ASK THE DOCTOR: Your child and the

ASK THE DOCTOR: Your child and the COVID vaccine

by Laura Byrne

When the Food and Drug Administration (FDA) approved Pfizer’s two-dose COVID vaccine for use in children ages 5-11, many parents rejoiced in this moment. But, we also know many of you have your hesitations—and some serious questions. You're not alone. That's why we’re once again turning to Dr. Christina Canody, director of the pediatric service line at BayCare and Dr. Allison Ford Messina, chairman of the Division of Infectious Disease of Johns Hopkins All Children’s Hospital, to get answers for you. Just like with adults and teens, Pfizer’s COVID vaccine for kids will be two doses, spaced three weeks apart with full immunity taking hold two weeks after the second dose. It is important to point out that a child’s dose is smaller than the adult and teen dose at 10 micrograms compared to the 30 micrograms adults and teens receive.

TBPM: We know there is hesitation among some parents about the COVID vaccine for their children since it’s a new mRNA vaccine they’ve never received before. What would you tell parents who are concerned about the COVID vaccine technology? TBPM: Some people are still skeptical about how quickly the COVID vaccines were developed. How do you address their concerns?

DR MESSINA: The way it works is not terribly dissimilar from many other vaccines. The change is in the delivery platform. The way I think about them [the mRNA vaccines] and the way this delivery platform works is they are very elegant. They only deliver just the protein that we need the body to make an antibody to and nothing else. There are no extraneous products. It’s a little molecule of fat in order to keep the mRNA stable. It’s a tiny piece of mRNA that’s delivered. It codes for something called a spike protein, and that’s what we need to make antibodies to prevent you from getting sick.

Sometimes people raise the concern, well—isn’t that bizarre that you are introducing mRNA to my cells? Remember that when you get sick with a virus, viruses always introduce their mRNA into your cells. They introduce a lot of mRNA. They introduce enough mRNA that it makes an entire virus. So, if you’re afraid of the vaccine because you are afraid of the exposure to mRNA, you are getting mRNA in spades if you actually get COVID. There’s really not a lot of difference between how your cells process the mRNA that the vaccine gives you versus the virus except— and this is a very important except—that the vaccine only contains just that little portion. It DOESN’T contain the whole virus. And if it doesn’t contain the whole virus, it’s not going to make you sick because it doesn’t replicate. All it does is give you a little bit of that protein so you can make antibodies to it.

Another thing that should make this less of a concern is that the 5-11-year-olds are getting this vaccine after literally millions and millions of people have already received it. And there have not been any serious safety signals that have been seen.

DR. CANODY: It’s important for families to know mRNA technology has been around since about 1990, so it’s been over 30 years. It’s been used especially in targeted and brain cancers where there are very specific cells to limit, so it’s a very targeted therapy. There is a lot of research and information. And when you put unlimited dollars, unlimited resources, and very smart people together, you can come up with a vaccine quickly. And obviously, this was not rolled out quickly in children. It took almost a year for it to come out in younger children, and they wanted to make sure it was safe. YOUR TEEN AND THE

COVID VACCINE: TBPM: Kids come in all shapes, Medical experts at Tampa General Hospital answer common questions sizes and weights. Should a smaller 5-year-old not receive the COVID vaccine quite yet, and on the flip side, should a larger 11-year-old opt for the dose teens and adults receive? DR. CANODY: A diverse group of children ages 5 through 11 were included in this study, and just as well of a diverse group of weights [was] in there. Based on the study data, there was really no difference in the weight-based dosing or in age-based within that realm. They truly looked at the response rate and any side effects that were found. In general, the side effects were even lower than in teenagers. And when it comes down to weight, it truly has to do with your immune system function. It’s one thing when you are talking about metabolizing an antibiotic and dosing it based on weight, and it’s another thing when we are looking at immune function. We know that throughout childhood and adolescence, the immune system takes different steps. We know there’s one step when they hit that 2-month-old age when the blood-brain barrier gets thicker. They hit another step around 6 months of age. They hit another step around 2-2.5, a little bit more around 5, and then again early on in adolescents somewhere between 10 and 12. And then we truly move into an adult immune system by age 15 to age 16.

TBPM: If a child already had COVID or recently recovered from COVID, should they wait to get the vaccine or not get it at all since they have a degree of natural immunity? TBPM: Should I give my child a dose of pain relievers like Tylenol or Motrin before their vaccination to mitigate any side effects?

DR. CANODY: They do have more robust immunity in those first few weeks to months after the infection, so for most families, we say wait at least two weeks from the complete resolution of symptoms. Now, if somebody still has loss of smell or taste, that’s not a resolution of symptoms. Those are still post-COVID or what we call long COVID symptoms, but in general, once they’ve resolved after two weeks, it’s okay to get that. If they prefer to wait a little bit longer or are worried about a reaction, I wouldn’t say waiting any longer than 2-3 months.

It’s important to know that right now that children are carrying the burden of 25% of all new cases in our country, so this is why this is the right time for kids to get the vaccine. DR. MESSINA: Even though COVID-19 is less serious in children, it is still in the top 10 leading causes of death in children right now. COVID-19 in the adult population is vying for number one or two causes of death in the United States. For children, it is still in the top 10; in fact, for older children, it’s in the top five. I think what people should understand is that children are a very healthy population, so there shouldn’t be any deaths or hospitalizations. TBPM: What side-effects of the COVID vaccine are being seen in kids ages 5-11? DR CANODY: In general, children tend to respond very well to the vaccine. The rates of fever are much lower [and so are] rates of fatigue and malaise. The overall side effects were a little bit of injection site pain or redness at the injection site. Unlike the adults where we really saw well over 50% have reactions, in children it’s much lower than that.

I don’t think you necessarily have to plan your schedule around getting the vaccine for kids, but maybe just understand for 24 hours not doing a lot of vigorous activity, especially in adolescents and older teenagers. TBPM: Speaking of side effects, we’ve heard of the rare instances of myocarditis in teen boys, specifically after the second dose. Is myocarditis something a parent should be concerned about with their younger children when they get the COVID vaccine? DR. CANODY: At this point in the studies, there were no cases of myocarditis in the younger children that were detected. However, knowing that 12-19-year-olds had the highest risk in adolescent males put us to be cognizant of that. And it really occurs after the second dose, not the first dose, so in the two weeks following the second dose, parents should look out for easy fatiguability, shortness of breath or not feeling well. But as I said, there were no cases of it in the preliminary studies.

There are several phases of the studies and once we start administering the vaccine, that is when phase four starts. Phase four is when we start collecting more information, and we’ll know more details as time goes on. DR. MESSINA: If you don’t need to, don’t take it, especially Motrin-type medications because they can actually blunt immune response a little bit—not completely, it’s not like it’s going to be worthless, but it will actually temper that immune response a little bit. TBPM: Can I just have my child take the first dose and not the second? DR. MESSINA: The issue with just having one is you need that next dose to really stimulate what’s called the memory cells in your immune system. If you have it once, you will make antibodies, but what happens over time—and this happens with whatever vaccine (and remember, a lot of vaccines are given as a series)—so that first dose of the vaccine helps your body make antibodies; the second dose educates your memory cells to always make antibodies. So, you are not really done until you’ve had that second

Doctors are dose. urging pregnant people to get the COVID vaccine. TBPM: What other concerns have you heard from parents about the COVID vaccine and their kids?

LEARN WHY. DR. MESSINA: The thing that’s the most unfortunate to me is that there was this rumor put by somebody somewhere that this could affect fertility, and there was never any reason to think that. We have tons and tons of data now that says that just doesn’t happen. The vaccine is encouraged by the American College of Obstetrics and Gynecology, the leading body of scientists and doctors who care for pregnant and women of reproductive age. TBPM: Can kids get the COVID vaccine with other immunizations like the flu shot or other scheduled vaccines? DR. CANODY: It is okay to do the vaccines at the same time. Based on the benefit versus risk, still being in the middle of a pandemic, it is important to get kids caught up on their vaccines and it’s okay to do COVID along with that. TBPM: Is the possibility of herd immunity in Florida a reason to not get the COVID vaccine? DR. MESSINA: I think this concept of herd immunity is a nice thought, but I don’t know how realistic that really is going to be. I think we’re in better shape than we used to be because cases are way down in Florida, which is great, but I don’t think we can be complacent and think it’s going to stay that way forever. TBPM: And we really don’t know how future potential variants will impact kids? DR. CANODY: We do know the vaccine has shown effectiveness against multiple variants. Recovering from one particular variant doesn’t necessarily mean you’re going to be immune to the next variant, so we do feel that based on the data we have that the vaccine is superior in providing long term protection.