Our review highlights that the balance of risks and benefits of COVID-19 vaccination in children is more complex than in adults as the relative harms from vaccination and disease are less well established in this age group.
“… we do not argue for or against vaccinating children against COVID-19 but rather outline the points to consider to highlight the complexity of policy decisions on COVID-19 vaccination in this age group.”
The critical question for implementing any vaccine is:
“do the benefits of the vaccine in preventing the harms of the disease outweigh any known or potential risks associated with vaccination?”
U.S. proceeding with vaccinating children 5-11y based on Pfizer trial of 2x 10 µg doses in 2,268 children aged 5-11y showing vaccine:
• well tolerated
• induced robust neutralising antibody response.
Safety bar for vaccinating <12y needs to be high as direct risk from COVID is low:
• #COVID19 is asymptomatic or mild in vast majority
• #LongCOVID may not be as prevalent
• #MIS / PIMS-TS is rare; majority make rapid & full recovery.
Potential harms from COVID vaccination less well established in children <12y:
• Can’t extrapolate directly from adults: children’s immune response differs
• Pfizer trial (n=2,268 aged 5-11y) too small to detect rare adverse effects.
Best argument for vaccinating <12y might be to prevent population harms and indirect effects:
• Help reduce transmission
• Help keep schools open
Those at higher risk of severe COVID due to underlying conditions/comorbidities likely to have greatest benefit from vaccination.
Coronavirus Infections in Children bit.ly/3ol42o3
Why is COVID-19 less severe in children? bit.ly/3qaHGIc
How Common Is Long COVID in Children? bit.ly/3BLvEa
Should children be vaccinated against COVID-19? bit.ly/2ZYyPi0
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To reassure parents, a reminder of some key facts about #COVID in #children:
#SARSCoV2 infection remains asymptomatic or mild in the vast majority of children, even with the #DeltaVariant. Hospitalisation and deaths from COVID are still rare in this age group.
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However, the greater transmissibility of the Delta variant means there is more COVID in *all* age groups, including children, so we will see more paediatric cases.
As a large number of older people are now vaccinated, the increase is blunted in the elderly so, compared with earlier in the pandemic, a higher *proportion* of current cases will be in children: this can give the mistaken impression that the Delta variant is targeting children.
Any debate about use of rapid antigen tests for screening well asymptomatic individuals for #SARCoV2 needs to acknowledge:
PCR may be more sensitive than LFTs BUT:
1. PCR is costly so not feasible for frequent testing of well asymptomatic except in wealthiest of settings
1/5
2. Inevitable delay in receiving PCR result means infected pass on virus in interim
3. Superior sensitivity of PCR is a disadvantage when detects low levels of virus that aren't transmissible or non-viable virus long after infection
2/5
Rapid antigen tests might miss some cases BUT
4. Lateral flow tests are sufficiently cheap to enable large proportion of the population to be screened frequently (even daily)
5. LFT result within minutes means infectious do not spread virus whilst waiting for result
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