Children ages 5-11 are now eligible to receive the Pfizer-BioNTech COVID-19 vaccine under an Emergency Use Authorization from the Food and Drug Administration. Emory University teamed up with our partners at Children’s Healthcare of Atlanta to answer parents’ questions on this important new development. 

The pediatric experts participating were:

• Evan Anderson, MD, a pediatric disease physician at Children’s, principal investigator for pediatric COVID-19 vaccine clinical trials of Pfizer and Moderna, and a professor of medicine and pediatrics at Emory University School of Medicine.
• Andi Shane, MD, division chief of pediatric infectious disease at Children’s and professor of pediatrics and chief of the Division of Pediatric Infectious Disease at Emory University School of Medicine. 

The following is adapted from their Facebook Live discussion on the topic:

Q: How is the COVID-19 vaccine for children ages 5-11 different from the previously approved vaccine and how does the dose compare to what an adult and older adolescent would receive? 

A:  Anderson: The COVID-19 vaccine for the 5- to 11-year-olds is exactly the same vaccine that is used for adults and for adolescents. But importantly the dose is different: it’s 10 micrograms instead of 30. So, it is one third of the dose used in adults and adolescents.

Q: If my family has had COVID-19, isn’t our natural immunity better than a vaccine? Why should I get my child vaccinated against a virus we’ve already had?

A: Shane: What we really understand about COVID-19 is that we don’t understand a lot, meaning we don’t really know how long natural immunity lasts and how long natural protection lasts. We are also starting to see some very compelling evidence that getting vaccinated after having a natural infection may provide additional protection when compared to just having a natural infection itself. Really, the best way to make sure children and adults who have had an infection are optimally protected is to get the COVID-19 vaccine.

Q: What are the long-term effects of the vaccine on such things as fertility and how can parents be sure that this vaccine safe for their young children?

A:Anderson: There is, in general, a fair amount of misinformation about vaccines, and I think it is important to visit trusted websites, such as the U.S. Centers for Disease Control and Prevention, which specifically addresses this question with the available data.

Importantly, there is no evidence to date that any of the COVID vaccines has impacted fertility. We have a substantial amount of experience with these vaccines in adults. Our experience in adults is much greater than we have typically had for other vaccines that have been licensed for children. Phase 1 of the clinical trials for this vaccine have been ongoing for a year and a half; phase 3 has been underway for well over a year now. Between the two mRNA vaccines, about 77,000 people have been in clinical trials with an mRNA vaccine for COVID-19 for more than a year. So, there is a tremendous amount of data from before the vaccine was licensed.

Additionally, many data systems are helping to assess risks that might exist with the vaccines. These data systems have identified a miniscule risk of myocarditis/pericarditis with the vaccines. This appears to resolve quickly without long-term consequences. The risks and benefits of the vaccines have been carefully evaluated and clearly favor vaccinating children and adolescents (Myocarditis and Pericarditis After mRNA COVID-19 Vaccination | CDC). Researchers are continuing to gather data and have not identified any other serious issues.

Q: What are some of the more common side effects parents could expect to see in their kids in this age group and how should they care for their child if they do experience side effects?

A: Shane: One of the reassuring things that we’ve seen in clinical trials in children 5-11 years of age is that the side effects have been very minor. When side effects were reported, soreness at the site of the vaccine has been the main complaint. Some children also reported fatigue, but overall side effects have been really minimal among the children who have received the active vaccine.

Q: If breakthrough infections are occurring in vaccinated adults and also vaccinated older children, why should I get my young child vaccinated?

A:Anderson: It is very important for parents to hear that COVID-19 is a very big issue in children. Currently in the United States, about 25% of COVID-19 is in children. That is a huge burden of disease. The total number of COVID hospitalizations among children is now much greater than that of any individual influenza season.

Importantly, in the 5-11 age range, the data presented by the CDC in the last several days shows that there have been 94 deaths in that age range. That actually ends up putting COVID-19 as one of the top 10 causes of death in children in this age range. I think this is an important thing for parents to hear and to understand. The clinical trials have demonstrated 90% efficacy in preventing COVID-19 in children. That is tremendous efficacy and is very similar to what we have seen with the adults.

A: Shane: I would also like to mention that many of the children that we have taken care of in the hospital have, unfortunately, not been vaccinated. Some of them were not age eligible and some did not take advantage of the opportunity to be vaccinated. It’s important to say that even though there are breakthrough infections among vaccinated children, they are mild, and very rarely require a child to receive care in the hospital.

A: Anderson: I would further add that many of our vaccines, such as our rotavirus vaccine and others, are most effective against severe disease and disease that results in hospitalizations or death. Our other vaccines are also less effective against any case of infection. The pattern here with the COVID vaccines working best against severe disease is very similar to what we see for many of our other vaccine-preventable illnesses.

Q:  Where can parents get their child vaccinated for COVID-19 and is it safe to get the COVID-19 vaccination at the same time as the flu shot and other childhood vaccinations? 

A: Shane: The first source is the child’s pediatrician. Many pediatricians’ offices are ready to administer vaccines, so I recommend that parents begin their search there. There are also many locations such as pharmacies and county health departments that have vaccines. The Georgia Department of Public Health has a vaccine finder or visit https://vaccinefinder.org/.

As the COVID-19 formulation for 5- to 11-year-olds is different from the adolescent and adult formulation, it is important to check in advance for availability of the 5- to 11-year-old COVID-19 vaccine formulation. Also, remember that while initial availability may be limited, supplies are being reinforced day by day. So, check back if it is not available in one location. Children’s is offering the vaccine in limited locations; learn more here.

Additionally, it is safe for children to receive a COVID-19 vaccine with other vaccines such as the flu vaccine. Everyone six months and older should receive a flu vaccine every season and a reminder that now is the time to make sure that you and your child have received your flu vaccines.

Q:  If my child is fully vaccinated, do they need to wear a mask around unvaccinated people? Can they celebrate the holidays, go to birthday parties, the store or the playground without a mask?

A: Anderson: Remember that it does take a while for the full immune response to develop in children, similar to adults. It is a two-dose vaccine administered about three weeks apart. Two weeks after the second dose your child should have a full immune response, similar to what we’ve seen in adults. I think the important thing is that even fully vaccinated individuals should continue to follow CDC guidance about the need for wearing a mask in various settings. That guidance has changed over time and probably will continue to change as we get COVID down to very low numbers.

A: Shane: In addition, I have to add that hand hygiene is also a very important component of protection, not only against the virus that causes COVID-19, but for the prevention of transmission of other bacteria and viruses as well.

Q: If my child is currently 11 years old, but will turn 12 soon, which vaccine should they get?

A: Anderson: They should get the vaccine that's available to them. They are now age eligible to receive vaccines so they can get the 10-microgram dose. Data presented at a recent meeting of the Advisory Committee on Immunization Practices found that the immune response in the 10- and 11-year-olds didn’t fall off in comparison to the younger children that also got the 10 microgram doses. Parents can feel confident that they don’t need to wait until their kids turn 12, and that they will not need a booster dose of 30 micrograms when they do turn 12. So, go ahead and get the 10-microgram dose.

Q: I personally have two children in the 5- to 11-year-old age range and that we are scrambling to vaccinate. I have one scheduled, and the other one will hopefully be scheduled soon. Dr. Shane, I know you also have a child who is in the newly eligible age range. Will you be getting your child vaccinated and how did you make your decision?

A: Shane: Already signed up and no question in my mind. Vaccines are really the best way we can prevent severe infections and get back to a normal life. We’ve had a lot of discussions at home about the vaccine and the importance of it. My child, like many children, does not like shots, but he understands that getting vaccinated will help to protect him and to protect others around him.

Children can understand these concepts and understand the importance of vaccines when explained to them in terms that they can understand. Of course, I also added the flu vaccine as well, so he wasn’t too excited about that but has been very accepting nonetheless.

For more information visit: choa.org/covid19vaccine