area. Both received their medical degrees from the University of Michigan and have leadership roles with the Tennessee chapter of the American Academy of Pediatrics (TNAAP) and ImmunizeTN.

“We recognize there is vaccine hesitancy across the state and we continue to educate and inform Tennesseans, including parents who are making these decisions for their children, on the safety and effectiveness of the COVID-19 vaccine,” Department of Health spokeswoman Sarah Tanksley states.

Sinard and Dentz say they hope more people will eventually decide to be vaccinated.

“Medical experts agree vaccines are the best way to get out of the pandemic,” Dentz explains.

“Nothing is without risk, but serious side effects from approved vaccines are extremely rare,” Sinard says. She and Dentz urge parents to ask questions and weigh the benefits and risks of COVID vaccination in consultation with their children’s pediatrician.

Parents still need to make sure their children are up-to-date on the routine childhood vaccinations for diseases such as polio, tetanus, measles, mumps and rubella.

In these days before a decision is made on vaccinations for 5- to 11-year-olds, it’s a good time to catch up on any missed vaccines, says Dr. Gayatri Jaishankar, professor of pediatrics at East Tennessee State University’s Quillen School of Medicine. While you’re at the pediatrician with your child, talk with him or her about what to do when vaccines become available to children in your child’s age group, she says.

Here are some basics on COVID-19 and vaccination for parents:

How many children actually get COVID-19?

It’s hard to say: Testing isn’t widespread, children with COVID-19 are often asymptomatic and often don’t act sick even when they are. That said, the Tennessee Department reported 240,000-plus cases of COVID-19 in the 0-18 age group through Oct. 12. The state says those age 14-18 accounted for 4 in 10 cases, almost 97,000 in all.

How does COVID-19 affect children?

Edwards

Data show that about 40% to 50% of children who catch COVID-19 will be asymptomatic, says Dr. Kathryn Edwards, professor of pediatrics in the division of infectious diseases at Vanderbilt University School of Medicine, where she also is vice chair for clinical research.

Asymptomatic persons show no symptoms and might not realize anything is amiss. They can, however, spread SARS-CoV-2, the virus that causes COVID-19.

Vladamir Berthaud, M.D., is leading COVID-19 clinical trials for children at Meharry.

-- Photo By Lyle Graves |The Ledger

“Children in general have the same susceptibility to acquiring the virus and are as likely as adults to transmit it,” explains Vladimir Berthaud, M.D., professor of medicine and director of the division of infectious diseases at Meharry Medical College. “However, they tend to be more asymptomatic than adults.” Compared with adults, the hospitalization rate for children with COVID-19 is lower, as is the mortality rate, he says.

The Tennessee Department of Health reported online that 22 people age 20 or younger – including eight children age 10 and under – had died from COVID-19 from the start of the pandemic through Oct. 14. That’s out of a total of 15,486 deaths.

“Even if you have one child who dies, that’s too much of a casualty,” Berthaud adds. “Children are not supposed to die so young.”

Berthaud is leading the COVID-19 trials at Meharry, including the clinical trials of Moderna’s mRNA vaccine on children, assisted by pediatric clinical investigators Dr. Xylina Bean, chair, department of pediatrics; Dr. Olayinka Onadeko, director of the Meharry Pediatric Clinic, Dr. Shahana Chaudhury and Dr. Christopher Keefer, both associate professors of pediatrics.

Older children experience symptoms more often than younger children, Edwards says, and about half of children hospitalized with COVID-19 are adolescents.

Additional risk factors for severe COVID-19 in children include obesity, underlying respiratory diseases such as asthma, neurological or developmental problems and seizures. Children who are immunosuppressed, those with complex medical conditions or with more than one medical condition also are at risk.

If my child is unlikely to get very sick with COVID, or even show any symptoms at all, should I be concerned?

Absolutely, Jaishankar says. Children can still get sick or hospitalized. And despite a misconception that children can’t transmit the disease as easily as adults or because they’re often asymptomatic, Jaishankar says, “They are just as infectious as an adult who has a fever from the disease.”

“Asymptomatic children can carry a high load of replicating the virus in their nasal passages and transmit the infection,” Berthaud acknowledges. “This raises alarming concern about emerging SARS-CoV-2 variants.” The virus will mutate as long as it can find people to infect, and some mutations will eventually become known as variants. Currently, the Delta variant of the original SARS-CoV-2 virus is circulating in the United States. It is much more contagious than the original version and is the reason for the surge in COVID-19 cases seen over the summer.

Are COVID-19 vaccines safe?

Meharry’s Berthaud says this is the question parents ask most often.

“The vaccine is safe in adults. It’s a very safe vaccine,” Berthaud says. Moreover, the vaccine has been safe in clinical trials for children, he adds. In the trials at Meharry, for example, “so far we have not recorded any serious safety signals warranting discontinuing the trials or changing the way we do it.”

Scientists developed the COVID-19 vaccines quickly but they didn’t short-circuit the approval and testing processes, says Vanderbilt’s Edwards, who has spent much of her career evaluating the safety and effectiveness of vaccines. Research on the methods used in the vaccines had been going on for years, she notes.

Vaccine makers and regulators will continue to examine vaccine safety even after any regulatory approvals. Vanderbilt’s Clinical Immunization Safety Assessment Center also is available for questions about vaccines, Edwards says.

What about the side effects?

After receiving a vaccine shot, a child may have pain at the site of the shot, just like adults, Edwards says. They also may experience some of the other reactions adults have, such as fatigue, aches, chills and fever, Jaishankar points out.

What about reports of children coming down with myocarditis after receiving a COVID-19 vaccine?

Many parents are concerned about myocarditis, an inflammation of the heart muscle, along with pericarditis, an inflammation of the lining outside the heart. Jaishankar says there’s evidence of greater risk of contracting myocarditis from COVID-19 itself, rather than from a COVID vaccine.

The CDC website says myocarditis and pericarditis can result when a person’s immune system causes inflammation in response to an infection. Symptoms can include chest pain, shortness of breath or palpitations. Since April 2021, increased cases of myocarditis and pericarditis were reported following the mRNA COVID-19 vaccination, particularly in adolescents and young adults, the CDC says. In most cases, those patients who sought medical care responded well to medications and rest and their symptoms improved, the CDC reports. It continues to recommend COVID-19 vaccination for everyone age 12 and older, saying the risk of COVID-19 illness and possible complications exceeds risk from the vaccine.

Are COVID-19 vaccines effective?

“The Moderna vaccine is the most effective,” Berthaud says. “It looks like its level of immunity is much higher and lasts longer” than immunity conferred by other vaccines.

Jaishankar says that mRNA vaccines – the Pfizer-BioNTech and Moderna vaccines – are highly effective. And Edwards says the immune response in 5- to 11-year-old children appears to be very similar to the responses in the older children and adults. The safety profile is similar, too.

My child already had COVID. Should he get vaccinated?

Yes. There’s no way to know the level of antibodies that someone will have after recovering from COVID-19, nor is there a way to know how effective the antibodies will be and how long they’ll last.

Edwards says that in general, the level of antibodies a person develops after getting COVID-19 will be proportional to how sick they were. In other words, people with minimal illness will have fewer antibodies.

Vaccines deliver a known quantity of mRNA to get the body to recognize the COVID-19 spike protein and manufacture antibodies. That’s why vaccines are useful and important for those who have already had COVID-19, she says.

Where can parents learn more about vaccinating children for COVID?

Start with your pediatrician, physicians say.

Pediatricians Sinard and Dentz urge parents to ask questions and weigh the benefits and risks of COVID vaccination in consultation with their children’s pediatrician. Meharry’s Berthaud says there are good online sources of information, such as the federal Centers for Disease Control, but a pediatrician will know the child. Edwards recommends the state of Tennessee Department of Health website.

“I think any time you’re getting medical treatment (for your child), you have a right to be concerned and cautious about it,” says Sandwith, whose toddler daughter was vaccinated as part of a trial. Parents need to talk with their child’s pediatrician so they can make an informed decision about vaccination, he says.

If a family doesn’t have a pediatrician or family doctor, Berthaud encourages them to go to community health care centers, nonprofit health services and the like.

Jaishankar acknowledges some parents may be concerned about hearing different information from physicians as the pandemic continues. Parents may say, “This is not what you told us last year,” she says. That’s because “what’s known about COVID-19 is ever changing as we do more studies.’’

Parents with questions about vaccinations need to be able to ask questions of health care professionals. They should receive thorough answers, Edwards says. “If you hear something that doesn’t make sense, ask your provider.”

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