COVID-19 Children’s Corner: November

October 31, 2021 by

COVID-19 children’s corner: brief updates on epidemiology, variants, vaccines and more…

by Dr. Debbie-Ann Shirley, MD

The pandemic and children. Nearly 6.3 million child cases of COVID-19 have been reported in the United States to date. While cases from the delta surge are on the decline, nationally still over 117,702 new child COVID-19 cases were reported in the week ending October 21st, with children accounting for 25.1% of weekly COVID-19 cases. Children are still less likely to be hospitalized or die from COVID-19 when compared to adults, but severe outcomes in children can occur. There have been over 1.9 million COVID-19 cases in children 5-11 years, with 160 deaths, while rates of hospitalization in this age group have been the highest ever.  To date over 5,200 patients have been diagnosed with the severe multisystem inflammatory syndrome in children following COVID-19 infection in the US, including 103 children from Virginia. The Virginia Department of Health has added cases among children to their COVID-19 dashboard page to help us better track the epidemiology of COVID-19 in our youngest patients.

Variants of concern. The delta (B.1.617) variant, which quickly emerged to become the predominant variant in the US, continues to account for almost all cases that we see locally and nationally representing >99% of viral lineages.

COVID-19 vaccines and children. The Pfizer vaccine was authorized by the FDA for children 5 to 11 years on October 29, 2021 following review of the trial data, and thoughtful deliberations by their advisory panel. Two 10 microgram doses given 3 weeks apart, which is only one-third of the dose given to adults and adolescents, was shown to provide similar high levels of protective antibody responses to that seen in older age groups. The antibodies produced demonstrated ability to neutralize the delta variant. Following completion of dose 2, there were 16 cases of symptomatic COVID-19 infection in the placebo group and 3 in the vaccine group, providing a descriptive vaccine efficacy of 90%. There were no cases of severe COVID-19 and children with underlying medical conditions, such as obesity, asthma and heart disease were included in the study.

The data from 2,250 children who were randomized 2:1 to receive the vaccine or placebo also showed that the side effects of the COVID-19 vaccine in this age group were mostly mild or moderate and short-lived. The most common side effect was pain at the injection site. Other common systemic side effects included fatigue, headache, and muscle aches, similar to those reported in adolescents and young adults. A supplemental safety group with an additional 2,250 children recruited after the initial enrollment following FDA request. No serious side effects related to the vaccine have been reported. No cases of myocarditis were reported.

The advisory group to the CDC is set to meet November 2nd, and if recommended by the CDC, vaccine will be distributed throughout the country as a new pediatric formulation. An improved buffer will allow this formulation to remain refrigerated longer, up to 10 weeks. There will be several opportunities for the 28 million US children in this age group now eligible to get the vaccine to receive through health departments, medical intuitions, doctor’s offices and pharmacies. Some jurisdictions may have school based and community pop up clinics. UVA will provide pediatric vaccinations in multiple settings, with more details available soon.

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