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CHILDREN AND COVID-19: A new subvariant, a new surge, and a new vaccine for kids under 5. What you need to know.

With the pandemic stretching into its third year and the highly contagious Omicron subvariant BA.5 variant driving new surges, science has achieved a major milestone in the fight against COVID-19—children as young as 6 months are now eligible for vaccination.

On July 14, 2022, Health Canada authorized the use of the Moderna Spikevax COVID-19 vaccine (25 micrograms) for children 6 months to 5 years of age, making it the country’s first COVID vaccine for children under 5. This joins the other pediatric vaccines approved for use in Canada—Pfizer-BioNTech vaccine (10 micrograms) for children aged 5 to 11 years old, half dose of Moderna Spikevax vaccine (50 micrograms) for children aged 6 to 11 years old, Pfizer-BioNTech vaccine (30 micrograms) for youth aged 12 and up and Moderna Spikevax vaccine (100 micrograms) for youth aged 12 and up.

This approval, based on review of clinical trial data from Canada and the U.S., means that approximately 1.7 million children are now eligible for vaccination. While some parents will hurry to get their younger children vaccinated as soon as possible, others will balk at the idea for a variety of reasons, ranging from the valid to the improbable. This will add to the challenges faced by healthcare workers as they cope with rising cases and an ever-morphing variant.

Here are 5 key concerns that healthcare professionals might be asked to address:

Concern #1: Children respond differently to COVID-19 than adults.

This is true for reasons that science is still trying to fully understand. One theory suggests that there are differences between the immune systems of children and adults, particularly with their T (memory) cells. Because these cells are mostly untrained in children, they may have a greater capacity to respond to new viruses and mount a quick and effective response. Another theory is that children’s noses have lower levels of the ACE2 receptor that allows the virus to enter cells. So, they may receive a smaller dose than adults should they contact the virus.

Concern #2: Children don’t get severely ill with the virus. 

While this may have been the case in previous waves, a rising number of kids and even babies are now being hospitalized with COVID-19 as Omicron infections keep surging around the country. Experts also suspect that Omicron may impact the airways more than the lungs. Although this may result in a less serious illness for adults, the same doesn’t hold for kids—especially those with respiratory conditions such as asthma. That said, experts still agree that most children will only show mild symptoms, although they can still pass on the infection even if they are asymptomatic.

Concern #3: The side effects of vaccines can be worse than the actual virus. 

Every medication has side effects, including vaccines. The clinical data on the new Moderna vaccine found fatigue to be the main side effect, along with irritability, crying, and pain at the injection site. These reactions were mild to moderate and went away within a day or two of vaccination. As for myocarditis, an inflammation of heart tissue that is a rare side effect of COVID-19 vaccinations, no cases were reported in the clinical trials.

It may help to reassure parents that vaccines for children are given at a smaller dose than those for adults. Health authorities recommended that children under 5 be given vaccine doses one quarter the size authorized for people over 12 years of age. Another advantage to the Moderna vaccine is that most children require only 2 shots—which means fewer needles for little kids.

Concern #4: The COVID-19 vaccine was rushed into production and is unsafe for children.

Vaccines are a contentious topic for some parents, with even routine vaccinations being fraught with misconceptions. A major one about the mRNA vaccine technology is that it was rushed into development without proper research. In fact, scientists have been exploring its use for other infectious diseases for over 25 years. After a thorough and independent review of the evidence, Health Canada has determined that the benefits of this vaccine for young children and infants far outweigh the potential risks.

Concern #5: The COVID-19 vaccines can’t curb transmission, so why bother?

This is a valid point, with the data still very sparse in this area. However, while the future of variants is uncertain, one thing is certain—having younger children vaccinated could help reduce more severe symptoms of COVID-19 and reduce the overall impact on healthcare.

Heading into the fall, experts are facing a lot of unknowns about the new rapidly changing BA.5 variant and how it will ultimately affect children and their families. But we do know we haven’t moved on from the pandemic, which makes patient counselling all the more challenging for healthcare professionals.  You can learn more about how to discuss the risks and benefits of children’s COVID-19 vaccinations here.

COVID-19 Vaccination in Children 5-11 Years of Age​: Practical Guidance for Discussing Risks and Benefits

Encouraging COVID-19 Vaccination in Adolescents 12 Years of Age and Older | MDBriefCase

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