COVID-19 children’s corner: brief updates on epidemiology, variants, vaccines and more…
by Dr. Debbie-Ann Shirley, MD
The pandemic and children. Nearly 5.8 million child cases of COVID-19 have been reported in the United States to date, with at least 561 deaths. Nationally over 206,864 new child COVID-19 cases were reported in the week ending September 23rd, with children accounting for 26.7% 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. Locally, we witnessed a sharp rise in pediatric COVID-19 associated hospitalization, mirroring the national trends among children and adolescents since the rise of the delta variant. Hospitalizations among unvaccinated adolescents are ten times higher than in those fully vaccinated. We have also seen a rise in new MIS-C cases over the past month, keeping in trend with expected lag time behind COVID-19 cases. To date over 4,661 patients have been diagnosed with the severe multisystem inflammatory syndrome in children following COVID-19 infection in the US, including 85 children from Virginia, of which nearly 20 were treated in our Children’s Hospital. MIS-C remains a reportable condition.
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. Vaccines remain effective at preventing severe disease, even from the delta variant, so we should continue to strive to increase vaccination coverage for those who are eligible to receive a primary series. Following an FDA EUA amendment, on September 23rd the CDC now recommends boosters for those who have already completed a primary series of Pfizer-BioNTech vaccination in those ages ≥ 65 years or at high risk of severe COVID-19 as well as those with occupational/ institutional exposure risk, based on waning protection from infection after 6 months. The VDH has updated their FAQs page, and vaccine providers, including at UVA, will begin scheduling boosters in October. Booster dose recommendations for Moderna and J&J vaccines are expected to follow by mid-October, pending further review by the CDC and FDA.
COVID-19 vaccines and children. The Pfizer-BioNTech companies have submitted their initial data from their Phase 2/3 clinical trial of the COVID-19 vaccine in children 5-11 years of age to the FDA. In press release, they report a two-dose regimen of 10 ug (the dose selected based on prior study) separated by 21 days achieved robust immune responses similar to the 16-25 year age group using immunobridging studies, with similar tolerability. This news provides promising hope that we may have a safe and effective vaccine for this age group soon. Results from the other two Pfizer age cohort studies (2-5 years and < 2 years) are expected at the end of the year. In the meantime, everyone ages 2 years and up should wear a mask in public indoor spaces. Two new studies confirm that masks do indeed provide an additional layer of protection to children in school and daycare. In Arizona, where school started one month earlier than in Virginia, schools without mask mandates were 3.5 times as likely to have COVID-19 outbreaks than schools that started the year with mask requirements. Another study looking at over 500 counties in the US found that pediatric cases increased at a higher rate in those without school mask mandates, providing good support for our own state mask requirements in school.
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