"Hi Alex. My (5 to 11) year old just got their 1st #COVID19 vaccine dose. Yay! Should we wait 8 weeks for the 2nd dose as recommended, or should we just get a 2nd dose ASAP at 3 weeks?"

No clear answer, but my wife & I WILL WAIT 8 WEEKS for our 5 year-old son.

Brief 🧵. (1/9)
A longer duration between 1st and 2nd doses of Pfizer-BioNTech vaccine has been shown to increase antibody levels and makes COMPLETE SENSE from the immunological perspective given our experience with all other vaccines in both kids and adults. (2/9)

Lots of clinical data now available suggesting extended-interval dosing for #COVID19 vaccines improves overall protection against COVID-19 infection versus shorter manufacturer recommended dosing intervals. Here's an example from Quebec. (3/9)

Data pending publication from the UK and Canada suggests that an extended-dosing interval ALSO REDUCES the incidence of myocarditis compared to shorter dosing intervals as well. NACI had access to this preliminary data when making their recommendations. (4/9)
We don't have published data yet, but a single dose is likely to elicit a significant immune response in young children which will likely be VERY protective within 2-3 weeks, in time for the holiday season and family gatherings, etc. (5/9)
The dosing intervals in the clinical trials were selected to be shorter, in large part because of a desire to get the trials done as quickly as possible by the various pharmaceutical companies.

They WEREN'T selected based on what was best for society, IMO. (6/9)
I would encourage parents to think 'long-term' here in terms of eliciting the most robust / long-lasting immune response possible for their kids.

That means waiting 8+ weeks for a 2nd dose, as per NACI recommendations. I am 100% confident with this for our 5 year-old. (7/9)
If you live in a jurisdiction where earlier doses are allowed, then it will be an individual choice for parents and caregivers. Talk to a trusted health care provider for more information and to have your questions answered. (8/9)
In the end, regardless of your choice, the MOST important thing is having your child be fully vaccinated, whether the dosing interval is 3 weeks, 8 weeks, or something in between. Just get it done!

Stay safe, everyone. (end)


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More from @awong37

8 Nov
"Hi Alex. What is this Western Canadian variant? Is it something to be worried about?"

Yes, there's a new Canadian AY.25 clade which originated from Idaho. This AY sublineage appears to have become dominant in Alberta and Saskatchewan. (1/9)

This is a bit technical, but as you can see in the phylogenetic analysis below, the strain appears to have originated from Idaho and then spread quickly throughout all of Western Canada. (2/9)

The same phylogenetic analysis is now color coded by province, so you can see how the strain has spread widely through BC (sea green), Alberta (yellow), and Saskatchewan (lime green). There's smatterings of cases in Ontario, too. (3/9)

Read 9 tweets
7 Nov
"Hi Alex. My 11 year-old is ready to get vaccinated. BUT, he/she turns 12 in less than a month. Should I wait and get the higher 30 μg dose of vaccine at age 12, or just go ahead & give the lower 10 μg dose right away?"

Answer: DON'T wait, go right away.

🧵 below. (1/7)
The appropriate dosing of vaccine ISN'T dependent on weight, but rather their age. The immune system of a 'small' 11 year-old is functionally the same as a 'large' 11 year-old. The immune response isn't weight-dependent, per se. (2/7)
Younger children in general have very active immune systems, another reason why lower dosing makes sense and leads them to produce the same degree of antibody response as those ages 16-25 who received a higher dose of vaccine. (3/7)
Read 7 tweets
27 Oct
"Hi Alex. If vaccinated folks can transmit #COVID19 like unvaccinated folks, why get vaccinated? Negative testing is good enough!"

Fully vaxxed persons transmit #COVID19 at FAR LOWER LEVELS than unvaxxed persons. Rapid antigen testing has limitations.

🧵 below to explain

If you're fully vaccinated, your chances of getting #COVID19 infection are MUCH lower, so your chances of transmitting are ALSO much lower too.

If you're fully vaccinated but still get #COVID19, you clear the virus MORE quickly, so you're less contagious overall.

This is why being fully vaccinated & PREVENTING #COVID19 infection is BETTER than just doing negative lateral flow testing (LFT, "rapid" tests).

Persons who are fully vaccinated protect themselves from infection as well as those around them MUCH BETTER.

Read 7 tweets
27 Oct
"Hi Alex. Do #COVID19 vaccines affect fertility? Should I get it if I'm pregnant?"

There's SO MUCH misinformation about how COVID-19 vaccines aren't safe in pregnancy or can affect fertility. THIS IS NOT TRUE.

Excellent link 👇 & short 🧵.


All the information we have with billions of doses of #COVID19 vaccine given is that there's NO EVIDENCE that COVID-19 vaccines affect fertility at all.

Every person, whether actively trying to conceive or just thinking about conceiving, SHOULD be vaccinated.

Acquiring #COVID19 while pregnant means a woman is at HIGHER RISK of needing hospitalization & ICU care versus not being pregnant. Being very sick with #COVID19 could be dangerous for baby.

All pregnant woman SHOULD be vaccinated to prevent serious illness from #COVID19.

Read 4 tweets
27 Oct
The benefits of vaccinating ALL children b/w ages 5-11 with Pfizer #COVID19 vaccine OUTWEIGHS known or potential risks.

A long-ish 🧵 on data & risk/benefits thus far.

As an ID physician, I'll vaccinate my 5 year-old w/ confidence, and recommend to others to do the same.

#COVID19 is a serious infection for all kids.

Although kids who acquire COVID are at much lower risk of death than adults, other complications can occur after recovery from acute infection, including Multisystem Inflammatory Syndrome (MIS-C), and Long #COVID.

Much higher rates of infection, hospitalizations, and deaths have been reported in children in last several months in the USA & Canada as a result of widespread transmission of the more contagious Delta variant.

Read 15 tweets
24 Oct
A LONG explanatory 🧵 on ICU 'capacity' & 'flow' in Saskatchewan & why we need MULTIPLE interventions to avoid compromised care for ALL #SK citizens & triage.

I'm going to use an analogy of ICU capacity = bathtub. Patients = water. Health care system = house.

Water is running into the bathtub. That's all the patients who need ICU care in Saskatchewan. Some have COVID, some don't. The patients have now overflowed our ICUs.

To cope, we've built walls up on our bathtub to hold more water. That's our 'surge' capacity.

We can only build walls up on the tub so much, because there's limits on what can be done safely w/ availability of specialized staff, especially nursing & respiratory therapists (who support ventilated persons).

We've reached that limit w/ ~120 pts in #SK ICUs.

Read 19 tweets

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