VACCINE RESOURCE COMMITTEE

of the Edmonton Zone Medical Staff Association

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COVID-19 Vaccine Question #10:

Should children get the vaccine?

All children over 6 months and youth should get their primary series of COVID-19 vaccine, and may be offered updated vaccines as well. The strength of the recommendation for additional doses is based on the individual child's context which includes their own medical risk and the current risk of COVID-19 infection. Children are less likely to have severe COVID-19; however, some healthy children and teens have required hospitalization, some with multisystem inflammatory syndrome requiring treatment, and kids can also have longer-term effects such as long-COVID.   

The majority of children and adolescents with COVID-19 have asymptomatic or mild to moderate respiratory infection. Nonetheless, a small number do get severe COVID-19 disease and some have had SARS-CoV-2-associated multisystem inflammatory syndrome in children (MIS-C), with significant direct morbidity.

Based on recommendations from the National Advisory Committee on Immunization (NACI), the recommendations below offer guidance for the vaccination of children aged 6 months and older and youth. A Canadian Paediatric Society (CPS) technical report with more details is available.

Children and youth aged 5 years and older

  • If Unvaccinated, a pimary series of an mRNA COVID-19 vaccine should be offered (currently this is one dose of XBB.1.5 mRNA vaccine)

  • Immuncicompormised children should have a 2 dose primary series, 4-8 weeks apart

  • If they have had an earlier vaccine, they should get a dose of an mRNA XBB.1.5 vaccine.

  • Now Pfizer or Moderna can be used in those 12 and up because myocarditis rates, which were a signal in younger males in the initial vaccine rollout, were higher round the first two doses. Now they are very low and equal between vaccines

  • See the CPS technical report, Safety and adverse events, Specific events, Myocarditis or pericarditis for details.

  • Novavax protein subunit XBB.1.5 vaccine, if available, may be offered to those 12 years of age and older instead

Information to counsel people concerned about myocarditis is below. Currently, the  benefits of preventing serious consequences of COVID-19 infection with vaccines far outweigh risk for myocarditis or pericarditis after the vaccine, and infection related myocarditis has been a higher risk than vaccine myocarditis.

For infants < 6 months:
Vaccination during pregnancy or breastfeeding is safe and is recommended. This adds protection for the pregnant individual, the fetus, and the infant in the first few months of life. A dose of COVID-19 mRNA XBB.1.5 vaccine in pregancy (or in early breastfeeding) for those not previously vaccinated and those who have received only non-XBB.1.5 vaccine previously. Vaccination of all eligible household members, caregivers, teachers, and other close contacts should be encouraged. 

Children aged 6 months to 4 years
Younger children (6 months to 4 years of age) who are medically complex and at higher risk for severe illness due to COVID-19 should be vaccinated with a COVID-19 XBB.1.5 mRNA vaccine

Standard risk children in this age group may be vaccinated, and this option should be discussed with parents. The current rates of COVID, their exposure risk (day care, school) and whether the child is in contact with someone at high risk of severe disease may be considered.

A primary series is two doses of Moderna or three doses total if any dose is Pfizer-BioNTech COVID-19 XBB.1.5 vaccine at least 8 weeks apart. If a child is immunocompromised they should have an extra dose.

 Children who previously received non-XBB.1.5 vaccines should receive an XBB.1.5 vaccine.

 Other points:

  • Children and adolescents with a history of confirmed SARS-CoV-2 infection should be offered a vaccination as above. See the CPS document’s Technical report for suggested intervals between infection and vaccination. Generally 6 months between infection and immunization is suggested but 3 months is safe especially if the child is at higher risk.

  • If an XBB vaccine has been received additional doses are not currently recommended.

  • COVID-19 vaccines may be given simultaneously with, or at any time before or after, any other vaccine(s) for children and adolescents of any age.

  • Acetaminophen or ibuporgen are not recommended routinely before vaccine but may be used after for discomfort or fever.

  • The CARD system for mat help families cope with fear and anxiety around injections.

Counselling around risks and benefits, and what to watch for post vaccination is required. If there are signs or symptoms suggestive of myocarditis (which was estimated to occur in about 1 in 83, 000 12-29 year olds after the second dose, and is lower now) refer to the CPS document Clinical guidance for youth with myocarditis and pericarditis following mRNA COVID-19 vaccination. All cases of confirmed myocarditis and pericarditis post-COVID-19 vaccination should be reported promptly to local public health authorities.

Children and adolescents with a remote history of myocarditis unrelated to COVID-19 vaccination MAY receive the vaccine if the myocarditis diagnosis is remote and they dont have current cardiac issues. 

If a child had anaphylaxis to an  mRNA COVID-19 vaccine, consultation with an allergist, other appropriate physician, or special immunization clinic should be sought prior to re-vaccination.

Sources:

Government of Canada: COVID-19 vaccines: Canadian Immunization Guide
Canadian Paediatric: COVID-19 vaccine for children and adolescents: Technical report
Biomedicines: COVID-19 Vaccines and Myocarditis: An Overview of Current Evidence