Kids and the Covid-19 vaccine: A pediatrician answers safety questions

Teenagers between the ages of 12 and 15 years old can now be given the Pfizer/BioNTech coronavirus vaccine, the US Centers for Disease Control and Prevention said Wednesday.

“CDC now recommends that this vaccine be used among this population, and providers may begin vaccinating them right away,” CDC director Dr. Rochelle Walensky said in a statement.

The approval will allow another 5% of the population — nearly 17 million teens — to be vaccinated, beginning immediately. A poll conducted during the first week of April found just over half (52%) of parents said they would be willing to vaccinate their children against Covid-19.

That still leaves many parents unsure of what to do, as misinformation campaigns on vaccine safety spread on social media.

What are the facts? We asked Dr. Yvonne Maldonado, who chairs the American Academy of Pediatrics Committee on Infectious Diseases, to answer questions parents may have.

Maldonado is also chief of Stanford University School of Medicine’s division of pediatric infectious diseases and is currently leading vaccine trials in children younger than 12.

The conversation has been lightly edited for clarity.

CNN: Some parents have had no issues getting vaccinated as adults but now find themselves fretting over giving the vaccine to their children. What message do you and the American Academy of Pediatrics have for these parents?

Yvonne Maldonado: The US Centers for Disease Control and Prevention, the US Food and Drug Administration and the vaccine companies have been very open and transparent with the American Academy of Pediatrics on all of the vaccine data, because they know that we advocate for children and parents and families.

Not only are we pediatricians — we are vaccine experts, and we have reviewed the data ourselves on all the trials so far, and we will review the additional data.

I personally am a liaison to the CDC’s Advisory Committee on Immunization Practices, representing the American Academy of Pediatrics, and have been briefed on all the data. I was reassured by both the safety and efficacy data regarding the Pfizer vaccine for all ages and especially for 12- to 15-year-olds.

As pediatricians, we would not agree with recommendations — even if they came from the federal government — if we did not feel that they were safe and effective given our vast experience with vaccinating children to keep them healthy in this country.

CNN: How will administration of the Covid-19 vaccine fit into the back-to-school vaccinations required for middle schoolers?

Maldonado: The American Academy of Pediatrics supports giving needed childhood and adolescent immunizations at the same time as COVID-19 vaccines, particularly for children and teens who are behind on their immunizations.

Because of the pandemic shutdown, many children haven’t caught up with their general vaccinations over the last year. There are national data suggesting the 11- to 12-year-old group is the one that is at the highest risk for being delayed in their other vaccinations.

The AAP believes the benefits of co-administration and timely catch up on vaccinations outweigh any theoretical risk. This belief is based on the substantial data collected on the safety of COVID-19 vaccines — and our extensive experience with non-COVID-19 vaccines — which show the immune response and side effects are generally similar when non-COVID-19 vaccines are given together as when they are administered alone.

If parents do have their teen vaccinated at a pharmacy or somewhere else other than the doctor’s office, they should let their pediatrician know right away so their medical record can be updated.

CNN: Some parents are hearing on social media that the vaccine might have a long-term impact on fertility. Since many kids reach puberty between the ages of 12 and 15, how can a parent be sure that the Covid-19 vaccine won’t affect their child’s development?

Maldonado: Oh my goodness, people have been saying this about every vaccine since I can remember! There’s a whole group of people who have been talking about what they call “primary ovarian insufficiency” and they’ve attributed that to other vaccines in the past. I’m not surprised if they are doing the same with the Covid-19 vaccine.

• CNN note: Primary ovarian insufficiency occurs when a woman’s ovaries stop releasing eggs. It’s extremely rare — with one case in 1,000 women under age 30. A 2018 study of almost 200,000 adolescent girls and women found no connection between primary ovarian insufficiency and any of the vaccines recommended for teens, including HPV, tetanus, diphtheria, pertussis (whooping cough), meningococcal disease or inactivated flu vaccines.

Maldonado: There is no evidence at this point that this vaccine will affect development or fertility. It is a mRNA vaccine platform — it enters the cell and serves as a template for development of the spike protein in the human cell — which then can stimulate antibody development.

The mRNA is made out of nucleic acids, which are basically the building blocks of all our cells, and these aren’t incorporated into anything. They just fall apart and are eliminated. Bottom line: I think that’s ridiculous.

CNN: What are expected side effects of the vaccine for children — will they be severe enough to cause a child to miss class and possibly endanger his or her grades?

Maldonado: Just like any other vaccine, children may feel a little tired, but I certainly don’t think it’s going to be a major reaction. More the type of things we are typically seeing — a sore arm, maybe some redness at the site of injection and maybe a low grade flu-like illness, if there is any reaction at all.

These symptoms should be all gone within 48 hours, but I think it may be a good idea to at least be ready for that. If families are worried about children missing school they could give the vaccines on a Friday or weekend.

I have no reason to believe that a child’s schooling will be impacted. In fact, I think this will be a great opportunity for people who have events planned for the end of the school year. Getting their kids vaccinated as soon as possible means that they’re going to be protected that much faster.

CNN: What do we know about dosages for children? As one parent put it — some of these 12-year-olds weigh as little as 60 to 70 pounds — so will they give the same dosage that is given to a much larger adult?

Maldonado: The FDA approved the Pfizer vaccine for 12- to 15-year-olds at the same dosage as that for adults. These dosages were well studied in a few thousand children of all ages and weights between 12 and 15 years old. So they will have looked at dosage very, very carefully to make sure that they are safe and effective.

But obviously, what we need to think about is whether or not the dosage will be different in children under 12, and that’s what we’re studying right now. There may be differences in responses in the smaller children, primarily because little kids are more likely to mount a higher fever in general than adults and older kids.

It may be that we need a lower dosage for younger children because obviously their immune system responses are much more robust. But those studies are still going on right now for kids under 12 so we don’t know yet.

We know from Pfizer’s top line data on the 12- to 15-year olds that the immune responses were more robust than the adults. And that’s actually a good thing.

CNN: This stronger immune response that children have — could it impact a child in any serious way, such as setting them up for long-term reactions to the virus that don’t go away?

Maldonado: Again, the vaccine is not a live virus vaccine. It’s not derived from animals, humans or even other viruses. It is made from synthetic nucleic acids.

The immune response to the vaccine has been tracked exceedingly carefully to be sure it doesn’t trigger the inflammatory pathway that is similar to the one that we see with long-term effects, and we haven’t seen that happen in any of the tens of millions of doses that have been given to adults or teens.

Not only have we not seen that happen, but the laboratory basis for that inflammatory response has also not been documented to happen with the vaccine.