Austria will vaccinate five to eleven-year-olds against Covid-19 with the Pfizer vaccine from Monday. The European medicines authority EMA has not yet approved the vaccine for that age group, but it is expected to do so in early December. The US FDA has already given that approval. In the Netherlands, the cabinet has asked the Health Council for advice on vaccinating children with a medical risk. But wouldn’t it be better to vaccinate all children aged five to twelve to reduce infections? “It is too early for that,” says Patricia Bruijning, pediatrician and epidemiologist at UMC Utrecht.
Two health considerations are important here: those for the individual child, and those for society as a whole. The first consideration concerns the risks of going through a Covid infection versus the risks of the vaccination. “A serious course of Covid-19 disease in children in this age group is extremely rare,” says Bruijning. “In Dutch hospitals, about forty cases of Covid-19 have been registered among children without underlying conditions. This could also be children who ended up in hospital with a broken leg and were found to have Covid.” Only 3 percent had severe Covid; there have been no deaths so far, says Bruijning.
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“Under normal circumstances, you wouldn’t easily pull out a national vaccination program with these kinds of numbers,” says Bruijning. “It is therefore really different than, for example, with meningococci B, where there is a high risk of death or long-term aftermath.”
Children who go through a corona infection are at risk of developing the condition MISC-C: multisystem inflammatory syndrome in children. The immune system goes haywire after a corona infection, which can damage all kinds of organs. “Not all hospitals register this,” says Bruijning. “I estimate the total in the Netherlands in this age group at about ninety to one hundred cases so far. Half of these children end up in ICU and recovery can take months. Often the heart is also affected.”
So if there is a reason to vaccinate children against Covid-19, it is MIS-C, according to the pediatrician. And what about lung Covid? “We don’t really know that yet,” she replies, “and that’s difficult to investigate. Children are more likely to suffer from fatigue symptoms, for a variety of reasons. And it is sometimes not clear in adults whether there is really a causal relationship with a corona infection.”
It is also not yet certain whether vaccination protects against MIS-C, and by how much. “In the UK there has been a remarkable decline in the number of MIS-C cases – without childhood vaccinations or reductions in infections among children,” says Bruijning. “If it turns out in teenagers that vaccination helps prevent MIS-C, then you have a strong argument for vaccinating younger children as well. But we are not that far yet.”
Effects
Then there is the risk of side effects from the vaccine in children. So far, this has been investigated in one study, with about 1,500 children who received the vaccine. No serious side effects emerged. “But that study was too small to rule out very rare side effects,” says Bruijning. Such a rare side effect is, for example, myocarditis, an inflammation of the heart muscle. It occurs in about 1 in 5,000 to 15,000 young men vaccinated. “This was only discovered when millions of people from this age group had received the vaccine,” emphasizes Bruijning. “You must therefore first have these kinds of experience figures before you can conclude that it is really safe enough to vaccinate healthy children, who themselves run very little risk of corona infection,.”
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But then the question is: would it inhibit the spread of the virus if children are vaccinated? “RIVM has used model calculations on this,” says Bruijning. “They show that you can limit the spread of the virus by another three percent. The effect on hospital admissions is less pronounced, and even more so on ICU admissions. In addition, this calculation assumes that you achieve a vaccination rate of 75 percent among children. That doesn’t seem realistic to me.”
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