new Pediatric respiratory reviews A study conducted in Israel examines the issues surrounding children aged 5 to 11 who are eligible for vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, researchers provide a detailed overview of the factors that can influence the decision to take or refrain from vaccination.
Stady: Covid-19 for children aged 5-11: examining issues surrounding vaccination and public health policy. Image Credit: hedgehog94 / Shutterstock.com
In many developed countries, most adults have been vaccinated against the coronavirus disease 2019 (COVID-19), making children the largest group of susceptible individuals in the population. Thus, children are not only at risk of contracting SARS-CoV-2 but often have to wear masks, cannot travel freely, must be tested regularly, and may be isolated after exposure to the virus.
The Pfizer/BioNTech COVID-19 vaccine was granted emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) at the end of October 2021 for use in children ages 5 to 11. The results of the company’s clinical trials showed an impressive 91% efficacy against symptomatic infection in children given one-third of the adult dose.
The experimental group did not report any severe COVID-19 cases in the study or the placebo groups. Furthermore, the number of participants was not large enough to detect uncommon events such as myocarditis, a significant adverse event associated with adult vaccination.
However, more than eight million children have already received the vaccine, including more than 25% of the US population. Roughly the same percentage of Israeli children have been vaccinated with one or more doses.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that vaccinating children for children ages 5 to 11 can avoid 80-226 hospitalizations during peak transmission, as well as prevent COVID-19 deaths and long-term consequences.
Are children at risk?
In general, children are at low risk of developing serious or fatal illness after infection with SARS-CoV-2. Furthermore, the US Centers for Disease Control and Prevention estimates the case-fatality rate (CFR) to be less than one in ten thousand in children ages 5 to 11.
However, since this is based only on known pediatric cases, the true CFR is likely to be much lower. In fact, the Israeli Ministry of Health has stated that between 50-70% of children who test positive for COVID-19 have an asymptomatic illness, confirming this assumption.
The child mortality rate ranges from 0.8 to 5 per million in different parts of the world, which is comparable to seasonal influenza rates. In contrast, the adult mortality rate is 1,000 to 3,000 per million.
Hospitalization rates for COVID-19 are also lower in this number of patients than in adults, at less than eight out of every thousand. More than 40% of these children have comorbidities, such as obesity, lung disease or premature birth. Priority should be given to such children in vaccination.
Israeli data shows only 11 deaths among children up to the age of 19 out of nearly 550,000 cases. Thus, the population mortality risk is less than 0.0004%, with a CFR of 0.002%.
Importantly, two of these deaths were of newborns born to mothers with severe COVID-19. Overall, there were 460 hospital admissions among children ages 5 to 11, of which 72 were cases of moderate to severe illness, and three deaths.
When compared with the number of hospitalizations due to severe illness among all age groups, the disease severity appears to be significantly higher among the elderly.
Apart from severe and dangerous diseases, millions of quarantines have been imposed since the beginning of the pandemic. In Israel, more than 280,000 children are in quarantine due to exposure to an infected individual since the start of the school year. The most affected were those aged 5 to 11 years.
More than 80% of individuals 16 years of age or older have been vaccinated with one or more doses of the vaccine in Israel, which corresponds to 57% of those aged 12-15 years. In most age groups, severe illness and risk of ventilation are significantly higher after infection with SARS-CoV-2 than after vaccination. The striking exception is in the case of young males, where those aged 16-19 years show a high risk of 12 per 100 000, although the number of events was relatively high among all age groups of males.
In fact, of the 146 documented post-vaccine myocarditis cases, only 18 occurred in females. The risks of this adverse event in young boys are therefore equal to the risks of ventilation. Notably, the highest rate of myocarditis followed the second dose of the vaccine.
Taken together, the available data from two years of the COVID-19 pandemic indicate that the risk of death or severe illness from infection is low in young children, who contribute to a large proportion of cases but few deaths. Worldwide, only 8,700 child deaths have occurred.
In this case, why do we recommend vaccinating children against COVID-19? One reason is the occurrence of long-term, non-fatal sequelae, such as pediatric multisystem inflammatory syndrome (MIS-C), or long-term COVID. MISC affected more than 5,000 children in the United States, of whom one in 100 died.
1% of children infected with COVID-19 were reported to be infected in children in Israel; However, some researchers do not consider this to be higher than the expected level. Given the higher risk of complications among children with comorbidities, especially those with obesity and chronic lung disease or immunosuppression, such subgroups should be given high priority for the vaccine.
While the vaccine reduces the odds of already low hospitalization or severe illness, even with the SARS-CoV-2 Omicron variant, which is said to have immune evading capabilities, the cost-effectiveness of this procedure deserves greater debate. This is especially true given the overwhelming evidence that most children infected with SARS-CoV-2 develop asymptomatic infections.
To date, more than four million children have been vaccinated against COVID-19 in North America, with no significant adverse effects reported over the past year. The risk of developing myocarditis reduces the usefulness of vaccination in young males; However, most cases are mild and self-healing.
The UK’s Royal College of Paediatrics and Child Health wrote: “The risks and benefits of vaccinating children and young people with COVID-19 are more balanced than in older age groups.” In contrast, the American Pediatric Association encourages pediatricians to actively promote the vaccine.
At best, the benefits to children are indirect, as it reduces transmission of the virus in general, encourages continuing education, and lowers the cost of the epidemic to society. One study indicated that quarantining students after exposure to SARS-CoV-2 at school where everyone was wearing masks was not supported by scientific evidence due to very low transmission rates. The scholars commented that the quarantine for students had come to stop, as “Maximizes disruption to personalized learning with uncertain benefit. “
Providing vaccines to children while many countries have not yet been able to provide adequate doses to the adult population is controversial – but if childhood vaccines are made available, perhaps they should target those most at risk. “
- Myers, V., Saban, M, and Welf-Meron, R. (2022). Covid-19 in children aged 5-11: a study of issues surrounding vaccination and public health policy. Pediatric respiratory reviews. doi: 10.1016/j.prrv.2022.03.002.