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Risk of COVID-19 in children low, but vaccines remain important

While the risks of serious illness and death from COVID-19 are extremely slim for children, experts say there is a very good reason for parents to get their children vaccinated.

COVID-19 has become one of the leading causes of death in children nationwide.

According to the Kaiser Family Foundation, COVID-19 became the seventh leading cause of death in children aged 1 to 4 in August and September. During the same period, it was also the sixth leading cause of death in children aged 5 to 14 and the fourth leading cause of death among adolescents and young adults aged 15 to 24.

The risk of children dying from COVID-19 may be low, but the disease can still be a major cause of pediatric death because most of the time “children don’t die” at high rates for whatever reason, Dr. Monica Gandhi, an infectious disease expert from UC San Francisco, said. But during the wave of Delta Variants, in places with low adult immunization rates, “children have had a lot of cases and there have been more child hospitalizations than we’ve ever seen before. “.

Nationally, 763 children under the age of 18 have died from COVID-19, according to the United States Centers for Disease Control and Prevention. This represents about 0.1% of deaths for which the person’s age is known (children make up 22% of the country’s population). In California, 37 children have died from COVID-19 – 0.05% of all deaths from COVID-19 – according to the State Department of Public Health.

The death of any child is tragic, especially one that can be prevented by vaccination, according to health experts.

“It’s kind of like, what if you have a totally safe vaccine,” Gandhi said, and a child “never gets cancer? “

Other reasons, experts say, to vaccinate children is to stifle the circulation of viruses among young people so that they do not then expose the elderly or those with weakened immune systems. Anyone in these groups who contracts a breakthrough infection despite being vaccinated is at higher risk of serious illness, hospitalization and death, data shows.

Additionally, children who contract COVID-19 are also at a rare risk of developing multisystem inflammatory syndrome in children, or MIS-C, which can trigger inflammation of the heart, lungs, kidneys, brain, skin. , eyes and gastrointestinal organs. There have been 660 cases of MIS-C in California, including six deaths, and more than 5,200 cases of MIS-C nationwide, including 46 deaths.

Preliminary data suggests that 8% to 9% of children admitted for MIS-C are diagnosed with myocarditis, an inflammation of the heart.

Some parents have expressed concern about the safety of COVID-19 vaccines, given their relative novelty. In the United States, only one vaccine – the Pfizer-BioNTech vaccine – is available for those under the age of 18.

The Pfizer shot has been fully approved by the United States Food and Drug Administration by ages 16 and over and cleared for emergency use for children 12 to 15 years of age. It could be cleared for emergency use in children 5 to 11 years old in early November.

Concerns have arisen about the risk of myocarditis as a side effect of the Pfizer vaccine. But there has been some promising, albeit limited, data for children aged 5 to 11.

A preliminary study showed no risk of myocarditis in a test group of children aged 5 to 11, Gandhi said, although an initial study only involved 2,268 children, 1,518 who received the vaccine and 750 the placebo. It’s fair to point out that the sample size is not large enough to detect rare side effects, Gandhi said.

Each dose of vaccine studied for children aged 5 to 11 contained only 10 micrograms; older recipients receive 30 micrograms per dose.

Adolescents and young adults are also at higher risk of myocarditis after an injection of Pfizer. According to the fact sheet distributed by the FDA, there is an increased risk of myocarditis observed, especially in the week after the second dose. The risk is higher in men under 40 than in older women and men. The observed risk is highest in boys aged 12 to 17.

Nevertheless, the overall risk of developing myocarditis in these groups remains low. And in a study of 63 patients diagnosed with post-vaccination myocarditis, 86% had resolved their symptoms during the study period.

“The course in the hospital is mild, with rapid clinical recovery and excellent short-term results,” according to the study’s authors, reported in the journal Pediatrics. Further study is needed before the long term implications can be assessed.

Anyone concerned about the rare risk of myocarditis may lengthen the time between doses of the Pfizer vaccine, Gandhi said. In her family’s case, she gave her 13-year-old son his second dose seven weeks after the first, and she plans to give the vaccine to her 11-year-old son as soon as it is approved for this age group. .

The official recommendation for Pfizer’s two-dose vaccine is to receive the second dose three weeks after the first; the CDC said the second dose can be given up to six weeks after the first dose.

Gandhi said she believed that extending the interval between the two doses significantly reduced the risk of myocarditis, data from other countries showed.

She pointed out that the risk of myocarditis from a COVID-19 vaccine is nearly four times higher in Israel than in the Canadian province of Alberta. In Israel, it usually only takes three weeks between two doses of Pfizer, as stated by the manufacturer. But in Canada, government officials have imposed a much longer gap between doses – typically one to four months, largely depending on supply.

Gandhi also cited data from health officials in British Columbia suggesting that the Pfizer vaccine works best if the interval between doses is longer than six weeks. Between the end of May and mid-September, studies there showed that the effectiveness of the vaccine against the infection was 90% or more if the interval between the two doses was greater than six weeks; it was 82% to 85% effective if the interval between injections was three to six weeks.

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